Health promotion for immigrant mothers of children with developmental disabilities: Towards a transformative approach

Authors

  • Luz Maria Vazquez York University
  • Nida Mustafa University of Toronto
  • Nazilla Khanlou York University
  • Attia Khan University of Toronto
  • Gail Jones Neighbours Allied for Better Opportunities in Residential Support
  • Jennifer Osei-Appiah Sodiya Peel District School Board
  • Mahdieh Dastjerdi York University
  • Louise Kinross Holland Bloorview Kids Rehabilitation Hospital

DOI:

https://doi.org/10.25071/1929-8471.105

Abstract

Background: High societal expectations that involve idealized and  labour-intensive mothering are a source of stress, anxiety, guilt and frustration for women. Immigrant mothers caring for children with developmental disabilities are disproportionately burdened with health inequities. Study goals: The overall goal of our study was to examine health promotion practices of immigrant mothers with children with developmental disabilities using the Health Promotion Activities Scale (HPAS). Methods: Twenty-eight mothers of children with developmental disabilities were interviewed using the HPAS. A grounded theory approach was utilized to analyze the qualitative data. Results: Immigrant mothers of children with developmental disabilities’ engagement in health promoting activities is influenced by their role as primary caregivers, the gendered nature of mothering, non-Western views on health promotion, mothers’ burden from inequities and structural barriers pertaining to funding,  disability, and migration status. The responses on the HPAS also underscore motherhood as a social construct with embedded assumptions and social expectations related to role and responsibilities that requires them to be “good” mothers. Discussion and Conclusion: There is need to incorporate transformative health promotion approaches in research and practice that consider mothers’ multicultural contexts.  The intersections of motherhood,  disability, gendered role expectations and migration need to be taken into account.

References

Abji, S., Pintin-Perez, M., & Bhuyan, R. (2020). In Canada, non-status women are being left behind: Non-status women remain largely invisible in the COVID-19 public health response and emergency support programs. Open Democracy. Retrieved from: https://www.opendemocracy.net/en/pandemic-border/canada-non-status-women-are-being-left-behind/

Ayo, N. (2011) Understanding health promotion in a neoliberal climate and making of health conscious citizens. Critical Public Health, 22,1, 99-105. Available at: http://ezproxy.library.yorku.ca/login?url=http://www.tandfonline.com/doi/pdf/10.1080/09581596.2010.520692 [Accessed 4 May 2019] DOI: https://doi.org/10.1080/09581596.2010.520692

Baum, F. and Fisher, M. (2014) Why behavioural health promotion endures despite its failure to reduce health inequities, Sociology of Health & Illness, 36, 2, 213-25. DOI: https://doi.org/10.1111/1467-9566.12112

Benbow, S., Forchuk, C., Gorlick, C., Berman, H. and Ward-Griffin, C. (2015). Social exclusion and health: The development of nursing knowledge, Clinical Journal of Nursing Research, 47, 3, 56-72. DOI: https://doi.org/10.1177/084456211504700305

Bourque, F., van der Ven, E. and Malla, A. (2011). A meta-analysis of the risk for psychotic disorders among first- and second-generation immigrants, Psychological Medicine, 41, 5, 897-910. DOI: https://doi.org/10.1017/S0033291710001406

Bourke‐Taylor, H., Pallant, J. F., Law, M. and Howie, L. (2013). Relationships between sleep disruptions, health and care responsibilities among mothers of school‐aged children with disabilities, Journal of Paediatrics and Child Health, 49, 9, 775-82. DOI: https://doi.org/10.1111/jpc.12254

Bourke‐Taylor, H., Lalor, A., Farnworth, L. and Pallant, J. F. (2014). Further validation of the Health Promoting Activities Scale with mothers of typically developing children, Australian Occupational Therapy Journal, 61, 5, 308-15. DOI: https://doi.org/10.1111/1440-1630.12137

Bourke-Taylor, H., Lalor, A., Farnworth, L., Pallant, J. F., Knightbridge, E. and McLelland, G. (2015). Investigation of the self-reported health and health-related behaviours of Victorian mothers of school-aged children, Australian Journal of Primary Health, 21, 1, 66-73. DOI: https://doi.org/10.1071/PY13056

Brar, S., Tang, S., Drummond, N., Palacios-Derflingher, L., Clark, V., John, M. and Ross, S., (2009). Perinatal care for South Asian immigrant women and women born in Canada: telephone survey of users, Journal of Obstetrics and Gynaecology Canada, 31, 8, 708-16. DOI: https://doi.org/10.1016/S1701-2163(16)34274-8

Brock, S. A. M. (2015). The individualization thesis and mothering children with disabilities, Journal of Family Studies, 21, 3, 261-81.

