The Day‐in‐the‐Life method for assessing infant caregiving in rural Pakistan

• Published date: 01 July 2023
• Author: Karen J. O'Donnell,John A. Gallis,Elizabeth L. Turner,Ashley K. Hagaman,Elissa Scherer,Siham Sikander,Joanna Maselko
• Date: 01 July 2023
• DOI: http://doi.org/10.1111/fare.12706

RESEARCH

The Day-in-the-Life method for assessing infant

caregiving in rural Pakistan

Karen J. O’Donnell

1,2

|John A. Gallis

2,3

|Elizabeth L. Turner

2,3

|

Ashley K. Hagaman

5,6,7

|Elissa Scherer

4,8

|Siham Sikander

9,10

|

Joanna Maselko

4,5

1

Center for Child and Family Health, Durham, NC

2

Duke Global Health Institute, Duke University, Durham, NC

3

Department of Biostatistics and Bioinformatics, Duke University, Durham, NC

4

Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill,

Chapel Hill, NC

5

Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC

6

Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT

7

Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, CT

8

RTI International, Research Triangle Park, NC

9

Human Development Research Foundation, Islamabad, Pakistan

10

Health Services Academy, Islamabad, Pakistan

Correspondence

Joanna Maselko, Department of

Epidemiology, UNC Gillings School of Global

Public Health, 135 Dauer Dr., 2101

McGavran-Greenberg Hall, CB #7435, Chapel

Hill, NC 27599, USA.

Email: jmaselko@unc.edu

Funding information

The study was supported by the National

Institutes of Health (U19MH95687, R01

HD075875, T32HD007168). JAG was

supported in part by CTSA grant

UL1TR002553.

Abstract

Objective: This manuscript describes the Day-in-the-Life

(DIL) method for assessing child caregiving activities, its

implementation, and findings regarding family members’

roles and associations with maternal depression symptoms.

Background: Infant caregiving activities are most com-

monly performed by the mother, although there is increas-

ing acknowledgement of others’contribution. Few methods

exist to measure the diverse caregiving activities that

mothers and others perform.

Method: Method development occurred within the Bachpan

Cohort Study in rural Pakistan (N=1154 maternal–child

dyads) when the child was 3months old. The DIL was

designed as a semi-structured interview in which the mother

describes her child’s day from their perspective. Regression

analyses were then used to explore the correlation between

the DIL and depression symptoms, using the Patient Health

Questionnaire-9 (PHQ-9) measure.

Received: 5 May 2021Revised: 18 October 2021Accepted: 25 February 2022

DOI: 10.1111/fare.12706

© 2022 National Council on Family Relations.

Family Relations. 2023;72:1237–1253. wileyonlinelibrary.com/journal/fare 1237

Results: The DIL method was easy to administer and dis-

played excellent interrater agreement. The findings indi-

cated that instrumental caregiving was mostly provided by

the mother alone, others in the household tended to con-

tribute more to infant social interactions, and there was

more support from others when the mother was less able

to provide care (e.g., when ill). Depression symptoms were

higher among women who experienced less contribution

from family members when the mother was less able to

provide care.

Conclusions: The DIL can be deployed to measure infant

caregiving activities and associations with maternal mental

health.

Implications: This method is promising for researchers

interested in disentangling the contribution of multiple

family members toward child caregiving and its impacts

on maternal and child health.

KEYWORDS

caregiving, infant, instrumental support, interview, mother

INTRODUCTION

Research on the caregiving provided for children, and especially infants, consistently shows that

the vast majority of caregiving activities are performed by the mother, although in line with

family systems theory, there is increasing acknowledgement of the contribution of other family

members (Cox & Paley, 1997). There is also increasing acknowledgement that the level of con-

tribution by various household members is very heterogenous and likely varies across different

social and economic contexts. Particularly in cultures where joint families and collaborative

caregiving is the norm, shared household labor and childcare is essential for family functioning

and well-being (Bennett, 1983; Kadir et al., 2003; Roopnarine et al., 2013). At the same time,

research on caregiver burden in the postnatal period points to negative consequences on out-

comes such as maternal mental health and child outcomes (Wagner & Valdez, 2020). Women in

low resource settings are at especially high risk of negative mental health outcomes given their

large burden of household work and child caregiving (Tai & Treas, 2013).

A substantial literature has highlighted how low social support is correlated with postpar-

tum depression (Dadi et al., 2020; Hutchens & Kearney, 2020; Yim et al., 2015). However, sev-

eral key areas remain less well understood. A key challenge has been the reliance on reports of

perceived support (Chen et al., 2007; Stuchbery et al., 1998). As these measures assess maternal

perceptions of not being supported, they may themselves be influenced by depression symptoms

(Asselmann et al., 2016; Stuchbery et al., 1998). Furthermore, they do not provide insight about

the nature of the caregiving burden. For example, the contribution of other members of the

family to caregiving has been of growing interest, and an increasing body of literature is

pointing to the importance of active participation in childcare from others, particularly fathers

and grandmothers, in predicting reduced symptoms of depression in the mother (Lin

et al., 2017; Smith & Howard, 2008) and improved child outcomes (Kim et al., 2016; Mezulis

et al., 2004; Singletary, 2021).

Indeed, many of these studies highlight the need for more cultural investigations given the

substantial variation of features of collaborative caregiving (e.g., caregiver composition, time

spent with other caregivers, and tasks and interaction contents performed by other caregivers;

1238 FAMILY RELATIONS