Using age-paced parenting newsletters as teaching tools in home visitation programs with at-risk Mexican immigrant families
Joni Weatherspoon, Ph.D.
Human Development and Family Studies
Oregon State University
Sally Bowman, Ph.D.
Associate Professor, Extension Family Development Specialist
Oregon State University
Rebecca Hernandez, Ph.D.
Research Associate
School of Nursing, Center for Health Disparities Research
Oregon Health & Science University
Clara Pratt, Ph.D.
Endowed Chair in Family Policy, Human Development and Family Studies
Oregon State University
Abstract
Spanish-speaking home visitors and Mexican immigrant mothers in a home visiting program for first-time parents at risk for poor child outcomes were interviewed to assess the value of El Primer Año del Bebé (Parenting the First Year), a Spanish language, age-paced parenting newsletter series covering the first twelve months of life. Age-paced newsletters are widely used in Extension programs and typically delivered by mail, but in this program home visitors delivered them personally, using them as a one-to-one teaching tool for families. Home visitors reported that age-paced newsletters provided these parents with important parenting information, particularly to counter family advice that differed from recommended practices. Parents reported reading the newsletter, learning from it, and changing their behavior in response to newsletter content.
Keywords: Mexican immigrant families, parenting, age-paced, newsletter, home visitation
Introduction
Mexican immigrant mothers are likely to be younger and have higher birthrates than the overall population. Unfortunately, there are few parenting education programs and materials designed especially for Latino families or specifically for Mexican immigrant families. As a result, many programs have adopted translations of materials that were initially designed for Anglo families. A review of cultural differences in parenting practices reveals that poverty and educational levels of parents contribute more to differences in parenting practices than ethnicity (Cardona, Nicholson, and Fox 2000; Bradley, Corwyn, McAdoo, and Garcia Coll 2001; Julian, McKenry, and McKelvey 1994; Fox and Solís-Cámara 1997; Laosa, 1980; Solís-Cámara and Fox 1995). It is possible that high-quality parenting education materials, such as research-based parent education newsletters, may be relevant across ethnic groups.
Extension age-paced parent education newsletters provide parents with information on child development and care that is keyed to the age of their child. By targeting information about a child’s development to the approximate time that changes are happening, age-paced newsletters acknowledge that most adults learn best when they have a particular need for the information presented and when it is presented in an accessible and understandable fashion (Cudabeck et al. 1985).
This current study examined the use of a Spanish version of Parenting the First Year, an age-paced Extension newsletter series developed at the University of Wisconsin. Studies have established that mailed age-paced newsletters are a useful source of information for Anglo parents of young children (Cudabeck et al. 1985; Garton et al. 2003; Weigel and Martin 2004), and that reading the Parenting the First Year newsletters contribute to the development of appropriate parenting practices (Riley et al. 1991). The positive impact of the newsletter on parenting behavior appears greater when parents discussed the content with others (Walker and Riley 2001).
According to Cheng Gorman (1996), culturally sensitive parent education programs may be translated, culturally adapted, or culturally specific. The Parenting the First Year series was translated with minor cultural adaptations to illustrations and text, including the addition of information on parents co-sleeping with their infant (D.A. Riley, personal communication, November 5, 2003). Like the original, the El Primer Año del Bebé series consists of 12 eight-page newsletters written at a fifth-grade reading level. Each issue in the series corresponds to a specific month in the first year of life, including information on common developmental milestones for that month and practical information on medical and safety issues, and parent and child activities.
This current investigation is the first to examine the use and impact of the El Primer Año del Bebé newsletter series. Through two related studies, we investigated its use with Mexican immigrant families in a home visitation program. These families were assessed to be at risk for poor child and family outcomes. We focused on two questions:
- How was the El Primer Año del Bebé newsletter series being used in a home visitation program for at-risk Mexican immigrant families?
- Were there changes in parents’ knowledge and skills related to the use of this newsletter?
