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| FINAL REPORT |
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HEALTH PROMOTION RESEARCH CENTRES PROGRAM
FINAL REPORT
McMASTER RESEARCH CENTRE FOR THE
PROMOTION OF WOMEN’S HEALTHSSHRC Project No. 813-92-0013
Margaret Denton, Maroussia Hajdukowksi-Ahmed, McMaster University 1280 Main Street West, CNH-429
Mary O’Connor, Isik Urla Zeytinoglu
Hamilton, ON L8S 4L9
For further information, please contact the Investigators at:
Phone: (905) 525-9140, ext. 23112
Fax: (905) 524-2522
E-mail mrcpowh@mcmaster.ca
Web Site Address: http://www.mcmaster.ca/mrcpowh/index.html
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General:
• A Feminist Health Promotion Research Model
• Feminist scholarship about women’s particular health concerns (silenced or overlooked)
• Scholarship about the differences in women’s lives and the contexts of those lives, often lost in more generalized population health studies.
• Evidence of the importance of women’s voices in research and health promotion
• Scholarship bringing to light the invisible work of women
Specific:
• Various research projects on workers in health and social services pointed to the high risk of chronic exhaustion and chronic stress.
• Specific research on home care workers found that they were two to three times more likely to have back strain, ligament strain, accidents and injuries, than women in other occupations.
• Projects on women living with disabilities pointed to the fundamental difficulties: of loneliness and isolation; of lack of advocacy; of inadequate and unsupportive employment opportunities; of lack of public knowledge of the experience of disabilities; of lack of access to public, leisure and workplace spaces.
• A number of research projects on immigrant women’s work and health identified mental health and occupational health as key areas of concern: A large percentage of immigrant women work in non-unionized, seasonal, insecure, low-paying jobs. Their working conditions have severe consequences on their physical and mental health (repetitive strain injuries, stress, anxiety, insomnia). Immigrant women face health problems through their life span: adolescents negotiating identities, middle-aged women with multiple care-giving responsibilities, the status and needs of the elderly.
• Research with single mothers on low incomes pointed to the dangers of stereotyping these women, identified the gender bias in family responsibilities and focused on the importance of social supports.
• An informal care network organized by lesbians in the community was able to resist some of the more coercive and uncomfortable aspects of care-giving.
KNOWLEDGE GAPS
• Although this Centre and other research centres focusing on women’s health have begun to delineate the differences in women’s lives and women’s health, more work needs to be done in researching these differences.
• More needs to be done to disentangle the complicated health effects of women’s work.
• Specific areas for more research include the health of immigrant women: their working conditions, their mental health, and the most effective, culturally appropriate health promotion strategies.
• A major knowledge gap is in long-term effects and effective policy changes.
• The effect of health reforms on different segments of female population
RECOMMENDATIONS FOR FUTURE RESEARCH
Longitudinal studies are needed on: the effects of community-based health promotion and feminist health promotion; the effects of chronic stress and exhaustion on women workers; social supports for vulnerable groups of women; the relation between culture and health.
Recommendations on Policy and Programming
• The McMaster Research Centre for the Promotion of Women’s Health (MRCPOWH) has had as its goal to establish a basis for new, community-generated approaches to promoting women’s health.
• We chose to focus the scope of the Centre's research activities around a specific social determinant of health: the impact of work, paid and unpaid, on women's health. We defined work very broadly to include both work outside and inside the home, including caregiving and self-care. Determinants of gender and culture were also explored.
• The choice of projects was guided by an awareness of the diversity of the community.
• At the same time, we were interested in doing community-based health promotion research. We wished to effect structural change
• Research fell within three main areas: 1) the impact of work, paid and unpaid, inside the home and outside the home, on women’s health; 2) work/health in specific populations of women, e.g. women with disabilities, immigrant women, adolescents, seniors; and 3) the effectiveness of individual coping strategies, and collective social change in promoting women’s health.
• To facilitate this research, we developed a research grants program to fund participatory action research projects on women and health promotion.
• In terms of research methods, the projects worked within a feminist participatory action research (PAR) framework.
• A major strength of MRCPOWH has been its interdisciplinary focus with links to Social Sciences, Humanities, Business, and the Health Sciences.
• Over the five years of its existence, MRCPOWH linked with other Centres for research and dissemination and built research partnerships with various community groups, agencies and organizations.
• The MRCPOWH principal investigators have published a book entitled, Women's Voices in Health Promotion (Toronto: Canadian Scholars Press, 1999). The objective of this collection of articles is to contribute to feminist research on women and health promotion. The book points to the differences in women’s lives, often lost in more generalized population health studies. Theoretically, the Centre’s research pointed to the epistemological importance of women’s voices in research and health promotion. The Centre’s research brought to light the invisible work of women as well as invisible and silenced groups of women.
• One finding of the Centre’s work was that the process of participatory action research can itself be health promoting.
• Theoretically, the research conducted through MRCPOWH has focused on gender and culture as determinants of health and on the process of feminist participatory research including women’s "voicing" as an integral part of that process. The research suggests that a feminist participatory action research is able to unearth and attend to women’s health issues that do not surface in traditional research. It also contributes to a health promoting process through empowerment and strategies for structural change.
• General recommendations arose out of the cumulative research of the centre, notably that longitudinal studies are needed on the effects of community-based health promotion and feminist health promotion; on the effects of chronic stress and exhaustion on women workers; on social supports for vulnerable groups of women; and on the need to study issues throughout the lifespan of women.
• Further research is needed on the impact of immigration on women's work and health. Similarly, research on the work-related health of visible minority women, women with disabilities, young women, older women, and lesbian women is needed.
• The Centre published eight issues of a newsletter, Promoting Women’s Wellness. We offered 25 workshops to the University and the community at large. We also developed a Working Paper Series and a Technical Report Series.
• In 1997, with the Atlantic Health Promotion Research Centre, MRCPOWH organized the Fifth National Health Promotion Research Conference, "Gender and Health Promotion: From Research to Policy." The Proceedings were published in 1998.
• In the same year, MRCPOWH also hosted a Summer Institute, entitled "Women and Health Promotion" in collaboration with the McMaster Gerontology Programme.
• The Centre continues to work within the Women’s Studies Program and its research wing, The Women’s Research Institute, as well as the Work and Society Program of Labour Studies at McMaster University. The principal investigators continue work in women’s health promotion through such projects as Training for Health Renewal in Mozambique (CIDA); The Social and Economic Dimensions of an Aging Population; or Community-University Research Alliances (CURA). They continue to publish in the field.
The McMaster Research Centre for the Promotion of Women’s Health (MRCPOWH) has had as its goal to establish a basis for new, community-generated approaches to promoting women’s health. The Centre focuses on interdisciplinary participatory action research on women, work and health. The researchers identify women’s work-related health issues, analyze the determinants of women's health, and develop and implement new strategies for promoting women’s health. The common approach is Participatory Action Research (PAR). Work is defined as paid and unpaid, at home and outside the home; it includes volunteer work and caregiving. MRCPOWH has adopted the Health Canada and World Health Organization definitions of health which include physical, mental, emotional, and spiritual health.
Research Methodologies: Objectives, Design and Populations Involved
Two recent shifts in the area of health provided impetus to the development of our research program. First there was a movement away from a bio-medical model of health to a focus on the determinants of health. These were expanded from lifestyle, environment and human biology approaches (Lalonde, 1974) to include a much broader range of social determinants, including social structures such as work or family life as well as social relations, including gender, social supports and culture.
Second, there was a shift in focus occurring in the health promotion field. The Ottawa Charter (World Health Organization, 1994) and, in Canada, Epp’s Achieving Health for All (1986), emphasized the broader determinants of health and enabling people to increase control over their health. They outlined strategies for improving health by: building healthy public policy, creating supportive environments, strengthening community action, developing personal skills and reorienting health services. This shifted the focus of health promotion from a concentration on lifestyle or behavioural change to promote healthy living to a consideration of structural change, community development and empowerment.
Our research program attempted to integrate these separate but complementary fields in health promotion research. We chose to focus the scope of the Centre's research activities around a specific social determinant of health: the impact of work, paid and unpaid, on women's health. We defined work very broadly to include both work outside and inside the home, including caregiving and self-care. We explored the consequences of work for women's physical and mental health and well being. In principle, we were interested in women’s views of their own health needs through their lifespan, and the research was guided by women’s articulation of those needs. The choice of projects was guided by an awareness of the diversity of the community in terms of race, income level, culture, language, sexual orientation, age, union/non-unionized workers, religion, and disability as well as other factors of difference. We thus recognize the diversity of women's participation in the workforce, paid or unpaid, and break the dichotomy between private and public spheres.
