Haradini Viktoria & Tapper Essi
Declaration
We, Viktoria Haradini and Essi Tapper, hereby declare that all the information is correct and accurate. We solemnly declare that all the information furnished in this document is free of errors to the best of our knowledge. We conducted this study on our own and without undue assistance within the framework of the Social Psychological program at the University of Skövde during the spring semester of 2021 to obtain a bachelor's degree in Social Psychology.
We also certify that the sources used are listed in the reference and that this study has not previously been submitted for examination or publication elsewhere.
16/4-2021
Viktoria Haradini and Essi Tapper
Haradini Viktoria & Tapper Essi
Abstract
Stress is something that affects women throughout their lives and has a huge effect on well- being. The negative consequences of gender inequality make it harder for women to improve their lives and be a part of the labour market because of responsibilities with children and housework. Women experience high levels of stress, which creates a burden affecting their health. The study aims to understand how gender roles, living and working conditions affect stress and stress coping for working Kosovo Albanian mothers in Sweden and Kosovo. The main focus is to understand how work-home relations affect these women in different societies. The study is based on theories of stress, stress coping, theory of gender and determinants of health. A qualitative study was carried out with individual semi-structured interviews concentrating on the phenomenological perspective with an in-depth insight into the women's experiences. Five women living in Sweden and five women living in Kosovo were interviewed digitally. The results show that personality, working and living conditions and social and community networks affect the experience and interpretation of stress and the choice of stress coping for the women depending on the context.
Key words: stress, stress coping, theory of gender, determinants of health, women, Kosovo Albanian, mothers, work-home relations.
Haradini Viktoria & Tapper Essi
Abstrakt
Stress är något som påverkar kvinnorna genom hela livet och har en stor påverkan på hälsan.
Negativa effekten av ojämlika könsroller gör det svårare för kvinnor att förbättra deras liv, vara en del av arbetsmarknaden och samtidigt ta hand om barnen och hushållsarbeten.
Kvinnor upplever högre mängder av stress, vilket skapar en börda som påverkar hälsan.
Syftet med studien är att förstå hur könsroller, boende och arbetsförhållanden påverkar stress och stresshantering för arbetande Kosovoalbanska mammor i Sverige och Kosovo.
Huvudfokus ligger i förståelse om hur arbets- och hemförhållanden påverkar kvinnorna i dessa två olika samhällen. Studien är baserat på teorierna stress, stresshantering, teorin om genus och hälsans determinanter. En kvalitativ studie genomfördes med individuella semistrukturerade intervjuer med fokus på fenomenologisk perspektiv med en fördjupad perspektiv på kvinnornas erfarenheter. Fem kvinnor i Sverige och fem kvinnor i Kosovo var intervjuade digitalt. Resultaten visar att personlighet, arbets- och livsförhållanden och sociala och samhälleliga nätverk påverkar upplevelsen och tolkningen av stress och den valda hanteringsmetoden av kvinnorna beroende av kontexten.
Nyckelbegrepp: stress, stresshantering, genusteori, hälsans determinanter, Kosovoalban, mamma, hem- och arbetsrelationer
Haradini Viktoria & Tapper Essi
Preface
Half of the interviews are translated from Albanian to Swedish with the best possible knowledge of the language. The quotes used are translated to English from Albanian and Swedish.
We want to thank the persons who helped us to find the participants for our study. Our deepest gratitude and thanks go to all the women participating in the study and sharing their private and sometimes hard experiences regarding their experiences. We want to also thank our instructor, Susanna Nordström, for her valuable opinions and guidance.
Haradini Viktoria & Tapper Essi
Content
1. Introduction... 1
1.1. Aim and Research Questions ……… ……….. 2
1.2. Disposition... 2
2. Theory………... 3
2.1. Stress………...………... 3
2.2. Stress coping ………...……….…. 4
2.3. Theory of gender………...…………....………. 5
2.4. Determinants of health………....…...……… 5
3. Previous research...7
3.1. Previous research about women, stress and stress coping………....…..….... 7 4. Delimitations ... 12
5. Method ... 13
5.1. Choice of method... 14
5.2. Selection of participants... 14
5.3. Instrument...15
5.4. Ethical consideration ... 15
5.5. Procedure……...16
5.6. Process of transcription ... 17
5.7. Quality criteria...18
5.8. Method of analysis... 18
6. Result and analysis ………...19
6.1. The experienced stress...21
6.1.1. The experienced stress by women in Sweden ... 22
6.1.2. The experienced stress by the women in Kosovo………...………...23
6.1.3. Positive stress…....………...………..25
6.2. Stress coping……….26
6.2.1. Stress coping for the women in Sweden………... 27
6.2.2. Stress coping for the women in Kosovo……….... 28
6.2.3. Social support……… 30
Haradini Viktoria & Tapper Essi
6.3. The cultural context……….. 32
6.3.1. Working and living conditions in Sweden……….…... 34
6.3.2. Working and living conditions in Kosovo……….……….... 35
7. Discussion and conclusion……….……. 37
References
Appendix 1 - Information letter
Appendix 2 - Consent for the interview Appendix 3 - Interview guide
1. Introduction
Throughout history, psychological studies about health had a majority of male participants.
These studies are generalised to the whole population and do not include the gender inequality that influenced health. Therefore, the starting point of the study will be the social construction of gender roles because the women's experience of stress and stress coping is important to include in the study of health (Hedenus, Björk & Greén 2015, p. 153). Gender inequities are current in every society. This means gender biases in power, resources, norms and values. The negative consequences affect women with a lack of influence on their health and unfair possibilities to improve their lives. Childcare responsibility is the most important role for women which creates a barrier in the labour market. Nevertheless, the women in Kosovo and Sweden do enter the labour market but at the same time are expected to carry out childcare responsibility. This burden has a negative impact on health with higher levels of stress. Gender inequities are present even in more equal societies, such as Sweden (CSDH 2008, p. 145).
