AN EVALUATION OF THE HEALTHY BEGINNINGS
PILOT PROJECTS IN CENTRAL VANCOUVER ISLAND
by
Vivien Millin
B . G.S . Open University, September 1993
M. Ed. The University of Northern British Columbia
PROJECT SUBMITTED IN PARTIAL FULFILMENT OF
THE REQUIREMENTS FOR THE DEGREE OF
MASTER OF EDUCATION
in
COUNSELLING

© Vivien Millin, 1999

THE UNIVERSITY OF NORTHERN BRITISH COLUMBIA
April 1999
All rights reserved.
This work may be
reproduced in whole or in part, by photocopy or
other means , without the permission of the author .

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ii
Abstract
This project was an evaluation of Healthy Beginnings
parent drop-in groups in the Central Vancouver Island Health
Region.

The groups were funded through the Ministry for

Children and Families .
Participants who agreed to take part in the evaluation
were contacted by phone to complete a questionnaire.
Participants were also invited to take part in focus group
discussions in each community.

Facilitators reviewed

progress through focus group discussions.
Questionnaire data indicated that there were no
significant differences between groups .

There was a high

level of satisfaction with the content presented in drop - in
groups. The group process experienced by participants was
stated as empowering.

Participants were generally satisfied

that Healthy Beginnings had met their expectations.
Data from participant focus group discussions
identified Health Nurses and Health Units as the primary
source of information concerning Healthy Beginnings.
Factors which helped them attend were identified . These
factors included appreciation of the opportunity for social
interaction, learning about child development and the warmth
and welcoming nature of the group.

Challenges identified

iii
included transportation, employment, family commitments and
parking.
Avoiding isolation was the main motivator for
attendance.

Feelings of increased well being, stress

reduction and support from other parents were identified as
making a difference to participants and their families.
Participants appreciated interaction with other adults
and the warmth and caring expressed by staff.

The

opportunity to socialize with their peers and learn from
other parents with no responsibility for organizing the
group was emphasized in focus group discussions .
Group members suggested they need more time for
discussion among themselves and that they value the learning
that occurs during those informal discussions.

Their

suggestions for ways that the community could improve
support to parents included improved public facilities for
feeding and changing babies .

They would also like to see

sidewalks and "child friendly" grocery checkouts in their
communities.
Facilitators were able to identify what had worked well
in groups as well as some challenges that had surprised
them.

They predict a growing demand for this type of

program and a continuing need for funding.

iv
Table of Contents

Abstract .... . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . ii
Table of Contents . . . . . . . . . . . . . . . . . .... . . . . . . . . ... . ... . . iv
List of Tables

... .. . . . . . . . . . . . . .... . . . . . . . . . . . . . . . . . . . vi

List of Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Acknowledgments .... . . . . . . . . . . . . . .... .. .. . . . . . . . . . . . . . viii
Chapter 1: Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... 1
Chapter 2: Literature Review .... . . . . . . . . . . . .. . ... . .. . ... 5
Resilience . . .... ... . . . . . . . . . . .. . . . . . . . . . . . . . . . ..... 5
Attachment . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. . ... . ..... 8
Intervention Outcomes .... . . . . . . . . . . . . . . .. . ... . .... 10
Program Evaluation . . . . . . . . . . . . . . . . . . . . . .. . ... . .... 12
Research Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Definition of Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . .... 18
Rationale .. . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . .. . . 19
Chapter 3: Method . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . .. ... . . 21
Chapter 4: Results ... . . . . . . . ... . . . . . . . ... . ... . .. ... .... 25
Questionnaire . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Participant Focus Groups . . . . . .. ... .. ... . . . . . . . . . . . 30
Participant Focus Group Discussi2 n Results . .. . . . . . 31
Facilitator Focus Group Discussion .. . ... . .. . . . . . . . 43

v

Chapter 5: Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Research Questions Answered .... ... .. ............... 52
Limitations of the Study . ........... . ...... .. . ..... 58
Ideas for Future Research . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Concluding Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
References .. .. ........... .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Appendix
A.

Participant Questionnaire ................ 65

B.

Letter of Consent . . . . . . . . . . . . . . . . . . . . .... 66

C.

Participant Focus Group Questions ........ 67

D.

Facilitator Focus Group Questions ........ 68

E.

Letter of Permission
from Allison Cutler . . . . . . . . . . . . . . . . . . . . . . 69

vi
List of Tables

1 . Evaluation Plan ....... ... . . . . . . . . . . . . . . . . . . . . ....... 24
2 . Participant Questionnaire Return Rates . . . . . . . . . . . . . . 25
3. Participant Questionnaire Results ... . .. ... . .. ....... 27
4. Between Groups and Within Groups Variance ........... 29
5. Participant Focus Group Discussion Themes ........... 41

vii
List of Figures

1. Questionnaire Results for Four Communities

......... 28

2. Attendance Information Compared
to Question Ratings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

viii
Acknowledgements
I would like to thank you, Dr. Bryan Hartman for your
support and advising during the course of this project and
to Dr. Peter MacMillan for your insight and feedback.
Thank you to all the participants throughout the Central
Vancouver Island Health Region who took time out of their
busy schedule to respond to the questionnaire and
participate in the focus groups . Without your responses and
feedback I could not have completed this project.
Thank you to the facilitators of the Healthy Beginnings
parent drop-in groups who encouraged participants to share
and for your helpfulness.
Thank you to my colleagues in the Central Vancouver Island
Health Region who supported my efforts: Allison Cutler and
Ann Williams .
Thank you to my co-workers at Community Care Facility
Licensing who patiently endured my trials and tribulations
during the final stages of preparing this project: Kathy
Torhjelm, Yvonne Betts, Stephen Morgan, Marion Taylor,
Shelley McClure, Christina vanden Bos and Liz Sharpe.
Thank you to Shelley McClure for reviewing my project and
for her encouragement.
Thank you to my unfailing friends, Anne St. Onge, Shirley
Higgins, and Andrea McKenzie for their never-ending
encouragement and support.
Thank you to my family for their unconditional love and
affection: Adam and Sascha.
To Mark Millin, the love of my life, thank you for making my
life rich with laughter and love.

Chapter One: Introduction
In May 1997 Minister Priddy announced $3 million for
health promotion and prevention innovations targeted to
children pre-birth to five years, including support services
for their families.
Ten provincial regions were identified as having
indicators of greatest risks to children from birth to five
years of age.

Risk indicators included: infant mortality,

parental substance abuse, teen pregnancy, proportion of
children in care and proportion of families on income
assistance (BC Ministry for Children and Families, 1998).
Central Vancouver Island was one of the regions selected for
a pilot program and was requested to develop pilot programs
with child care as a focus.
These "Healthy Beginnings" programs were initiated
through a collaborative partnership between the Ministry for
Children and Families and the Central Vancouver Island
Health Region.

Four communities within this region

developed Healthy Beginnings programs: Port Alberni/West
Coast, Parksville-Qualicum, Nanaimo/Ladysmith and
Duncan/Cowichan.

Provincial criteria required that pilots:

• be creative and innovative

2
• include members of the community and clients in
planning and, where appropriate in delivery of
services
• address the needs and resources of aboriginal
children and families
• contribute to linking of existing services,
especially those provided through public health
funding
• build on existing strengths of individuals and
communities
• address identified risks for children 0-5 years in
each region
• be sustainable over time
• include potential for additional funding from other
sources
• ensure a balance of urban and rural planning
Pilot programs in The Central Vancouver

Island Region

were developed with a commitment to:
• operate from a health promotion/population base
(i.e., will offer basic supports for all parents and
children)
• will do everything possible to remove or minimize
barriers to participation

3

• begin by focussing on new parents with children from
birth to six months
• work to build the resilience of very young children
by building the resilience of their parents
• build the resilience of parents by emphasizing self
care, promoting peer support, modelling healthy play
and behaviour management with their children,
developing skills in help seeking and advocacy for
their child when needed
• incorporate the expertise of early childhood
educators along with health and social service
professionals to provide a well-rounded and
"normalized" approach to parents' and infants' needs
• contribute to the ongoing improvement of early
childhood education and care services through
ongoing participant feedback as well as formal
evaluation of the pilots (BC Ministry for Children
and Families, 1998).
Programs have been developed with a universal focus
rather than one of targeting "high risk" parents or infants.
The focus is empowering parents to support each other and to
build on the capacity of parents to care for and promote the

4
healthy development of their children (Central Vancouver
Island Regional Operating Agency, 1997).
This project evaluated the Healthy Beginnings parent
drop-in groups to determine what is working or successful
for parents, what is not working, and why. Participant
questionnaires and focus group discussions were utilized to
understand and document the difference Healthy Beginnings
made to children and families in The Central Vancouver
Island Health Region. These evaluation findings may be used
as a planning tool for future programs.

