This study explored the use of inductive anthropologic research methods of observation and semistructured interviews to examine health-related communication and lines of influence in Mexican and Filipina immigrant and U.S.-born mother–adult daughter dyads as these relate to the construct of subjective norms. In general, mothers considered their daughters to be credible and trustworthy sources of information and frequently consulted them on a variety of health-related topics to facilitate their decision making. Credibility was not based on mothers’ perception of daughters’ expertise on a given topic per se but rather the daughters’ ability to access relevant information and the level of comfort, familiarity, and mutuality in the relationship. The latter is consistent with and presents a specific case of the major finding from the 3Cs study, that the context of relational culture has many direct and important implications for cancer screening and other health-related behaviors (Pasick, Burke, et al., 2009
Daughters influenced their mothers’ health in both subtle and obvious ways including facilitating their ability to navigate the health care system, motivating them to seek care, and contributing to decision making. For mothers of limited English proficiency, bilingual, bicultural daughters functioned as language brokers. Relationship quality and daughters’ geographic proximity to mothers’ place of residence were also factors in health-related communication and lines of influence in mother–adult daughter relationships.
Our findings represent only a first step in refining the subjective norms construct for women of diverse backgrounds. However, we believe they provide support both for the inclusion of adult daughters in assessments of subjective norms as related to cancer screening and for the methods that more closely portray behavior as it occurs in daily life compared to the typical origins of behavioral constructs in expert opinion. Current measures of the subjective norms construct have included best friend, sister, mother, partner, and doctor as potential influencers of a woman’s decision to obtain cancer screening; however, they have not included adult children. Results of this study show that adult daughters can influence their mothers’ health-related decision making. The complexity of mother–adult daughter relationships and interactions raises questions about the rather simplistic dimensions of the common subjective norms constructs: (a) What does your (referent person) think of mammography? and (b) How often do you do what your (referent person) thinks you should do? Our results suggest that it would be appropriate to develop and test quantitative survey measures that include adult daughters as referents in a woman’s mammography practices. In addition, these questions should also consider life stage, geographic proximity, relationship quality, and motherhood status of daughters. It is likely to be beneficial to explore these potential modifiers among existing referents as well.
Although the research methods used in this study illuminated lines of influence and provided insight to how communication takes place, the potential to generalize from our findings is limited by the small size and purposive nature of our sample. Women in this study were educated and had access to health insurance and thus did not represent U.S. Filipina and Mexican women with financial access barriers. Also, because participants were observed in a constructed research environment, further exploration should observe communication in real-life settings.
Most important, we believe that this study demonstrates the richness and complexity of behaviors and relationships that have been treated, by comparison, with extreme simplicity in traditional behavioral theory. With even the small glimpses of mother–daughter dynamics provided in the above quotations, it is now difficult to imagine the value of the question, “How often do you do what your daughter wants you to do?” The inductive exploration of social context using a variety of methods holds great promise for understanding the behaviors and life circumstances relevant in confronting health disparities.