All aspects of both studies were reviewed and approved by the sponsoring university’s Institutional Review Board (IRB) for the Protection of Human Subjects. Approved protocols were followed to assure the highest quality data collection and protection of participants. Trustworthiness (Guba and Lincoln 1982) was considered in the design and implementation of data collection with detailed attention paid to the translation, transcription, and analysis processes. One member of the research team was a Mexican immigrant, and another was partially bilingual. Both of these members had experience working with Mexican immigrant families.
Home visitation program context
The home visitation model developed by Healthy Families America (Daro and Harding1999) was used to assess first-time families prenatally or at the time of a first birth for risk factors associated with poor child outcomes (child maltreatment or lack of school readiness). Families at potential risk may volunteer to receive intensive home visitation by supervised paraprofessionals during the first three years of the child’s life. This voluntary prevention-focused home visitation program seeks to help first-time parents develop safe, nurturing, and developmentally appropriate parenting practices. In the program we examined, Healthy Start of Marion and Polk Counties, all families were Mexican immigrants. The most common risk factors for these families were inadequate income, low education, or the mother’s lack of supportive adult friends or family members; such isolation was typically the result of recent immigration.
Paraprofessional home visitors who were both bilingual and bicultural visited each enrolled family at least three times per month to provide parenting information and support in accessing other needed services. These home visitors were Mexican immigrants themselves, except for one bilingual home visitor. The Healthy Start program was funded by the state Commission on Children and Families in collaboration with the participating county government. Numerous community agencies collaborate in providing “wrap-around” services to meet individual family needs, including county Extension; Women, Infants, and Children (WIC); public assistance; public health; housing; and local food banks.
This two-part study examined the use of El Primer Año del Bebé in the context of Healthy Start, an intensive home visitation program for at-risk Mexican immigrant families, through focus groups with home visitors and interviews with Mexican immigrant mothers.
STUDY 1
Methods
We conducted a focus group interview in Spanish with seven of the ten bicultural and bilingual Healthy Start home visitors. Focus group questions included the following:
- How do you use the newsletter with families?
- What do you find to be useful about the newsletter?
- How could the newsletter be improved?
The moderator followed up on fruitful topics that arose during the discussion (Morgan 1997). The focus group interview was audiotaped and then translated into English and transcribed by a professional bilingual translator/transcriptionist. To assure accurate translation, 20 percent of the translated/transcribed data was randomly selected and reviewed by another bilingual Spanish-English speaker following a procedure suggested to assure accuracy in translations. Few discrepancies between the two translations were identified. The two translators gave priority to remaining faithful to the speaker’s intent. Analysis of qualitative data was conducted by two research team members using MAXqda2© software to facilitate coding. The data were first sorted for keywords or concepts that reflected participants’ perceptions, clustered into themes, and checked for inter-rater reliability (Lofland and Lofland 1995). Themes were assigned codes, and passages reflective of the identified themes were coded accordingly.
Findings
Home visitors reported that during the first home visit each month, they gave parents (typically the mother) the issue of El Primer Año del Bebé that corresponded to the age of their infant. They reviewed key newsletter content during the visit and left the newsletter with the mother. During subsequent visits, the home visitors continued to refer to the newsletter content. The home visitors described the newsletter as a “teaching tool,” a “guide when talking with families,” and a resource with which to “reinforce” important parenting ideas and practices. In short, the newsletters formed the core curriculum for the home visits.
The home visitors believed that the newsletter was effective because the content was age-paced and focused on critical information for new parents. As one worker said, “It covers all the problem areas (on which) we otherwise wouldn’t have information in Spanish.” One home visitor said “…it’s really easy for the moms with lower education level to read. It’s short and the information is just what they want and need.”
The home visitors reported that hand delivering the newsletters was important for many of the at-risk families. One home visitor reported, “I can just give it to her (one mother), and she says, ‘Oh great, you brought me another one of those.’ And she’ll sit and read the whole thing before our next visit…. but many of my other families either can’t read or reading is very difficult for them, and so it’s better to go over it with them.”