Calabrese, S.K., Meyer, I.H., Overstreet, N.M., Haile, R. and Hansen, N.B. (2015). Exploring discrimination and mental health disparities faced by black sexual minority women using a Minority Stress Framework, Psychology Women Quarterly, 39, 3, 287-304. DOI: https://doi.org/10.1177/0361684314560730

Castañeda, H., Holmes, S.M., Madrigal, D.S., Young, M.E.D., Beyeler, N. and Quesada, J., (2015). Immigration as a social determinant of health. Annual Review of Public Health, 36, pp.375-392. DOI: https://doi.org/10.1146/annurev-publhealth-032013-182419

Chen, S.-Q., Chen, S.-D., Li, X.-K., & Ren, J. (2020). Mental Health of Parents of Special Needs Children in China during the COVID-19 Pandemic. International Journal of Environmental Research and Public Health, 17(24), 9519. MDPI AG. Retrieved from http://dx.doi.org/10.3390/ijerph17249519 DOI: https://doi.org/10.3390/ijerph17249519

Courcy, I., & des Rivières, C. (2017). “From cause to cure”: A qualitative study on contemporary forms of mother blaming experienced by mothers of young children with autism spectrum disorder, Journal of Family Social Work, 20, 3, 233-50. DOI: https://doi.org/10.1080/10522158.2017.1292184

Duff, C., Puri, A.K. & Chow, C. (2011). Ethno-cultural differences in the use of alcohol and other drugs: Evidence from the Vancouver Youth Drug Reporting System. Journal of Ethnicity and Substance Abuse, 10: 2-23. DOI: https://doi.org/10.1080/15332640.2011.547791

Edge, S. and Newbold, B. (2013). Discrimination and the health of immigrants and refugees: Exploring Canada’s evidence base and directions for future research in newcomer receiving countries. Journal of Immigrant and Minority Health, 15,1, 141–48. Available at: http://doi.org/10.1007/s10903-012-9640-4 [Accessed 4 May 2019]. DOI: https://doi.org/10.1007/s10903-012-9640-4

Ford, C.L. and Airhihenbuwa, C.O. (2010). Critical race theory, race equity, and public health: toward antiracism praxis, American Journal of Public Health, 100, S1, S30-S35. DOI: https://doi.org/10.2105/AJPH.2009.171058

Gee, G. (2016). Racism as a social determinant of health inequities. Report presented to the Robert Wood Johnson Foundation: Leveraging the Social Determinants to build a culture of health. Available at: http://healthequity.globalpolicysolutions.org/wp-content/uploads/2016/12/RacismasSDOH.pdf [Accessed 20 September, 2017]

Gee, G.C. and Ford, C.L. (2011). Structural racism and health inequities: Old issues, new directions. Du Bois Revue, 8,1, 115-32. DOI: https://doi.org/10.1017/S1742058X11000130

Hankivsky, O., Grace, D., Hunting, G., Giesbrecht, M., Fridkin, A., Rudrum, S., Ferlatte, O. and Clark, N. (2014). An intersectionality-based policy analysis framework: critical reflections on a methodology for advancing equity. International Journal for Equity in Health, 13,119. DOI: https://doi.org/10.1186/s12939-014-0119-x

Hankivsky, O., Reid, C., Cormier, R., Varcoe, C., Clark, N., Benoit, C. and Brotman, S. (2010). Exploring the promises of intersectionality for advancing women's health research. International Journal for Equity in Health, 9,1, 5. DOI: https://doi.org/10.1186/1475-9276-9-5

Heller, T., Gibbons, H. M., and Fisher, D. (2015). Caregiving and family support interventions: Crossing networks of aging and developmental disabilities, Intellectual and developmental disabilities, 53, 5, 329-45. DOI: https://doi.org/10.1352/1934-9556-53.5.329

Henderson, A., Harmon, S., and Newman, H. (2016). The price mothers pay, even when they are not buying it: Mental health consequences of idealized motherhood. Sex Roles, 74,11-12, 512-26. DOI: https://doi.org/10.1007/s11199-015-0534-5

Netto, G., Bhopal, R., Lederle, N., Khatoon, J. and Jackson, A. (2010). How can health promotion interventions be adapted for minority ethnic communities? Five principles for guiding the development of behavioural interventions. Health promotion international, 25, 2, 248-57. DOI: https://doi.org/10.1093/heapro/daq012

Golden, S. D., and Earp, J. A. L. (2012). Social ecological approaches to individuals and their contexts twenty years of health education & behavior health promotion interventions, Health Education & Behavior, 39,3, 364–72. DOI: https://doi.org/10.1177/1090198111418634

Green, F.J. (2015). Re-conceptualizing motherhood: Reaching back to move forward, Journal of Family Studies, 21, 3, 196-207. DOI: https://doi.org/10.1080/13229400.2015.1086666

Hyman, I. and Wray, R. (2013). Health Inequities and Racialized Groups – A Review of the Evidence. Prepared in collaboration with Toronto Public Health.