The reason that Kosovo Albanian women are chosen is that the strongly traditional gender role is still accurate in Kosovo. There are not many gender differences in attendance to education in the country (Farnsworth, Morina, Ryan, Rrahmani, Robinson-Conlon & Banjska 2018, pp. 33-34). Gender inequality becomes visible in the labour market. Only 18 % of women are employed, which is one of the lowest female labour force participation rates in the world. Barriers affecting women’s participation in the labour market include, for example, childcare responsibility (The World Bank Group 2018). In Sweden, the employment rate for women is the highest in the European Union by 79,7 % (Ekonomifakta 2020). One of the many aspects of this is that according to the measurement by the European Institute for Gender Equality, Sweden is the most equal country in Europe. However, inequality is very much present in Swedish society, such as gender-based pay inequality and unpaid work for home- and childcare (Regeringskansliet 2019). Therefore, as mentioned before, the women who make it into the labour market are still expected to carry out unpaid work for home- and childcare (Farnsworth et al, 2018, pp. 37-38). The reason that Kosovo Albanian women in Sweden are chosen is that many women with Kosovo Albanian origins live in Sweden.
Stress and stress coping are the main aspects of health in this study. Stress and coping processes are biological with influences on the living and working condition. The experience depends on the nature of the trauma and the experience of stressors. Gender differences in stress and stress coping depends on social expectation regarding gender roles (Folkman 2011, pp. 4-5). According to several studies, women, as a consequence of their gender role, experience a higher level of stress (Folkman 2011, pp. 63-65). A study made in 2020 by the Public Health Agency of Sweden shows that 18% of the women and 11% of the men feel stressed. The report of residents in Sweden that were born in Europe shows that 21% of them feel stressed. Except for war-related trauma, data about stress statistics in Kosovo couldn’t be found. Because of the lack of studies, we want to include Kosovo Albanian women in the aspect of health and their experience of stress.
Something that stress, stress coping and gender inequalities have in common are that it occurs in a context. The context includes the quality of living and working conditions and individual and social factors which determines health (Rostila & Toivanen 2018, p. 165). This affects the expected gender role as a woman, the experience of stress and the opportunity of coping with it. Therefore, our aim with this study is to understand how the gender role, living and working condition affects stress and stress coping for working Kosovo Albanian mothers in Sweden and Kosovo. Our goal is to reach out with our study to the society in Kosovo and everyone with Kosovo Albanian origins to notice the importance of how the social construction of gender roles affects women's health.
1.1. Aim & Research Questions
The purpose of this study is to understand stress and stress coping for the working Kosovo Albanian mothers in Sweden and Kosovo.
How is stress experienced by the women?
How is stress coped with by the women?
How do the determinants of health in Sweden and Kosovo affect the experience of stress and stress coping for the women?
1.2. Disposition
The following pages contain a description of the theoretical standing point of the study. The chosen theories are relevant to the aim and research question. After this, the former research relevant to this study is presented. The delimitation summarizes the result of former research and what aspects are delimited and related to this study. Thereafter the method is presented which includes the choice of method, selection of participants, empirical instrument, ethical consideration, the procedure of the interview, process of the transcript, quality criteria of the collected data and method of analysis. The description of the method includes the specific procedure of the study in order to increase the credibility, understanding of the reasoning and structure of the study. Afterwards, the result is structured into themes and codes of the collected data and each theme is supported by quotes to increase the credibility. The result answers the research questions of the study. During the next part, the themes and codes in the result are analysed by applying the chosen theories in order to explain the result. The last part of the discussion and conclusion contains feedback on the aim and research questions of the study and what the conclusions are of the research. The connection of the result and analysis to former research and broader social perspective are discussed. The conclusion ends with a description of strengths and weaknesses of the study and suggestions for future research.
2. Theory
Based on social psychology, our study is connected with social psychological theories to understand individuals as a part of society. The main concepts are stress, stress coping, theory of gender and determinants of health. This includes the definition of stress, how it occurs and stress coping. Theory of gender explains the construction of socially accepted behaviour regarding gender and impacts of possibilities or obstacles for a healthy lifestyle.
Determinants of health include different risk and protection factors which affect our health and well-being. The determinants of health-model include all the different factors influencing our lives and health. These theories help us to understand stress and stress coping experienced by working Kosovo Albanian mothers.
2.1. Stress
Stress can be defined from a biological and social perspective. The biological perspective explains the body's endocrine activity when stress is threatening (Gurung 2010, p. 102). The aim is to find a balance between activity and rest (Kazemi 2009, p. 51). The social psychology aspect of stress is an interaction between the individual and society (Rostila &
Toivanen 2018, p 255). The definition of stress also includes three types of stressors:
environmental stress, individual stress and stress resulting from a transaction between the individual and the environment. Stress occurs when the environmental demands exceed the individual’s resources and results in negative stress (Folkman 2011, pp. 16-17). The environmental demands can be the expectation of taking the role of a caregiver for your children at the same as working but the resources, such as time and energy, are not enough.
This is negative stress because it is long-lasting, difficult to get free from and decrease the capacity. In the case of negative stress, the human body never goes back to the normality stage. Nevertheless, the reaction of stress is mostly a positive reaction to an event or daily stressors. Positive stress engages, stimulates and helps manage the situation with a positive achievement (Rostila & Toivanen 2012, p. 241). Therefore, the variation of negative and positive stress depends on the severity and duration. Even though negative and positive stress is a biological reaction, the stress factors are subjectively perceived with an effect from the surroundings (Gurung 2010, p. 102). Negative stress leads to psychological symptoms such as depression and a stressed body with physical symptoms such as high blood pressure (Rostila & Toivanen 2012, pp. 248-249).
2.2. Stress coping
Stress affects our lives in many different ways, and it is important to find ways to cope with it. The definition of coping is “an individual's effort to master demands (conditions of harm, threat, or challenge) that are appraised (or perceived) as exceeding or taxing his or her resources” (Monat & Lazarus 1991, p. 6). In Coping theory, two major categories are brought to the fore: problem-focused coping and emotion-focused coping. Problem-focused coping refers to the efforts of improving the person-environment relations by changing the way of doing things and confronting the person who created stress. This form of coping includes a review of the different options for change to manage the demands. The appraisal review is
influenced by individual belief and problem-solving skills (Monat & Lazarus 1991, p. 211).