Participant

questionnaires were used to collect information on the
number of sessions attended, awareness of community
resources for parents and children, knowledge of child
development and health and safety issues affecting children,
infant feeding and nutrition, levels of confidence and
support in the parenting role and the level of satisfaction
with Healthy Beginnings. Participant focus group discussions
collected information on the accessibility of Healthy
Beginnings, reasons for attending drop-in groups, what
difference attending groups may have made and suggestions
for improvements. Facilitator focus group discussions
identified successful strategies, parent referral to other
community resources, levels of parent competency, parenting
skills, parent isolation and level of participant change.

5

Chapter Two: Literature Review
Resilience
The term resiliency is relatively new; it began
appearing about twenty five years ago.

Garmezy and Masten

(1991) define resilience as "a process of, or capacity for,
or the outcome of successful adaptation despite challenging
and threatening circumstances".

Garmezy (1993) describes

resilience as the ability to spring back from adversity.
Resilience is not static , when the situation changes so may
one's resiliency.

Radke-Yarrow and Brown (1993) also

focussed on the fluidity of resilience when they described
children having setbacks when faced with new stressful
situations.
Four characteristics associated with childhood
resiliency are, an active approach to problem solving, a
tendency to view experiences constructively, the ability to
gain positive attention from others and the ability to use
faith to maintain a positive outlook on life (Werner, 1984).
In order to develop trust, children need to establish a
close bond with at least one caregiver.

Werner notes that

resilient children seem to be able to recruit surrogate
parents when required .

Werner ' s research suggested that

children exposed to serious challenges or disasters cope

6

better when they have a belief that they have some control
over their fate.
Resilience tends to focus on individual and family
strengths rather than deficits,

(Barnard, 1994).

The

meaning attributed to experience and the ability to reframe
the conceptual or emotional response a parent has to his/her
child may provide a model of effective coping for the child.
Barnard suggests that the parents' ability to reframe their
child's stubbornness into determination or independence can
change their perception of the child as difficult or
challenging.
The Rochester Child Resilience Project (Cowen, Wyman,
Work, and Parker, 1990, p. 192-212) reported that a cluster
of five variables, global self worth, empathy, realistic
control, interpersonal problem solving skills and selfesteem , correctly predicted children's stress-resistant or
stress-affected status in 84% of cases reviewed.

This study

found that the quality of the child's environment played an
important role in protecting children against the effects of
stress.

The environment also promoted adaptive behaviours

and instilled in the child the belief that he/she could deal
with adversity.
Variables identified as risk factors in one situation
can become protective factors in another (Rutter, 1987).

7

Rutter identifies four mediating mechanisms, reduction of
risk impact, reduction of negative chain reactions,
establishment and maintenance of self-esteem and opening of
opportunities.

He also suggests that secure attachment

relationships between the child and parents provide
protection against later risk environments.
Fonagy. Steel, Steele, Higgitt and Target (1993)
suggest that the current interest in resilience is part of a
shift in focus to prevention, which is driven by economic
factors.

They also note intergenerational transmission of

insecurity; the parents' perception/model of relationships
may influence the child's security of attachment.

The

relationship between infant-caregiver attachment and
parental attachment security is powerful.

Secure attachment

is a goal of intervention because of developmental
advantages, but also because it will direct how the children
cope with problems through their life span.

Reflective self

function, the understanding of mental states, and the
capacity to contemplate alternative perceptions offer huge
benefits to the individual when dealing with adversity
(Fonagy et al ., 1993).
When children experience extreme stress the quality of
the care they receive from adults is most important.
Children living through wars and disasters cope much better

8

if they do not experience separation from parents and if
they perceive their parents as coping effectively (Masten
et. al., 1990).
Zimmerman and Arunkumar (1994, p. 7) encourage
researchers to identify factors which "innoculate" against
the effect of risk factors rather than focussing on negative
outcomes.

They suggest that prevention strategies build on

capacity and should involve social institutions and
communities in forming strategies to foster resilience.
Cicchetti and Garmezy (1993, p. 499) emphasize the need
for longitudinal studies to enable us to understand more
They

about resilience as a process rather than a product.
also caution against making assumptions that children

identified as resilient have actually been exposed to the
stressor under investigation.
Reviewing

literature on

early child development,

resilience,

as

it

relates

to

leads directly to a consideration

of the work on attachment.
Attachment
Karen's book, "Becoming Attached" reviews a history of
the major figures in this research.

He begins by outlining

Bowlby ' s research on early separation/deprivation.

Bowlby

could be considered as the founder of attachment theory.
had a long working relationship with Mary Ainsworth who

He

9
developed the Strange Situation laboratory assessment of
security of attachment.

Both Bowlby and Ainsworth were

convinced that the nature of one's earliest relationships
determined how one felt about one's self and one's
expectations of others.

The quality of that early

attachment affected how the individual approached human
connections at later stages of life and in periods of crisis
(Karen, 1998).

Main (Karen, 1998, p. 364) developed the

Berkeley Adult Attachment Interview which resulted in her
identifying three major patterns of adult attachment that
paralleled Ainsworth's childhood attachment categories.
Main ' s work supported the assumption that being able to put
feelings into words makes them available for review,
reworking and access of new information.

Unlike Ainworth's

categories, which labeled the relationship and not the
individual, Main's system identified each adult with a
single attachment-style.

Main's model neglects the

possibility of adults relating differently to different
relationships.
Maccoby describes infancy as being characterized as a
state of "prepared readiness" on the part of parent and
child to develop reciprocal behaviours .

Attachment

behaviour is very much dependent on the responsiveness of
the caregiver (Maccoby, 1992, p. 1009).

Responsiveness to

10
the demands of the infant results in children having the
security to explore their environment.

The child's social

capacity expands when the mother can respond appropriately
to his/her demands.

As the child internalizes the quality

of the parental relationship, future patterns of
relationship building are established.

Maccoby (1992, p.

1014) suggests that "_any enduring parental influence stems
mainly from the nature of the relationships parents have coconstructed and continually reconstructed with their
children".
The raising of competent, resilient children is a
community responsibility involving the family, government
and community health services (Steinhauer, 1996, p. 212).
The primary goal of the first year should be to ensure the
mother's health, development and delivery of a healthy baby
and the availability of a support system that enhances a
secure attachment with the mother.

Steinhauer suggests that

a secure attachment is necessary to provide for the child's
physical and emotional needs.
Intervention Outcomes
The child development and long-term outcomes of
successful interventions suggests that health, well being
and competence are intertwined.

Early childhood experiences

have a profound impact on brain development.

The human

11
brain may have sensitive developmental periods during which
pathways will be established if the child receives
stimulation.

Hertzman (1996, p. 12) suggests that many of

the most effective interventions are modest involving
community development, emphasis on population health,
recreation programs for children and strong support
networks.

He also argues that it is important to provide

programs to optimize cognitive and social emotional
development of children (Hertzman, 1996).
New brain imaging techniques confirm that good prenatal
care, warm attachments between children and adults and
positive, age-appropriate stimulation affect children's
development for a life time (Newberger, 1997, p. 4).
Although heredity determines the basic number of brain cells
a child starts out with, the child's environment determines
how the brain's circuits will develop.

During the first

three years of life, brain connections develop in response
to stimulation, good or bad.

High levels of stress can

result in the production of cortisol, which causes depletion
of brain cells and may interfere with the child's ability to
respond to stress in the future.
There is an interplay between genetics and nurturing
which influences adult competence and coping.

Community

initiatives need to build on each other to optimize outcomes

12

for children and families (Keating and Mustard, 1996, p.
12) .

Program Evaluation
What kinds of community programs are effective?

Dunlap

discovered that membership is an important aspect of
empowerment. Parents were motivated to take part in
preschool activities because their children would benefit
(Dunlap, 1993 , p. 508).

Parents coming together in the

preschool setting developed new and innovative ways to solve
problems and were able to transfer their skills to other
areas of the community.
Powell (1989, p. 3) emphasizes the importance of
programs being a collaborative venture between parents and
staff.

Programs should empower parents to learn from each

other and develop a strong social network so that they are
not reliant on professional intervention.
Trivette, Dunst and Deal (1997, p. 75) suggest that
early intervention programs will be more effective if a
resource-based rather than a service-based approach is
taken .

A resource-based approach recognizes families as

being part of a broader community and that this is their
major source of support and resources.

