Health promotion for single mothers: How to reach the socially disadvantaged

1. Health promotion for single mothers: How to reach the socially disadvantaged Toni Faltermaier University of Flensborg (Germany) Institute of Psychology, Dep. of Health Psychology and Health Education E-mail: faltermaier@uni-flensburg.de Funded by the Landesvereinigung für Gesundheitsförderung e.V. Schleswig-Holstein and the Ministery for Social, Health and Consumer Protection des Landes Schleswig-Holstein In collaboration with the students Anke Munz, Christa Schwegmann und Eva Winter

2. Problem • Socio-economic inequalities in health, marked health differences in social status, gender, etc. • Interventions in prevention and health promotions do not reach the socially disadvantaged groups most in need • Reasons: social disadvantaged groups are more difficult to reach, they tend to have less health consciousness, and interventions do not consider the social and psychological conditions of these groups • Adequate concepts for health promotion should be both theoretically and empirically grounded

3. Single mothers as target group • Health promotion should concentrate on specific target groups at risk • Single parents are a growing group of the populations in western industrial societies: In Germany 1,4 million single parents live with at least one child in household (1,9 million children) • 88 % of single parents are women • Empirical evidence that single mothers have both more social and economicals problems and more health problems than comparable groups • Consequence: demand for prevention and health promotion addressing single mothers

4. Questions • What are the specific health needs of socially disadvantaged single mothers? • What subjective and social preconditions have to be considered in planning health promotion interventions for these women? • What concrete approaches have to be used in health promotion for this group?

5. Theoretical background • Salutogenic perspective • Health as a multi-dimensional phenomena • Subject-orientation: Potentially competent persons • Psycho-social determinants of health: stressors, coping efforts, perceived risks, risk behaviours, personal and social resources, sense of coherence, lay concepts and theories of health, and health behaviours • Health promotion has to consider the social and subjective conditions of participants, has to be adapted to their life world,

6. Methods • Pilot studies: qualitative interviews with experts and single mothers • Development of a questionnaire instrument (31 items, including open questions) • selection of a (non-representative) sample of socially disadvantaged women from urban and rural areas • Field approach: mothers attending kindergartens (in underpriviledged districts), job centers, counselling offices • descriptive und analytical analyses

7. Results • Perceived health and different indicators of health • stressors, coping efforts and health • perceived health risks and health resources • risk behaviours and health behaviours

8. Table 1: Sample of single mothers (n = 117): description

9. Subjective Health Very good good moderate bad very bad 0,0% 5,0% 10,0% 15,0% 20,0% 25,0% 30,0% 35,0% 40,0% 45,0% subjective perception of health

10. Positive Indicators of Health

11. Negative Indicators of Health

12. Table 2:Associations between positive indicators of health and subjective health (significant correlations, ** p<0,01)

13. Table 3:Associations between negative indicators of health and subjective health (significant correlations, ** p<0,01)

19. Table 6: Perceived health risks (first ranks from 17 categories)

20. Table 7: Perceived health resources(first ranks from 17 categories)

21. Health Behaviours

22. Risk Behaviours

23. Conclusions for Health Promotion 1 • General need for health promotion for single mothers is confirmed again (subjective health) • specific health needs are identified especially in indicators of mental health (inner balance, life satisfaction, energy, and depressive feelings) • Frequent life stressors are identified in women‘s financial problems, in problems with the child‘s father and with local authorities; the strongest predictor for health is stress in the housing situation

24. Conclusions for Health Promotion 2 • Problems to adequately cope with life stressors: Coping behaviour includes smoking, difficulties in help seeking, lack of salutogenic orientation for life management (SoC) • The majority of women perceives both their health risks and health resources; thus, they are important preconditions for health promotion

25. Conclusions for Health Promotion 3 • Most women believe that they can personally contribute to their health • Most single mother realistically report their risk behaviours (too much smoking and eating); in reporting health behaviors especially the deficits are worth noting (sleeping, relaxing, recreation, and medical check-ups)

26. How to reach these women for health promotion? • Professional interventions in settings and in institutions familiar to these women (kindergarten, schools, etc.) and in their local communities • Implementation of health promotion in institutions of the social and educational systems • Planned practice project: health promotion programs for single mothers with parallel child care

27. Program in health promotion for single mothers • Interventions in familiar kindergarten in social disadvantaged communities • group program for single mothers : „Time for me. What can I do for me and my health“ • parallel free child care by child care center • 10 sessions over 6 months plus booster session • 4 groups with 12-15 women • group moderation: specifically trained psychologist or health educational scientist • Evaluation study (pre/post/follow-up)