Islam, F., Khanlou, N. & Tamim, H. (2014). South Asian populations in Canada: migration and mental health, BMC Psychiatry, 14, 154. DOI: https://doi.org/10.1186/1471-244X-14-154

Jennings, J., Khanlou, N. and Su, C. (2014). Public health policy and social support for immigrant mothers raising disabled children in Canada, Disability and Society, 29,10, 1645-57. DOI: https://doi.org/10.1080/09687599.2014.966804

Khanlou N, Vazquez LM, Pashang S, Connolly JA, Ahmad F, & Ssawe A. (2021). 2020 Syndemic: Convergence of COVID-19, gender-based violence, and racism pandemics. Journal of Racial and Ethnic Disparities. DOI: 10.1007/s40615-021-01146-w https://link.springer.com/article/10.1007/s40615-021-01146-w DOI: https://doi.org/10.1007/s40615-021-01146-w

Khanlou, N., Ssawe, A., Vazquez, LM., Pashang, S., Connolly, JA., Bohr, Y., Epstein, I., Zahraei, S., Ahmad, F., Mgwigwi, T., & Alamdar, N. (2020a). COVID-19 pandemic guidelines for mental health support of racialized women at risk of gender-based violence: Knowledge synthesis report. Funded by Canadian Institutes of Health Research (CIHR) Operating Grant: Knowledge Synthesis: COVID-19 in Mental Health & Substance Use. York University. https://nkhanlou.info.yorku.ca/files/2020/11/Khanlou_COVID19-Pandemic-guidelines-for-mental-health-support-of-racialized-women-at-risk-of-GBV.Nov2020.pdf?x68747

Khanlou N, Ssawe A, S Zahraei, Connolly JA , Pashang S, Bohr Y, & Vazquez LM. (2020b). Information Sheet 16: Gender-Based Violence and the COVID-19 Pandemic: Risk Factors and Systemic Challenges. Toronto, ON: York University. https://nkhanlou.info.yorku.ca/knowledge-transfer/publications

Khanlou N, Jones G, & Yoshida K. (2018). Impact of gender and migration status on accessing direct/ flexible/ self-directed social funding for developmental services in Ontario. Funded by Ministry of Community and Social Services (Developmental Services Research Grant).

Khanlou N, Mustafa N, Vazquez LM, Davidson, & Yoshida K. (2017). Mothering children with developmental disabilities: A critical perspective on health promotion. Health Care for Women International (38)6, 613-634. Available url: http://dx.doi.org/10.1080/07399332.2017.1296841 DOI: https://doi.org/10.1080/07399332.2017.1296841

Khanlou N, Haque N, Davidson D, & Dastjerdi M. (2016). Voices of immigrant mothers of children with disabilities: Availability and use of social support. Toronto: York University. https://nkhanlou.info.yorku.ca/files/2014/12/Voices-of-Immigrant-Mothers-of-Chidlren-with-Disabilities-Research-Report-Khanlou-et-al.2016.pdf

Khanlou, N., Haque, N., Sheehan, S. and Jones, G. (2015). “It is an issue of not knowing where to go”: service providers’ perspectives on challenges in accessing social support and services by immigrant mothers of children with disabilities, Journal of Immigrant and Minority Health, 17, 6, 1840-7 DOI: https://doi.org/10.1007/s10903-014-0122-8

LeBesco, K. (2011). Neoliberalism, public health, and the moral perils of fatness, Critical Public Health, 21, 2, 153-64. DOI: https://doi.org/10.1080/09581596.2010.529422

Lee V, Albaum C, Tablon Modica P, Ahmad F, Gorter JW, Khanlou N, McMorris C, Lai J, Harrison C, Hedley T, Johnston P, Putterman C, Spoelstra M, & Weiss JA. (2021). The impact of COVID-19 on the mental health and wellbeing of caregivers of autistic children and youth: A scoping review. Autism Research. https://doi.org/10.1002/aur.2616 DOI: https://doi.org/10.1002/aur.2616

Liu, J.J., Davidson, E., Bhopal, R.S., White, M., Johnson, M.R.D., Netto, G., Deverill, M. and Sheikh, A. (2012). Adapting health promotion interventions to meet the needs of ethnic minority groups: mixed-methods evidence synthesis, Health Technology Assessment (Winchester, England), 16, 44,1. DOI: https://doi.org/10.3310/hta16440

Lynam, M.J. (2005). Health as a socially mediated process: theoretical and practice imperatives emerging from research on health inequalities, ANS Advanced Nursing Science, 28,1, 25-37. DOI: https://doi.org/10.1097/00012272-200501000-00004

Manuel, S.A. (2015). The individualization thesis and mothering children with disabilities. Journal of Family Studies, 21, 3, 261–81. DOI: https://doi.org/10.1080/13229400.2015.1086404