Emotion-focused coping refers to thoughts or actions to relieve the impact of stress, for example, by avoiding thinking about the trouble or distancing oneself from it. The emotional reaction of coping makes the person feel better (Monat & Lazarus 1991, p. 6) and appraise the situation as unchangeable (Monat & Lazarus 1991, p 211). To fully understand coping and managing the demands during stress, it is required that both the function of problem- focused and emotion-focused is considered (Monat & Lazarus 1991, p. 210). The reason is that in stressful situations, the reaction is a complex combination of both coping methods (Monat & Lazarus 1991, p. 6). One of the most important coping strategies is through received and perceived social support. Many studies have shown that women more frequently provide and give support and help others within their social network (Gurung 2010, p. 159).
2.3. Theory of gender
The theory of gender is defined within scientific research as a framework to theorize the social construction of putting people in categories depending on their biological sex. These categories affect social and psychological life (Magnusson & Marecek 2010, p. 47).
According to the theoretical perspective of the gender order, gender is practised within a social process which reflects our biological sex. Nevertheless, the practised gender is not a free choice but a structure of socially accepted behaviour that restricts people from the freedom of actions (Eriksson & Gottzén 2020, pp. 37-38). Gender order identifies the social construction of gender as women being generally treated as subservient to men. The reason is that the cultural dimension of femininity and masculinity affects firstly the relation of power where men have access to the majority of the power. Secondly, the relation of production affects the distribution of allowance and status in the working place which in most cases benefits men. Thirdly, emotional relations affect the acceptance of emotional energy depending on gender (Eriksson & Gottzén 2020, pp. 38-39). Therefore, the social constructions of behaviour, attribute and activities of specific gender controls the actions of the individual (Rostila & Toivanen 2018, p. 68). The ideal of femininity emphasizes the importance of taking responsibility as a caregiver for the family. Women experience higher levels of mental illness because the responsibility can be overwhelming and create a feeling of guilt and inadequacy (Hedenus, Björk & Greén 2015, pp. 161-162). In these situations, the
expectation in the working place and private life together with the demand of femininity can exceed the individual’s resources which results in high levels of stress (Folkman 2011, pp.
16-17). The broad definition of gender order is the theoretical starting point for our study.
The social construction of socially accepted behaviour for women can explain their experience of possibilities or obstacles for a healthy lifestyle.
2.4. Determinants of health
People are exposed to different determinants of health, including risk and protective factors.
A good environment, housing conditions, possibility for recreation and the social community are part of the protective factors in the society. The risk factors are balanced with the protective factors in everyday life. Both factors are important for describing the determinants of health. Dahlgren and Whitehead (1991) describe the influence of different levels on structures in their determinants of health model. The different levels in the rainbow model work both as risk and protection factors. The rainbow consists of five concentric semicircles.
The first circle presents the age, gender and inheritance. The second semicircle presents individual life factors like exercise, sleep- and food habits. The third semicircle consists of community networks, for example, social relations and support. The fourth semicircle contains living and job conditions including education, nutrition, healthcare and work environment, unemployment and accommodation. The last semicircle represents general socioeconomic, cultural and environment-related factors (Pellmer, Wramner & Wramner 2017, p. 24). All of these different levels and factors affect the health of the working mothers in the interview. The determinants will be examined from different levels of the model and how these different risk and protective factors create stress, and if some of these factors rise above others. How the social relations and living conditions in Sweden and Kosovo, for example, affect stress and stress coping for the Kosovo Albanian women.
A salutogenic point of view includes thoughts of processes creating health and factors affecting these processes. One important determinant of health is the feeling of connection which helps people to manage obstacles and stress in everyday life. The feeling of connection is defined with three dimensions. Comprehensibility includes, that an individual understands for example a stressed situation. Everything that is understandable is easier to manage.
Possibility to handle situations is defined as the resources an individual has to encounter the existing demands. Meaningfulness aims at the level an individual feels that life has an emotional meaning (Pellmer, Wramner & Wramner 2017, p. 25). A strong feeling of social connection helps against long-termed stress which includes that a person experiencing a feeling of connection has better possibilities to manage difficult situations. The salutogenic view includes that the focus lies in identifying and mobilizing strengths to manage stress and empower emotional relations. Other factors affecting health and stress is the feeling of social support, security, good living conditions and job relations including clear rules and the feeling of being able to affect the working situation (Pellmer, Wramner & Wramner 2017, p.
26). We will use the theory of determinants of health in our study to understand different factors creating stress for the women. We will examine if the feeling of social connection has an effect on the experienced stress and stress coping for the women.
Determinants of Health:
3. Previous research
The ten scientific articles are previous research with a focus on the determinants of stress and
stress coping for women in different contexts. Interpretations of stress and stress coping are referred to the relationship between work and home and the expectation of the gender role as a woman. These topics give an insight into different stressors for women. All of the previous research has been carried out around the world in different societies and cultures with different possibilities and obstacles. Nevertheless, the importance lies here on the result that shows similarities of how the gender role affects women's health negatively. We did not find previous research about stress for Kosovo Albanian women in Sweden or Kosovo, but that is one of the reasons our study is important.
3.1. Previous research about women, stress and stress coping
Ahlborg Gunnar and Håkansson Carita (2017) researched stress in their study “Occupations, perceived stress, and stress-related disorders among women and men in the public sector in Sweden”. Stress-related disorders are a big burden for individuals and society and because of that, it is important to regard stress in a wider context and identify different stressors. The study aimed to examine potential associations between occupations, perceived stress, stress- related disorder and gender differences. They mailed a survey to 3481 employees in the public sector in Western Sweden. The results showed a clear association between imbalance between different jobs and perceived stress and stress-related disorder. They found that an imbalance between doing things for themselves and others increases stress for women. The study also found that part-time work and no physical activity was associated with stress- related disorders among women. The study is useful for us because it gives an insight into various perspectives about jobs and stress in Sweden for women.
“Prevalence of and Factors Linked to Occupational Stress in Public and Private Organizations in Kosovo” is a study by Tolaj Sejdë, Havolli Ymer and Beqiri Gent (2020) where they studied different factors causing stress among employees. Stress is an increasing problem for companies and organizations, but there hadn’t been studies on the prevalence of stress among workers in Kosovo. They sent a survey to 340 public and private sector employees aged 25 to 65 years. They had more male answers (61%), and the employees were from many different backgrounds. They found that stress adversely affects employees with 1-20 years of work experience and females. The identified cause to stress is high demands, lack of control,
support and relationships. Public sector employees reported higher stress levels. With the help of this study, we got information about the prevalence of stress and identifying factors that cause stress for Kosovo employees. Unfortunately, it does not give a perspective of working mothers, but the study offers an insight into Kosovo Albanians work life.
