Reid, Colleen J.

Current social services provided in Canada for low-income women are primarily 'crisis management' in nature as they almost exclusively provide safe housing, adequate nutrition or employment training, and many are under severe financial pressure due to a shifting public policy. As a result, services offered for single mothers living below the poverty line rarely deal with health promotion in terms of physical activity, even though it has been demonstrated that socioeconomic status is a key determinant of health (Frankish, Milligan & Reid, 1996). Although there are many positive mental and physical health benefits associated with regular physical activity (King 1991), its organizational context remains problematic for those who live in poverty and are unable or unwilling to conform to dominant expectations inherent with the consumption of modern forms of physical activity. A moral reasoning tone pervades prescriptions for maintaining and improving health, and those unable to achieve and maintain good health are considered individually responsible, thus obscuring organizational and structural factors that limit involvement. The purpose of this case study of the YWCA was to examine the provision and consumption of health and wellness services for low-income single mothers. Research questions were posed in four areas: i) what meanings do low-income single mothers and YWCA service providers associate with the provision of health and wellness services; ii) how are health and wellness services located within the political, social and economic context of the YWCA; iii) are there points of disjuncture between the provision and consumption of health and wellness services for low-income single mothers; and iv) if points of disjuncture are uncovered, what are the possibilities for emancipatory change in service provision? Several bodies of literature were reviewed to inform the study: social construction of poverty, ideologies of health and physical activity, feminist organization theory, and feminist action research (FAR). FAR is a research process that merges participatory action research with critical feminist theory. Key principles of feminist action research include: 1) gender as a central piece to emerging explanatory frameworks (Maguire, 1987); 2) collaboration and negotiation at all stages of the research process between the researcher, the service providers and the research participants (Green et al., 1995); 3) empowerment through giving control of the research process and decision making to the research participant, while deconstructing the power structures associated with social class (Fals-Borda, 1991; Fawcett, 1991); and 4) social/organizational action and emancipatory change enabled through the democratic production of knowledge (Green et al., 1995). The research methodology involved an examination of: 1) The meanings and experiences of eleven low-income single mothers participating in the FOCUS Pre-employment Training Program which has a wellness component. The data collection strategies included focus groups; a validation meeting the original participants; observations during group meetings and program sessions; and informal discussions. 2) The meanings and experiences of five service providers who were either facilitators of FOCUS or occupied management positions in the YWCA. The data collection strategies included one-on-one semi-focused interviews; observations of program meetings, group and informal discussions; and a final meeting to discuss potential change. 3) Relevant documents, including brochures, pamphlets, reports and promotional flyers to obtain background and contextual information about the YWCA. The data was analyzed using inductive analysis and the qualitative software program, Q.S.R. NUD.IST. The overall finding was that neither the service providers nor the single mothers viewed wellness as a priority. At the organizational level, the explanation for this finding was that physical activity opportunities were not valued by the funders, whereas employment training was their primary concern. The YWCA's upscale health and wellness services, which offered another opportunity for single mothers to participate, catered on a fee-for-service basis to middle and upper income women and men and pursued a market-driven ideology towards service provision, thus making low-income single mothers' involvement less likely. The social, economic and political context in which FOCUS was situated had a profound influence on the nature of service delivery, and funding constraints were a source of stress for the service providers and infringed on the nature and scope of the services offered for the single mothers. Themes related to points of disjuncture included the service providers' attitudes towards the provision of health and wellness services. Some providers believed that within the confines of the organizational structure and the FOCUS program guidelines, the physical activity opportunities offered to the women were sufficient. Conversely, other providers believed that the organization could take a more active and critical role in determining routes for change and establishing stronger connections between health and wellness activities and the other components of the FOCUS program. All of the service providers alluded to the importance of the women's input and the "organic growth" of the program, however the program's strict curriculum and scarce evaluations resulted in a non-collaborative approach to service delivery. From the single mothers' perspectives, stereotypes of the lazy and unmotivated "welfare single mother" inhibited their involvement in community life, including organized forms of physical activity (Fraser & Gordon, 1994; Lord, 1994; Belle, 1990). The women reported experiences with discrimination, a cycle of poverty, complications with social assistance, social stigmas, and childcare responsibilities as their major constraints. Three main reasons for the women's lack of participation were their low sense of entitlement towards physical activity, their ambivalence towards their bodies, and little access to wellness facilities. However, involvement in health and wellness activities was a low-priority for the FOCUS participants, though some of the single mothers mentioned the desirability of incorporating more regular activity sessions into the FOCUS curriculum. Other tensions arose between the realities and ideals of feminist organizing. Distinctions based on class, ethnicity and age separated the upper managerial service providers, the on-site facilitators, and the women accessing the program, perpetuating an elitist, non-collaborative and hierarchical organizationial structure. Based on the single mothers and the service providers' suggestions, four major recommendations for change were provided. First, the participants should be central to and fully collaborative in the organizational processes of the YWCA. Second, if the women involved in the program value physical activity, they should determine ways in which it can become a part of their daily reality. Third, for those involved with the planning and implementation of the FOCUS program, the role of the funders vis a vis the needs of the participants should be determined, and a consistent and 'women-centered' approach to service delivery established. Finally, the YWCA's approach to wellness service delivery should be evaluated and re-conceptualized so that it fulfills and is congruent with the YWCA mission statement. What remained unexplored by the service providers was the potential for the women to redefine hegemonic notions of physical activity (Birrell & Richter, 1987) and to be involved in a meaningful and self-expressive form of activity (Hargreaves, 1990). By listening to the various perspectives and situating experiences within the organizational, political, economic and social contexts, this study provided the beginnings of a critical understanding of the tensions involved in women organizing for women to promote physical activity.