Service approaches

tend to be deficit-based whereas resource approaches are
asset - based with a focus on building competency and

13

community capacity.

Strengthening community support and

systems for the needs of children and families ensures
accessibility since they are more likely to be stable.
Program evaluation is often utilized to make decisions
about service delivery and resource allocation.

The Cornell

Empowerment Group favours an emphasis on program
improvement, process versus product and quality
determination.

Empowerment-oriented evaluation focuses on

the needs and concerns of the least powerful (often intended
beneficiaries of programs) .

This model suggests that

evaluation should consider issues of accessibility and the
fit with participant needs (Cornell Empowerment Group,
1989).
Barnett reviewed a variety of early childhood programs
to determine long-term effects of child care, early
intervention, preschool education and Head Start programs
(Barnett, 1995). Short - term effects of child care depend on
the quality of care provided and the richness of the child's
home environment. Earlier entry benefited children from
impoverished homes, while children from home environments
which were highly supportive of cognitive and social
development did not realize similar gains (Barnett, 1995, p.
27). Home - visiting programs appeared to be ineffective in
improving children's development, but did improve maternal

14
and child health and reduced child abuse and neglect.
Project CARE, The Infant Health and Development Program,
Even Start, and The Comprehensive Child Development Program
have produced short-term results with improved IQ scores.
language skills and behaviour. Of the 21 large - scale stud i es
reviewed, IQ effects persisted the longest in the two
experimental studies that enrolled infants in full-day
educational child care programs (Barnett, 1995, p. 35).
Across all the studies there was evidence that early
childhood care and education programs (ECCE) can improve
school success. Teachers and parents reported long-term
positive effects on both socialization and delinquency
reduction.

The Perry Preschool study found that ECCE was

associated with increased commitment to school, better
relationships . economic success, and for girls, increased
marriage and fewer out-of-wedlock births (Barnett, 1995, p.
41) . When considering the effect of age of entry into a
program, it may be important to look at infants and continue
programs to kindergarten age to maximize the effects on
brain development .
Benner (1997, p . 7) reviewed nine home visiting
programs. They had positive outcomes resulting in improved
IQ scores, reduced risk factors, reduced child abuse and
neglect and improved home environments. Benner found that

15

Hawaii's Healthy Start Program and the Florida Longitudinal
Home Visitor Program were able to provide substantial
benefits to families as a result of early and consistent
intervention. The intensive centre-based educational day
care program combined with family support offered at Project
CARE improved cognitive outcomes, language development, home
environments, and parents' attitudes toward their children
(Benner, p. 5) .
Olds, Hill and Rumsey (1988) reviewed the twenty-year
history of the nurse home visitation program in Elmira, New
York and determined that the program had reduced anti - social
behaviour and delinquency in children. The program also
reduced child abuse and neglect .
The Ministry of Community and Social Services in
Toronto reviewed ten prenatal/infant development primary
prevention programs . A technical advisory group to the
ministry found that most programs involved home visits to
at-risk families and focussed on issues surrounding diet,
family planning, attachment, social isolation of the mother
and mental , behavioural and cognitive development of infants
(Ministry of Community and Social Services, 1989, p. 9).
Five of these programs were identified as models for
prenatal/infant development programs and included The
Prenatal and Early Infancy Project, The Child Health

16
Supervision Project , The Yale Child Welfare Research
Project, Becoming a Family Project and The Montreal Diet
Dispensary Project . These model programs demonstrated short term positive effects for children in the forms of better
physical health, better nutrition, fewer feeding problems ,
fewer accidents and less abuse by parents. Short-term
benefits for parents included improved networks of social
support, improved parenting skills and confidence in
parenting, better parent-child interactions and less child
abuse (Ministry of Community and Social Services, 1989, p.
16). Long-term positive effects for children included better
behaviours at school and improved attitudes toward school,
less delinquency and a higher rate of pro-social attitudes.
Long-term benefits for parents included increased school
registration and completion by mothers and higher rates of
employment (Ministry of Community and Social Services, 1989,
p. 17). This review showed cognitive development effects as
being inconsistent.

Programs with the greatest impact had

multiple components, home visits, parent ' support groups plus
child care and they were of two to five year duration.
This report makes the point that research and programs ,
which dominate the literature, are primarily American
programs focussing on ghetto populations. The literature may
not reflect Canadian sub-groups of at-risk families, which

17

would include single mother families, new immigrant, rural,
and First Nations families (Ministry of Community and Social
Services, 1989, p.

41). The report also makes the point

that "universal access to a prevention program is important
to encourage broad community participation and ownership."
The universal focus of Healthy Beginnings with its focus on
capitalizing on the strength, competencies and adaptive
skills of people within the community make it an appropriate
subject to explore the following research questions.
Research Questions
Question 1: Does attending Healthy Beginnings drop-in
groups improve parents' levels of confidence in their
parenting skills?
Question 2: Does attending Healthy Beginnings drop-in
groups reduce reported isolation for parents of infant
children?
Other program components were evaluated and made up the
following list of related questions:
Question 1: How many sessions were attended?
Question 2: What were participants' reasons for
attending Healthy Beginnings?
Question 3: What was liked least/best about Healthy
Beginnings?

18
Question 4: Did parents' awareness of community
resources, knowledge of child development, health and
safety issues and infant feeding increase?
Question 5 : Did participants feel supported in their
parenting role by the group/community?
Question 6: How satisfied were participants with
Healthy Beginnings?
Question 7: What strategies did facilitators identify
as successful?
Question 8: How successful was referral of participants
to other community resources?
Question 9: Did parent competency improve?
Question 10: What was the level of participant change?
Question 11: What was the effect of other events/
circumstances?
Definition of Terms
Health Promotion
Promotion is a process of enabling people to increase
control over and improve their health and well being.
Prevention
Prevention is

anticipatory

action

taken

to

avoid the

occurrence of a given problem or to reduce the incidence of
that problem in the population.

19
Early Intervention/Support
Early intervention services provide outreach and
additional supports to people recognized to be at risk of
experiencing problems, or who are in the early stages of
development of problems (Central Vancouver Island Health
Agency, 1997).
Rationale
The purpose of this project is to promote the healthy
development of children and their families, including
support to parents to acquire or improve parenting skills,
and to provide enriched developmental experiences for
children between birth and six months of age.
Parenting is the most complex and important job in our
society according to the 1996/97 Annual Report of the
Children's Commission.

Often parents do not have the

support of extended family members to assist them to fulfill
their role.

Research on early brain development recognizes

the importance of effectively nurturing children's
emotional, physical and intellectual functioning.

The

quality of children's early attachments influences brain
development.

In order to reduce a child's vulnerability to

stress and increase his/her capacity for resilience, we need
to do as much as possible to encourage the establishment of

20
a close bond with a caregiver (hopefully one or both
parents) during the first years of life.

21
Chapter Three: Method
Each of the four service areas, Port Alberni/West Coast
(Port Alberni) , Parksville-Qualicum (Parksville), Nanaimo/
Ladysmith (Ladysmith) and Duncan/Cowichan (Duncan), offered
drop-in groups at one or more community sites.

New parents

learned about Healthy Beginnings groups from health nurses
and prenatal instructors.

They saw a variety of advertising

materials at community centres and community agencies.

New

parents were able to self refer to a drop-in group.
The information collection process was broken into
three segments: a questionnaire, participant focus groups,
and facilitator focus groups.

An outline of the information

expected to be collected and the source of the information
is given in Table 1 (p.24).

The source of collection for

each data item listed is marked with an "X".

Non-applicable

sources for each data item have been indicated with a dash
("-").

Facilitators requested that participants complete a
registration form, which had a space to indicate whether
they were willing to be contacted by a researcher for
evaluation purposes .

Facilitators passed copies of

registration forms to the researcher when the participant's
child reached six months of age.

22
The researcher mailed a consent letter to the
participant with a stamped, addressed envelope.

When the

consent letter was returned to the researcher, the
participant was contacted by phone.

If the timing was

convenient for the telephone interview, the researcher
reviewed the issue of consent and completed the
questionnaire with the participant.

If the time was not

convenient, another time for the call was arranged.
Focus groups were conducted with facilitators.

Focus

groups were conducted with participants in each community.
The researcher created a group environment that
nurtured different perceptions and points of view, without
pressuring participants to vote, plan or reach consensus
(Krueger, 1988, p. 18). Open-ended questions were used to
allow respondents to determine the direction of the
response. The researcher avoided responding to comments or
signaling approval by verbal or non-verbal means to avoid
influencing discussion.