Knapp Ellen and Fosshaug Isabella (2015) studied stress in their study “Könsskillnader i stress hos förvärvsarbetande män och kvinnor i Sverige: en kvantitativ studie om stress utifrån arbetsmarknadsfaktorer samt teorier om familjeförhållanden”. They aimed to find out if there were gender differences in stress levels and to study work-related stress. The quantitative study was made in Sweden in 1991 with 3402 participants and in 2010 with 4415 participants aged 18-75. The result, in this study, included that women experience more stress than men. They found also that there is more stress in the public sector and that the level of work-related stress decreases when individuals get older. The study helps us to better understand the stress situation in Sweden among women and in their family relations and also compare our future findings with the findings in this study.
Babatunde Akanji, Chima Mordi and Hakeem Adeniyi Ajonbadi (2020) carried out a qualitative study, “The experiences of work-life balance, stress, and coping lifestyles of female professionals: insights from a developing country”. The purpose was to explore the experiences of work-life balance concentrating on the causes of imbalances, stress and coping techniques experienced by female medical doctors in Nigeria. The chosen method was one- to-one, in-depth interviews with 52 Nigerian female medical doctors to collect the qualitative data. The result shows difficulties with time management which creates a negative impact on the work-home relation. Another stressor for work-family conflicts was the inequality of tasks at home. The doctors used individual coping methods as mitigating strategies. The study is valuable for us because it unveils the importance of working and living conditions in the work-life demands facing women considering different cultures. Differences between our study and this one are that we don’t have a specific occupation group we focus on, and the culture in Kosovo and Sweden is different from Nigeria.
Ozlem Ornek and Melek Esin (2020) carried out a quantitative study, “Effects of a work- related stress model based mental health promotion program on job stress, stress reactions and coping profiles of women workers: a control groups study”. The research, focuses on the problem of rapidly increased stress in work causing many different stress reactions, diseases and unhealthy behaviour in Turkey. The study aimed to examine the effects of work-related stress models with the help from the “Workplace Mental Health Promotion Programme” on job stress, social support, emotional and biological reactions, work absenteeism, job performance and coping profiles of women workers. The study used a pre-test, post-test and non-equivalent control groups design including 70 random-selected women workers with 35 in each study group. The program was an intervention including 12 weeks of follow-up. The research measurement was the assessment form and a self-reported checklist. The result showed no differences in sociodemographic characteristics, general health or working conditions between the intervention and control groups. Three months after the intervention, there was a significant decrease in job stress, physical and mental reactions’ scores and work absenteeism with an increase in job performance and social support among the intervention group. The program showed positive effects on coping profiles. Our study aims to understand how the workplace and private life affect stress and stress coping.
Camille Hall (2018) carried out the study “It Is Tough Being a Black Woman:
Intergenerational Stress and Coping”. Hall researched how ethnicity, gender, and class significantly affect coping. The qualitative study examined how black mothers and daughters coped with stress. The chosen method was convenience and snowball sampling methods to recruit a sample of 168 persons identified as Black or African American of whom 90 are mothers, and 78 are daughters. Participants were interviewed face to face multiple times to get an understanding of their perceptions of stress, and the coping strategies they used to manage stress. The results indicated that education helped the women to learn how to cope with stress. Analysis of the data found three major themes: the dimension of stress, stressors, and coping strategies. The women described different stressors like racism, colourism, sexism and health problems. Strategies to handle these stressors were reliance on prayer and church attendance, self-care and psychotherapy. Participants also reported that each coping response came with some negative and some positive consequences, including health problems
(mental/physical) and strained familial relationships. In our study, the main focus is not ethnicity; nevertheless, the women's situation and different stressors will be taken into account for the women in Sweden and Kosovo.
Cyndi Brannen and Kathy Petite (2008) carried out the study “An Alternative Framework for Understanding Women’s Caregiving Stress - a qualitative application of the ways of coping model” to present an alternative to inventory checklist approaches to measuring coping. They utilized a qualitative approach to explore themes of problem-focused, emotion-focused and meaning-focused coping in a sample of 98 women from diverse backgrounds and caregiving situations. A narrative approach allowed the researchers to situate coping within the context of the caregiving experiences that the women discussed and helped to get a broader understanding of coping strategies and stress reduction. As a data collection method, they used focus group interviews. The focus groups were conducted at various locations and ranged in size from six to ten women. They found that different strategies are more effective for stress reduction in relation to the amount of perceived control. The problem-focused category was used most often. Another result was that active control over the stressor almost always led to stress reduction. The study is relevant in our study because the participants are mothers with the expected role as a caregiver while working at the same time.
Anna Jurczak, Małgorzata Szkup, Krzysztof Safranow, Agnieszka Samochowiec, Sylwia Wieder-Huszla, Joanna Owsianowska and Elżbieta Grochans (2019) studied women, stress and coping in their research “The influence of genetic factors on personality and coping with stress among healthy late reproductive age women”. Women are at a higher risk of experiencing stress and their reactions to stress are stronger. The psychology of stress and the chosen stress-coping strategy is affected by the person's personality traits. The study aimed to analyze stress-coping styles and personality traits in women. The study involved 345 healthy women from Poland, whose mean age was 42.3 years. They used genetic testing and different kinds of tests, for example, The Coping Inventory for Stressful Situations. The results they found included that all personality traits correlated statistically significantly with the choice of task-oriented and emotion-oriented coping. The choice of coping style was significantly related to personality traits which of some were genetically determined. This study can be
applied to the participants that argue their coping method as a personality trait rather than the environment as a determining factor.
The article “Relationship of Work-Family Conflict with Job Demands, Social Support and Psychological Well-Being of University Female Teachers in Punjab” by Akram Mahvish Fatima and Abid Hussain (2020) studied the relationship of work-family conflict with job demands, social support and psychological well-being of female teachers in universities of Punjab. Stratified random sampling technique was used to select 410 female teachers for the sample from the Punjab province. They sent out questionnaires to collect the data and used Structural Equation Modeling and t-test to analyse the data. The results showed that job demands and social support significantly related with the work-family conflict which had a significant relationship with psychological well-being. It was recommended that teachers and administration could use individual and organizational training strategies to reduce the conflicts. We can use the study to examine how different job demands and social support affect the work-family conflicts and well-being for the women.