At the same time, we were interested in doing community based health promotion research. We wished to effect structural change through policy making, community development, and empowerment of the women themselves to promote health. We understood community to include: women’s groups, associations, support groups, cultural associations, committees, consumer groups, labour unions, organizations, and employers or employer organizations as long as these groups were investigating their own health needs.
Research fell within three main areas: 1) the impact of work, paid and unpaid, inside the home and outside the home, on women’s health; 2) work/health in specific populations of women, e.g. women with disabilities, immigrant women, adolescents, seniors; and 3) the effectiveness of individual coping strategies, and collective social change in promoting women’s health. We made an effort to work with individuals and groups not usually involved in research, such as immigrant women, but in doing so to protect their anonymity and confidentiality.
In order to fulfill our research mandate, we developed a set of research guidelines including criteria for selecting research sites and research methods. We chose three criteria that would influence our choice of research sites: 1) type of work; 2) high-risk segment of the population;
3) specific health problem. We developed several women’s health promotion research projects in each of these three sites. For example, several projects studied different working environments such as factory work, and community based health and social service agencies. Other research sites were constituted by a particular population segment, for example, lower-income women, the elderly, refugees, lesbians, young women, and persons with disabilities. Other research sites would focus on specific health problems, for example, women who have identified stress and tiredness as health problems, women with multiple sclerosis or women with physical and mental disabilities.
To facilitate this research, we developed a research grants program to fund participatory action research projects on women and health promotion. Faculty and graduate students were encouraged to apply for funding on behalf of a community group interested in conducting a participatory action research project. In all we funded 28 projects; priority was given to projects which used a participatory action framework, although we did support a few excellent projects on women’s health promotion which did not use this approach. Projects were presented in report form and discussed in our workshop series, newsletters and at conferences.
In terms of research methods, the projects worked within a feminist participatory action research (PAR) framework. Briefly, its four principles are: a) the research problem is defined by those people who share the problem, rather than by the academic researcher; b) the people who define the problem participate in the research process from beginning to end to ensure they are creating their own research products; c) the goal of the research is the transformation of oppressive social structures for the improvement of their daily lives; d) academic researchers who were involved because they had access to institutional funding as well as their training in research skills, had to be willing to relinquish a good deal of their usual academic role in order to encourage the transfer of knowledge-making from the academy to the people in their local communities (Hall, 1981). Furthermore, MRCPOWH was committed to ensuring that the community groups which helped create research knowledge would also have the opportunity to determine how their contribution was to be recognized and to what other uses their knowledge could be put beyond the academic knowledge dissemination forums of books, journal articles and conference presentations. Several community groups took up this challenge. For example, several Latin American participants along with other immigrant women wrote and performed a health promoting play in Spanish for their community; a second put on a ‘Share and Tell’ event; two other groups became involved in television round table discussions; others published results of their projects in newsletters, presented their findings at the MRCPOWH workshop series and at several conferences (e.g. the Summer Institute on Women’s Health Promotion in 1997 and National Health Promotion Research Conferences in Montreal and Halifax in 1996 and 1997.
Research within the groups generally progressed in two stages. The first entailed work with focus groups or with feedback from the larger constituencies, if they existed, to establish the main concerns about their health. What are the major problems and issues? Are there any identifiable health concerns in the workplace? Do they have any specific causes? How do women cope with the problem? Do they see changes that can be made? The second stage had to do with implementing changes to promote health and documenting the success of those changes. Some groups spent most of their time on the first, while others quickly decided to move on to the second.
As academics, our main involvement in the process was as researchers documenting the process and the results. We helped collect data and tell the women’s stories of health problems and health-promotion activities. It was their own and the group's activities and consensus that motivated those involved; nevertheless, within the participatory research model, we were also involved in facilitating their action for change.
The research projects have used a range of definitions of PAR in their health promotion research. On one side of the spectrum, they relied on the expertise of academic researchers and their technology to design the methodology, collect the data, control the budget, and analyze the data with community participants deciding on issues to be examined and action to be taken. On the other side of the spectrum, it was community participants who chose the methodology, collected the data, conducted the action and controlled the budget assigned to them. Some projects stopped at the level of recommendations, others facilitated the implementation of action, and in others still, the action was embedded in the project.
As noted, a fundamental principle of PAR is the transformation of social structures for the improvement of daily lives. In the health promotion research projects presented here, this was accomplished in different ways. Some of these can be easily measured, others cannot. In many, action (and the product: e.g. empowerment; acquisition of various skills) was embedded as part of the process.
Collaboration, Networking, and Multi-disciplinary Research
A major strength of MRCPOWH has been its interdisciplinary focus with links to Social Sciences, Humanities, Business, and the Health Sciences.
The four principal investigators and about a third of the Centre's research affiliates were from disciplines that were considered to be outside the domain of health (Anthropology, Economics, English, French, Geography, Gerontology, Human Resources/Management, Labour Studies, Political Science, Social Work, Sociology, and Women's Studies). Many of our affiliates were also from Health Sciences: Clinical Epidemiology and Biostatistics, Family Medicine, Nursing, Occupational Therapy and Physiotherapy, and Psychiatry. We thus recognized the importance of interdisciplinarity in research on health and in the practice of health promotion.
Over the five years, the principal investigators have worked on interdisciplinary projects with colleagues from the Faculties of Health Sciences, Social Sciences, Business and Science and from programmes and schools such as Gerontology, Labour Studies, Women's Studies and the School of Occupational Therapy and Physiotherapy. They have also represented MRCPOWH in various health related committees: in the Faculty of Health Sciences (I.U. Zeytinoglu on the Health Sciences Research Advisory Board; M. Denton on the Health Sciences Council). They were also members of the Advisory Boards of health-focused projects (M. Hajdukowski-Ahmed on the Advisory Committee of the McMaster Health Reach Programme of the Centre for Peace Studies and the Centre for International Health, M. O'Connor on the Advisory Committee of Women & Violence Careworker Program).
The Principal Investigators have presented papers at conferences nationally and internationally in varied fields. (M. Denton in Sociology, Anthropology, Gerontology, Quality of Life, Women’s Health, Home Care, and Health Promotion conferences; M. Hajdukowski-Ahmed at Health Promotion, Women’s Health, PAR, Multicultural Health, Ethnic Studies, and Theory conferences; M. O’Connor at Health Promotion, Health Systems Analysis, Multiple Sclerosis, Women’s Health, Home Care and International Development conferences; I.U. Zeytinoglu at Health Management, Industrial Relations, Health Promotion, Business and Health Care, and Health Policy conferences).
The MRCPOWH's research affiliates have been involved in a number of projects integrating researchers from different disciplines (e.g., V. Walters from Sociology collaborated with researchers from Nursing and Geography; V. Chouinard from Geography and M. Westmorland from Health Sciences, OT/PT worked with two principal investigators of MRCPOWH). They have presented research results at conferences (e.g., V. Walters from Sociology and J. Aronson from Social Work at the McMaster International Conference on Women's Health) and published in journals of their disciplines as well as interdisciplinary journals.
Over the five years, MRCPOWH has also worked with students from various disciplines, as researchers, as grant recipients, or as supervisees of the principal investigators. These include students from Business, Clinical Epidemiology and Biostatistics, English, Gerontology, Industrial Relations, Midwifery, Nursing, Social Work, Sociology, and Women’s Studies. The principal investigators have given guest lectures to classes in Medicine, Women’s Studies, Nursing, Midwifery. They .
In 1997 MRCPOWH became an affiliate of McMaster University’s Work and Society M.A. and undergraduate programme, an interdisciplinary strategic research and teaching area.
The annual meetings of Health Promotion Research Centres hosted by Health Canada have provided extensive networking and collaboration possibilities. By 1996 the Centres formed the Canadian Consortium of Health Promotion Research Centres. Over the five years of its existence, MRCPOWH has linked with other Centres for research and dissemination.
MRCPOWH has collaborated with the following research centres:
• Atlantic HPRC-- MRCPOWH and AHPRC, co-organized and hosted the Fifth National Conference on Health Promotion Research held from July 4-5, 1997, at Dalhousie University in Halifax, Nova Scotia. The theme of the conference was Gender and Health: From Research to Policy. MRCPOWH organized and chaired the scientific review committee and the setting up of the program of papers and posters; we also managed the call for proposals for and selection of synthesis papers, commissioned by NHRDP and The Women’s Bureau. The Proceedings of the Conference appeared in 1998.
• Prairie Region HPRC: M. Hajdukowski-Ahmed was a panelist in a teleconference on Health Promotion through Popular Theatre, organized by PRHPRC (1995); MRCPOWH became a partner in a CIDA Tier I proposal for Health Renewal in Mozambique which was successful ($3m) (1997). M. O’Connor was an external examiner for a Ph D student in the Department of Community Health at the University of Saskatchewan (1997).