An assistant recorded the

discussion on audiotape and took comprehensive notes on the
discussion and interactions among participants.

The

researcher employed strategies for dealing with challenging
participants.

During pre-session small talk, seating

arrangements were planned to have dominant talkers close to
the facilitator and shy participants placed opposite to

23
allow the use of eye contact and body language to ensure
that everyone had a chance to be heard (Krueger, 1988, p .
77).

Closing questions brought the discussion to an end and

gave the facilitator an opportunity to summarize and check
with participants as to accuracy of summary and to ensure
that there were no further areas of concern (Ellis, 1998, p.
117) .

Data were analyzed from completed questionnaires and
themes were identified from participant and facilitator
focus groups .

Using the information gathered and analyzed,

a report was written describing the findings.

The report

outlined the limitations of the study and listed
recommendations arising from the evaluation .

24
Table 1:
Measure
No. of sessions attended

Evaluation Plan
Question-

Participant

Facilitator

naire

Focus Group

Focus Group

X

Reasons for attending

X

Healthy Beginnings (HB)
What was liked best/least

X

about HB
Successful strategies
Awareness of community
services for parents

X

X

Parent referral to other

X

community resources
Awareness of community
services for children

X

Parent competency
Knowledge of child
development

X
X

Effect of other event/

X

circumstances
Knowledge of health and
safety issues

X

concerning children
Knowledge of infant
feeding/nutrition
Level of confidence in
parenting
Level of support in
parenting role
Level of satisfaction
with HB
Accessibility of HB
location
Level of participant
change

X
X
X
X

X

X

Level of parent isolation

X

Parenting skills

X

25

Chapter Four: Results
Questionnaire return rates for each community are
summarized in Table 2.

Table 2 :

Participant Questionnaire Return Rates
Consents

Consents

%

Mailed

Returned

Returned

Duncan

34

14

41 %

Ladysmith

7

7

100%

Parksville

14

8

57 %

Port Alberni

22

16

73 %

Community

Eighteen consent letters were mailed to Duncan
participants who had indicated on their registration form
that they were willing to be contacted by a researcher .
Sixteen consent letters were mailed to participants who
began attending before the registration form was developed.
Eight registration forms were returned to the facilitator
indicating that they did not wish to be contacted by a
researcher for purposes of evaluation.

In the other three

communities all of the participants who completed
registration forms indicated their agreement to be contacted
by a researcher .
Questionnaire
Question one on the questionnaire was used to measure
effects of attendance on levels of satisfaction and will be

26
reported at the end of the questionnaire results section.
The following results describe responses to questions two to
eight on a seven part Likert scale with one meaning
"strongly disagree" and seven meaning "strongly agree".
Results are summarized in Table 3.

27
Table 3 :

ParticiJ2ant Questionnaire Results

Question I Community

Q2

Q3

Q4

QS

Q6

Q7

Q8

Standard

N

Mean

Duncan

14

6.57

0.76

Ladysmith

7

4.86

2.27

Parksville

8

5.00

1. 41

Port Alberni

16

5.56

1. 36

Duncan

14

6.29

1. 64

Ladysmith

7

4.86

1. 95

Parksville

8

4.63

1. 41

Port Alberni

16

5.38

1. 26

Duncan

14

6.14

1.10

Ladysmith

7

4.43

2.23

Parksville

8

5.50

1. 31

Port Alberni

16

5.94

1.48

Duncan

14

5.86

1. 23

Ladysmith

7

5.43

1. 51

Parksville

8

4.88

1. 36

Port Alberni

16

5.81

1. 22

Duncan

14

6.29

0.99

Ladysmith

7

6.43

0.79

Parksville

8

5.63

1. 30

Port Alberni

16

6.25

1. 06

Duncan

14

6.57

0.65

Ladysmith

7

6.29

0.76

Parksville

8

6. 56

0.76

Port Alberni

16

6.69

0.60

Duncan

14

6.64

0.63

Ladysmith

7

6.14

1. 07

Parksville

8

6.50

1. 07

Port Alberni

16

6.81

0.40

Deviation

28

Figure 1 illustrates questionnaire results for all four
communities.

7.0
6.0

lU 5.0

a::

0
0

(/)

Ill Duncan

4.0

•Ladysmith
EJ Parksville
m:J Port Alberni

< 3.0
~ 2.0
~

1.0

0.0
1

2

3

4

5

QUESTION NUMBER

6

7

Figure 1 : Questionnaire Results for Four Communities

An ANOVA test was performed to determine variation
between groups and within groups and is presented in Table
4.

29
Table 4: Between Grougs and Within Grougs Variance
SUMMARY

Variance

Groups

Count:

Sum

Average

q1

45

255

5.67

2 . 27

q2

45

245

5.44

2 . 57

q3

45

256

5 . 69

2. 40

q4

45

252

5.6

1.7

qS

45

278

6.18

1.10

q6

45

295

6.55

0 . 43

q7

45

297

6.6

0 . 56

ANOVA

Source of

Variation

ss

df

MS

F

P- v alue

F

crit:

Between Groups

61. so

6

10.24

Within Groups

486.04

308

1. 58

6 . 49

1.82E-06

2 .13

significant
p< . 000002

Total

547.55

314

Attendance information compared to question ratings is
presented in Figure 2.

30

7. 0
LU
0::
0

6.0

5.0

(.)

4 .0

<

3.0

(/)

~
~

B 5 or Less
• 5 to 10
I:J 10 to 20
820 +

2.0
1.0
0.0
1

2

3

4

5

6

7

QUESTION NUMBERS

Figure 2: Attendance Information Compared to
Question Ratings
Participant Focus Groups
Focus groups were held in Shawnigan Lake (for the
Duncan/Cowichan area) , Ladysmith, Parksville and .Port
Alberni.

The number of participants in the groups ranged

from 4 to 8.
Data were collected by recording on audiotape and by
written notes taken by the focus group assistant.

Data were

transcribed and analyzed, themes were identified and coded
by the means of coloured highlighters.
summarized and interpreted.

The themes were then

The following presentation of

results is arranged to reflect the questioning route
outlined in the Healthy Beginnings Focus Group Questions
sheet in Appendix C .

31

Participant Focus Group Discussion Results
Question 1: How did you hear about the Healthy
Beginnings Group?
A major theme for all four communities was that parents
heard about Healthy Beginnings from the Health Unit or
Health Nurse either at baby clinics or during home visits.
Referrals from friends or community agencies were also
common to all four communities.

Some Parksville

participants received information about the group from
attending a breastfeeding clinic and some had seen an
advertisement in the local newspaper.
Question 2: What helps or makes it hard for you to come
to the Healthy Beginnings group?
In all four communities, the major theme for what
helped seemed to be the opportunity to get out of the house
and meet other young mothers.

There was general agreement

that the participants felt it was important to attend the
group meetings and that it was the main source of adult
interaction of the week for them.

In all four groups,

participants described getting everything done the night
before so that they could be ready for the group the next
morning.

Parksville participants commented on the

facilitator being very welcoming as contributing to making
it easy to attend.

A second theme identified collection and

32
exchange of information as being an important element in
what motivated them to attend the group meetings.

A desire

to find out about child development and community resources
was common to all four communities.

Participants seemed t o

especially value being in a situation where they could
observe other mothers and babies in a friendly,

relaxed

setting where they did not feel their questions would seem
stupid.

Port Alberni and Parksville participants identified

the fact that the program was publicly funded as being
important.

They suggested that the fact that mothers could

attend without becoming involved in planning or organizing
the meeting place or session topics made it easier to
attend.

Ladysmith participants mentioned timing of the

group sessions.

The participants enjoyed having the group

in the morning as it worked well with their babies'
schedules.

Child minding was identified as a factor that

motivated mothers to attend.

The mothers found it easier to

relax when they knew that their older children were cared
for in an adjacent room.

The mothers appreciated the

opportunity to focus on their babies.
Transportation and family commitments were the main
inhibiting themes that affected attendance at Healthy
Beginnings.

Port Alberni and Duncan participants

experienced difficulties getting to the group by public

33
transportation.

Bus service was limited and schedules were

not convenient.

Most of the mothers in Port Alberni (5 of

7) walked to the meetings with their babies in strollers and
reported that it was difficult to board a bus with an
infant, a stroller and a diaper bag, especially if they were
also travelling with a toddler.
Ladysmith and Duncan participants mentioned family
commitments as a barrier to attending the group sessions.
Participants expressed their frustration at trying to meet
the needs of other family members before they could take
time for themselves and get to the group.

They described

finding it difficult to arrive on schedule for any events.
Parksville participants had difficulty finding parking.
There is parking attached to the building where they meet,
but the building is multi-purpose and very busy.

