McMunn Anne, Bartley Mel, Kuh Diana
Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK.
Soc Sci Med. 2006 Sep;63(6):1561-72. doi: 10.1016/j.socscimed.2006.03.039. Epub 2006 May 15.
Data from a prospective British birth cohort study showed that women who were childless, lone mothers or full-time homemakers between the ages of 26 and 53 were more likely to report poor health at age 54 than women who occupied multiple roles between these ages. To explain this finding we developed and tested a theory of role quality based on the concept of agency by drawing on Giddens' theory of structuration and Doyal and Gough's theory of human needs. According to our theory, the patriarchal structuration (drawing on Giddens' term) of work and family roles provides both limitation and opportunity for the expression of agency. Doyal and Gough's theory of human needs was then used to identify the restriction of agency as a possible influence on health. This theory of role quality was operationalised using a measure of work (paid and unpaid) quality at age 36 and a measure of work and family stress between ages 48 and 54. The relatively poor subjective health in mid-life of lone mothers was explained by work and family stress and adult social class. In contrast, the poor health in mid-life of long-term homemakers and childless women was less easily explained. Homemaker's excess risk of reporting poor health at age 54 remained strong and significant even after adjusting for role quality and socioeconomic indicators, and childless women were at an increased risk of reporting poor health despite the social advantage inherent in attaining educational qualifications and occupying professional or managerial occupations. This study highlights the need to develop measures of role quality specifically designed to capture agency aspects of social roles.
一项前瞻性英国出生队列研究的数据表明，在26岁至53岁之间无子女、单亲母亲或全职家庭主妇的女性，在54岁时比在这些年龄段扮演多种角色的女性更有可能报告健康状况不佳。为了解释这一发现，我们借鉴吉登斯的结构化理论和多亚尔与高夫的人类需求理论，基于能动性概念开发并测试了一种角色质量理论。根据我们的理论，工作和家庭角色的父权制结构化（借用吉登斯的术语）为能动性的表达提供了限制和机会。然后，多亚尔与高夫的人类需求理论被用于确定能动性的限制作为对健康的一种可能影响。这种角色质量理论通过36岁时工作（有偿和无偿）质量的衡量以及48岁至54岁之间工作和家庭压力的衡量来实施。单亲母亲中年时相对较差的主观健康状况可由工作和家庭压力以及成人社会阶层来解释。相比之下，长期家庭主妇和无子女女性中年时的健康不佳则较难解释。即使在调整了角色质量和社会经济指标之后，家庭主妇在54岁时报告健康状况不佳的额外风险仍然很强且显著，并且无子女女性尽管在获得教育资格以及从事专业或管理职业方面具有社会优势，但报告健康状况不佳的风险却有所增加。这项研究强调需要开发专门设计用于捕捉社会角色能动性方面的角色质量衡量方法。