The home visitors said that because the newsletter was “expert-based,” it was particularly valuable to address culturally relevant parenting practices that were safety concerns. For example, several home visitors noted that the mothers they visited were concerned about placing their infants on dirty apartment carpets. Because of these concerns many families prefer to use baby carriers and walkers even for very young infants. In one issue, the newsletters focused on the developmental importance of floor play and highlighted the potential dangers of walkers. The home visitors followed up by helping families think of alternatives to walkers. As a result, several families started using blankets to cover the floor and reduced the use of walkers. One home visitor described an instance when a father bought a walker but the mother resisted using it because she had learned about the disadvantages of walker use in the newsletter. “When he brought the walker home, she said to him, ‘Look, I told you to read this.’ And they returned it (the walker).”
All the home visitors agreed that the expert-based newsletters were useful in reinforcing their advice when it conflicted with traditional family practice. Many parents live with extended families, and as one home visitor pointed out, “They’ve got five people in the family saying this, and you’re one person saying something else.” Rather than personally confronting families with unsafe practices, they could retain positive personal relationships with the families by pointing to the newsletter. One home visitor described it this way: “When you know that they’re doing the opposite of what is recommended and safe…. you can say, ‘Well, it says in here why that’s not good’. So then it’s not just on you (the home visitor).”
STUDY 2
Methods
To further explore the impact of the newsletters on parent knowledge and skills, parents were interviewed in Spanish by the home visitors during the course of a regularly scheduled home visit. Parents were assured that participation was voluntary and confidential and that refusal to participate would not affect the delivery of home visitation or other services. They were informed at the outset that they would receive a small gift (a Spanish language children’s book) whether or not they participated.
Interview questions
Interview questions assessed the usefulness of the newsletter in comparison to other parenting information, the extent to which it was read by the parents and shared with others, and the impact of the newsletter on parents’ self-reported behavior changes. The home visitors had input into the design of the questionnaire, although the majority of the items were drawn from previous evaluations of the Parenting the First Year newsletter (Riley et al. 1991). Interview items assessed parents’ knowledge of eight health and safety practices that were included in the newsletters, including giving sugar to baby, giving honey to baby, using walkers, using a high chair for feeding, using baby carriers, putting baby to sleep on his/her back, putting baby on the floor to exercise, and exposing baby to secondhand smoke. Parents were asked how often they engaged in each practice, using a five-point scale ranging from 1 (never) to 5 (all the time). To assist parents who may have been unfamiliar with such scaled responses, home visitors were provided with a pictorial representation of a ladder with these responses arranged on it from the bottom of the ladder (1) to the top (5).
In addition, parents were asked how much the newsletters helped them learn about six types of parenting tasks: child development, provision of a stimulating environment, health and feeding, safety, discipline, and coping with stress. Responses were given on a Likert scale ranging from 1 (“It didn’t help me at all”) to 4 (“It helped a great deal”), using a similar pictorial ladder. Two open-ended questions were included: “Is there anything you would change or add to El Primer Año del Bebé?” and “Is there anything else you would like to tell us about the newsletters?” Responses were recorded, transcribed, translated, and coded according to themes that emerged in the analysis. Demographic data were obtained from program records.
Some of the interview questions dealt with critical issues affecting child health and safety (such as putting babies to sleep on their backs). If a mother’s responses indicated that she was not aware of the appropriate health and safety practices covered in the survey, interviewers reviewed the appropriate parenting practices at the end of the interview. At this time, the home visitor also provided the mother with a summary of the recommended health and safety practices in Spanish.
Interview participants
Approximately 12 percent (241) of the Latino first-birth families in the two counties during 1999 and 2001 were enrolled in the home visiting program during the time of the study. All 241 families in the program had been identified as at-risk for poor child outcomes. Of the 241 enrolled families, only families who had had been in the program for 11 or more months were considered for interviews. Forty-two were selected to participate in interviews. The average length of service was 16 months; all mothers had received at least 6 newsletters; and 90 percent had received all 12 issues of the newsletter series. Interviews were completed with all 42 selected families. The parents in the 42 families did not differ significantly in age, education level, income level, or length of service from the other Mexican immigrant families in the home visitation program.