Often

participants had to park one or two blocks away and they
found it difficult to transport the baby and all their
equipment to the site.
Question 3: What were your main reasons for attending
Healthy Beginnings?
In all four communities, the main theme was that
mothers attended these groups to avoid isolation.

They saw

the group as an effective way to meet other young mothers
and network .

Closely related to this theme was the degree

34

of support that mothers felt from the other group members.
They saw each other as a resource for information and
encouragement, and that other members reinforced the choices
they were making about parenting.
Learning about community resources, being exposed to
guest speakers and special topics were mentioned as reasons
for attending the group.

The issue of guest speakers

produced lively debate.

Although participants enjoyed being

able to request speakers or particular topics, they were
clear that they enjoyed their own discussion more.

They

enjoyed being recognized as the experts on their babies and
the source of ideas and problem resolution for each other.
The Parksville participants mentioned that facilitator
style was an important factor for them.

They found the

facilitator was accepting and maintained a neutral position
in discussions.

They appreciated the fact that she

encouraged all points of view and used gentle redirection
when required.
Question 4: Please tell us what difference if any
coming to the group makes for you and your family?
In all four communities, the two major themes were
stress reduction and increased sense of well being.

Many of

these mothers were experiencing a great deal of stress
adapting to the role of parenthood.

Often they described

35

extended family members as exerting pressure on them because
they held different values about parenting.

Mothers

suggested that their parents were out of date, old fashioned
and not very patient with having babies around.

The mothers

found support for their ideas and values around parenting at
the Healthy Beginnings group.

The mothers reported that

coming to the group had allowed them to feel more relaxed
and less stressed.

Many of the participants had felt

frustrated and burnt-out before attending Healthy
Beginnings.

Several mothers expressed the view that the

group was preventative in that it allowed them to cope with
stress and had improved their marital and extended family
relationships.
A related theme was new ideas about parenting and
positive feedback from peers.

Participants often took

pamphlets home to educate family members, to relay new
information on brain research and infant development.

There

seemed to be a significant difference in the way the past
generation and the current generation handled crying babies.
The current generation mothers were more likely to pick the
baby up when crying, but faced criticism from their mothers,
who thought they would spoil the baby.

The mothers agreed

that being a brand new parent seemed to elicit a great deal

36

of advice from family members that was often contrary to the
new ideas on parenting being discussed in the groups.
Duncan participants thought that the opportunity for
the babies to interact with each other was a benefit.

They

also appreciated the "round robin" part of their meeting and
suggested that it gave them a feeling of connection.

They

not only enjoyed hearing amusing stories from the other
mothers, but also thought that the interaction improved
conversations with their spouses.

There was general

agreement that child care was labour intensive and they did
not have much opportunity to take part in other activities
that they might discuss with their spouses .
Parksville participants appreciated the facilitator's
ability to encourage everyone, especially when they made
mistakes, and how she reminded them that they did not have
to be perfect.

This group positively identified the fact

that their facilitator was open to learning and how she
reflected on how she had parented her children and admitted
that she had made mistakes and might do things differently
now.

The participants saw her attitude as empowering.
Question 5: What do you like most about the Healthy
Beginnings drop-in sessions?
The major theme from all four groups was that

participants liked getting out and meeting other adults.

37

They felt welcome and comfortable and enjoyed seeing their
babies interact with one another.

They also enjoyed having

someone else available to hold or amuse their babies.
Participants emphasized how valuable they found the support
and feedback from other members and facilitators.
Snacks were mentioned as being a favourite part of the
group by the Port Alberni and Ladysmith groups.

The Duncan

group identified the warmth of the staff as a very important
aspect of what they liked most about the group.
The Parksville group talked about their ability to
direct how the group would develop and function and how much
they appreciated that freedom.

They were enthusiastic about

the facilitator's ability to reinforce discussion and to
find additional resources or information to support their
interests.

They identified her as a very skilled

facilitator, someone who could bring the group together,
while nurturing their ability to direct the group's
development.
Shortly after this discussion, a young mother with a
toddler and an infant came into the room.

The young woman

stated that she could not stay, but would return the next
week.

The group immediately welcomed her.

They offered her

coffee and refreshments and invited her to stay and listen
to the rest of the discussion.

The woman introduced

38
herself, told us that she was having a hard time coping,
because she had two children to care for and that she had a
personality disorder.

The group was very accepting.

One

mother offered to give her a ride to the group and another
invited her to the church she attended, since the young
woman was not finding her own church very accepting.

This

was a very powerful demonstration of the acceptance level of
the group and their ability to be self-directed.
Question 6: What would you like to tell the drop-in
staff about the way they treated you. your children and
the others who come to the drop-in groups?
The major theme was that participants appreciated the
warmth, friendliness and support of the drop-in staff.

The

Port Alberni group identified the facilitator as a very
warm, caring person, who called them at home if she thought
they needed it.

There was a great deal of enthusiasm about

the facilitator's approach and her contribution to the
group.

One mother suggested, and others agreed, that more

personal time with the facilitator would be a benefit.

They

also enjoyed the child care arrangement and appreciated the
quality of the care their toddlers received from the staff.
The Ladysmith group expressed its appreciation for the
friendliness and warmth the staff provided to the members
and wanted to encourage them to keep up the good work.

The

39

Duncan group was very appreciative of having a warm,
friendly place to bring their new babies and to be able to
maximize their efforts toward successful child development.
The Parksville group made similar comments and suggested
that the Healthy Beginnings group was the most welcoming
place to go with a baby.
The Port Alberni group expressed appreciation of guest
speakers and especially valued the advice they received on
breastfeeding.
speakers.

There was some disagreement about guest

One mother felt that sometimes guest speakers

made assumptions about group members' parenting skills that
put the speaker in the position of being an expert.
mothers did not have that perception.

Other

All participants

agreed that they needed to be open to all ideas, and that
there was no perfect way to be a parent.
Question 7: Do you have any suggestions for improving
the Healthy Beginnings group?
The major theme presented was that participants would
like more time for individual discussion.

Most participants

valued the check-in times and would like them to be longer.
The Parksville group identified their space a being a major
concern; they have out grown their site.

40

Question 8: In what other ways do you think our
community might support parents of babies?
The major theme was that participants would like to see
more public facilities providing spaces for families with
young children, especially comfortable places to breastfeed
and to change infants.

Participants would also appreciate

work environments that were conducive to breastfeeding. One
participant was about to return to work at a university and
talked about the difficulty of breastfeeding in an open
office area.

Her employer did provide breaks for

breastfeeding, but the office space has no privacy.
The lack of child care, especially spaces for infants,
was another area that participants identified as one where
the community needed to support parents.

Community

activities for mothers and young children was suggested as
another form of support that needed to be enhanced.

One

mother would like to see subsidized fitness programs for
mothers and infants.
Participants in the Duncan and Ladysmith groups would
like to have sidewalks provided in their communities.

Port

Alberni and Duncan participants would like to see "child
friendly" checkouts provided in grocery stores.

A summary

of participant focus group discussion themes is provided in
Table 5.

41
Table 5: Participant Focus Group Discussion Themes
Question

Duncan

Question 1:

Health Nurse

How did you
hear about

Friends

Healthy

Ladysmith

Parksville

Port Alberni

Health Nurse

Health Nurse

Health Nurse
Friends

Community

Breast feeding

agency

clinic

Friends

Community

Beginnings?

agency
Friends
Newspaper Ad.

Question 2:

Social

Interaction

Facilitat or

Getting out,

What helps you

interaction.

with others.

welcoming.

meeting other

to come?

Finding out

Time.

Getting out,

mothers. Having

about

meeting other

questions

community

mothers. Child

answered.

resources.

minding.

Program being

Learning about

Program being

publicly funded.

child

publicly

development.

funded.

Food.
Question 3:

Transportation

Family

Parking.

Transportati on.

What makes it

Family

commitments.

Transportation.

Employment.

hard for you

commitments.

Getting to

to come?

anything on
time.

Question 4:

Avoid

Avoid

Avoid

Avoid isolation.

What are your

isolation.

isolation.

isolation.

Group support.

main reasons

Speakers

Networking.

Exchange ideas

Learning about

for attending?

&topics.

Group

with peers.

community

support.

Facilitator 's
skill level.

resources.
To talk to the
other mothers.

Question 5:

Support from

Support for

Stress relief.

Increased well

What

other parents.

new ideas.

Positive

being.

difference

New ideas

Dealing with

feedback from

Stress

does the group

about

pressure

peers.

reduction.

make to

parenting.

from

Encouragement

New ideas about

you/family?