The article “Gender, social support and posttraumatic stress in postwar Kosovo” by Jennifer Ahren, Sandro Galea, William Fernandez, Bajram Koci, Ronald Waldman and David Vlahov (2004) studied social support and traumatic experience depending on gender. The study was conducted two year after the war in Kosovo in 2001. The participants were 306 emergency department Kosovoalbanian patients. The result shows that 97,4% had experienced traumatic events and 89,5% had post traumatic stress syndrome (PTSD). Patients with PTSD symptoms were a majority of women and others with bad traumatic events. The traumatic events had a greater detrimental effect on men. Women received more social support which had a proceting effect. Two years after the war, the prevalence of post traumatic stress syndrome remains high particularly for women with lower social status. Social support may be the most important health effect. Although the study is about traumatic events from the war, it shows the importance of social support which is a part of the interview questions. This study was chosen because it is one of the very few studies made about women's health in Kosovo.
4. Delimitations
The conclusion of previous research is that studies about women that experience stress and cope with it within different societies are influenced by living and working conditions within different contexts. The studies show how the social construction of gender determines the health of working mothers and how these possibilities affect stress and stress coping. The social construction of gender is created within the social environment, but at the same time, the norms of gender are shown to be similar in different social environments. In general, the studies show a similarity of the experiences stress and stress coping for women who are working and are expected to carry out childcare responsibilities. These similarities depend on the global view of gender. The studies show that the possibilities of defying the gender norms depend on personality, the working and living condition and social and community network, which are included in the model of “determinants of health”.
Previous research shows a lack of studies about stress experienced by women of Kosovo Albanian origin living in Kosovo or other countries such as Sweden. Not a single study was found about working Kosovo Albanian mothers. Therefore, the choice of this study was clear because of its importance to notice the topic of Kosovo Albanian women's health. This study focuses on the experienced everyday stress and stress coping of working Kosovo Albanian mothers and the determinants of stress. As opposed to previous research, this study focuses delimited on women of Kosovo Albanian origin living in Sweden and Kosovo in order to demonstrate the effect of different working and living conditions and social and community network on stress. The previous research had a larger amount of participants, interviewed the participants longitudinally and had a quantitative direction. These parts would enable the result of the study and generalise to the society in Kosovo and for Kosovo Albanian women in Sweden. But because of the limited resources and the research design, this had to be omitted.
5. Method
A qualitative study with interviews has been carried out. The qualitative method was chosen because the woman's point of view and experience has given a detailed and in-depth insight about stress and coping related to work-family relation (Bryman 2018, p. 562). Follow-up
questions have been included to understand the broad perspective of the different reasons for stress and ways of coping with it. A survey could have answered the questions about stress, but the qualitative perspective provides profound and nuanced answers with interaction about the experienced situations and feelings. With a qualitative approach, the interest was about the women's experience and interpretation of stress on a deeper level (Bryman 2018, p. 563).
The phenomenological perspective is a part of the study to analyse the content of people’s experience. The phenomenological study describes the common meaning of individuals regarding the experience of a phenomenon (Creswell 2018, p. 75). The collected data is from women experiencing the phenomenon, which in this case is stress, and analysed whether these experiences can result in a general description for working Kosovo Albanian mothers.
Phenomenological studies typically include a group of individuals who have all experienced a phenomenon (Creswell 2018, p. 76). Individuals have subjective experiences of the phenomenon and also common experiences with other people. The phenomenological data collection involves interviewing individuals who have experienced the phenomenon. The data analysis follows a systematic procedure starting with broader units of analysis continuing to narrow units with detailed descriptions that describe what the individuals have experienced and how they have experienced it (Creswell 2018, pp. 76-77).
By interviewing working mothers in Sweden and Kosovo, a broader understanding is received about how and which determinants of health affect the experienced stress and chosen coping method. The main focus has been to find out how working and having a primary role as caregiver for their children affect stress for the women. The interest has been in how these different societies affect stress for working Kosovo Albanian mothers. Studying Kosovo Albanian mothers with different backgrounds gave a better and broader understanding of the phenomenon (Bryman, 2018, p. 102). The aim was to investigate the individual, community, working and living factors on the individual stress and to get an increased awareness and a deeper understanding of the social reality of the different countries (Bryman, 2018, p. 104). The aim has been to understand stress in different settings and examine ways of coping strategies that are used by the working mothers.
5.1. Choice of method
The methods of data collection for the research were individual semi-structured interviews.
The structure of questions followed four topics - stress, stress coping, theory of gender and determinants of health - within the specific aim of the study. The open questions have provided wide and inclusive answers. This has enabled flexibility for both the participants to form their answers and as an interviewer to ask follow-up questions (Bryman 2018, p. 563).
The interviews took place digitally via a Facebook video call. The equipment that was used included a microphone to record the interview for the transcript.
5.2. Selection of participants
The selection of participants is ten working Kosovo Albanian mothers living in Kosovo and Sweden. The women are between the age of 25 to 45 years old, working and have children.
The participants have been found with goal-oriented selection where the participants fulfilled the criteria of the aim of the study and answered the research questions. They have been found through a request in a Facebook group. The five women in Sweden have origins in Kosovo and have been living in Sweden for at least ten years. Women are the chosen participants because previous research and theory suggest that they experience more stress in connecting working life with childcare responsibility. We chose women aged 25 to 45 because they have more likely finished their studies, entered the working life and have children. The interviewed women have different backgrounds and experiences in life.
