Developing technology affords children with complex congenitally malformed hearts a chance for survival. Parents gratefully pursue life-saving options on behalf of their children, despite the risks to the life of their child, and uncertainty about outcomes. Little is known about how mothers and fathers experience parenting a child whose new state as a survivor may include less than optimal developmental sequels.
Our study involved multiple interactive interviews with 9 mothers and 7 fathers of infants and preschool children with hypoplastic left heart syndrome who had survived the Norwood surgical approach. Qualitative methodology included grounded theory methods of simultaneous collection and analysis of data, and we used open and selective coding of transcribed interviews.
Parents used normalization in the context of uncertainty regarding the ongoing survival of their child. Parents described their underweight children as being on their own growth curve, and viewed their developmental progress, however delayed, as reason for celebration, as they had been prepared for their child to die.
There is growing evidence that children with congenitally malformed hearts who require surgical intervention during the first year of life may experience developmental delay. The use of normalization by their parents may be effective in decreasing their worry regarding the uncertain future faced by their child, but may negatively affect the developmental progress of the child if they do not seek resources to assist development. Advice from paediatric specialists for parents to view their children as normal needs to be balanced with assistance for parents to access services to support optimal growth and development of their child.
This study investigated the use of health-related services by low-income Canadians living in two large cities, Edmonton and Toronto. Interview data collected from low-income people, service providers and managers, advocacy group representatives, and senior-level public servants were analyzed using thematic content analysis. Findings indicate that, in addition to health care policies and programs, a broad range of policies, programs, and services relating to income security, recreation, and housing influence the ability of low-income Canadians to attain, maintain, and enhance their health. Furthermore, the manner in which health-related services are delivered plays a key role in low-income people's service-use decisions. We conclude the paper with a discussion of the health and social policy implications of the findings, which are particularly relevant within the context of recent health care reform discussions in Canada.
Department of Mental Health, Grey Nuns Community Hospital, Caritas Health Group, 1100 Youville Drive West, Edmonton, Alberta T6L 5X8, Canada. dliu@cha.ab.ca
This qualitative study explored participants' experiences of a supported-employment program. Understanding participants' opinions of a supported-employment program may provide insights into what processes and outcomes are meaningful and important for participants and may enable an evaluation of such processes and outcomes for their congruence with occupational therapy practice.
Supported-employment program participants with schizophrenia (N= 7) were recruited from an agency and interviewed individually with open-ended questions. Data were analyzed using a grounded-theory approach.
We developed a tentative grounded theory with three themes of supported-employment program outcomes: (a) removing barriers to job seeking, (b) improving psychological well-being, and (c) participating in work.
Supported-employment program participants can achieve meaningful personal outcomes even though they do not obtain competitive employment. These programs removed barriers to job seeking, but personal readiness and efforts in job seeking contributed most to obtaining employment.
To investigate whether the cognitive development of young children in poverty is affected by activities of their primary caregiver and by household income source, which are two components of family poverty experience that have been affected by recent welfare reforms.
Bivariate and multivariate analyses were used to examine the relationships that caregiver activity, household income source, and family characteristics (family income adequacy, caregiver depressive symptoms, caregiver education) have with the cognitive development of 59 impoverished children less than three years old.
Of the three poverty experience variables included in the multivariate analysis, only employment as the exclusive source of household income had an independent relationship (positive) with children's cognitive development. Two of the family characteristics, income adequacy and caregiver education, also were associated with the children's cognitive score, and they were both better relative predictors than the employment-only income source variable. Income adequacy was positively associated and caregiver education was negatively associated with children's cognitive development.
Although recent welfare reforms, in combination with economic growth and declining unemployment, have changed the poverty experience of young families by increasing the proportion that secure at least part of their income from employment, our study provides preliminary evidence that these reforms have made little difference for most young impoverished children. Instead, our findings suggest that the cognitive development of young children is influenced as much by the actual amount of household income as by their parents' activity and source of income.
