Context Matters: Work, Health, and Quality of Life of Regulated Home-Based Childcare Workers in Quebec &amp; Ontario
Creators: name: Stitou, Mariam
Publisher: name: Université d'Ottawa / University of Ottawa
Year: 2017
Subjects: Home-Based Childcare Workers
Work
Health
Quality of Life

description: Home Based Childcare (HBC) workers have demanding work conditions, enjoy no or few social benefits, are paid less than the national average wage, and many of them intend to leave this occupation (Doherty, Lero, Goelman, Tougas, Lagrange, 2000). The available studies on early childcare workers in Canada have often excluded HBC workers from their analyses or grouped them with other types of early childcare workers in their analyses, which make it difficult to tackle the particularities of this specific subgroup of workers. In light of the limited studies on regulated HBC workers in the Canadian context, this thesis aimed to provide insight on these workers' health and broader social determinants of health in two Canadian provinces where they are the most concentrated. The overall purpose of this thesis is to document the perceived health and chronic conditions of HBC workers, highlighting the broader social determinants of their health (e.g. work, lifestyle). This thesis had four objectives: 1. Assess regulated HBC workers' health-related quality of life and investigate the relationships with socio-demographic characteristics. 2. Examine chronic health conditions affecting regulated HBC workers and identify the social determinants of health factors associated with chronic conditions. 3. Draw an overview on broader social determinants of health factors among regulated HBC workers using the Dahlgren and Whitehead model. 4. Undertake a job analysis of regulated HBC workers In the first Manuscript, the perceived health-related quality of life of home-based childcare workers in two Canadian provinces, Quebec and Ontario, was assessed using survey methods. Results show that HBC workers in Quebec positively perceive their overall physical health and negatively perceive their overall mental health. Those working in Ontario report both good overall physical and mental health-related quality of life and also report better mental and physical health-related quality of life compared to those in Quebec. That is, they have fewer problems with work or other daily activities due to their health, feel less physical pain, less fatigue, less nervousness, and are less depressed than workers in Quebec. HBC workers experience more pain, more fatigue, more interference of health problems with social activities, and more psychosocial distress compared to Canadian women in general. Finally, our study supports that being over 40 years old, being married or in a common-law union, and working in Ontario were factors relating positively to the perceived health-related quality of life among HBC workers when controlling for the level of education and the annual gross income. In the second manuscript, chronic health conditions affecting regulated HBC workers in Quebec and in Ontario and the broader social determinants of health factors associated with these were examined using survey methods. The study revealed that one out of two HBC workers had a chronic condition. Chronic back pain, asthma, hypertension, skin diseases, and arthritis are the main five chronic conditions among HBC workers. Also, five out of ten HBC workers with a chronic condition report chronic back pain as their main health condition. Finally, workers over 40 years of age, those who were somewhat physically active or inactive, having poor relationships with their supervisors or parents of children, and working for five years or more reported more chronic conditions as diagnosed by a health professional. In the third manuscript, the broader social determinants of health among regulated HBC workers in Quebec and in Ontario were examined using a mixed methods approach. Results showed significant differences in social determinants of health between HBC workers in Quebec and in Ontario in terms of age and factors related to individual lifestyles, social and community networks, structural factors, and general socio-economic conditions. In the fourth manuscript, HBC workers’ job content, context, and requirements were described and factors that affect their health and well-being were identified using qualitative methods and emphasizing the workers’ perspectives. Results showed that HBC workers’ job differs from centre-based childcare workers. They perform business administration tasks and more housekeeping and domestic work than workers in the centre-based childcare, which affect their health and well-being. They are paid on a per child basis but their level of education, experience or input into care is not taken into consideration. In addition, HBC workers reported factors related to the context and the content of their job such as the high physical and mental efforts, the absence of contact with other adults during working hours, the lack of external help during working hours, the difficulty of filling available spots, the exposure to noise and bad odours, the interference of work with personal and family life, the low and precarious remuneration and the lack of benefits as potential factors that may affect their health. Finally, the thesis conclusion provides an overview of HBC workers’ health and determinants of their health identifying remaining gaps in our knowledge of HBC workers’ health and determinants of health where future research is required. Future studies are encouraged to consider using multiple approaches (e.g. online surveys, paper survey, etc.) and multiple languages (e.g. Chinese) to reach a larger number of participants. Stakeholders and decision makers are encouraged to consider provincial differences in social determinants of health to implement interventions to reduce disparities and health inequities among HBC workers.