Countr
y Age Chil
dren Marital
status Studies Employment, % Came to Swede
n Interviewee
1 Swede
n 34 3 Married Production
technique Production
technique 100% 2003
Interviewee
2 Kosovo 30 2 Married German
language German embassy
100% -
Interviewee
3 Kosovo 44 3 Married High School
Teacher Masterchef 100% - Interviewee
4 Swede
n 34 2 Married Leadership and
organisation Labour market
secretary 100% 1993
Interviewee
5 Swede
n 38 3 Married Social work and
nurse Nurse 30% 2000
5.3. Instrument
To achieve qualitative results, an interview guide has been applied during the interviews. The general guidelines are that questions have been posed in a comprehensible language and the interviews have taken place in a safe environment with the best equipment available. Follow- up questions were added during the interviews in order to get a deeper understanding of the specific question (Bryman 2018, p. 566). The interviews were done in Swedish and Albanian, depending on what the participants prefered. Initially, the interview began with background questions and continued with questions related to topics from the research question. The topics followed the order of questions about first stress and then stress coping. All questions have proceeded from different determinants of health to get a deeper understanding of how women experience stress. This process of questions is shown in the interview guide which is attached to Appendix 3.
5.4. Ethical considerations
The ethical question has been highly considered thoroughly in the study. The role as researchers has been by showing respect towards the women that have been interviewed. It was important not to let the opinions or experiences of the researcher affect the interview questions and analysis in order to contain objectivity. The questions are about delicate and hard life events in the context of stress and understanding and empathy has been shown in discussing these matters.
The first step in the interview was to inform the participants about ethical principles. The principles included information requirements about the aim of the research and the different
Interviewee
6 Swede
n 37 2 Married Social science,
leadership Administrator for migration agency 80%
1992
Interviewee
7 Swede
n 38 2 Married Social work Unit manager for
care 100% 2006
Interviewee
8 Kosovo 28 2 Married Law Salesperson, part-
time -
Interviewee
9 Kosovo 30 2 Married Albanian
language English teacher 80% - Interviewee
10 Kosovo 45 2 Married Mathematical
teacher Mathematical
teacher 100% -
moments in the research. The participants have the right to know what moments are included in the study. Their participation is voluntary, and they have the right to back out of the research at any moment without explanation. The consent requirement is about the freedom for the person involved in the study to decide if they want to be a part of it or not. The women who were a part of the study had received information about the study to decide if they want to give their consent or not. The respondents in the study have left their consent optionally. Confidentiality requirements are that participants are coded instead of using their names or personal information. Information has been treated with the highest possible confidentiality. The anonymity ensured that our personal opinions did not affect the results and that privacy has been kept throughout the study. The utilization requirement concludes that the collected data of the individuals have only been used for the research purpose. Data has been stored carefully so that unauthorised persons do not have access to it. The interview continued only if the participants had signed under their approval (Bryman 2018, pp.
170-171).
5.5. Procedure
The first step was to send a request to a Facebook group to find the participants. The potential respondents were contacted and informed about the study in advance. They received information about the aim and ethical considerations of the study, with information about their confidentiality and the possibility to end their collaboration at any time if wanted.
Afterwards, interview appointments were booked with the women. The interviews with women in Kosovo and Sweden have been digital via Facebook-video call. For better interaction, the web cameras were on. To facilitate the transcript, a voice recorder on the phone was used by both researchers. If some technical issues would occur the researchers would be able to send the material to each other. The recorder was on even after all the questions had been asked because sometimes the interviewee felt freer to open up more (Bryman 2018, p. 580). Five women from Kosovo and five women in Sweden were interviewed for around 1 hour. The interview questions were on-site and gave the participants time to think and reflect on the answers. In some cases, all the interview questions were not asked because the interviewee answered them themselves which gave flexibility for follow up questions. After the interview, each of them was transcribed (Bryman 2018, p. 533).
Some technical difficulties did occur because the interviews were made online via the internet. Internet connection was sometimes bad which resulted in deteriorated video picture and voice quality. Sometimes, the video picture stopped before starting to work again. There were some voice issues where the interviewee experienced echoing or could not hear the question which had to be repeated. Quality issues occurred in the recorded material because the interviews were recorded through a computer. Some words were inaudible, said too quietly or incomprehensive and therefore had to be marked in the transcription with question marks (Bryman 2018, p. 581). This may have resulted in some interpretation differences and that some important information was inaudible. For this reason, the material was recorded by both researchers for the possibility of listening to the material from another recorder. The interviewee can have been affected by the online environment by feeling more distant than in an interview situation face-to-face.
5.6. Process of transcription
All of the interviews were transcribed after each interview. Names of the interviewees were not used, but instead, they were numbered as interview 1, interview 2 and so on. By using the recording app it was possible to slow down the speech, turn off background noise and listen to it frequently. The transcribing for one interview took around five to seven hours. In order to keep the focus, breaks were held. Some repetition and usage of filler words were transcribed, but not the ones being unnecessary for understanding the meaning of the answers. Half of the interviews were held in Albanian and the other half in Swedish. Each researcher transcribed five interviews, the researcher with knowledge of Albanian language transcribed those made in Albanian, and the other researcher transcribed those made in Swedish. The interviews made in Swedish and Albanian were transcribed literally to each of the questions in the interview guide.
The transcribed interviews were summarized along with the interview questions. This process went from 109 pages of the transcript into 31 pages. The deleted part where the times when digital errors occurred, questions were repeated or the conversation was about another topic.
This may be a risk factor of missing out on important information but the work of choosing
important parts was made carefully and detailed. The focus was only on the specific answers from the interviewee and not the body language because it is irrelevant to thematic analysis.
After the transcription, the process of coding started by printing the pages in order to easier get a grip of the different codings. Every page was coded in detail about the women's experience in order to see a pattern. This would facilitate thematic analysis. After coding, an overview of the collected coding was made to make sure every part is included. Afterwards, the codings with similar patterns were structured together after each research question. These codings were compiled within specific themes and subthemes. The themes were structured along with the research questions to facilitate the thematic analysis with the theoretical outset.
5.7. Quality criteria
Reliability, replication and validity are criteria for the evaluation of the quality of the study (Bryman 2018, p. 70). Reliability regards the question of whether our result of the study is possible to achieve again if the study is duplicated or if our result were possible to receive only once because of coincidence. Reliability is similar to the criteria of replication. Our study needs to be replicable by another researcher. For this reason, it is important, in a detailed manner, to write down all the different stages taking place while making the study.
Internal reliability is important in the aspect that we as researchers have the same interpretation of the answers in the interviews (Bryman 2018, p. 465).