• Montreal HPRC: M. O’Connor joined a panel on women’s health promotion organized by the Montreal Centre for the Annual Conference of l'Association Latine pour l'analyse de systémes de santé, Montreal, May 1995.
• BC Consortium: MRCPOWH acted as consultants on the Royal Society Participatory Research publications authored by Larry Green and Jim Frankish.
• University of Toronto Centre for Health Promotion: M. Denton contributed to the Centre for Health Promotion conference on the Effectiveness of Health Promotion (1996); in 1996 MRCPOWH collaborated with several other centres which include: University of Toronto, Women’s College Hospital, the Centre for Research on Violence Against Women and Children, University of Western Ontario, the Kitchener Centre for Research and Education in Human Services, and the Toronto Community-Academic Partnership on a proposal for a Centre of Excellence in Women’s Health. Together we formed the Community/Academy Consortium. The proposal was successful at stage one but not at Stage 2. In 1997 M. O’Connor was an external examiner for a Ph.D. thesis in the Department of Community Health at the University of Toronto.
• University of Toronto and the Centre for Women’s Health Research (Women’s College Hospital): MRCPOWH has been part of a regional working group on Participatory Action Research (1996-1997). Heather McLean was invited to be a guest speaker at the MRCPOWH Summer Institute on Health Promotion (1997).
• London Sexual Assault Centre, consulted with MRCPOWH's co-researchers of the Immigrant Women Survivors of Torture Project on the issue of women victims of sexual torture.
• Toronto, Sheridan College, a team of researchers led by Dr. Ushi Chowdry consulted with MRCPOWH (Immigrant Women, Work and Health) for their project on Mental Health of East Asian Women.
• University of Calgary: W.E. Thurston (Office of Gender and Equity Issues) and M. O’Connor collaborated on a position paper, "Women’s Health Promotion" for the Canada/U.S.A. bilateral Women’s Health Forum (1996) (See section 4).
We have also been involved with the Canadian Public Health Association Perspectives project with M. O’Connor as a corresponding member. MRCPOWH was also involved in consultation meetings for the National Health Forum (1996) and the Health Promotion and Population Health Roundtable, Health Canada, Ottawa, March 1996.
In 1997, MRCPOWH co-hosted the visit of Ela Bhatt, the founding member of the Self-Employed Women’s Association and of the first women’s cooperative bank in India. She spoke on "When Women Organize for Change."
Research partnerships have been established with the following groups or agencies/organizations:
· The Breast Cancer Survivor Network of Ontario
· Canadian Voices
· Community Action Program for Children
· Nobody's Perfect
· Parent-Child Program
· CATCH
· Parents Helping Parents
· STAR
· Community Support Worker Program
· Council of Indo-Canadian Communities
· Department of Public Health
· Dundurn Community Services
· Ganohkwá srá/Family AssaultSupport Services
· Hamilton Automobile Club
· Hamilton Catholic Family Services
· Hamilton Civic Hospitals, Dept. of Surgery
· Hamilton Status of Women
· Hamilton Workers Advisory Group
· Hamilton-Wentworth Housing Authority
· Hamilton-Wentworth Home Care Program
· Hamilton-Wentworth Department of Public Health Services
· Hamilton-Wentworth District Health Council
· Hamilton Multicultural Centre
· Health Rights Coalition
· Interval House
· Mother's Family Law Advocacy Programme
· Multicultural Health Coalition
· Multiple Sclerosis Society, Hamilton
· North Hamilton Comm. Health Centre
· Occupational Health Clinics for Ontario Workers
· Partners in Care: Learning Together
· Path Employment Services
· Planned Parenthood Association
· Public Health Nursing
· Social Planning & Research Council of Hamilton and District
· SISO (Settlement & Integration Services Organization)
· SHAIR (Society for Hamilton Area International Response)
· Sexual Assault Centre
· St. Charles English-As-A-Second-Language Programme
· St. Elizabeth Visiting Nurses' Association
· St. Joseph's Community Health Centre
· St. Joseph Immigrant Women's Centre
· United Disabled Consumers
· United Food and Commercial Workers Union
· Visiting Homemakers Association of Hamilton Wentworth
· VON Visiting Nursing Program
· Work-Able Services Inc.
Applicability of New Conceptual Models
Since 1994, in our working papers, conference presentations, workshops and journal articles we have been developing and discussing a feminist participatory action research model for health promotion. We have also discussed work, gender, race and culture as determinants of health. We broadened the usual definition of work to include unpaid as well as paid, at home as well as outside the home. We have paid particular attention to the diversity of women--in terms such as sexual orientation, ability, ethnocultural diversity--in our research, presentations and in our selection of projects to be awarded grants from MRCPOWH. Lastly, the work of the research centre has contributed to the theory of voice and voicing in feminist studies.
Particular work on a feminist participatory action research model started in 1995 with the MRCPOWH’s first Working Paper: "A Theoretical and Methodological Framework for Research on Women, Work and Health." A revised version was published as "Women and Health Promotion: A Feminist Participatory Model", Chapter 5 in Doing Health Promotion Research: The Science of Action, edited by J. Sippert, W.E. Thurston and V. Wiebe. A final version appears as Chapter 1 in our Women’s Voices in Health Promotion (1999). We have used this theoretical model and methodological approach in our many participatory action research projects, conferences and publications.
The MRCPOWH principal investigators have published a book entitled, Women's Voices in Health Promotion (Toronto: Canadian Scholars Press, 1999). The first three chapters are co-authored by the principal investigators and outline a new conceptual approach to the health and health promotion of women in the Canadian society. The rest of the book includes articles by MRCPOWH's collaborators who discuss their innovative research on women, work and health promotion. The objective of this collection of articles is to contribute to feminist research on women and health promotion. This is a new field of inquiry and this book describes the current state of the discipline, provides a forum for the dissemination of recent research, encourages readers to expand upon this research, and articulates new questions and goals for the promotion of women's health.
By providing a forum for the articulation of women's experiences by women themselves, this book contributes to a growing feminist scholarship about women's particular health concerns from their perspective. These concerns, previously silenced or overlooked, have been recently recognized as significant in health research. A feminist participatory action research also accounts more accurately for the diversity of women and their health needs. This book will, therefore, make a significant contribution to both Women's Studies and Health Sciences. It will appeal to a divergent academic audience in the fields of anthropology, gerontology, health studies and medicine, cultural studies, labour studies, nursing, occupational health, occupational therapy and physiotherapy, social work, sociology, and women's studies. The collection can also be used as a textbook in courses on women's health.
In 1996, M. O'Connor co-authored a paper with W.E. Thurston on "Health Promotion for Women: A Canadian Perspective" as a background paper for the Canada/U.S.A. Women's Health Forum which took place in August 1996. This paper is printed in Women's Health Forum: Preventive/ Health Promotion Strategies, pp. 1-24, and on disk: Canada-U.S.A. Women's Health Forum: Commissioned Papers. It has already been cited in the National Forum on Health, Vol II.
In 1996, M. Hajdukowski-Ahmed focused her research on the reframing of PAR in a multicultural context. She presented a paper in Cerisy-La-Salle, France entitled "Dialogisme et sciences sociales: théorie critique ou pratique théorique?", a revised version of which was published as "Bakhtin without Borders: Participatory Action Research in the Social Sciences" South Atlantic Review (Duke University) 97 (1998): 643-669. PAR is described as a dialogical process conducive to participatory democracy. Her particular theorizing of voice appears in chapter 3 of Women’s Voices in Health Promotion while this book as a whole emphasizes the importance of women’s voices.
Another publication from research at the centre emphasizes women’s voices: Voicing Our Stories: Women Remaking Their Lives (Toronto: Second Story Press, 1999). This is an edited collection of powerful stories from women in the Hamilton Region about women, work and health which is targeted to health promotion practitioners, decision makers and the general public. The professional will find this a useful resource that speaks to the ways in which women achieve health and recover.
All four principal investigators have also been working with the PAR Research Group of the Toronto Women's College Hospital and Research Centre to refine PAR concepts and methodology and to share their findings on PAR projects.
A paper entitled The Impact of Work on Women's Health: A Review of Recent Literature and Future Research Directions has been published in the Canadian Journal of Women's Health Care, Vol 8(2), pp. 18-27, 1997 contributed to our understanding of women’s work by reviewing recent literature on the impact of work and women's health, defining women's work to include paid work mostly done outside the home as well as unpaid work of homemaking and volunteering.