Babies

parents.

from

parenting.

interact with
each other.
Round robin
makes a
feeling of
connection.

facilitator.

42
Table 5:
Duncan

Question

(continued)

Ladysmith

Parksville

Port Alberni
Interaction with

Warmth of

Interaction

Interaction

What do you

staff.

with other

with other

other adults.

like most?

Access to

adults.

adults.

Getting out.

resources and

Getting out.

Group process -

Snacks.

Snacks.

self-directed.

Question 6:

advice.

Facilitator
and guests.
Question 7:

Appreciate

Appreciate

Welcoming place

Appreciate the

What would you

warm friendly

friendly

to go with a

warmth/caring.

like to tell

environment.

warm staff.

baby.

Enjoy guest

the drop-in

Appreciate help

speakers.

staff?

with baby.

Appreciate child
care worker.
Advice on
breastfeeding
was helpful.

Question 8:

Weekly check

Time to

Suggestions

in.

talk.

individual

for

Ability to

discussion.

improvement.

direct
group.

Better space.

More time for

Question 9:

Provide

Provide

Provide

Provide suitable

What could the

sidewalks.

suitable

suitable breast

breast feeding

community do

Provide "child

breast

feeding areas

areas in public

to support

friendly"

feeding

in public

places.

parents of

grocery

areas in

places.

Provide change

babies?

checkouts.
Subsidize

public
places.

Provide change
tables in

tables in
washrooms.

fitness

Provide

washrooms.

Provide "child

programs for

change

Provide "child

friendly"

mums and

tables in

friendly"

grocery

infants.

washrooms.

grocery

checkouts.

Provide

checkouts.

activities

Maintain child

for mums and

safety seats in

infants.

grocery carts.

More child
care for
infants.
Provide
sidewalks.

43

Facilitator Focus Group Discussion
A Facilitator Focus Group discussion was held in
Nanaimo with six facilitators attending.
Data were collected by recording on audiotape and by
written notes taken by the focus group assistant.

Data were

transcribed and analyzed, themes were identified and coded
by the means of coloured highlighters.
summarized and interpreted.

The themes were then

The following presentation of

results is arranged to reflect the questioning route
outlined in the Healthy Beginnings Facilitator Focus Group
Question sheet in Appendix D.
Question 1: What differences did you observe that
Healthy Beginnings made to participants?
The major theme was that coming to the group
"normalized" the mothers' experiences.

The group made the

mothers feel that they were not alone, which was especially
important for first time mothers.

They enjoyed making

connections with each other and receiving support for their
ideas about parenting.
Two examples were given of the group helping mothers to
avoid

serious

depression.

This

theme

involved the

group

providing support and helping the depressed mothers to feel
more confidant in their parenting role and it reduced their
isolation by making connections with other mothers.

This

44
connection

and

the

ability

to

community

was

seen

as

powerful

a

form

friendships
deterrent

to

in

their

mothers

feeling overwhelmed .
A third theme involved the group facilitating the
discovery of neighbours with similar interests and children
of similar ages .

Facilitators from several communities gave

examples of mothers reporting they had lived in the area for
four or five years but didn't really know anyone.

One

facilitator mentioned two mothers who lived on the same
street, with babies born within days of each other, who
didn't know each other.
Another theme dealt with mothers reporting fewer visits
to their doctor .

The participants were able to get many of

their questions answered by the group and by the guest
speakers.

One facilitator added that there was a reduction

in the time required by staff to answer questions because
parents were able to access answers from group members.

It

was suggested that this allowed more time to focus on more
high risk families.
The final theme involved mothers being proactive about
requesting phone lists of people willing to be contacted by
group members and forming a co-op for babysitting.

45

Question 2: What effect did the Healthy Beginnings
groups have on parent isolation?
Since the group felt we had talked about parent
isolation in the previous question and there was general
agreement that reducing isolation was a primary outcome of
Healthy Beginnings we moved on to the next question.
Question 3: In what ways did the Healthy Beginnings
group increase participant feelings of parent
competency?
A major theme was the acknowledgement from facilitators
and other group members that each mother was doing a good
job.

They felt that parents felt more confident when it was

pointed out to them that they were the expert on their
babies.

The fact that the facilitators stepped back and let

the group generate solutions to problems, allowed mothers to
air concerns and select strategies from the peer wisdom of
the group.

There were several examples of difficulties

presented by mothers during the round robin component of the
group, which resulted in brainstorming of ideas.
A second theme was reinforcement for current thinking,
trends and research on parenting.

Sometimes mothers ask if

facilitators have handouts on issues. The group mothers
would like to educate their mothers and other family members
on new ways of parenting.

46

One facilitator remarked that she had really found
herself reflecting on her own parenting since observing and
interacting with the Healthy Beginnings group.

There was

general agreement among the facilitators that they were
impressed by the efforts these mothers were putting into
parenting.
Question 4: In what ways did the Healthy Beginnings
group improve participant parenting skills?
A major theme was whether guest speakers contributed to
improving parenting skills .

Facilitators seemed divided on

this issue, some of them had groups that really enjoyed
having speakers.

Others stated that participants enjoyed

having topics raised, but preferred to have their own
discussion without a guest speaker .

They were in agreement

that it was important to draw on the knowledge of the group
and to ensure that they felt comfortable enough to give
their opinions and perceptions.

There was also general

agreement that participants did not want to be "talked at"
by experts.

One facilitator suggested that perhaps speakers

needed to be selected that could utilize an adult education
perspective rather than one of being an instructor.

There

was discussion on how important the style of the presenter
was when dealing with adults.

47

There were ongoing requests for presentations from a
nutritionist as babies were introduced to solids.

One

facilitator suggested that speakers be selected based on
their ability to work with the group to bring out their
discussion and questions, rather than presenting an agenda
to them.
Another theme involved the philosophy behind
facilitation, in particular, presenting the idea that
participants are competent, capable and that every child is
unique.

The group felt that their facilitation encouraged

members not to take a body of knowledge and apply it to all
situations, but to see what worked and what fit for their
particular situation.

One facilitator talked about

reinforcing the idea that all kinds of parents are
successful and that their kids turn out "o.k." even if they
did not do it the same way she did.

This facilitator tries

to get the message out to parents that there is no one,
perfect way to be a parent, but that many approaches work
well and produce healthy children.
Question 5: What were the results of the referral
process to other community resources?
The major theme was that often facilitators don't know
what the results of the referrals are.

They mentioned that

it was a slow process getting a response from other agencies

48

and that it required persistence to get results.

Since the

mothers requiring referrals were often having a difficult
time with everyday tasks, it seemed unlikely that they could
manage the frustration of finding their way through the
system.

Referrals covered a wide range of community

agencies including respite care, income assistance, housing,
transportation, breast feeding, safety, nutrition, motor
vehicles, employment standards, occupational therapy, infant
development, nurses/doctors and skin specialists.
Question 6: How was the group affected. both in a
positive and negative way. by other events and
circumstances?
A major theme identified was group dynamics when there
was someone in the group whose behaviour or attitudes were
challenging or disruptive.

Several examples were provided

and included a young woman who was mentally challenged and
who tended to monopolize the conversation.

Others included

a couple who had been directed to attend the group by the
court, a teenage mother who was a drug abuser and a man who
attended who had rigid values around parenting.

Each of the

groups had appeared to accept these parents, but one
facilitator said that she heard feedback in the community
that drop-in members didn't want these people in their
group.

The discussion began to focus on the issue of

49

economic class distinction and how surprised the
facilitators were to encounter this phenomenon in the
Healthy Beginnings groups.

The facilitator focus group

seemed divided on this point; some of the Healthy Beginnings
groups seemed to be homogeneous with no issues around
membership. while other groups had experienced some
challenges.

The facilitators of these challenged groups

reported that the group members had accepted the "problem"
parents and that these parents were still attending.

One

facilitator reported that she had been told by several
parents that they felt their group had "turned yuppie".
There was general agreement that teenage mothers would
benefit from their own group.

The teenage mothers have

different needs and are struggling with different family
issues.

There was also agreement that in most cases the

groups seemed to work better if all the participants were
mothers.

The facilitators were checking into the

feasibility of having an evening meeting when fathers could
attend also. perhaps once a month with specific topics
scheduled.
One facilitator mentioned the difficulty of knowing
what had not been successful for the participants if they
attended only one group. The facilitators acknowledged that
their usual procedure was to phone the new person to check

so
and see how they were doing and to identify what their needs
were. Facilitators were in agreement that it was challenging
to balance the needs of the group and the needs of
individuals who may be coping with different life issues.
Question 7: What worked well in the Healthy Beginnings
groups?
The major theme identified was that bringing the
mothers together, provided a structure for them to meet, but
that it was then necessary to get out of the way and let the
mothers direct their group .