In this dissertation I critique the notion that health is affected by poverty through primarily material factors. In fact, poor women are systematically excluded from resources and opportunities to pursue their health. This feminist action research project addressed how poverty and exclusion influenced poor women's health, examined how a group of women negotiated their experiences of poverty and health, and developed action strategies to address their shared concerns ... The women lived in material deprivation and could not afford the most basic living necessities. They felt stereotyped, excluded, and invisible in their every day lives ... The women had limited access to health-promoting resources, and their interactions with authorities were shaming which negatively influenced their psycho-social health through stress, depression, low self-esteem, and anger ... The women's shame, material scarcity, and limited access to resources engendered feelings of lack of control and hopelessness and influenced their health. The women's varied discourses of poverty and health reflected attempts at finding legitimacy in a society that systematically excluded and de-legitimized them. Through their conversations and our feminist action research work together, they uncovered legitimate identities within experiences of poverty and ill-health and advocated action and social change. They cited a 'livable' income, accessible health-promoting resources, and redressing stigmatizing practices and policies as changes required to improve their health. These findings confirmed that the social determinants of health must be re-framed to better understand the effects of exclusion on poor women's health and that inclusion, respect, and dignity are fundamental conditions for promoting health.

Currently, the determinants of health perspective conceptualizes women’s health as a complex mix of social, political, economic and biological factors. Measurements of women’s health have typically relied on a biomedical model, viewing health as independent from the social environment. This gap between health determinants conceptualizations and the measurements of health affects research, policy and practice in the early 21st century. When applied to women’s health, standard mea- surements often result in oversights, errors, inconsistencies and simpli- fications. Critical social justice agendas, compatible with determinants discourse, are consequently unable to meet the increasing demand for accountability and evidence-based research, policy and practice. The purpose of this paper is to examine this gap between conceptualizations and measurements of women’s health and suggest ways to advance measurements. Four questions frame this discussion: (1) How have health researchers conceptualized women’s health? (2) How have health researchers measured women’s health? (3) How can the social determinants of health perspective, specifically focusing on gender, advance both conceptualizations and measurements? (4) What are the implications for research in women’s health? -- From publisher description.

There are many positive health benefits associated with regular physical activity, and the health risks of inactivity are equally clear. Most of the research on physical activity, however, has been contained within the sport, exercise and recreation disciplines. Studies on the implications of physical activity for disease prevention, management and rehabilitation are increasing but are still limited in number and scope. As well, the relationship between physical activity and the well-being of individuals and communities has not been adequately understood, and the linkages between disease, social and psychological well-being, and physical activity need to be explored more fully. Finally, it has been argued by feminist researchers that the biological, psychological, social and cultural experience of being female in our society has not been adequately addressed in much of the health and exercise literature. This literature review originated from the difficulties policy makers, practitioners, and programmers experienced in accessing diverse sources of research, and the challenges they faced while attempting to make sense of conflicting conclusions. Notwithstanding, the current health and well-being trends in the Canadian population provided an additional imperative for this project. Girls are less active than boys at most ages, women have been experiencing increasing rates of various diseases such as fibromyalgia, coronary heart disease and cancers, and both girls and women experience body image dissatisfaction, low self-esteem and eating disorders at a much higher rate than boys and men. This literature review tackled the complex relationship between health and physical activity in the context of girls and women’s lives through a multi-disciplinary and holistic approach. From this analysis, future research strategies and policy implications to support and improve the health and well-being of girls and women were identified.