Validity involves an evaluation of whether the conclusions generated from the interview are connected or not to the aim of the study (Bryman 2018, p. 72). Different kinds of validity can be investigated. But in our qualitative study, internal, external and inferential validity is important. Internal validity is about the relation between the interview and theoretical perspective, which in this case are stress, stress coping, theory of gender and determinants of health (Bryman 2018, p. 465). It was therefore important to connect the interview guide with the research questions to get a result in order to answer the aim of the study. External validity concerns the question of which degree the results can be generalized beyond the specific study context and into other social environments and situations (Bryman 2018, p. 466).
Inferential validity concerns the author’s role in drawing conclusions that are consistent with
their research and the results they got (Bryman 2018, pp. 73-74). We have evaluated the different validity themes after our accomplished study and evaluate the affections.
5.8. Method of analysis
Thematic analysis is used for this study because the method identifies “themes and patterns of meaning across a dataset in relation to a research question” (Braun & Clarke 2013, p. 175).
The motive behind the decision of thematic analysis is because of its potential to compile patterns of the data which gives a conceivable structure in the result. The procedure started with transcription of the interviews which has been read many times in order to get an overall picture of the material. Some notes have been taken in the transcript that seemed potentially interesting. The next step was to code the whole transcript on hard-copy data (Braun &
Clarke 2013, p. 202). The process of complete coding aimed to identify everything in the data related to the research questions. The codes are “based on the semantic meaning of the data”
which mirrors the participants’ language and concept and not on their body language or how it was expressed (Braun & Clarke 2013, pp. 206-207). Afterwards, the codes were divided into themes. Before defining and naming the themes, they have to be reviewed for a thematic map describing their relation (Braun & Clarke 2013, p. 203). The themes have a “central organising concept” which identifies salient patterns of meaning in the data and capture important aspects related to the research questions (Braun & Clarke 2013, p. 224). Before deciding on the themes and codes for the analyses, they have been reviewed to ensure quality that captures the meaning of data. In the part of the analysis, the focus of every theme is defined and provides a dominant pattern of the data. The semantic meaning of data is analysed in a descriptive form referring to the theories (Braun & Clarke 2013, p. 252).
6. Result and analyse
Three different themes were found after coding the data: stress, stress coping and the cultural context. Subthemes for stress include the experienced stress for women in Sweden, the experienced stress for women in Kosovo and positive stress. Stress coping has subthemes coping methods used by the women in Sweden, coping methods used by the women in Kosovo and social support. The last theme, the cultural context, has the following subthemes: work
and living conditions in Sweden and work and living conditions in Kosovo. Themes and subthemes are presented in relation to the given interview answers.
Five of the interviewed women are living in Sweden and five in Kosovo. The interviewed women had an average age of 35,5 years, and all of them have children on an average of 2,3 years. All the women are married and have been for a longer time. The majority of the women living in Sweden live outside the city near to the countryside as opposed to the women from Kosovo who live in cities. All of the women have an education varying from high school to master level. Four of the women living in Sweden are studying at the same time as working. All the women are working, but not necessarily full working hours. The work amount varies from 30% to 100%. Women in Sweden have more regular hobbies than women in Kosovo. Hobbies and interests vary from exercise and gardening to baking and reading. In Kosovo, social networks are highly common and valued. The women who are living in Sweden came here between 1992 to 2006. The women living in Kosovo are all, except for one, born and raised in Kosovo. One has lived abroad during the war.
Four of the women in Sweden had burnout because of the high level of negative stress during a long period. The responsibility of childcare, work and studies caused high stress which was not manageable to be coped with. Before the burnout, they focused on following a schedule of priorities that abated the possibility of coping with the stress. The lack of time and knowledge made it difficult. After the burnout, they received professional help from the health care centre. The help facilitated the planning of priorities for more free time, routines with regular coping methods and received social support. Stress is mostly coped with a hobby. The majority of the women in Kosovo experience high levels of stress but see it as a part of everyday life. However, they do not report as many mental and physical symptoms of stress as the women in Sweden. Stress has to be coped with by finding a solution during the moment of stress. Regular coping methods and hobbies were not very common because of the lack of time, but the social network had major importance. It was perceived as an escape from everyday routines and stress. They emphasized the social support from family in finding a solution to the situation as a relief from stress.
Our study focused on understanding the experienced stress for the women, but we want to mention some differences between women in Kosovo and Sweden. The women live in different environments which affect their experience of stress. Women in Kosovo live with a larger family including in-laws when women in Sweden live with their nuclear family. Many of the women in Kosovo keep the stress to themselves and do not share it with others. None of the women in Kosovo tells that they would have had a burnout even when they have had long periods of stress when almost all women in Sweden tell that they have had a burnout.
The coping methods are also different between women living in Kosovo and Sweden. None of the women in Kosovo speaks about meditation or going to a therapist when it is quite common in Sweden. Women in Kosovo emphasize social support as a coping method. They prefer to handle the stress at the moment or to use an avoidance coping strategy contrary to women in Sweden.
6.1. The experienced stress
The result shows how the overall experience of stress by all the women is affected by trying to balance work and family life. There is a high demand for keeping up with all the responsibility in everyday life. The demands were not only from the social network but also from themselves to keep up with everything as a mother and employee. Nevertheless, the stress was experienced differently even if they live in the same environmental context. One of the explanations about these differences was from the women in Kosovo. Two women argued that personality is the determining factor for how stress is experienced because they mostly highlighted the stress as always present, especially as a woman with children and work.
“If you give yourself stress, stress will follow you. [...] Of course, you have a lot of stress as a woman but you have to learn to cope with it. [...] ...we need to cope with
stress right away on our own.” - Interviewee 3.
Other women explained that stress is not a common conversation topic within the social circle because it is socially perceived as personal and occurs on serious events. Everyday stress is socially perceived as brief and passing. The women in Sweden experienced stress very difficult and as non-manageable. It is socially acceptable to share the experience of stress, but three women perceived the word as overused. The focus was never on how to
manage stress but instead on the experienced stress which in fact can cause a higher experience of stress. Nevertheless, the women experienced stress with major facilitation after receiving help from the health care centre.
The general result can be explained by three types of stressors within the theory of stress. The definition of stress as an interaction between the individual and society can be applied to that all women experience stress more or less within themselves as individuals. The interaction with society means the environmental demands about the norm and values within social networks and society which affect the level and number of stressful situations (Rostila &
Toivanen 2018, p. 255). As the result, the woman emphasizes the stressful consequences of responsibility in everyday life which is connected to stressors of environmental stress. The stressors of individual stress explain the argument of personality as a determining factor for stress. The women highlighted the stress as always present and therefore caused by oneself.