Facilitators felt that

providing child minding, snacks and administration and
facilitation of the group allowed the mothers to focus on
developing friendships and making connections and to learn
from one another.
A second theme involved a lack of partnership in
communities .

Facilitators had experienced challenges when

dealing with community members, community agencies and high
profile individuals in the community.

Sometimes the

perspective was presented that in the past people had gone
out for coffee to meet other mothers, why did people need a
group to do it now?

There was general agreement that

everyone is short of funding dollars and new programs are
rigorously scrutinized by the community.

The challenges of

working mothers were also acknowledged . Working mothers

51

often do not have the same opportunities to form friendships
and network with other mothers in their community as stayat-home-mothers.
Question 8: What would you like to change about the
Healthy Beginnings groups?
The general consensus was that more groups were needed
and more funding would be required to support them.

Most of

the groups had outgrown their space and needed to split into
two groups.

Facilitators wondered how they would manage

these extra groups with the resources available.

There was

a brief discussion about the optimal number of participants
for a group.

The consensus was that seven to twelve people

in a group worked well.

When facilitators consider the

number of babies born in their communities and the number of
mothers attending Healthy Beginnings they are convinced that
they will be faced with increased demand for these groups in
the future.

52

Chapter Five: Discussion
This section presents a discussion and analysis of the
data from a questionnaire distributed to Healthy Beginnings
participants and qualitative data gathered from participant
and facilitator focus group discussions .

The discussion

begins with an analysis of the following two research
questions:

(1) Does attending Healthy Beginnings drop-in

groups improve parents' levels of confidence in their
parenting skills; and (2) Does attending Healthy Beginnings
drop-in groups reduce reported isolation for parents of
infant children?

As well, related questions dealing with

levels of awareness of community services for parents and
children, knowledge of child development and health and
safety issues, infant feeding and levels of support in the
parenting role will be discussed.
Research Questions Answered
Question 1: Did attending Healthy Beginnings increase
parents' levels of confidence in their parenting
skills?
Questionnaire data supports the information gathered in
the participant focus-group discussions, where mothers
identified feeling more confident about parenting after
attending Healthy Beginnings.

Interactions with

participating mothers and other relatives regarding new

53

ideas about parenting appeared to be a significant pressure
on new parents.

Related information about the levels of

support experienced by group participants seemed to
contribute to how confident parents felt.

Questionnaire

data support the focus-group discussion data, which garhered
information about how supported parents felt.

Participants

emphasized the importance of receiving support and of being
able to access information from peers.
Information relating to feelings of parent competency
gathered in the facilitator focus-group discussion also
supports the finding that Healthy Beginnings seems to help
new parents to feel more confident.

Reinforcement of

current thinking and trends in parenting, as well as an
emphasis on the new mother being the "expert" on her baby
appear to be powerful strategies for recognizing the
efficacy of parenting in these new mothers.
Facilitator focus-group discussion identified that they
observed changes in participants which would indicate that
parenting skills increased as well as did levels of
confidence in parenting .

The "softening" or "moderating" of

parenting styles seems to have been accomplished by a
combination of peer interaction and the presentation of new
information.

The group dynamic of "normalizing" the new

parent's experience with their baby is a powerful outcome of

54

bringing new parents together.

The skill level of

facilitators, their ability to provide an environment that
recognizes the needs of adult learners, and their commitment
to empowering parents, all appear to have made a significant
contribution to participants' growth .
Question 2: Did attending Healthy Beginnings drop-in
groups reduce reported isolation for parents of infant
children?
The focus group discussion information gathered about
participants' reasons for attending Healthy Beginnings,
suggest that avoiding isolation was the major motivator for
attending groups.

Participants also identified getting out

and meeting other mothers as a major influencing factor for
getting mothers to attend group sessions.

The focus-group

discussion section that dealt with what participants liked
most about the group sessions also resulted in interaction
with other adults being identified as a powerful motivator.
Participant suggestions for program improvement focussed on
providing more time for them to interact with each other.
The questionnaire information gathered on participant
satisfaction with Healthy Beginnings; in particular, their
feeling that they got what they came for, suggests the
participants are very happy with the program.

Since there

was an indication that reducing isolation was the main

55
motivator for attending groups, and that satisfaction was
high, Healthy Beginnings participants seemed to experience a
change in their level of isolation.
Facilitators identified a reduction of isolation as one
of the differences they observed in participants in focusgroup discussions.

The examples they presented of mothers

finding that they did not know their neighbours, and the
disclosure by participants that they knew very few people in
their community, suggest that isolation is a very real issue
for new mothers.

Facilitation of referrals to other

agencies also suggests that it would reduce isolation for
new mothers, while expanding their knowledge of community
resources.
Participants indicated that their awareness of
community resources for parents and children had increased,
when responding to questionnaire items dealing with these
two issues.

Ladysmith and Parksville had lower rates of

agreement for these two items.

It is not clear whether the

smaller size of the Ladysmith community meant that there
were fewer resources for parents to discover, or that
because the group had not been running for as long they had
less opportunity to be exposed to resources through guest
speakers.

Parksville is more of a retirement community than

any of the other targeted communities.

It is not clear

56

whether there was a lower rating for improved knowledge of
resources because the population base is different, with
different resources available, or whether participants came
to the group with a broad knowledge of resources in place.
Participant focus group discussions seem to indicate that
while learning about resources was not the most important
factor in deciding whether to attend, group members did
appreciate improving their knowledge.

Information from

facilitator focus group discussions suggest that group
members improved their knowledge of community resources by
sharing information with each other.
Knowledge about health and safety issues concerning
children seems to have increased for most participants.
based on information gathered on the participant
questionnaire.
this item.

Ladysmith had a lower rate of agreement on

It is not clear if this is because the group has

had a different focus when choosing topics up to this point,
or whether this is a reflection of reduced exposure to guest
speakers because the group has not been operating as long as
some others.
Questionnaire information seems to suggest that
participants did increase their knowledge about infant
feeding and nutrition.

Participant focus-group discussions

identified that helpful advice on breastfeeding had not only

57

benefited babies, but also had significantly changed mothers
Suggestions for

levels of confidence about breastfeeding.

ways that the community could support parents of infants
focussed on the need for improved breastfeeding and change
areas for infants in community facilities.

Facilitators

identified infant feeding and nutrition as topics that
participants requested frequently.

They also suggested that

the introduction of solid foods was an issue that parents
sometimes had difficulty understanding.

Facilitators often

requested handouts to show to participating mothers and
other family members.
Questionnaire and focus group discussion information
seems to confirm that parents feel supported in their
parenting role in association with attending Healthy
Beginnings.

Increased well being and more relaxed attitudes

toward parenting seem to result from the support they
experience at Healthy Beginnings.

The participants seem to

be forming friendships and networks that will expand beyond
their group experience.

Their suggestions about ways the

community could support them further make interesting
avenues for further community development.
Questionnaire results for the number of sessions
attended seems to suggest that "dosage" has a positive
effect.

Parents who had frequently attended sessions seemed

58

to be more satisfied, or more convinced that Healthy
Beginnings had met their needs .

The first four questions on

the participant questionnaire seem to have an overall trend
towards greater satisfaction with more sessions attended .
This trend is not as noticeable for the last three items,
which may suggest that people attend for as long as they
need to, to get what they want or to reach a level of
awareness that is adequate for them.
Limitations of the Study
The foremost limitation of the study concerns the
research design, since the study did not include an
experimental design with randomized assignment of the
independent variable it is difficult to assert that Healthy
Beginnings caused the changes observed in participants.
There are many other factors within the individuals, the
family and the community , which may have contributed to
changes (e.g. maturation) .

The lack of a comparison group

also makes it difficult to attribute causation to the
independent variable .
There are internal validity issues when a program has a
universal focus.

The issues of class differences, which was

identified in facilitator focus - group discussions about the
effects of other events and circumstances, might suggest
that it would have strengthened the study to have known more

59

about socioeconomic factors associated with the mothers'
families.
The validity of the questionnaire is a further
limitation.

The questionnaire was developed for this study

and has not been used in other studies, therefore, its'
content validity is questionable .

The questionnaire appears

to have face validity from the participants' responses to
questions.

The fact that the questionnaire utilized a

retrospective analysis of the experience of being a new
parent is problematic.