The principal investigators have also been publishing on gender as a determinant of health. Denton and Walters have published on Gender as a Determinant of Health in Social Sciences and Medicine (1999) and Mary O’Connor has presented a paper and published on Gender as a Determinant of Health and its Implications for Health Promotion Policy (Geneva, 1999) [see Dissemination section of this Report].
A. General:
Besides developing a new model of feminist health promotion research, the Centre’s research projects addressed varied determinants of health using the Ottawa Charter strategies as a starting point for community-based action to improve women’s health. The Centre’s work contributes to a growing feminist scholarship about women’s particular health concerns, issues that have previously been silenced or overlooked. It points to the differences in women’s lives, often lost in more generalized population health studies. Theoretically, the Centre’s research pointed to the epistemological importance of women’s voices in research and health promotion. The Centre’s research brought to light the invisible work of women as well as invisible and silenced groups of women.
One finding of the Centre’s work was that the process of participatory action research can itself be health promoting. We found that in the projects conducted, we were able to identify six different ways in which health promotion occurred. They were:
1) Empowerment of Participants: The process of PAR is itself empowering, as according to its own definition the process is also a product. Women who participated in projects in focus groups, discussion groups and workshops reported empowerment verbalized as enhanced self-concept and self-esteem; as increased critical thinking and an exchange of knowledge and skills.
2) Development of Leadership Skills: During the course of projects, several women took a leadership role organizing health promoting events such as: a South Asian student organized a cultural event; several Latin American women organized health promotion workshops, a health promotion play and the first International Women’s day for Latin American Women in Hamilton.
3) Development of Critical Thinking Skills: Through group discussions, women developed critical thinking skills and questioned inequities, discrimination, and silencing procedures. For example, women in the Work Action Group noticed that there was a frequent shifting in their assigned tasks, and linked this practice with a possible prevention of collective action on the part of the plant management. In another example, women and men with disabilities together identified factors which contribute to healthier work environments for persons with disabilities.
4) Sharing of Knowledge and Skills: Women shared their knowledge, coping strategies and recommendations for change. Community participants learned about conducting research from the academic participants and academic participants learned about the health concerns and health promoting activities from the community participants. Knowledge was transferred beyond the group as well. For example, young mothers receiving social support spoke to health care providers about their experiences and concerns. Academic participants were invited by a medical school to discuss how to be gender and culture sensitive practitioners.
5) Action for Change: Research participants used research to find a resolution to an identified problem. For example, a group of women with multiple sclerosis used the results of their study to lobby for change in transportation for people with disabilities. Another group of women researched information about health and safety in the workplace and produced a brochure for their fellow employees. And, based on findings from focus groups and a questionnaire, changes were made at several health care agencies to create healthier working environments for their employees.
6) Mutual Aid and Support Groups: Many of the PAR groups met over 6 to 24 months on a regular basis and constituted themselves as support groups by sharing experiences and information. For example, Latin American women, women with MS, young mothers on social support all continued meeting even after the specific projects were over. Many made lasting friendships, thereby decreasing their loneliness and isolation.
7) Knowledge Development and Dissemination: Knowledge was disseminated through reports, presentations at workshops and conferences, articles in local newspapers, graduate student MA and PhD theses, working papers, journal articles, and through the publication of a book.
8) Policy Making: Academic participants were sought by health promoting agencies, policy making agencies and community health centres to participate in policy making at the local, regional, national and international levels.
The long-term effects of these PAR projects and the knowledge that has been created has yet to be researched; nevertheless, community participants are continuing the work, becoming leaders, policy makers and teachers in the area of health promotion. Academic participants, including graduate and some undergraduate students will start new research and action as a result of this research.
B. Specific:
Specific research findings were the result of the many individual research projects conducted through the Centre, particularly in four areas: the health of public sector and service agency workers; the health of women with disabilities; the health of immigrant and refugee women; and the health of women across the lifespan.
In Healthy Work Environments in Home Care Agencies, the examination of the health and work life of home care workers in three non-profit community based health and social services suggests that women working in this field are at risk for physical and mental ill-health. They were two to three times more likely to have back strain, ligament strain, accidents and injuries, than women in other occupations. In research on Female Social Workers Working in Child Welfare the women are shown to be at risk of poor health: workers report that chronic exhaustion as well as other stress related problems are related to their work. In Work and Health Issues Among Public Sector Employees it was found that chronic debilitating stress and chronic fatigue are the two most common health issues faced by public employees who were integrating their paid work and family responsibilities.
In Promoting Health with Women with Multiple Sclerosis a fundamental difficulty in living with a chronic or progressive condition is coping with loneliness and isolation. It was also found that health care workers as well as the general public were often uninformed about a disease such as MS. Positive Work Environments for Women and Men with Disabilities pointed to the need for dignity and respect in the workplace. Health Leisure and Women with Mobility Disabilities found that leisure was an import aspect of these women’s health and well-being and their leisure options were limited by their dependence on caregivers, by limited incomes, by the cost of equipment and by transportation problems.
A number of research projects on immigrant women’s work and health identified mental health as a key area of concern. A large percentage of immigrant women work in non-unionized, seasonal, insecure, and low-paying jobs. Their working conditions have severe consequences on their physical and mental health (repetitive strain injury, stress, anxiety, insomnia). Immigrant women face health problems through their life span: adolescents negotiating identities, middle-aged women with multiple care-giving responsibilities, the vulnerable elderly. We Are Making A Difference, a project initiated by a small group of immigrant women in a non-unionized process plant, identified the unhealthy space and conditions of their work. In Adolescent Self-Concept and Mental Health Promotion in a Cross-Cultural Context South-Asian adolescents consistently reported on their desire to fit within the Canadian society as well as to maintain traditions and customs.They also reported on their stress which resulted from gendered expectations and interactions with the dominant culture.
Specific findings resulted from the research projects which we have grouped under the category of women across the lifespan. Young Mothers: A Poverty of Support found the danger of society’s stereotyping of teen mothers, the gender bias in family responsibilities, and the importance of social supports. The action undertaken in this PAR project (the young mothers’ presentation of a workshop to a secondary school, an article in a local newspaper and a discussion group on local television) served the purpose of educating the public; it alleviated some of the negative stereotypes and provided a forum for an ongoing relationship and support for the young mothers involved. The results of the project Promoting Health Through Intergenerational Volunteering showed that seniors felt that volunteering in elementary schools had positively affected their mental health; the program also had positive results for the children involved. Counting On Desire: Supporting a Lesbian with Breast Cancer the women were able to resist some of the more coercive and uncomfortable aspects of informal caring. The findings from the project The Bronzed Aesthetic supported the growing literature from Australia showing that sun exposure behaviours are most effectively changed by reconstructing the social milieu that equates tanned skin with beauty. Outsiders Within: Women’s Experiences in the Family Law System reported that negotiating child custody, support and access in an institutional system that is often unsupportive of women and children can have long-term negative implications for their physical, emotional and financial well-being. Promoting Women’s Health Through Volunteering found that although the volunteers reported feeling empowered by their work, they also provided recommendations of ways in which the safety and well-being of volunteers could be improved. The findings of Work Related Health Issues for Managerial Women and Men: The Case of Chartered Accountants substantiated the higher pressures of balancing work and family responsibilities on mothers with young children.
Policy and Program Implications of the Findings
A. General:
General recommendations arose out of the cumulative research of the centre, notably that longitudinal studies are needed on the effects of community-based health promotion and feminist health promotion; on the effects of chronic stress and exhaustion on women workers; on social supports for vulnerable groups of women; and on the need to study issues throughout the lifespan of women.
We recommend that support be given for community-based participatory action research which will enlarge present official understandings of women’s lives, filling the gaps in traditional research: the structures of labour, the gendered roles of women’s everyday lives; women’s understandings of physical and emotional health.
Continued research is needed on women’s paid and unpaid work and health, inside and outside the home. To overcome its invisibility, women’s work must be documented and its impact on women’s lives and health must be studied from the perspective of women themselves.
Although all women share the common experience of gender, and gender discrimination, the health issues of women cannot be assumed to be homogenous; research and health promotion strategies must address the diversity of the lived experiences of Canadian women.
Women’s voices represent the concreteness of women, their corporeal and social anchoring. Programming and policy development should attend to women’s voices.
B. Specific:
More specific recommendations arose out of individual projects: Health services should be reoriented to address the health concerns of their workers. Health and social service agencies need better working conditions to relieve the workers’ chronic stress and exhaustion. Public Sector employers should make changes to the work environment to make the integration between work and family more manageable.
Home care services and health care workers generally should be offering increased support services, advocacy and opportunities for peer support groups for women with multiple sclerosis. A key recommendation of Positive Work Environments for Women and Men with Disabilities was the provision of education on disabilities for employers and co-workers, in addition to the physical improvement of the work environment. Programming for people with disabilities should include facilitating leisure activities.
