‘It's just the nature of the work’: Barriers and enablers to the health and well‐being of preconception, pregnant and postpartum working women in a community service organisation

Abstract

Poor lifestyle practices, combined with excess weight gain and weight retention during the preconception, pregnancy and postpartum periods can increase health risks for mothers and their children. Little is known about how workplaces impact the health and well‐being of women of child‐bearing age, particularly across work roles and settings. This qualitative descriptive study explored the enablers and barriers to the healthy lifestyle practices and well‐being of women of reproductive age within an Australian community services organisation by capturing the perspectives of both the women and workplace executives. Eleven interviews were conducted with executives (n = 12), and three focus groups and three interviews were conducted with women (n = 16). Data were thematically analysed, and six main themes were identified: blurring of the role and work environment, clarity and equity in policy and entitlements, the nature of community services work, individual responsibility for health, tiered levels of support and a management‐driven culture of awareness and support. Barriers included high‐stress roles, work targets, sedentary work behaviours, lack of clarity around policies, funding and the emotional labour associated with community services work. Hands‐on leadership, open communication, work relationships, resourcing and manager training were identified as facilitators. While findings indicate agreement between executives and the women, many executives focused on the challenges associated with pregnancy in the high‐risk workplace environment and did not perceive specific barriers for those in non‐frontline roles. Management education to generate an understanding of women's needs during this life stage and increased resourcing to facilitate workplace well‐being would be beneficial.

What is known about this topic?

• Workplaces can present particular challenges to the healthy lifestyle practices and well‐being of women, particularly during the preconception, pregnancy and postpartum periods.

• The community service sector is heavily dominated by women and has high rates of turnover, heavy workloads and exposure to abusive behaviours.

What this paper adds?

• Key barriers in the community services sector include the perceived incompatibility between high‐intensity work roles and the flexibility needed for caring responsibilities.

• Tiered supports, including government funding, organisational policies, management understanding and supportive work relationships, are needed to coordinate the health and well‐being of women during this life stage.

1. INTRODUCTION

Women of child‐bearing age are increasingly presenting with high body mass indices, poor lifestyle practices and chronic conditions (e.g. diabetes or hypercholesterolemia; Barfield & Warner, ²⁰¹²; Madden et al., ²⁰²¹). For women who have children, approximately half will gain excess weight during pregnancy and up to 73% will retain extra weight into the postpartum period, thus conferring increased risk of adverse mother and child outcomes (e.g. caesarean section or macrosomia; Goldstein et al., ²⁰¹⁷; Hollis et al., ²⁰¹⁷). While many previous studies explore the health of preconception, pregnant and postpartum (PPP) women, including within the primary care setting (Walker et al., 2021), few details the importance of workplace involvement in the health and well‐being of employed women. This may be due to the tendency to separate occupational health from broader public health research (Ahonen et al., 2018), or indeed, a disjoint between occupational health and pregnancy, which is typically the remit of the healthcare system. In our previous qualitative study, we examined the barriers and enablers to the healthy lifestyle behaviours, weight management and well‐being needs of working women during the preconception and pregnancy periods within an Australian university setting (Madden et al., 2021). However, these findings were highly contextual and do not necessarily translate to other university settings or workplaces. The extent to which the health and well‐being of PPP women vary according to their workplace or setting remains to be determined.

Community service organisations provide support and services for the benefit or welfare of community members with specific needs or vulnerabilities (e.g. age or socio‐economic disadvantage; Australian Taxation Office, ²⁰¹⁷). In Australia, the sector is heavily dominated by women and workers are an average age of 42 years old (inclusive of the older aged‐care employee demographic; Australian Institute of Health and Welfare, ²⁰²¹). Services include foster care, out‐of‐home care (OoHC), specialist schools and homelessness support services. The sector faces numerous challenges, not limited to a societal undervaluation of care work, including high staff turnover, workforce casualisation, high levels of work‐related injury or illness, heavy workloads and finite resources (Australian Bureau of Statistics, 2018; Cortis & Blaxland, ²⁰¹⁷). The work role can be emotionally demanding, with many of those engaged in social work reporting exposure to negative behaviours or abuse while working (Ravalier et al., 2020). However, while previous literature indicates that these challenges may contribute to employee stress, dissatisfaction and burnout (Ravalier et al., 2020), there is little research to illustrate how community service workplaces may impact the healthy lifestyle practices and well‐being of women across the PPP periods. This is notable, given the high number of women of reproductive age engaged in this sector, the considerable work demands and, from an employer's perspective, the potential for decreased staff retention, loss of valuable knowledge and skills and the impact on the service user (Healy et al., 2007). Therefore, the aim of this study was to fill this gap by exploring the enablers and barriers to the healthy lifestyle practices and well‐being of PPP women within a community services organisation by capturing the perspectives of both PPP women and their employers.

