Sense and susceptibility: how mothers view accidental injury risk and develop safety strategies for pre-school children

The prevailing rates of morbidity and mortality resulting from accidents in the youngest and most vulnerable members of our population are a cause for concern. Reducing childhood accidents has been identified as a priority for improving health in the United Kingdom and in many other countries. Despite mothers being identified as the main carers for pre-school children, relatively little research has examined mothers' perceptions of childhood accidents or explored their experiences and expectations of health professionals in promoting safety. This study examines mothers' perceptions of childhood injury risk, the ways in which mothers develop knowledge and skills for keeping their children safe and how they are motivated to adopt accident prevention strategies. The mothers' perceptions of the health visitor role in promoting the safety of pre-school children are also examined.This study was undertaken within one Health Board district in Scotland, using a combination of quantitative and qualitative survey methods. A questionnaire was posted to eight hundred mothers of pre-school children, randomly selected from the Primary Health Care Data Base and to two hundred mothers whose pre-school children had attended the Accident and Emergency Department as a result of an accident within three months prior to the survey. From the survey respondents, forty mothers were selected as key informants and participated in qualitative, in-depth interviews. Quantitative data were analysed using the Statistical Package for Social Scientists. The interviews were tape recorded and transcribed to facilitate a systematic approach to content analysis.The combined results reveal the complexity of caring for children safely, although certain aspects of this process can be understood by recognising distinct but interacting knowledge, perceptions and motivations. Mothers believed that much of their knowledge for protecting their children was common sense, indicating how many safety practices were socially constructed according to the norms of their social network. Mothers' perceptions of childhood injury risk were influenced by their families' accident experiences. However, new or unfamiliar risks were often not anticipated by mothers. This lack of generalisation from accident experiences and from prior knowledge may limit maternal motivation to adopt specific safety practices.Mothers describe their motivation to adopt safety actions as being informed by a rational process of weighing up the risk of injury against the resources they had available. Mothers' perceptions of the susceptibility and severity of injury to their child were found to differ from the more objective measures of accident epidemiology. The mothers were most concerned about dramatic, but rare accidents outside the home, whilst severe and common accidents in the home concerned them less. This tendency to sensationalise certain injuries arguably detracted them from developing protective strategies to reduce the greatest causes of morbidity and mortality in pre-school children. Health visitors who could relate to the mothers social context were valued, particularly by lone mothers and others in situations of multiple disadvantage, who had specific needs for proactive social support.The implications of these findings are discussed in relation to accident prevention approaches and the role of the health visitor. The value of an integrated research method for investigating the accident problem and for understanding mothers' perceptions is discussed and directions for future research are suggested

Indigenous lands and health access:The influence of a sense of place on disparities in post-stroke recovery in Taiwan

Despite many countries having policies and systems for universal healthcare coverage, health disparity persists, with significant variations in disease prevalence and life expectancy between different groups of people. This focused ethnography explored the post-stroke recovery of Indigenous and non-Indigenous populations in three geographical areas in Taiwan. Forty-eight observations and 24 interviews were carried out with 12 dyads of stroke survivors and family caregivers, revealing their varied experiences of healthcare. Findings indicate that repeatedly engaging in social activities in the same place increases stroke survivors' attachment to the environment, facilitating their reintegration into the community and improving wellbeing following stroke. The significance of ‘place’ in post-stroke life and healthcare access is particularly salient for Indigenous people's recovery. Indigenous people tend to employ cultural symbols, such as Indigenous languages and kinship ties, to define and interpret their surrounding environment and identity. Indigenous people residing within or close to their own native communities make better recoveries than those based in urban settings, who are attached to and yet located away from their native lands. A sense of place contributes to identity, while loss of it leads to invisibility and healthcare inaccessibility. To promote equitable healthcare access, future policymaking and care practices should address the environmental and cultural geography and structural barriers that impede the connection between minority groups and the mainstream community healthcare system. The study findings suggest extending welfare resources beyond Indigenous administrative regions and establishing partnerships between Indigenous organisations and the mainstream healthcare system. Leveraging Indigenous people's attachment to cultural symbols and increasing healthcare facilities staffed with Indigenous healthcare workers could help ease structural barriers, maintain identifiable Indigenous beneficiaries and increase entry points into the mainstream healthcare system.</p

Biographical continuation:Recovery of stroke survivors and their family caregivers in Taiwan

AIM: To explore the experiences pertaining to long-term care services from the perspectives of dyads of stroke survivors and their family caregivers in indigenous and non-indigenous communities. BACKGROUND: Stroke occurrence is a life-changing event associated with quality of life for stroke survivors and their families, especially those who provide primary support. Indigenous people are more likely to experience a stroke at a younger age and have a higher likelihood of hospitalisation and death due to health disparities. Few studies have investigated family dyads or indigenous populations to understand their experiences of coping with changed body-self and to contextualise their reintegration into communities post-stroke. METHODS: Ethnographic fieldwork over nine months in 2018-2019 with indigenous, urban-based, and non-indigenous populations, resulting in 48 observations and 24 interviews with 12 dyads in three geo-administrative communities. FINDINGS: The post-stroke recovery trajectory is illuminated, delineating the dyads' life transitions from biographical disruption to biographical continuation. The trajectory is shaped by seven states involving four mindsets and three status passages. The four mindsets are sense of loss and worry, sense of interdependence, sense of independence, and wellbeing state. The status passages identified in this study are acceptance, alteration, and identification. A community-based and family-centred long-term care system, aligning with medical healthcare and community resources, underpinned each dyad's biographical continuation by: (1) providing rehabilitation that afforded time and space for recovery adaptation; (2) acknowledging the individuality of family caregivers and helping to alleviate their multitasking; and (3) reintegrating stroke survivors into their communities. Key to determining the quality of recovery for the indigenous participants was their reintegration into their native community and regaining of identity. Therefore, integrating post-stroke care into various care contexts and incorporating indigenous-specific needs into policymaking can support dyads in adapting to their communities.</p