PAR health promotion projects with immigrant, refugee, and radically diverse women produced other recommendations. Non-unionized work sites with a large concentration of Immigrant women employees need a system of independent advocacy committees which would look after their occupational and mental health needs, have the mandate and power to inform, recommend, negotiate, implement and evaluate changes. More safety inspectors are needed. ESL classes relevant to occupation should take place in the worksite. The category of temporary workers should be better protected or eliminated. A fair, consistent, gender equitable, free and prompt system of accreditation should be put in place of all skilled and professional immigrants, along with free access to Canadian occupational and professional retraining, with the collaboration of professional organizations. Grants should be available to both male and female immigrants in the family category who wish to take time off their bread-winning occupations if they want to retrain. Immigrants in the family class should be treated as individuals and not dependents. A network of advocates and professional mentors is recommended. Culturally grounded forms of knowledge on health promotion, culturally grounded/sensitive services and policies should be integrated in the field of health (medical schools, midwifery, nursing, OT/PT, community health centres, sexual assault centres, DHC, etc.). Particular attention should be given to mental health issues. A politics of identity recognition, respect and effective representation should be encouraged and implemented at all levels. Attention and services should be particularly available during the first 3 years of immigration in Canada, and relevant to the different stages of women’s life. Researchers should be vigilant about he ethical use of the racially or culturally grounded knowledge they produce. Recognize and answer the special mental health issues and needs of refugee women and immigrant women who came as refugees, on their terms. Open new horizons in research and health promotion to integrate the needs of an increasingly mobile and diverse population, bearing in mind that immigrant women who reported higher health satisfaction could function well in both their language(s) and cultures(s) and in English, mainstream context, and who were satisfied with their employment situation.
The research with young mothers suggests that more education should be developed to counteract the stereotyping of young mothers and that proactive peer work could be helpful in building self-esteem. The work on Intergenerational Volunteering in schools indicates that such programs should be encouraged and supported. The research on Supporting a Lesbian with Breast Cancer suggests a model of care that successfully counteracts gendered exploitation. The research on Tanning suggests that health promotion programming should be directed at the level of reconstructing the social milieu that equates tanned skin with beauty. Work with women in child custody cases points to the need for improvement in the family law system, and the first step would be to include at all levels of planning, development and delivery of any service or program women who had been through the process. The research on Chartered Accountants concludes that the crucial advantage to employers in trying to make the workplace more friendly to the needs of families is the value of trained employees to the firm. Research on Stop the Violence encourages communities to take action against violence through enacting changes in schools and in sports. Insisting that children in the classroom and in their recreational environments behave with zero tolerance for violence will help to create a violence free society. The study on Volunteering suggests that volunteer services should expand the training needs and opportunities for volunteers to share their experiences with staff and other volunteers.
Legacy of the Program and this Centre
The 1993 funding of six Health Promotion Research Centres in Canada for five years as a joint initiative of Health Canada and the Social Sciences and Humanities Research Council of Canada will have a long-term impact on Canadian health research. With the funding of the centres came funding for networking with all the Health Promotion Research Centres across Canada, including annual meetings. There has been a significant critical mass of research conducted by these centres over the five years on strategies for promoting health. The networking relationships begun with this initiative have continued with the establishment of the Canadian Consortium of Health Promotion Research Centres which is active in undertaking collaborative research initiatives.
The McMaster Research Centre for the Promotion of Women’s Health was the only one of these centres to focus on women’s health. Its work on the social correlates of women’s health and illness has offered a balance to the very strong biomedical emphasis that has characterized so much research on women’s health. It has helped bring gender to the forefront in debates concerning the social bases of health. Even though a population health model has been embraced in recent years, leading to a greater recognition of the social determinants of health, little attention has been devoted to gender and so the work of the Centre has been particularly important. In focusing on women’s paid and unpaid work, the Centre has helped to correct the undue emphasis in the past on women’s reproductive health. The focus has allowed the researchers to explore these two key spheres of women’s lives, looking at women’s caring roles within the home as well as their roles in the paid labour force. The research includes a variety of work settings and shows how changes in these have implications for women’s health. In addition to showing what women share, the participants in the Centre’s research have sought to focus on diversity among women, representing the concerns of immigrant women, lesbians, older and younger women, professional women, homemakers, and others whose distinctive experiences are often ignored. The research has recognized various health promotion strategies: individual and collective actions as well as the steps that might be taken to achieve more enduring cultural and structural changes. Perhaps the most important feature of this collective effort is that it gives voice to the concerns of women themselves. In recognizing the professional dominance that has so often silenced women’s voices, MRCPOWH has chosen to provide a vehicle for the articulation of women’s concerns. It has focused on ’ordinary’ women and the health issues that influence their lives.
Although MRCPOWH is not a teaching unit within McMaster University, we have offered supervision to a number of graduate and undergraduate students in the field of women’s health and we have facilitated, through consultation and our seed grants program, graduate research in women’s health promotion. We have also, through research, consultation and advocacy, offered assistance to agencies and women’s groups in the community.
Theoretical and Practical Uses
Theoretically, the research conducted through MRCPOWH has focused on gender and culture as determinants of health and on the process of feminist participatory research including women’s "voicing" as an integral part of that process. The research suggests that a feminist participatory action research is able to unearth and attend to women’s health issues that do not surface in traditional research, particularly in an increasingly diverse population and with an increasing awareness of the need to take diversity into account. It also contributes to a health promoting process through empowerment and strategies for structural change. Whereas women's conditions were formerly excluded from research, participatory action researchers can encourage women to bring their lives to the forefront by supporting them in taking their daily lives as the starting place for research and action. Women can be at the centre of knowledge-making about their own lives through setting their own agendas about what needs to be researched, how it needs to be researched, and what needs to be changed. Through this process, women can be empowered. No longer objectified by research, they become their own investigators. In this process of collective articulation of problems, women develop an awareness of how their lives are affected by social structures. Women voicing their own issues brings forward an "embodied" knowledge and leads to empowerment. Feminism brings to participatory action research greater attention to gender as a social structure.
Our research has shown that women's work is multi-faceted. What is known is that there is a significant relationship between women's work, paid and unpaid, and their health; however, whether paid and unpaid work positively or negatively influence women's health is still debated (See Chapter 2 of Women’s Voices in Health Promotion). More research is needed on work-related health issues in specific occupations and workplaces. The physical and mental impacts of homemaking and volunteering on women's health are particularly in need of study. Research is needed on the impact of immigration on women's work and health, and on the impact of the volunteering and caregiving work of immigrant and refugee women on their health and well-being. Further, research on the effect of intra- and inter-cultural conflicts, and of mainstream media, organizations and institutions on the mental health of immigrant women is needed. Similarly, research on the work-related health of visible minority women, women with disabilities, young women, older women, and lesbian women is needed. Contemporary changes in the socio-economic environment, including the creation of primarily part-time, temporary, or contractually limited jobs, the rapid expansion of computer and information-based technology, and the federal and provincial governments' budgetary cutbacks and fiscal and social reform policies, dramatically influence the work environments of women. The impact of such changes on diverse groups of women and their health should be studied. Women are achieving individual and collective successes, developing coping strategies for work-related problems. These strategies are now being discussed publicly. This knowledge needs to be furthered in order to build healthy public policy with regard to women and work, to create supportive environments in which women's work is valued, and to strengthen community action by and for women. Women have yet to achieve equality in Canadian society; justice and equity at work and in the home are central to the successful promotion of women's health.
The consistent complaints of stress and exhaustion by women workers in our studies--particularly home care workers, social service agency workers, and more generally women trying to cope with the demands of family and work--needs to be addressed by policy makers. So too, the repeated findings about the isolation of, lack of respect towards, and inadequate services for people with disabilities. Consistent also in our research is the finding that adequate social supports determine health for people with disabilities, immigrant and refugee women, young mothers, and immigrant and refugee women. Policy makers and program designers then should attend to the diversity of women and their support needs.
Besides the many community forms of dissemination related to individual research projects--including television programs, plays, "share and tell" sessions, workshops in schools, newspaper articles-- the Centre published eight issues of a newsletter, Promoting Women’s Wellness. A workshop series drew participation from the University and the community at large. We offered 25 workshops, predominantly by our affiliates often with their community partners. The workshops were on a variety of topics related to research methodologies; women’s health promotion; and women, work and health. Maroussia Hajdukowski-Ahmed has been the editor of the newsletter as well as the coordinator of the workshop series since the inception of the Centre.
The MRCPOWH Working Paper Series was initiated in 1994 and the Technical Report Series in 1996. To date, a total of 12 working papers and 8 technical reports have been published and one working paper to be completed by Spring 1999 (See list below).