All 42 interviewed parents were mothers who were the primary caregivers to the infant. Mothers’ ages ranged from 14 to 38 years; the average age was 23. Spanish was the primary language of 95 percent of the participants, who came from 15 different Mexican states. Almost all of the mothers (83 percent) were living with the biological father of their child at the time of the interview; 49 percent were married. On average, mothers had completed 8.4 years of school (range of 3 to 13 years). All families had monthly incomes between $645 and $1,000, well below the federal poverty level.
Results
More than 90 percent of the interviewed mothers stated that they read all the newsletters; only one parent stated that she never read the newsletters. Most (76 percent) reported sharing the newsletter with someone else; 64 percent shared it with their partner and 19 percent shared it with a relative or friend. When asked how the newsletter compared to other sources of information the mothers rated the newsletter as better than other written materials, relatives, nurses, other parents or friends. Almost all (75 percent or more) of the mothers reported that the newsletters helped “some” or “a great deal” in the six parenting areas of child development, providing a stimulating environment, health, safety, positive discipline, and coping with stress. Ratings of helpfulness in five of the six areas did not vary significantly by mother’s age, education level, or level of social support.
When parents were asked about eight specific safety and health practices addressed in the newsletters, a majority reported that they were using appropriate practices in six of the eight areas (Table 1). The vast majority (88 percent) of parents reported that they “always” put their babies on their backs to sleep; 61 percent reported “always” or “most of the time” using high chairs; and 57 percent reported putting their babies on the floor to exercise. All mothers reported “never” or “almost never” exposing their babies to smoke. Most also reported that they refrained from giving their babies honey (93 percent) and sugar (76 percent) – serious health concerns among Mexican immigrant families. More than half of the mothers, however, reported occasional use of baby walkers (71 percent) and baby carriers (50 percent) despite the newsletters’ recommendations against these practices.
Table 1. Percentage of Parents Reporting Use of Parenting Practices and the Helpfulness of Newsletter in Learning Each Practice (N = 42)
| Parenting Practice | Practice Used “Never or Almost Never” |
Practice Used “Often or All the Time” |
Parents Learning Recommended Practice from Newsletter |
|---|---|---|---|
| Expose Baby to Smoke |
100%* | 0% | 93% |
| Give Baby Honey | 93% | 7% | 97% |
| Give Baby Sugar | 76% | 24% | 93% |
| Use Baby Walkers | 29% | 61% | 90% |
| Use Baby Carriers | 50% | 50% | 69% |
| Put Baby on Back to Sleep |
12% | 88% | 95% |
| Use High Chair | 39% | 61% | 97% |
| Put Baby on Floor to Exercise |
43% | 57% | 98% |
Note: Bold indicates the percentage reporting use of the recommended practice
More than 90 percent of the parents reported learning about appropriate practices from the newsletter. When asked to explain exactly what they had learned from the newsletters, more than half of the mothers (26) were able to explain in some detail exactly what they had learned from the newsletter for at least four of the eight practices. For example, one mother explained the reason she started to put her baby on the floor to exercise: “I put her that way after reading the newsletter, and she began to play with her feet and hands.”
In some instances, mothers’ responses reflected the tension between practices from the culture of origin and those advocated by the newsletter. One mother said, “I didn’t know that honey is bad for (my baby’s) health….I would have given it based on my customs.” Another mother who reported never giving sugar to her baby said “in my culture (everyone) uses sugar, but it’s not healthy.” Seven mothers made specific suggestions for changes or additions to the newsletters, such as including more information on how to prepare for going to work. One mother said, “The truth is they (the newsletters) are very good and helped me a lot as a first time mother. I liked that (the home visiting program) stimulated me to read the newsletters.”
Summary and discussion
The Spanish version of the age-paced newsletter Parenting the First Year (El Primer Año del Bebé) was adopted by home visitors for use in a home visitation program for high-risk first-birth Mexican immigrant families. Focus group and interview results indicated that both home visitors and parents found the newsletters to be helpful. Most mothers reported it to be a more helpful source of parenting information than any other source.
