Caring for "parentless" children: An exploration of work-related experiences of caregivers in children's homes in Ghana

Abstract

Background: Child caregiving work is an essential occupational activity that makes important contributions to the wellbeing of children in the global community. In residential institutions that provide care for children without parental care (CWPC), the often difficult backgrounds of the resident children imply that people signing up for employment as caregivers face challenging work tasks. In the context of Ghana, West Africa, the nature of the socio-cultural and political landscape for raising children adds to the backgrounds of the children to suggest that the work situation could be even more complicated for people entering this occupation. Interestingly, when research is initiated into this complex world of care, the focus tends to be on outcomes for the children. Policy and research priorities have often been to understand the various ways in which the lives and development of the children are affected by that environment. In this sense, attention is rarely paid to the experiences of the employees whose job it is to look after the children. How caregivers experience and navigate this work environment and the impacts that their work has on their health, wellbeing and work practices is therefore largely unknown. This lack of knowledge bodes for scientific understanding and evidence-based occupational intervention to support caregivers on whose successes the children’s growth and wellbeing depend. Purpose: This project was designed to explore this largely unknown area of work. The idea was to generate insights regarding the work-related experiences of employed caregivers in children’s homes (CHs) in a context like Ghana. Using the standpoint of the health promotion theory of Salutogenesis, the project aim was specifically to generate knowledge about caregiver perception of the CWPC in their care, the care work itself and their motivation for doing what they do in the context where they do it. It was also to try to understand the types, nature and sources of possible stressors confronting caregivers in their work and the resources that they draw on to manage their work situation. Finally the project was intended to explore in-depth, the implications that the structuring and funding of CHs have for caregiver work performance and health. Methodology: A qualitative approach with phenomenological design was adopted for this exploration. This approach and design were chosen because of the interest in obtaining in-depth insight into caregivers’ subjective as well as shared lived experiences and meaning making of the phenomenon of caregiving as a job within the children’s home context in Ghana. A combination of participant observation, focus group discussions and individual interviews was used to collect data. The final textual data were analyzed using thematic network analyses. Findings: It was found that caregivers perceived the residential children as children of God, belonging to ‘white men’ (due to the use of children’s rights laws to raise them) and difficult to raise. Caregivers were mainly motivated by faith or religion, personal social circumstances (such as childlessness) and economic gain. Interestingly, it emerged that aspects of the work environment that were identified as stressors also tended to be resources for caregivers. These included the children, issues related to child rights, the job itself, the work environment, institution-community relations and relationships between caregivers and their own families. Caregiver faith and intrinsic motivation stood out as the primary reported resources. It was also found that the structure adopted by children’s homes impacts caregiver work performance by increasing work stress levels, complicating some caregivers’ ability to bond with the children and limiting the amount of time that some caregivers have to spend with their own families. These impacts then exposed caregivers to physical, mental and social health risk factors including injuries from slips and falls, mental strain, and loss of social support. Further, it emerged that funding source impacts the frequency of training caregivers receive, the extent of help caregivers receive with their own healthcare costs as well as the extent to which caregivers utilize international regulations like child rights principles in doing their jobs. Conclusion: Caregiver perceptions of the CWPC in their care and motivations for the care work are primarily influenced by their belief systems, cultural values, personal social desires and interpretation of international children’s rights laws. While certain perceptions of CWPC (e.g. as “God’s children”) lead caregivers to show a willingness to engage perceived difficulties in the work, interpretations of international children’s rights laws as “foreign”, spoiling of children, threatening to their jobs and non-fitting to the Ghanaian socio-cultural context affects their attitudes and behaviours towards their jobs and the children. Caregivers experience stress from multiple sources in their work and rely primarily on religion and personal strength as resources to deal with the stressors with little support from their institutions. The structuring of the institutions further complicates the stress situation for caregivers with sources of funding sometimes adding to caregiver stress and other times buffering caregivers against stress. The findings suggest a need for stakeholders’ careful attention to work design and strategizing for residential institutions like children’s homes taking into account caregiver health and well-being. Careful attention to education and the strategies adopted for the implementation of international law and principles in local contexts is also suggested by the findings.