In 1997, with the Atlantic Health Promotion Research Centre, MRCPOWH organized the Fifth National Health Promotion Research Conference, "Gender and Health Promotion: From Research to Policy." In the same year, MRCPOWH also hosted a Summer Institute, entitled "Women and Health Promotion" in collaboration with the McMaster Gerontology Programme.
For a full publication list of MRCPOWH related research, see Appendix A below.
Met Objectives, Lessons Learned
The Health Promotion Research Centres Contribution Program promised to develop community-based strategies for health promotion. The McMaster Research Centre for the Promotion of Women’s Health had as its particular objectives to:
• establish a basis for new, community-generated approaches to promoting women’s health.
• focus on interdisciplinary participatory action research (PAR) on women, work and health.
• define work as paid and unpaid, at home and outside the home.
• adopt the Health Canada and World Health Organization definitions of health which include physical, mental, emotional, and spiritual health.
• conduct research falling within three main areas: 1) the impact of work, paid and unpaid, inside the home and outside the home, on women’s health; 2) work/health in specific populations of women, e.g. women with disabilities, immigrant women, seniors; and 3) the effectiveness of individual coping strategies, and collective social change in promoting women’s health.
• make an effort to work with individuals and groups not usually involved in research, such as immigrant women, but in doing so to protect their anonymity and confidentiality.
• choose projects guided by an awareness of the diversity of the community in terms of race, income level, culture, language, sexual orientation, age, union/non-unionized workers, religion, and disability as well as other factors of difference.
• effect structural change through policy making, community development, and empowerment of the women themselves to promote health.
With the 28 community-based research projects funded by MRCPOWH, their specific health promoting outcomes and community-related dissemination, and with the publication of Women’s Voices in Health Promotion and other peer-reviewed publications, we feel the Centre has met its objectives.
We have learned the value of participatory action research for the empowerment of women and the identification of women’s health issues. What we have also learned is the difficulties related to this work: particularly the demands on time and commitment for researchers and generally the lack of validation within the structures of the university for interdisciplinary and community work. In future we would ask for more institutional support particularly more release time to conduct this kind of research and to manage a multi-disciplinary research centre.
We plan to:
• Continue to publish reports and working papers through the MRCPOWH series.
• Continue to present our findings at national and international conferences and workshops.
• Submit and publish academic articles reporting the results of our research projects on women, work and health in peer reviewed academic journals.
• Continue ongoing collaboration with academic units such as the Work and Society Program of Labour Studies at McMaster University.
• Having helped establish the Institute for Women’s Research--the research arm of The Women’s Studies Programme at McMaster University--MRCPOWH will continue to do research on Women and Local Environments (the Institute’s theme) and health.
• Expand our collaboration at the international level [Mozambique, India, Turkey, U.S.A., France].
• Train students in our field of research through academic innovative programmes at McMaster.
• Work towards new projects in partnership with the community (e.g. Hajdukowski-Ahmed with Community-University Research Alliances).
McMaster Research Centre for the Promotion of Women’s Health PUBLICATION LIST
BOOKS:
Denton, M., Hajdukowski-Ahmed, M., O'Connor, M., Zeytinoglu, I.U., eds. Women's Voices in Health Promotion. Toronto: Canadian Scholars’ Press, 1999.
INTRODUCTION: By Margaret Denton, Maroussia Hajdukowski-Ahmed, Mary O'Connor & Isik Urla Zeytinoglu
CHAPTER 1: A Theoretical Framework for Research on Women's Health Promotion
By Mary O'Connor, Margaret Denton, Maroussia Hajdukowski-Ahmed, Isik Urla Zeytinoglu, & Karen Williams
CHAPTER 2: Women's Work, Women's Voices: From Invisibility to Visibility
By Isik Urla Zeytinoglu, Margaret Denton, Maroussia Hajdukowski-Ahmed, Mary O'Connor, & Lori Chambers
CHAPTER 3: Women's Voices in Health Promotion: Theoretical And Methodological Implications
By Maroussia Hajdukowski-Ahmed, Margaret Denton, Mary O'Connor, & Isik Urla Zeytinoglu
WOMEN WORKERS IN HEALTH AND SOCIAL SERVICE AGENCIES
CHAPTER 4: Healthy Work Environments in Home Care Agencies
By Margaret Denton, Isik Urla Zeytinoglu, Sharon Webb, & Jason Lian
CHAPTER 5: Promoting The Physical And Mental Health of Female Social Workers Working in Child Welfare
By Nora Gold
CHAPTER 6: Work And Health Issues Among Public Sector Employees
By Allison L. McKinnon
WOMEN WITH DISABILITIES AND HEALTH PROMOTION
CHAPTER 7: Promoting Health With Women With Multiple Sclerosis
By Mary O'Connor, Jacqueline Low, Julia Shelley, Catherine Hopwood, & Sharon Webb
CHAPTER 8: Positive Work Environments for Women and Men with Disabilities
By Isik Urla Zeytinoglu, Muriel Westmorland, Pam Pringle, Margaret Denton, Vera Chouinard, & Sharon Webb
CHAPTER 9: Health, Leisure and Women with Mobility Disabilities
By Jennifer Hoyle
IMMIGRANT, REFUGEE AND VISIBLE MINORITY WOMEN AND HEALTH PROMOTION
CHAPTER 10: "We Are Making a Difference": the Women's Worksite Action Group: A Participatory Action Research Project
By Maroussia Hajdukowski-Ahmed, Myrna Pond, Isik Urla Zeytinoglu, & Lori Chambers
CHAPTER 11: Adolescent Self-concept and Mental Health Promotion in a Cross-cultural Context
By Nazilla Khanlou & Maroussia Hajdukowski-Ahmed
CHAPTER 12: Stress Indicators and Management for Immigrant, Refugee and Minority Women
By Basanti Majumdar, Sarah Ellis, & Penny Dye
WOMEN ACROSS THE LIFESPAN
CHAPTER 13: Young Mothers: a Poverty of Support
By Christine Walsh
CHAPTER 14: Promoting Health Through Intergenerational Volunteering
By Margaret Denton, Lili Dolina, Allison Cummings, & Sharon Webb
CHAPTER 15: Counting on Desire: Supporting a Lesbian with Breast Cancer
By Chris Sinding
CHAPTER 16: The Bronzed Aesthetic: the Social Construction of Women's Tanning
By Kathleen Wilson, Theresa Garvin, & Colin McMullan
CHAPTER 17: Outsiders Within: Women's Experiences in the Family Law System
By Karen Bridgman-Acker
CHAPTER 18: Stop The Violence: a Community-based Violence Prevention Project
By Ronald Bayne
CHAPTER 19: Promoting Women's Health Through Volunteering
By Margaret Denton, Isik Urla Zeytinoglu, Sharon Webb, Jason Lian, & Karen Barber
CHAPTER 20: Work-related Health Issues for Managerial Women and Men: the Case of Chartered Accountants
By Janet Romaine & Isik Urla Zeytinoglu
The Grassroots Women’s Collective, ed. Voicing Our Stories/ Remaking Our Lives: Women Speak Out. Toronto: Second Story Press, 1999. 136 pgs.
CHAPTERS IN BOOKS:
Denton, M.A., Raina, P., Lian, J., Gafni, A., Joshi, A., French, S., Rosenthal, C. and Willison, D., "Health, Age and Financial Preparations for Later Life." Forthcoming in Bryan E. Spencer (ed.) Independence and Economic Security of the Older Population. Vancouver: University of British Columbia Press, 1999.
O’Connor, M. "Gender and the Determinants of Health: Implications for Health Promotion Policy". In Tant qu’on a la santé ed. Mary-Josée Bournier. Geneva: IUED, 1999.
Hadjukowski-Ahmed, M. " Bakhtine sans frontieres: dialogisme dans les sciences sociales. La theorie de l’action participante dans un contexte multiculturel", in Bakhtin and the Social Sciences, Clive Thomson ed., London: Mestengo Press, University of Western Ontario (galleys), 1999.
O'Connor, M., Denton, M., Hajdukowski-Ahmed, M., Williams, K., Zeytinoglu, I.U., "Women and Health Promotion: A Feminist Participatory Model". Chapter 5 of Doing Health Promotion Research: The Science of Action, eds. J. Sieppert, W.E. Thurston, V. Wiebe. Calgary: Health Promotion Research Group, University of Calgary, 1998. pp. 63-80.
ARTICLES IN REFEREED JOURNALS:
Low, J., Shelley, J. and O’Connor, M. "Problematic Success: A Account of Top-down Participatory Action Research with Women with Multiple Sclerosis" Field Methods (February 2000).
