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In the Netherlands, like other European countries, there are major concerns about the affordability of the welfare state. Two new acts aimed towards transitions in the social and health domain, by establishing frameworks for the re-allocation of care responsibilities towards lower professional levels and from formal to informal caregivers. Care workers must provide more complex care with lessening financial means, and thus are confronted with heavier workloads, decreased working hours, flexibilization of labor, job insecurity and unemployment, i.e. precarious work which is more often faced by women, leading to health problems related to old age and work. On top of this they are expected to take care of their families as informal caregiver or as volunteer, and evidence suggests that this moral appeal affects women more than men. It is unknown how paid care workers, informal caregivers and volunteers balance their paid work, informal caregiving and health in the new context. Feminist scholars have indicated that knowledge of how growing precariousness creates new gender dynamics in the interplay between health, participation in paid (care) work and informal care is lacking. It is largely unclear how gender (and other) inequalities are currently (re)produced within societal and organizational contexts. In addition, several (emancipatory) organizations advocated for gender specific monitoring of the consequences of current policy measures as it is unknown if, and how, they (re)produce gender inequalities in how men and women negotiate health, paid work and informal care. Therefore, ZonMW formulated this as one top priority within the call.

 

We aim to gain in-depth insight into how health, paid care work and informal care are negotiated by male and female nursing home caregivers, informal caregivers, and volunteers. We will do so by engaging nursing home caregivers, informal caregivers, and volunteers’ in participatory health research into their lived experiences at the nexus of gender (e.g. men and women), age (45-65), class (in particular lower educated women in elderly care), and ethnicity (e.g. white Dutch, migrant background). In this study, we approach gender as a dynamic biosocial process as biological sex is “socially mobilized in determining who gets to do what, when, where, and how; under what conditions; with what outcomes and consequences including access to participation.” Intersectionality offers in-depth insight into the relationship between health, identities, and society, and in health disparities between and within groups, including those with intersectional invisibility. PHR further aims to enhance participation of research participants whose life or work is subject of the research, and fosters dialogue with relevant stakeholders in all phases of the research process. By doing so, it aims to ‘give voice’ to marginalized groups .

 

The study is a multi-staged and multi-stakeholder process consisting of four phases that iteratively build on the findings of former phases: Exploration (phase 1); Clarification (phase 2); Contextualization (phase 3) and Action (phase 4). In this research, we will use various methods of data- collection and analysis, including photo-voice (phase 1), semi-structured interviews and focus groups(phase 2), ethnography (phase 3) and stakeholder dialogues (phase 4). We will foster an ongoing dialogue within and between our PHR team (academic researchers and co-researchers, all phases), with interviewees (in phase 2), those involved in ethnography (in phase 3), and other relevant stakeholders over the course of the project (all phases). By doing so, we aim to foster a mutual learning process for all. Participating stakeholders consist of (a) consortium partners, and (b) other organizations or policy makers invited by co-researchers and consortium partners. Stakeholder dialogues, in which insights will be shared and reflected upon by stakeholders with different perspectives, are organized by the end of each research phase, including in the final phase 4, in which we aim for concrete measures to establish gender and diversity sensitivity in health policies, promotion, interventions, and in health care. Ultimately, our aim is to contribute to a more equitable distribution of opportunities for health, labour participation and informal care across gender, age, ethnicity and SES.

 

This project is highly feasible. The applicants are experts in participatory action research, elderly care, gender studies in medicine, occupational health, and intersectionality. Consortium partners, consisting of health care organizations, occupational physicians, migrant and womens’ organizations are strongly informed by their constituency and highly motivated to contribute to this study and to disseminate and implement the research findings.

 

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