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Health Care Access and Utilization by Young Mothers Experiencing Homelessness: a Bourdieusian Analysis with an Arts-Based Approach

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Health Care Access and Utilization by Young Mothers Experiencing Homelessness: a Bourdieusian Analysis with an Arts-Based Approach Health Care Access and Utilization by Young Mothers Experiencing Homelessness: A Bourdieusian Analysis with an Arts-Based Approach by Clara Juandó-Prats A thesis submitted in conformity with the requirements for the degree of Doctor of Philosophy Lawrence S. Bloomberg Faculty of Nursing » University of Toronto © Copyright by Clara Juando-Prats 2017 Health Care Access and Utilization by Young Mothers Experiencing Homelessness: A Bourdieusian Analysis with an Arts-Based Approach Clara Juandó-Prats Doctor of Philosophy Lawrence S. Bloomberg Faculty of Nursing University of Toronto 2017 Abstract Young mothers experiencing homelessness and their children have low economic and social resources and worse physical and mental health outcomes than their more resourced counterparts. Furthermore, their use of health care resources is constrained by social factors that remain understudied. Following a relational approach based on Bourdieu’s theory of practice, this study aimed to explore and understand the relationships between the social position that these young mothers occupy and their health practices (access/use of healthcare resources and other behaviors). This study also sought the impact of an arts-based approach on community involvement. Through qualitative inquiry I used discursive montage and participatory graphic elicitation. The former consisted of an analysis of the media artifacts on young mothers experiencing homelessness, aiming to understand how they are socially positioned and how this ii relates to social structures. The graphic elicitation consisted of a semi-structured and an elicitation interview, the latter based on their artwork created during the study. The artwork created by young mothers, volunteers, and by myself was included in the analysis; it was also a tool for my reflexive process. All data were analyzed through a dynamic process of data abstraction using Bourdieu’s concepts of habitus, capital, and field. Results showed an embodiment of the social values related to the conceptualization of youth that excludes young homeless mothers and sees them as deviant. Young mothers are portrait in the media as unskilled and immature, with a low chance of social success. The contradictions drawn from this social construction of youth and mothering affect not only their daily life but how they take care of their health and that of their children. Participants tended to avoid situations in which they may feel judged or brushed off, which resulted in them minimizing their encounters with healthcare providers. This study has identified a healthcare gap related to the adequacy of existing resources, as well as a need for creative approaches to connecting young mothers with providers. iii Acknowledgments This journey lasted four years and ten months. If I put it in perspective it does not seem much, it is only a ten per cent of my life, but it is a quarter and a third of my sons’ lives. In this case, numbers matter; and I hope that this work will inspire their curiosity and passion for knowing and understanding the amazing world we live in. This journey has been full of steady daily work; fighting the adversities, enjoying the view, gathering stamina from dreams, nurturing dedication from love, and sketching life to make sense of it; but although intense, I have never been alone. First of all, my gratitude goes to my supervisor Dr. Jan Angus; for giving me strength, directions, support, comments, and for the long theoretical—and less theoretical—discussions. Thanks for not giving up on me although my unconventional ideas. Secondly, my gratitude goes to my committee members: Dr. Janet Parsons and Dr. Diane Farmer; for encouraging me without limits, for feeding my brain, and for the detailed and deep revisions provided. I am sure I have had the best committee that I could have ever had. The inspiration and strength I have found in all of you kept me moving forward; thank you for teaching me to see the lights and shadows of the picture. For the financial support I am especially thankful to the Bloomberg Faculty of Nursing, University of Toronto. Their generosity enabled my condition as a full time doctoral student. The economic support received through the Canadian Institutes of Health Research (CIHR), the Center for Community Engagement—University of Toronto, and the Applied Health Research Center—St. Michael’s Hospital, has been extremely valuable. Thanks to Dr. Denise Gastaldo and Dr. Sioban Nelson, at the Bloomberg Faculty of Nursing; their innovative views are building a strong core of research and academic nurses who are changing the present. Thanks also to the kindly donations of Peter Tolken, Carolina Testa, and Northern Artists. This study could not have happened without the development and conduction of a program for young mothers living on the margins. This was the essence of the research and without this I could not have offered to the young mothers a safe space to create and express. My most sincere gratitude goes to Lorena, Rose, Corina, and Joanna; to Sketch, College Montrose, Planned Parenthood Toronto, and June Callwood Center. Thanks to the artists who volunteered their time iv in the program: Simin Keramati, Rochelle Dorosh, and Keileigh Lowe. And thanks to all the volunteers, cook, and staff who were (and still are) part of the program. Whoever has seen me frequently during these years, knows that this dissertation has not only occupied all my free time, but it has changed my life. For this I moved to a different country, Canada, which is much colder than my home country, and for this I moved to a city without the sea—thing that forced my adaptability more than speaking a new language. I adventured in an Odyssey with a clear Ithaca in mind, and towards it I sailed without pause. In this journey, I have met new friends; and they have helped me as if they knew me since we were young. Their patience and caring has been essential for me to complete this dissertation. Thanks to April, Sanjeev, Jordi, Vivian, Denise, Debora, Nicole, Barbara, and Carolina. Thanks for giving and sharing with me so much. To my people overseas: my friends and mentors in Spain. Thanks for their unconditional and constant support that has overcome the time difference. You have been present every day despite the distance. I have learned that Whatsapp and FaceTime are tools that can break space barriers. Dr. Teresa Puig, Dr. Maria Gasull, Silvia, Laura, Sergi, Paola, Carme, Ferran, and Rosa: thanks, my dear friends. Thanks to my mom, Elisa, for rising and loving me unconditionally. Thanks to all the amazing moms that have been involved in the project. If you read it, know that all this was only because of you; for your value, your strength, your resilience. For being the mothers we always wanted to have. Thanks for teaching me so much. My final lines of gratitude go to my sons Nic and Dan, who have made feel Canada our home. Thanks for keeping my feet on the ground, for encouraging me and for making every day a good day from the start. You are my Ithaca. v Notes to the Reader and Glossary As a brief guide to clarify some of the terms I frequently use in this dissertation I provide in this page a glossary. Concepts developed by Bourdieu are not included here as these will be described in detail in the pages that follow. As a clarification on the use of the term homelessness, whenever I use it by itself I am including in it the term at risk of homelessness, according to the Canadian Definition of Homelessness which is explained on page 109. The names of the participants are all pseudonyms. All the details of their lives, which might make the participants identifiable, have been changed, modified, or removed. So the details you will read in the quotes or stories—such as places or children’s characteristics—do not correspond with any participant in particular. Glossary Media The means of communication that reach people widely, as in newspapers, magazines, radio, and Internet-based sources. Practices Part of the Bourdieusian term of habitus. These are the actions, habits and performances done by agents. Sketching The art of capturing an image, body, or scene at a given time; usually through a free hand drawing which can be rough and without many details. Structure/s The system that organizes the social order and that is common to all the agents who participate in that order. From a Bourdieusian perspective, a structure works both as an objective system of positions (of individuals, groups, and institutions), hierarchically organized, and as the internalization of such positions into systems of dispositions and expectations shared among members of a social group. vi Table of Contents Acknowledgments ..................................................................................................................... iv Notes to the Reader and Glossary .............................................................................................. vi Table of Contents ..................................................................................................................... vii List of Figures and Tables ........................................................................................................ xii Chapter 1 Introduction ................................................................................................................ 1 Preface ................................................................................................................................... 1 Structure of the dissertation ..................................................................................................
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