For my research purposes, I conceptualized FAR as a framework that blended feminist theory with participatory action research in order to make women central in my work. Since FAR espouses collaboration between "marginalized" women, service providers concerned about their welfare, and researchers, I assumed there would be a sense of collaboration, empowerment and trust among the research participants that would lead to emancipatory change. Since the women involved with the YWCA differed considerably both in the meanings they brought to their participation and of themselves as women, service provision needs to be sensitive to these differences based on class, age, race, ethnicity, lifestyle choices and privilege. Due to the organizational constraints, I was never able to fully challenge the label of the traditional researcher and was instead allied with the service providers who had rarely before challenged their own power base. Since the pre-employment training program caters to three different groups of women in a single year, establishing a trusting and collaborative relationship with the research participants was hindered. [...]Tom (1996) states that, ...if we do not make a conscious commitment to emergent and changing research design, we run the risk that collaborative-looking actions will be mistaken for genuine collaboration with the consequence that opportunities for collaboration will be missed.

The social, psychological, and physical health benefits of participation in physical activity and other forms of recreation are well documented (Frankish, Milligan and Reid; Sallis and Owen; Reid and Dyck), and evidence suggests that low-income women view access to community recreation as an important dimension of their health and their communities (Weber; Frisby and Hoeber). Although many community recreation departments in Canada have a social mandate of providing services to all citizens to promote health and well being, consistent barriers to regular involvement persist for those who live on the margins and are unable to conform to dominant expectations inherent in modern forms of public recreation (Frisby, Crawford and Dorer; Lyons and Langille;Harvey). With its individualist ideology, classist notions of self-responsibility, and fees for service, we argue that community recreation has become a two-tiered system where only those with sufficient social, cultural, and financial resources can participate (Kidd). Consequently, insufficient subsidies, policies requiring "proof of poverty," and discrimina- tory practices exclude poor women from being actively involved in health-promoting forms of community recreation. The purposes of this paper are: i) to examine how low-income women see involvement in community recreation contributing to their health, and ii) to examine low-income women's experiences with exclusionary community recreation policies and practices. Hearing the voices of those who are marginalized from the knowledge production and policy development process is important when considering how public sector programs, policies, and practices can become more inclusive (Lord and Hutchison; Frisby and Hoeber). Through fostering inclusion rather than classist forms of service delivery, the community development and social justice mandates of many community recreation departments is advanced thus providing health-promoting resources for those living on the margins.

Provides an overview of the scope of the community based research (CBR) process as it relates to research focused on girls and womens health, and gender and health related issues. Although it is not an exhaustive guide, it is intended to give readers a solid understanding of CBR. One of a series of four WHRN primers focused on key areas and innovative approaches in girls' and women's health and gender and health research. Our Common Ground was developed out of a dialogue between an academic researcher with a background in gender, women’s health, and community based research (Colleen Reid); a community based researcher and practicing social worker (Robin LeDrew); and an academic researcher with training in medical physics (Elana Brief). This dialogue was supported and encouraged by the Women’s Health Research Network (WHRN) co-leaders, WHRN members, as well as attentive and engaged external reviewers. Throughout the development of Our Common Ground we debated language, format, and the intended audience. We wanted to develop a research guide rooted in the experiences and practices of community researchers, a guide that reflected the current Community Based Research (CBR) environment, and one that can help new researchers connect with this approach. To that end we held a series of events and gatherings that were structured as conversations with individuals and groups interested in CBR. The document before you emerged from these conversations. In Our Common Ground we provide an overview of the scope of the CBR process as it relates to research focused on girls’ and women’s health, and gender and health related issues. Although it is not an exhaustive guide, it is intended to give you a solid understanding of CBR. We hope that you find ways to use this document to help you advance your thinking about CBR, girls’ and women’s health, and gender and health, and, ultimately to identify the kind of research that most captures your passion and imagination.