In the end, it is the stress resulting from a transaction between the individual and environment that may or may not result in stress (Folkman 2011, pp. 16-17). The women in Kosovo that experience stress as brief and passing do not only have the personality of coping with stress but also live in an environment where everyday stress is socially agreed as passing and part of life. The women in Sweden and Kosovo with negative stress experience environmental stress because of demands. After professional help for the women in Sweden, the interaction of the individual and society was in balance even though the environmental demands are still the same. The individual stress was more adaptable.
6.1.1. The experienced stress for women in Sweden
The majority of the women define stress as a negative aspect with high expectations of everything being perfect, not manageable and when there is too much going on at work, school, childcare and family. The negativity of stress can be explained by the expectation that everything has to be perfect which is difficult to fulfil. A few of the women did not have the knowledge or understanding of the existence of stress and therefore experienced it very difficult:
“The first time I didn't know it was stress. [...] I was available at my job around the clock, during evenings and weekends [...]. I never connected it with stress symptoms until it was too late. So stress is negatively perceived.” - Interviewee 6.
When the women gave examples of the most stressful situation, they presented moments of longer periods of high strain. Therefore the experienced stress lasted for a longer time. The symptoms were most commonly exhaustion, irritation and sadness. The negative experience affected the children. A few of the women had symptoms of changed behaviour, mood, focus and were not able to relax.
Burnout was a common consequence of the experience of high negative stress for a longer period of time. After the women received professional help from the health care centre, they experienced stress with the facility and it was more manageable. Today the stress is in balance because of the new coping method presented by the professional help. The coping method is used regularly which has developed a more positive interpretation of stress. They have learned to recognize the symptoms of stress, set clear limits and therefore perceived stress more positive:
“I did not know how to cope with stress and got into depression. [...] I decided to change my job and learned how to cope with stress and started with writing an
everyday plan of priorities, and what is most important for me and how I will manage everyday life, so I had to work a lot and fight with myself...”
- Interviewee 1.
According to the theory of stress, when the environmental demands exceed the individual resources, negative stress occurs. This part of the theory explains the primary negative stress felt by these women. They felt the environmental demands regarding everything to be perfect and done in time, which was difficult to fulfil because they did not have enough individual resources. The individual resources can be time and energy in order to take care of the children, go to work and have free time (Folkman 2018, pp. 16-17). The experienced stress of the women was long-lasting because they did not understand, as the example above shows, the consequences of continuing work outside working hours. The long-lasting stress never allows the body to go back to the normalitystage and the symptoms, as mentioned,
exhaustion, sadness and irritation occur. Because of the difficulty to get free from negative stress, it led to burnout for the women. After receiving professional help, the woman felt more positive about stress. They learned methods of how to let the body into the normality stage by doing something they love. This activity stimulated positive stress and they could see a positive achievement (Rostila & Toivanen 2012, p. 241). By doing the activities, decreased the duration of stress and the feeling of negativity decreased (Gurung 2010, p.
102).
6.1.2. The experienced stress for women in Kosovo
The experienced stress for the women in Kosovo varied from person to person, but the majority presented stressful moments with a specific event that lasted for a shorter period of time. The majority of women do not share their stress with others, only with the closest friends or family members in order to find a solution to the stress. The perceived stress was explained as something highly common for women because of the responsibility at the working place and housework. They did not experience the pressure from their social network but they highlighted the pressure from themselves to be a perfect mother that provides love, food and the possibility of education for their children. This pressure was a motive for some of the women to manage stress but for others, the pressure led to high levels of stress. One of the women explained the pressure of not feeling good enough as a mother at the same time feeling independence because of work:
“I have thought of quitting my job a few times because I can't deal with it. But then I remember the support of my colleagues. The job decreases the stress. At home my in-laws support me. When I get home my children have eaten, showered and done
their homework which makes me glad”. -Interviewee 8.
Another woman felt the pressure, but also at the same time, the motive to keep fighting to afford a good education for her children.
The ones perceiving a high level of stress are the majority that did not manage stress well.
The feeling of not being able to finish job assignments at work, housework at home and taking care of the children led to stress. Symptoms of this pressure are chaotic reaction,
crying, not sleeping well and losing focus. Two of the women had a positive view of stress.
They argued that stress has to be accepted as a part of life in order to manage it, and the experience of negative stress is caused by the person itself. If stress is overanalyzed and overthought then it is not manageable. Every stress moment has its solution. They emphasized that the individual is not the only one in this world, but have a family to think about, and there are people with worse circumstances in life. In the end, all women emphasised the importance of conscious or unconscious support and positivity from their workplace and social network to lighten this kind of stress.
The women's experience of feeling stressed in specific situations can be related to the theory of stress. The theory explains the women's stress as not long-lasting and does not always end in negative stress (Rostila & Toivanen 2012, p. 241). The women with a positive view on stress defined stress as brief and manageable. This view evolves a feeling of being able to have control of the situation because the individual resources are balanced with the environmental expectations (Folkman 2011, pp. 16-17). Because of the effect from the surrounding, such as mentioned before, with social support from in-laws and other family members develop a positive perception of stress (Gurung 2012, p. 120). The majority of women that experienced negative stress explained the causes to be the feeling of not being enough. As opposed to the women in Sweden, the women in Kosovo did not emphasize the environmental demands as causing negative feelings. Environmental demands include the expectation of being an ideal woman, mother and employee from their colleagues and social network. Instead, it is the individual demands on themselves of trying to be a perfect mother that causes a motive for some of the women to keep fighting, when others experienced this with difficulty (Rostila & Toivanen 2018, p. 241).
Few of the women that experienced negative stress explained it as not being able to finish all their responsibilities. This can be applied to the environmental demands as the majority of women in Sweden felt this way. The demands of all the responsibility exceeded the individual resources and ended in long-lasting negative stress (Folkman 2011, pp. 16-17).
The women referred to the role of a mother and a woman when they discussed stress. The women felt the pressure of being a mother at the same time as feeling guilty of working. This
