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Understanding Parental Theories About Children's Health by Melita M. Vaz a Dissertation Submitted in Partial Fulfillment of Th Understanding Parental Theories about Children’s Health by Melita M. Vaz A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy (Social Work and Psychology) in The University of Michigan 2009 Doctoral Committee: Associate Professor Mary Ruffolo, Co-chair Professor Lorraine M. Gutierrez, Co-chair Associate Professor Ramaswami Mahalingam Assistant Professor Dale K. Fitch © Melita M.Vaz 2009 Acknowledgements I would like to convey my gratitude to various people who assisted me at various points in this project. My committee members, Mary, Lorraine, Ram and Dale, who guided me through the process of planning this research study and guided me through the analysis. Fr. Denis Pereira, Fr. Karlu Dias, Ms Nalini Lobo, Ms Patricia Lobo, Ms Swapna Redij and Ms Kriti for their assistance in recruiting participants. Ms. Jyoti Goyal and Ms. Nijika Shrivastwa for the transcription My close friend and colleague, Ms Sheetal Goel for assistance in ensuring the reliability of the study. My Mum, Marina and Jenell Clarke, my best buddy in the U.S. for checking the grammar and APA style of the drafts. Assistant Librarian, Ms Shyamala for granting me special permission to access the library collection at Tata Institute of Social Sciences, Deonar, Mumbai, India. The members of Osterweil House and my buddeez, Jenell and Asha for offering me a bed and a roof on the odd occasion when I required it en route to and from India. My own adolescent, Malcolm Z. who brings joy and colour to my life, and gives life more purpose. Lastly, but most critically, Rackham Graduate School and the Doctoral Office in the School of Social Work for their monetary grants which enabled the timely completion of the project. ii Table of Contents Acknowledgements ............................................................................................................. ii List of Figures .................................................................................................................... iv List of Appendices .............................................................................................................. v Abstract …………………………………………………………………………………..vi Chapter 1. Introduction ..................................................................................................................... 1 2. Methods......................................................................................................................... 21 3. Parental Theories of Health: Some Direct Answers ..................................................... 45 4. Lay Theories of Health Related to Food, Friends, and Media ...................................... 76 5. Education as a Health Issue ........................................................................................ 117 6. Lay Theories: What Influences Them? ....................................................................... 137 7. Discussion and Implications ....................................................................................... 152 Appendices ...................................................................................................................... 166 References ....................................................................................................................... 287 iii List of Figures Figure 1.1. My initial formative model ........................................................................................ 20 4.1. Parental notion of how friends influence the adolescent child ................................ 115 4.2. Parental notion of how mass media influence the adolescent child ......................... 116 5.1. Parental lay theory about risks to adolescent health ................................................ 136 iv List of Appendices Appendix A. Review of studies on parenting in India ..................................................................... 166 B. Introductory letter to school principals ...................................................................... 169 C. Short form asking for parent volunteers ..................................................................... 170 D. Verbal script for informed consent ............................................................................ 172 E. Frequently Asked Questions about the study ............................................................. 173 F. List of Organisations working on Child Related Issues ............................................. 176 G. Parents’ Interview Schedule ....................................................................................... 177 H. Example of a code memo created for Food using the Lexical Search function ......... 186 I. Tables related to Chapter 2 .......................................................................................... 187 J. Tables related to Chapter 3 .......................................................................................... 191 K. Tables related to Chapter 4 ........................................................................................ 232 L. Table related to Chapter 5 .......................................................................................... 248 M. Code System .............................................................................................................. 253 v ABSTRACT Understanding Parental Theories about Children’s Health Using a comparative ethnographic design, 19 mothers and fathers of children aged 13 to 15 years were interviewed on their lay theories of health and illness of adolescents. Participants were recruited through government-aided, private schools in Bombay (now Mumbai), India, and included educated parents of different economic backgrounds. The interview included open-ended questions and measures like the Parental Health Locus of Control. Transcribed data was analysed in MaxQDA using an inductive thematic analysis approach. When presented with known risk conditions such as HIV/AIDS, smoking tobacco and drugs parents minimised the likelihood of these to school-going children. Their explanations were similar to le cordon sanitaire observed in persons with risky sexual behaviours. Parents viewed school as safe and reported such conditions were more likely when children enter college. In contrast, parents were more concerned about road accidents. They also associated risk to adolescent health with the influence of bad friends and mass media. These could cause premature sexual awareness in adolescent children and could possibly distract the child from the approved goal of education. Parental lay or ethnotheory pertaining to health of adolescents appeared to place an overwhelming importance on good educational choices and performance to the point where good health might vi sometimes be compromised to give the child an educational advantage. Children’s education also caused much stress and anxiety in terms of pressure of syllabus and inability to approach teachers with concerns. Christian parents in the sample were marginally more aware of adolescent health concerns than Hindu parents. They also had better knowledge of resources through the institutional church. No major gender influences were observed. The implications of minimising risks to adolescent health could mean that parents are less likely to recognise or seek professional help for such health conditions unless they interfered with academic work. Further, parents are more likely to rely on personal and familial resources. This indicates a need for better parent education. Social workers and health workers also need to reflect on how to reduce the stress associated with education, and how to enable and empower parents to work in greater partnership with schools. vii Chapter 1 Introduction My dissertation explored how parents in India conceptualise the health of their adolescent children. In this chapter I first give some background to the study of adolescent health in India. Next I describe the literature on lay theories, addressing specifically two types of lay theories: those pertaining to health and illness, and to parental ethnotheories. For each of these theories, I describe the state of research in the Indian context. Adolescent Health in India There is not much clarity in India about who exactly constitutes an adolescent (United Nations Fund for Population Activities [UNFPA], 2003). The term ‘youth’ appears to be more popular, especially in policy discussions. Apart from clarity over terminology, Indian census findings do not even list separately the population figures for this important group on their website, and most government policies in India do not address the needs of this age group separately (UNFPA, 2003). This may be one reason which has led some social scientists to question whether adolescence as a developmental stage exists in Indian society, especially in rural areas (Jayaram, 2000; Saraswathi, 1999). Some like Saraswathi opine that adolescence as a developmental period is less relevant to rural areas where young people often enter the workforce very early in life. According to UNFPA estimates, there are around 239 million young people in India between 10 and 19 years of age. They account for 22.8% of the population (UNFPA, 2003). Adolescents face many health-related challenges: During this period of rapid, physical change, poor nutrition is a potential hindrance to bodily growth (UNFPA, 2003). In addition, some developmental challenges have the potential to endanger the health of the child. One such challenge is
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