Regarding practices that home visitors identified as of particular concern with this population, mothers overwhelmingly reported knowing the appropriate parenting practices from the newsletter and in most instances reported using those practices. This was especially clear in areas critical for infant health such as exposure to secondhand smoke, giving infants honey in the first six months, and putting babies to sleep on their backs. Areas where mothers were less likely to use appropriate practices, such as using walkers and baby carriers or putting the baby on the floor for exercise, although important, were less critical for child health. Parents reported understanding the recommended practices but many families did not implement the recommendations due to poor housing conditions.
Newsletters appeared to offer effective support to new parents who were attempting parenting practices that differed from traditional cultural and familial practices. Both home visitors and parents reported referring to the newsletters as authoritative sources in these instances.
Study limitations
Focusing on at-risk Mexican immigrant families who were engaged in a home visitation program meant that our sample was relatively small and not representative of Latino families. Such limited samples are common in studies of “low visibility populations” that are difficult to locate and engage (Faugier and Sargent 1997). Although it is best to design educational materials for a specific cultural group, the question was whether parent education newsletters originally designed for Anglo families and adapted to Spanish-speaking parents could be useful with at-risk Mexican immigrant families (Umañ a-Taylor and Fine 2001). Since the home visitors and the at-risk families shared the same Mexican immigrant culture, the home visitors were able to adopt and use the newsletters in culturally meaningful ways. Because the home visitors selected the newsletter series as a curriculum, it is not surprising that they viewed it in a positive light. What emerged from the focus group with home visitors, however, is how they used the newsletter to support safe parenting practices that were at odds with traditional cultural practices.
The study is also limited by the retrospective, qualitative design. Although the interview questions specifically asked parents about the impact of the newsletters on their knowledge and practices, it is possible that parents did not remember what was learned from their home visitor versus what was learned from the newsletter. In fact, when asked if the newsletter helped her learn about walkers, one mother responded, “I don’t remember if I got the information from you or it (the newsletter).” A more comprehensive, comparison group design would be needed to determine the relative utility of home visitors versus newsletters alone versus home visitor delivered newsletters.
Finally, the use of home visitors to administer the interview may have affected the participants’ responses. Parents may have answered so as to please the home visitor, who had introduced them to the newsletter and encouraged its use. However, parents did not use all recommended practices, which suggests their willingness to be truthful in the interviews. We believe the limitations inherent in using known interviewers were balanced by the advantages. By collaborating with home visitors to reach and interview at-risk Latino families, we accessed “insider’s knowledge” (Berg 1988) to locate and engage a mobile and difficult-to-reach population. Recent recommendations for research methods with Latino populations have acknowledged the value of face-to-face interactions with a known and trusted person because such interactions make participants more comfortable in sharing their own thoughts and opinions (Umañ a-Taylor and Bamaca 2004).
Implications for practice
Previous research with Anglo parents has found age-paced parenting newsletters to be an effective means of communicating child-rearing information. When presented with a limited number of affordable Spanish language parenting materials, the bilingual, bicultural home visitors in this study creatively combined a proven, cost-effective resource with a culturally appropriate delivery method. In so doing, parents learned and adopted many desirable parenting practices. Extension educators in other settings should consider how high-quality written materials can be used in ways that respect the cultural preference for personal interaction among Latino families, particularly Mexican immigrant families. This study also demonstrates the value of delivering research-based Extension publications through partnerships with direct service agencies. Such collaborations extend the reach of Extension programming and materials.
References
Berg, S. 1988. Snowball sampling. In S. Kotz and N.L. Johnson (eds.), Encyclopedia of Statistical Sciences, Vol. 8 (pp. 529-532). New York: Wiley.
Bradley, R.H., R.F. Corwyn, H.P. McAdoo, and C. Garcia Coll. 2001. The home environments of children in the United States Part I: Variations by age, ethnicity, and poverty status. Child Development 72:1884-1867.
Cardona, P.B., B.C. Nicholson, and R.A. Fox. 2000. Parenting among Latino and Anglo-American mothers with young children. Journal of Social Psychology 140:357-366.