Denton, M.A. and Walters, V., "Gender Differences in Structural and Behavioural Determinants of Health: An Analysis of the Social Production of Health." Social Sciences and Medicine 48 (1999): 1221-1235.
Denton, M.A., Zeytinoglu, I.U., Webb, S.., Lion, J. "Occupational Health Issues Among Employees of Home Care Agencies." Canadian Journal of Aging 18.2 (1999): 154-181.
Hajdukowski-Ahmed, M., Denton, M.A., O’Connor, J., and Zeytinoglu, I.U. "Gender Patterns in Faculty Participation: A Decade of Experience at a Mid-Sized University." The Canadian Journal of Higher Education XXIX (2), (1999).
Hadjukowski-Ahmed, M. "Bakhtin without borders: Dialogism in the Social Sciences", South Atlantic Review, special issue on Bakhtin/"Bakhtin", Fredric Jameson ed., Peter Hitchcock, guest ed., Duke University Press, 1998,643-669.
Low, J. The concept of hardiness: persistent problems, persistent appeal. Holistic Nursing Practice. 13.3 (1999): 20-24.
Robb, R., Denton, M.A., Joshi, A., Lian, J., Gafni, A., Rosenthal, C. and Willison D., "Valuation of Unpaid Help by Seniors in Canada: An Empirical Analysis." Forthcoming to Canadian Journal on Aging, December, 1999.
Westmorland, M. G., Zeytinoglu, I.U., Pringle, P., Denton, M.A. and Chouinard, V. "The Elements of a Positive Workplace Environment: Implications For Persons With Disabilities." Journal of Work 10 (2), (1998) 109-117.
Low, J. The concept of hardiness: A brief but critical commentary. Journal of Advanced Nursing 24 (1996): 588-590.
Thurston, W.E. and O'Connor, M. "Health Promotion for Women." (January 1996). Background Paper, published by Health Canada for the Canada/U.S.A. Women's Health Forum, Ottawa, August 1996 (hard copy, disk and web site).
Zeytinoglu, I.U., M. Denton, M. Hajdukowski-Ahmed and M. O’Connor. "Women’s Work and Health: Literature Review and Future Research Directions." The Canadian Journal of Women’s Health Care 8(2), October, 1997: 18-27.
PAPERS COMPLETED/SUBMITTED TO JOURNALS FOR PEER REVIEW:
Zeytinoglu, I.U., Denton, M., Webb, S., and Lian, J. "Musculoskeletal Disorders Among Office and Visiting Home Care Workers: Associations with Work Factors and Injuries." Submitted to Women and Health, May, 1999.
Denton, M., Zeytinoglu, I.U., Webb, S., Lian, J. "Restructuring in Health Care: Effects on the Health and Well-Being of Home Care Workers." Submitted to Social Science and Medicine, June, 1999.
TECHNICAL REPORTS OF MRCPOWH:
Denton, M.A., Zeytino_lu, I.U., Barber, K. and Pringle, P., "Healthy Work Environments in Community Based Health and Social Service Agencies Stage One Report: Focus Group Findings", MRCPOWH Technical Report Series #1, April 1996.
O'Connor, M., Low, J., and Shelley, J., "Support Needs for Women with Multiple Sclerosis" prepared for the Hamilton-Wentworth Victorian Order of Nurses, St. Elizabeth Visiting Nurses' Association and The Visiting Homemakers Association of Hamilton-Wentworth, MRCPOWH Technical Report Series #2, June 1996.
Zeytino_lu, I.U., Westmorland, M., Pringle, P., Denton, M. and Chouinard, V., "Positive Work Environments for Women & Men with Disabilities: Focus Group Results," MRCPOWH Technical Report Series #3, Dec. 1996.
Khanlou, N. and Hajdukowski-Ahmed, M., "Mental Health Promotion Among Female Adolescents Living Within a Cross-Cultural Context: Participatory Action Research with South Asian-Canadian High School Students", MRCPOWH Technical Report Series #4, June 1997.
Dolina, L., Denton, M., Cummings, A. and Webb, S., "Evaluation of the Hamilton-Wentworth Regional Public Health Department Intergenerational Volunteer Program in Elementary Schools", MRCPOWH Technical Report Series #5, July 1997.
Denton, M.A., Zeytino_lu, I.U., Webb, S. and Lian, J., "Healthy Work Environments in Community Based Health and Social Service Agencies: Employee Questionnaire Report", MRCPOWH Technical Report Series #6, April, 1998.
Denton, M.A., Zeytino_lu, I.U., Webb, S., Barber, K. and Lian, J., "Healthy Work Environments in Community Based Health and Social Service Agencies: Volunteer Questionnaire Report", MRCPOWH Technical Report Series #7, April, 1998.
Hajdukowski-Ahmed, M. and Farragheh, M., "Immigrant Women, Work and Health: A Review of Literature", MRCPOWH Technical Report Series #8, December, 1999.
Hajdukowski-Ahmed, M., Justin, S., Pond, M., Farragheh, M., "Healing from Torture: Immigrant Women Survivors of Torture Conduct a Health Promotion Project", MRCPOWH Technical Report Series #9, December, 1999.
Hajdukowski-Ahmed, M., Pond, M., Zeytinoglu, I.U., Chambers, L., "We Are Making a Difference: Immigrant Women’s Action Group Conduct a Health Promotion Project in a Food Processing Plant", MRCPOWH Technical Report Series #10, December, 1999.
Hajdukowski-Ahmed, M., Maraj, D., Chudyk, B., "Wasted Skills: The Costs of Non-Accreditation of Foreign Educated, Foreign Trained Female Physicians", MRCPOWH Technical Report Series #11, December, 1999.
Hajdukowski-Ahmed, M., "De Mujer a Mujer: Latin American Women Conduct a Health Promotion Project on Mental Health", MRCPOWH Technical Report Series #12, December, 1999.
WORKING PAPERS OF MRCPOWH:
Denton, M., Hajdukowski-Ahmed, M., O'Connor, M., Williams K., and Zeytino_lu, I.U., "A Theoretical and Methodological Framework for Research on Women, Work and Health." MRCPOWH Working Paper Series #1, June 1994, 35 pp.
Hopwood, C., "Women and Multiple Sclerosis: Models, Needs and (Support) Services." MRCPOWH Working Paper Series #2, September 1994, 52 pp.
Chouinard, V., Denton, M., Westmorland, M., and Zeytino_lu, I.U., with the assistance of Behnke-Cook, D., "Women with Disabilities and Positive Work Environments: A Literature Review." MRCPOWH Working Paper Series #3, May 1995, 33 pp.
Trollope, K. "Towards Indigenous Notions of Women's Empowerment in India." MRCPOWH Working Paper Series #4, March 1997, 13 pp.
Zeytino_lu, I.U., Denton, M., Hajdukowski-Ahmed, M., and O'Connor, M.,"The Impact of Work on Women's Health", MRCPOWH Working Paper Series #5, February 1996, pp. 26.
Denton, M. & Walters, V., "Age Differences in Canadian Women's Own Perceptions of Their Health", MRCPOWH Working Paper #6, September 1996, 52 pp.
Gold, N., "Using Participatory Research to Help Promote the Physical and Mental Health of Female Social Workers in Child Welfare", MRCPOWH Working Paper Series #7, October 1996.
Denton, M. and Walters, V., "Gender Differences in Structural and Behavioural Determinants of Health: An Analysis of the Social Production of Health", MRCPOWH Working Paper Series #8, August 1997.
Hajdukowski-Ahmed, M. and Kohli, P., "South Asian Immigrant Women and Health in Canada: Strengths and Stresses. A review of literature", MRCPOWH Working Paper Series #9, November, 1999.
Justin, S., & Hadjukowski-Ahmed, M., "Surviving Torture: A Working Paper on Immigrant Women Survivors of Torture", MRCPOWH Working Paper Series #10, December, 1999.
PROCEEDINGS:
Zeytinoglu, I.U., Denton, M., Hajdukowski-Ahmed, M., & O’Connor, M. Women’s Paid Work, Unpaid Work and Occupational Health. The IIRA, 11th World Congress Proceedings, Vol. 2: 267-271, Bologna, Italy, 1998.
O’Connor, M. Co-edited and Introduction: Gender and Health: Proceedings of the Fifth National Health Promotion Research Conference. Halifax, 1997.
O’Connor, M. "Links between Women’s Health and Health Promotion," Gender and Health: Proceedings of the Fifth National Health Promotion Research Conference. Halifax, 1997.
Hajdukowski-Ahmed, M., Pond, M. & Zeytinoglu, I.U. Health Promotion with Immigrant Women: Epistemological, Ethical and Practical Considerations. Proceedings, National Conference of the Canadian Ethnic Studies Association, Winnipeg, 1995.
