This week’s journal club will review this study: Low income mothers, nutrition and health: a systematic review of qualitative evidence by Pamela Attree.
A transcript of the discussion can be accessed via the Archive.
The issues: Household poverty and food in the UK
Food poverty occurs in households that
do not have enough food to meet the energy and nutrient needs of all of their members. (link to ref)
It was reported last year that food poverty has been on the rise in the UK, including in households that have someone in employment.
In recent years in the UK , eradicating child poverty was declared as a priority for the (Labour) government. There was significant investment in services aimed at households with young children, alongside changes to the tax and benefits system. However, the targets for reducing child poverty were not met (see above link).
There were some interventions that were structural (e.g. income-based) and complex (e.g. SureStart for families with young children). However, the most prominent public health campaigns relating to household poverty and family health were, essentially, behaviour-change led.
For example, the ’5 a day’ campaign (resources can be viewed here) seeks to address poor nutrition by educating the public about eating better, with a particular focus on raising the intake of fruit and vegetables.
In the paper we are reviewing, these issues are summarised thus:
Following Kneipp and Drevdahl (2003), this paper will argue that if health policies are to be effective they must take full account of the ‘socio-political backdrop that shapes life circumstances’ (p. 167).
Household food practices are regarded in the paper as essentially gendered, in that women (mothers) most often make choices about food purchasing and preparation. Low-income mothers’ experiences relating to household nutrition are explored in the review as an aspect of their strategies for ‘managing poverty’.
We reviewed a ‘traditional’ systematic review study in #PHTwitJC 9 : ‘traditional’ in that the studies included were of experimental design, and the data that were synthesised were therefore quantitative. This study used a ‘systematic review’ method to identify relevant literature for inclusion, but aimed for only qualitative studies. The synthesis of the data/ findings from the studies therefore was conducted in a different manner, using thematic analysis.
If you are interested in exploring systematic reviews and their application to qualitative research further, there is a good amount of literature on the topic. There are interesting questions about whether it is a fitting approach for qualitative methodologies; and slightly different frameworks have been developed for systematically reviewing, or synthesising, qualitative research evidence(including ‘qualitative meta-synthesis’ and ‘meta-ethnography’). There is an interesting discussion of the issues in this article.
In this study, 11 research articles were ultimately included in the review, after four relevant studies were rejected at the quality appraisal stage.
Atree identified three main analytic themes from the mothers’ experiences of poverty across the 11 studies: ‘Strategic adjustment’, ‘Resigned adjustment’, and ‘Maternal sacrifice’. Strategies included buying the cheapest available foods; rarely preparing ‘proper meals’ , and prioritising the children’s nutritional needs over their own. Perhaps unsurprisingly, the lone mothers in the studies found it hardest to manage poverty consistently. The discussion brings out the moral and political dimensions of women’s household and food management experiences, particularly the emphasis on individual responsibility for maintaining one’s health and that of one’s children.
Journal club will take place on Sunday 4th March, 8.00-9 .00 GMT. All are welcome to join the chat on Twitter, just search for and use our hashtag: #PHTwitJC. If you miss the time slot but have comments or questions, we will pick them up and incorporate them into the archive, if you use the hashtag.
- Were the aims of this study clear?
- Was the systematic review comprehensive? (consider research designs included, inclusion and exclusion criteria, would all relevant studies have been identified?)
- Was the approach to analysing and synthesising the data transparent and appropriate for qualitative data?
- Do you believe the results? Are other interpretations possible?
- What implications do the findings have for public health practice & policy?