It is difficult to know if

participants' view the first six months of being a parent
with "rose coloured glasses" when they reflect back on it,
or if they remember it as being worse than it was.
Ideas for Future Research
Further investigation is necessary to explore long-term
effects of this type of early intervention.

Community

initiatives, which seek to build on the strengths of
individuals and communities by focussing on providing
support to parents of infants, need to capitalize on the
successful strategies identified as programs are evaluated.
Longitudinal study of the effects of successful attachment,
enhanced infant stimulation and quality nurturing of the
type promoted in the Healthy Beginnings groups will
hopefully improve outcomes for families and children.

60
Concluding Comments
The major findings of this study are that:
Attending Healthy Beginnings drop-in groups improved
parents' levels of confidence in their parenting skills
and reduced reported isolation for parents of infant
children.

61
References
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Perception? The American Journal of Family Therapy.
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Barnett, W.S. (1995). Long-Term Effects of Early Childhood
Programs on Cognitive and School Outcomes. The Future
of Children. Vol. 5, No. 3, 25-47.
Benner, A. (1997) Early Support and Prevention: Outcomes and
Cost Effectiveness. Victoria: Ministry for Children and
Families, 1-19.
Cicchetti, D. and Garmezy, N. (1993). Prospects and Promises
in the Study of Resilience. Development and
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The Cornell Empowerment Group (1989). Empowerment Through
Family Support. Networking Bulletin Vol. 1 Issue 1, 224.
Cowen, E.L., Wyman, P.A., Work, W.C. and Parker, G.R.
(1990). The Rochester Child Resilience Project:
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Co-operative Preschool Education. Child Welfare. Vol.
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Canadian Association of Family Resource Programs.
Fonagy, P., Steel, M., Steele, H., Higgitt, A. and Target,
M. (1993). The Emanuel Miller Memorial Lecture 1992,
The Theory and Practice of Resilience, 231-257.
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Children in Poverty: Resilience Despite
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Garmezy, N. and Masten, A . S . (1991).
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Radke-Yarrow, M. and Brown, E . (1993)
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Social

64

APPENDIX

65
Appendix A: Healthy Beginnings Participant Questionnaire
Client I.D. Number: _ _ _ _ _ HB Site: _ _ _ _ _ Date Completed : _ _ _ __

HEAL THY BEGINNINGS PARTICIPANT QUESTIONNAIRE
In order to plan our program needs and to clearly describe to our funders the value of
groups for parents of infants, we would like to have some feedback from you about how
we are doing. Participation is voluntary and you are free to refuse or stop the interview
at anytime. Your privacy will be protected by not revealing participant names, not
associating participants' names with the results of individual surveys or patterns of
survey results.

1)

Approximate Number of Sessions Attended?
Check (,I) the box opposite the answer you choose.

0Under5
0 Between 5 and 10
0 Between 10 and 20
0 More than 20

The following list has examples of some of the ways Healthy Beginnings (HB)
may have helped parents. Please tell us how helpful you found the sessions for
each of these purposes, using a 7 point scale, ranging from 1 meaning "strongly
disagree" to 7 meaning "strongly agree".
2)

HB improved my awareness of
community services for parents

3)

Strongly disagree
1

Strongly agree
5
6
7

2

3

4

HB improved my awareness of
community services for children

2

3

4

5

6

7

4)

HB improved my knowledge about
health and safety issues concerning children

2

3

4

5

6

7

5)

HB improved my knowledge about
infant feeding and nutrition

2

3

4

5

6

7

6)

HB increased my feelings of

2

3

4

5

6

7

confidence in parenting
7)

HB increased my feelings of support in
my parenting role

2

3

4

5

6

7

8)

I got what I came for from HB

2

3

4

5

6

7

66
Appendix B: Letter of Consent

HEALTHY BEGINNINGS
NANAMIO HEALTH UNIT
1665 GRANT AVENUE
NANAIMO BC

Dear --------------------My name is Vivien Millin and I am conducting an evaluation of Healthy Beginnings
drop-in groups to complete an M.Ed. (Counselling) at the University of Northern British
Columbia. Your registration form indicated that you would be contacted by a
researcher and I would like to explain what this involves.
The purpose of the study is to find out if the program is meeting your needs and what
kinds of things you look for in a drop-in group and what things about the group are
most helpful. If you agree to my contacting you by phone I will complete a list of
questions with you that will take approximately fifteen minutes. Your participation is
completely voluntary and you are free to refuse or stop the phone interview at any time.
All information will be number coded and strictly confidential. Your identity will not be
revealed without your written consent. This study does not involve deception,
discomfort or danger.
Please read the following paragraph and if you agree to participate, please sign below:
I understand that any information about me obtained from this research will be kept
strictly confidential and that my identity will not be revealed without my written consent.
Signature ---------------------------

Date _ _ _ _ _ _ __

------------------------

Date _ _ _ _ _ _ __

Researcher

If you have any questions please contact Vivien Millin at (250) 741-5463.
For further information about this research please contact:
Dr. Bryan Hartman
University of Northern British Columbia (250) 960-5555
Please return this form in the enclosed stamped, addressed envelope.

67

Appendix C: Participant Focus Group Questions

HEALTHY BEGINNINGS - FOCUS GROUP QUESTIONS
Introductions:

1)

Name, babies' name and ages.

How did you hear about the Healthy Beginnings Group?

2) What helps or makes it hard for you to come to the Healthy Beginnings Group?
Prompts:

3)

•
•
•
•

information about community services
specific speakers
to meet other parents
to make friends

Please tell us what difference if any coming to the Group makes to you and your
family?
Prompts:

5)

accessibility, location, transportation, time
baby's response, family's encouragement
other commitments

What were your main reasons for attending Healthy Beginnings?
Prompts:

4)

•
•
•

•
•
•

feelings about self as parent
feeling relaxed/competent/skilled
taking care of own needs (emotional, physical , etc.)

What do you like most about the Healthy Beginnings drop-in sessions?
Prompts:

•
•
•

talking with facilitators
space, location, facility
information sharing

6) What would you like to tell the drop-in staff about the way they are with you, your
children, and the others who come to the drop-in?
7)

Do you have any suggestions for improving the Healthy Beginnings Group?

In what other ways do you think our community might support parents of
8)
babies?
Summarize .. .and closing.

68
Appendix D: Facilitator Focus Group

HEALTHY BEGINNINGS

1)

Facilitator Focus Group Questions
What differences did you observe that Healthy Beginnings made to participants?
Prompts:

2)

•
•
•

What effect did the Healthy Beginnings groups have on parent isolation?
Prompts:

•
•

+

3)

friendships formed
knowledge of community resources
willingness to seek help

In what ways did the Healthy Beginnings group increase participant feelings of parent
competency?
Prompts:

4)

why they occurred
participant feedback form information
networking

•
•
•

participants helping each other
networking
interest in becoming co-facilitators

In what ways did the Healthy Beginnings group improve participant parenting skills?
Prompts:

•
•
•

knowledge of community resources
knowledge of child development
managing health and behaviour challenges

5)

What were the results of the referral process to other community resources?

6)

How was the group affected, both in a positive and negative way, by other events and
circumstances?
Prompts:

•
•
•
•
•
•

weather
health
children
time of year
transportation
child care

7)

What worked well in the Healthy Beginnings groups?

8)

What would you like to change about the Healthy Beginnings groups?

69
Appendix E: Letter of Permission from Allison Cutler
CENTRAl.

VANCOUVER ISLAND

HEALTH REGIOM

February 17, 1999
Ethics Review Committee,
Office of Research and Graduate Studies,
University of Northern British Columbia,
3333 University Way,
Prince George, BC
V2N4Z9
To Whom It May Concern:
Re : Permission for Research Project
-The Central Vancouver Island Health Region (CVIHR) is pleased to grant permission to
Vivian Millin to conduct research within our agency as part of the requirements of her
graduate program.
It is our understanding that Ms. Millin will be conducting phone interviews with Healthy
Beginnings group participants as well as conducting focus groups with group participants
and facilitators,
·we also understand that participation in this research is voluntary. Verbal and written
permission will be sought from all research participants and participants may chose to
withdraw from the study at any time without penalty. We understand that the data will be
coded and reported without identifiers. Ms. Millin will produce a report of her findings
and provide the CVIHR with a copy.
·sincerely,

Allison Cutler
Regional Coordinator, Child Youth Family Health

I

610-495 Dunsmuir Street;
Nanaimo, British Columbia
V9R 6B9

'Healthy People and Healthy Communities'

Tel: (250) 755-3010
Fax: (250) 755-7353
Toll Free: ~
-