Zeytinoglu, I.U. Changing Concepts: Women’s Health and Paid/Unpaid Work. Proceedings, CIRA 1995 Annual Conference: 165. Montreal, 1995.
ABSTRACTS:
Denton, M., Zeytinoglu, I.U., Webb, S., & Lian, J. Restructuring in Health Care: Effects on the Mental Health and Well-being of Home-care Workers. Abstracts, Canadian Industrial Relations Association: web page. Ottawa, 1998.
Zeytinoglu, I.U., Westmorland, M., Pringle, P., Denton, M., & Chouinard, V. The Impact of Paid and Unpaid Work on the Health of Women and Men with Disabilities. Abstracts, Fifth Canadian Conference on Health Promotion. Halifax, 1997.
Denton, M., Zeytinoglu, I.U., Health and Safety in Women’s Work: The Case of Homecare Workers.
Abstracts, Fifth Canadian Conference on Health Promotion. Halifax, 1997.
Denton, M., & Zeytinoglu, I.U. Healthy Work Environments in Communit Based Health and Social Service Agencies. Abstracts, Fourth Canadian Conference on Health Promotion: 60. Montreal, 1996.
Denton, M., Zeytinoglu, I.U., Barber, K. & Pringle, P. Health and Safety in Women’s Work: The Case of Homecare Workers. Abstracts, International Association of Health Policy 9th Congress: 23. Montreal, 1996.
Hadjukowski-Ahmed, M., Pond, M., & Zeytinoglu, I.U. Immigrant Women, Work and Health. Abstracts, Fourth Canadian Conference on Health Promotion: 61. Montreal, 1996.
Zeytinoglu, I.U., Westmorland, M., Pringle, P., Denton, M. & Chouinard, V. Positive Work Environments for Women with Disabilities. Abstracts, Fourth Canadian Conference on Health Promotion: 61. Montreal, 1996.
Zeytinoglu, I.U., Westmorland, M., Pringle, P., Denton, M., and Chouinard, V. Exploring Work and Health Relationships with Women with Disabilities. Abstracts, International Association of Health Policy 9th Congress: 23. Montreal, 1996.
Zeytinoglu, I.U., Denton, M., Hajdukowski-Ahmed, M., & O’Connor, M. Women’s Work and Health: A Critical Review of the Literature and Suggestions for Future Research. Programme & Abstracts, Conference on Business and Health Care: A Work and Health Perspective: 26. Toronto, 1996.
O’Connor, M., Hadjukowski-Ahmed, M., Denton, M. & Zeytinoglu, I.U. Theoretical and Methodological Premises for Women's Health Promotion Research. Abstracts, Third National Conference on Health Promotion Research, Calgary, 1994.
CONFERENCE & INVITED PRESENTATIONS:
O’Connor, M. "Gender and the Determinants of Health: Implications for Health Promotion Policy". In Tant qu’on a la santé [Gender, Health and Development], Institut universitaire d’études du développement, Geneva, January 1999.
Denton, M. "Aging and Health." Presentation to the Hamilton-Wentworth Visiting Homemakers Association Board Members, 1999.
Denton, M. "Women’s Voices in Health Promotion." Presentation to the Sociology Faculty, University of Winnipeg, Manitoba, Canada. 1999.
Denton, M. "Women’s Work and Women’s Health: The Case of Home Care Work." Presentation to the Sociology Department, University of Winnipeg, Manitoba, Canada. 1999.
O’Connor, M. "The Voices of Health," ACCUTE, Learned Congress, Ottawa, May 1998.
Zeytinoglu, I.U., Denton, M., Hajdukowski-Ahmed, M., O’Connor, M. Women’s paid and unpaid work and occupational health. International Industrial Relations Association. Italy, 1998.
O’Connor, M., Low, J., Shelley, J. Group Interventions with Multiple Sclerosis: Two Initiatives in Hamilton-Wentworth. MS Regional Care Conference, Toronto, Feb. 1997.
O’Connor, M. "Links between Women’s Health and Health Promotion," Gender and Health: The Fifth National Health Promotion Research Conference. Halifax, 1997.
Swinton, M., Van Berkel, C., O’Connor, M. "Peer Support: The Main Reason Why Women Attend the Programs Offered Through the Hamilton-Wentworth Community Action Program for Children (CAPC)." Poster, Fifth National Health Promotion Conference, Halifax, July 1997.
Low, J., Shelley, J. and O'Connor, M. "The Unpredictability of Everyday Life: Ethical, Logistical, and Practical Problems in Doing Field Work with Women with Disabilities," International Ethnographic and Qualitative Research Conference, McMaster University, May 1996.
Low, J., O’Connor, M, and Shelley, J. "Support Needs for Women with Multiple Sclerosis," Beyond 2000: The Changing Face of Community Care, Sixth National CHCA Conference, Winnipeg, Oct. 1996.
Hadjukowski-Ahmed, M., Pond, M., & . Zeytinoglu, I.U. "Immigrant Women, Work and Health Promotion". Fourth Canadian Conference on Health Promotion, "Health Promotion and Population Health: a Meeting of Ideals", Montreal, June 1996.
Hadjukowski-Ahmed, M., Pond, M.,& Zeytinoglu, I. U. "Participatory Action Research, Immigrant Women and the Exchange of Knowledge and Skills in Health Promotion Projects". International Multidisciplinary Conferences, Women's College Hospital at University of Toronto, June 1996.
Hadjukowski-Ahmed, M. "Participatory Action Research in Health Promotion with Immigrant Women: an Experience in Multicultural Critical Pedagogy". International Multidisciplinary Conference, "Teaching to Promote Women's Health, Women's College Hospital, Toronto, June 1996.
O'Connor, M., Low, J. and Shelley, J. "Health Promotion with Women with Multiple Sclerosis," Fourth Canadian Conference on Health Promotion: Health Promotion and Population Health: A Meeting of Ideals, Montreal, June 1996.
O'Connor, M., Low, J. and Shelley, J. "Lessons for the Doctors: Women with Chronic Disability Inform Their Physicians," Teaching to Promote Women's Health, Toronto, June 1996.
Hadjukowski-Ahmed, M., Denton, M., O’Connor, M. & Zeytinoglu, I.U. "Women's Work and Health: a Critical Review of the Literature" paper and abstract, "Business and Health Care: a Work and Health Perspective Conference", Toronto, May 1996.
Zeytinoglu, I.U., Denton, M., Hajdukowski-Ahmed, M. and O'Connor, M. "Women, Work and Health" Business and Health Care: A Work and Health Perspective. Joint Conference of the Institute for Work and Health and the Centre for Health Economics and Policy Analysis, May 1996, Toronto.
Hadjukowski-Ahmed, M., Pond, M., & Zeytinoglu, I.U. "Working together with Immigrant Women on Health promotion Projects, Using Participatory Action Research. Achievements and Challenges". Third National Conference of The Canadian Council of Multicultural Health: "Innovating in Hard Times", Montreal, May 1995.
O’Connor, M. "Les femmes et l'augmentation de travail non-recensé" Annual Conference of l'Association Latine pour l'analyse de systèmes de santé, Montreal, May 1995.
Hadjukowski-Ahmed, M. Dialogism and Ethno-Cultural Diversity: a Constructive Challenge to Canadian Identity", Thirteenth Biennal Conference, "Canada in Crisis", Canadian Ethnic Studies Association, Winnipeg, October 1995.
Hadjukowski-Ahmed, M., Pond, M., & Zeytinoglu, I.U. "Health Promotion in a Multicultural Context: Epistemological, Ethical and Political Considerations". Thirteenth Biennal Conference of the Canadian Ethnic Studies Association, Winnipeg, October 1995.
O'Connor, M., Denton, M., Hajdukowski-Ahmed, M., Williams, K., Zeytinoglu, I.U., "Women and Health Promotion: A Feminist Participatory Model" Third National Conference on Health Promotion, Learned Societies Conference, Calgary, 1994.
Denton, M., Hajdukowski-Ahmed, M., O’Connor, M., Williams, K. and Zeytinoglu, I.U. "A Theoretical and Methodological Framework for Research on Women, Work and Health," presented: at the International conference on Women's Health, Key Research and Health Care Issues, McMaster University, April 1994; and at the Annual Canadian Sociology and Anthropology Association, Learned Societies Conference, Calgary, June 1994.
Hadjukowski-Ahmed, M., Denton, M., & Zeytinoglu, I.U. "A Theoretical and Methodological Framework for Research on Women, Work and Health". Conference on Women's Health: Key Research and Healthcare Issues, McMaster University, Health Science Centre, Hamilton, April1994.