Mawani, F. N. (2014). Social determinants of refugee mental health. In: Simich L. and Andermann L. (eds). Refugee and Resilience (pp. 27-50). Springer, Dordrecht. DOI: https://doi.org/10.1007/978-94-007-7923-5_3

Mays, V.M., Ponce, N.A., Washington, D.L. and Cochran, S.D. (2003). Classification of race and ethnicity: Implications for public health, Annual Review of Public Health, 24, 83-110. DOI: https://doi.org/10.1146/annurev.publhealth.24.100901.140927

Meng, X. and D’Arcy, C. (2012). Common and unique risk factors and comorbidity for 12- month mood and anxiety disorders among Canadians, Canadian Journal of Psychiatry, 57, 8, 479-87. DOI: https://doi.org/10.1177/070674371205700806

Osypuk, T.L. and Acevedo-Garcia, D. (2010). Beyond individual neighborhoods: A geography of opportunity perspective for understanding racial/ethnic health disparities, Health Place, 16, 6, 1113-23. DOI: https://doi.org/10.1016/j.healthplace.2010.07.002

Pederson, A., Greaves, L. and Poole, N. (2014). Gender-transformative health promotion for women: a framework for action, Health Promotion International, 30,1, 140-50. DOI: https://doi.org/10.1093/heapro/dau083

Petrenchik, T. M. (2008). Childhood disability in the context of poverty. Hamilton, ON: CanChild Centre for Childhood Disability Research.

Priest, N., Perry, R., Ferdinand, A., Paradies, Y. and Kelaher, M. (2014). Experiences of racism, racial/ethnic attitudes, motivated fairness and mental health outcomes among primary and secondary school students, Journal of Youth and Adolescence, 43,10,1672-1687. DOI: https://doi.org/10.1007/s10964-014-0140-9

Rezaee, JR. (2020 March 27). An Intersectional Approach to COVID 19 She-Covery. YWCA Toronto, A Turning Point for Women, United Way. Available from: https://www.ywcatoronto.org/takeaction/additional/intersectional

Ruiz-Casares, M., Rousseau, C., Laurin-Lamothe, A., Rummens, J.A., Zelkowitz, P., Crépeau, F. and Steinmetz, N. (2013). Access to health care for undocumented migrant children and pregnant women: the paradox between values and attitudes of health care professionals, Maternal and Child Health Journal, 17, 2, 292-8. DOI: https://doi.org/10.1007/s10995-012-0973-3

Sanou, D., O’Reilly, E., Ngnie-Teta, I., Batal, M., Mondain, N., Andrew, C., and Bourgeault, I. L. (2014). Acculturation and nutritional health of immigrants in Canada: a scoping review, Journal of Immigrant and Minority Health, 16,1, 24-34. DOI: https://doi.org/10.1007/s10903-013-9823-7

Shirazi, M., Shirazi, A. and Bloom, J. (2015). Developing a culturally competent faith-based framework to promote breast cancer screening among Afghan immigrant women, Journal of Religion and Health, 54,1, 153-9. DOI: https://doi.org/10.1007/s10943-013-9793-z

Statistics Canada (2013). 2011 National Household Survey. Catalogue no. 99-010-X2011029. Available at : http://www.statcan.gc.ca/pub/89-503-x/2015001/article/14315-eng.htm[Accessed 20 September 2017]

Statistics Canada (2011). Visible Minority Women. Available at: file:///Users/mac/Desktop/WCH%2015%20OCT%202017/Visible%20Minority%20Women.webarchive [Accessed 26 September 2017].

Stokols, D. (1992). Establishing and maintaining healthy environments: Toward a social ecology of health promotion, American Psychologist, 47, 1, 6–22. DOI: https://doi.org/10.1037/0003-066X.47.1.6

Tabatabai, A. (2020). Mother of a person: neoliberalism and narratives of parenting children with disabilities. Disability & Society, 35(1), 111–131 https://doi.org/10.1080/09687599.2019.1621739 DOI: https://doi.org/10.1080/09687599.2019.1621739

Thomson, M. S., Chaze, F., George, U. and Guruge, S. (2015). Improving immigrant populations’ access to mental health services in Canada: a review of barriers and recommendations, Journal of Immigrant and Minority Health, 17, 6, 1895-905. DOI: https://doi.org/10.1007/s10903-015-0175-3

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Published

2021-12-22

How to Cite

Vazquez , L. M., Mustafa, N., Khanlou, N., Khan, A. ., Jones, G., Osei-Appiah Sodiya, J. ., … Kinross, L. . (2021). Health promotion for immigrant mothers of children with developmental disabilities: Towards a transformative approach. INYI Journal, 12(1). https://doi.org/10.25071/1929-8471.105