Cheng Gorman, J. 1996. Culturally-sensitive parent education programs for ethnic minorities. PC Reports 7-96-26. New York: New York University Psychoeducational Center.
Cudabeck, D., C. Darden, P. Nelson, S. O’Brien, D. Pinsky, and E. Wiggins. 1985. Becoming successful parents: Can age-paced newsletters help? Family Relations 34:217-275.
Daro, D.A., and K.A. Harding. 1999. Healthy Families America: Using research to enhance practice. Future of Children 8:153-176.
Faugier, J., and M. Sargent. 1997. Sampling hard to reach populations. Journal of Advanced Nursing 26:790-797.
Fox, R.A., and P. Solís-Cámara. 1997. Parenting of young children by fathers in Mexico and the United States. The Journal of Social Psychology 137:489-495.
Garton, M., K. Hicks, M. Leatherman, M. Miltenberger, P. Mulkeen, L. Nelson-Mitchell, and C. Winland. 2003. Newsletters: Treasures or trash? Parenting newsletter series results in positive behavior changes. Journal of Extension, 41(1). http://www.joe.org/joe/2003february/rb5.shtml
Guba, E.G., and Y.S. Lincoln. 1982. Criteria for assessing the trustworthiness of naturalistic inquiries. Educational Communication and Technology Journal 30:233-252.
Julian, T.W., P.C. McKenry, and M.W. McKelvey. 1994. Cultural variation in parenting: Perceptions of Caucasian, African-American, Latino, and Asian American parents. Family Relations 43:30-37.
Laosa, L.M. 1980. Maternal teaching strategies in Chicano and Anglo-American families: The influence of culture and education on maternal behavior. Child Development 51:759-765.
Lofland, J., and L.H. Lofland. 1995. Analyzing Social Settings: A Guide to Qualitative Observation and Analysis. Belmont, California: Wadsworth.
Morgan, D. L. 1997. Focus Groups as Qualitative Research. Thousand Oaks, California: Sage.
Riley, D.A., G. Meinhardt, C. Nelson, M. J. Salisbury, and T. Winnett. 1991. How effective are age-paced newsletters for new parents? A replication and extension of earlier studies. Family Relations 40:247-253.
Solís-Cámara, P., and R.A. Fox. 1995. Parenting among mothers with young children in Mexico and the United States. The Journal of Social Psychology 135:591-599.
Umaña -Taylor, A.J., and M.Y. Bamaca. 2004. Conducting focus groups with Latino populations: Lessons from the field. Family Relations 53:261 – 273.
Umaña -Taylor, A.J., and M.A. Fine. 2001. Methodological implications of grouping Latino adolescents into one collective ethnic group. Hispanic Journal of Behavioral Sciences 23:347 – 362.
Walker, S.K., and D.A. Riley. 2001. Involvement of the personal social network as a factor in parent education effectiveness. Family Relations 50:186-193.
Weigel, D., and S. Martin. 2004. From uncertainty to support: Communicating with new parents through newsletters. The Forum for Family and Consumer Issues 9. http://www.ces.ncsu.edu/depts/fcs/pub/9_3/newsletters.html
Authors
Joni Weatherspoon, Ph.D.
Human Development and Family Studies
Oregon State University, Corvallis, Oregon
Sally Bowman, Ph.D.
Associate Professor, Extension Family Development Specialist
Oregon State University, Corvallis, Oregon, 97331-5106
541-737-1020, fax 541-737-0999
email:bowmans@oregonstate.edu
Rebecca Hernandez, Ph.D.
Research Associate, School of Nursing, Center for Health Disparities Research
Oregon Health & Science University, 3455 SW US Veterans Hospital Rd,
Portland, Oregon 97239-2941
503-494-0107, fax 503-494-4678
email: hernandr@ohsu.edu
Clara Pratt, Ph.D.
Endowed Chair in Family Policy, Human Development and Family Studies
Oregon State University, Corvallis, Oregon, 97331
541-737-0941, fax 541-737-1076
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