2. METHODS

2.1. Study design

This qualitative descriptive study was conducted with MacKillop Family Services, a community service organisation that provides foster and kinship care, residential care, family support, alternative education and homelessness and disability services in New South Wales, Western Australia, Australian Capital Territory and Victoria, Australia. MacKillop employs 1400 staff in metropolitan and regional centres across Australia, led by an Executive Team of 17. The present study was part of a larger mixed methods project to create a workplace‐specific intervention to improve the health and well‐being of women employees across the PPP periods. A pragmatic approach was adopted to understand the ‘who’, ‘what’ and ‘where’ of participant experiences. Focus group participants and a human resources (HR) representative were invited to review the current paper to enhance the validity of the findings. Social sciences or health sciences researchers experienced in qualitative research methods were involved in all aspects of the study. This study was approved by the Monash University Human Research Ethics Committee (Project ID: 26934).

2.2. Participants and recruitment

Employees: All individuals self‐identifying as women, aged 18–45 years, employed at MacKillop Family Services were invited to participate in a focus group or 1:1 interview session. Sixteen participants (13 participants in three focus groups and three 1:1 interviews) were recruited via an expression of interest email sent by HR and via poster advertisement circulated across the organisation. Targeted expressions of interest were also distributed to the pride, disability, education and reconciliation action plan (Aboriginal and Torres Strait Islander communities) groups and to all employees on maternity leave between December 2020 and March 2021. Explanatory statements and consent forms were emailed by the researchers to women who expressed an interest in taking part.

Executives: Executive group participants were proposed by HR and management. Thirteen executives received an invitation to participate in an interview from an HR representative, along with an explanatory statement and consent form. Agreement and consent to participate were given directly to the researchers. Twelve executives participated in the interviews.

2.3. Procedure

Employees: Demographic information was collected prior to the focus groups and interviews via an anonymous online Qualtrics questionnaire. Work and Well‐being focus groups (n = 3) and interviews (n = 3) were conducted online with 16 MacKillop women employees, aged between 24 and 38 years, during February–March 2021 using Zoom (Zoom Video Communications Inc, 2021). Focus group sessions were facilitated by two researchers (BH and SKM) and interviews were facilitated by one researcher (BH). Researchers had no prior relationship with participants. Sessions were informed by the semi‐structured employee question schedule (Table S1) and lasted 35 min to 1.5 h, with longer timeframes provided for focus groups compared to interviews. Discussions explored PPP health, health objectives and initiatives, work and health and a workplace portal for PPP women.

Executives: Executive group interviews (n = 11) were conducted online with 12 members of the MacKillop executive team from December 2020 to January 2021 using Zoom. Interview schedules were emailed to executives in advance of the sessions (Table S2), and interviews were facilitated by one researcher (BH or SKM). Interviews lasted between 21 and 38 min. Discussions explored executives' work roles, a workplace portal for PPP women, and barriers and facilitators to the health and well‐being of PPP women working at MacKillop.

All sessions were audio recorded via Zoom and transcribed using Otter (Otter.ai, 2021; Zoom Video Communications Inc, ²⁰²¹), with transcripts checked for accuracy by SKM. Field notes were taken during all sessions.

2.4. Data analysis

Data analysis was guided by the six phases of thematic analysis (Braun & Clarke, 2006) to determine the barriers, enablers and needs specific to the health and well‐being of PPP women at MacKillop, as perceived by employees and executives. Two researchers (SKM and CB) met via Zoom to discuss the research question and strategy for analysis. Both researchers independently coded and recoded one focus group and one executive interview using NVivo (QSR International, ²⁰¹⁰). Discrepancies were resolved by comparison and discussion of code properties. The remaining data were coded and arranged according to ‘barriers’, ‘enablers’ and ‘needs’. Codes were then grouped together to form overarching themes by SKM, before being reviewed by CB and the rest of the research team.

3. RESULTS

3.1. Participants: Employees

The mean age of the employees was 31.5 years and 12 employees had children (Table 1). Employees worked in a variety of roles across the organisation (e.g. OoHC and education), and 11 employees worked full‐time (69%).

TABLE 1.

Demographic information of preconception, pregnant and postpartum employees (N = 16)

Variable	Participants
Age, mean (range), years	31.5 (24–38)
Children, n (%)
Yes	12 (75)
No	4 (25)
Number of children
Mean (range)	1.4 (1–2)
Median	1
Workplace role, n (%)
Education	3 (18.75)
Out of home and home‐based care	5 (31.25)
Support, disability and family and community services	5 (31.25)
Other (family focus multisystemic therapy, family preservation and reunification response)	2 (12.5)
Not stated	1 (6.25)
Employment status, n (%)
Full time	11 (69)
Part time	4 (25)
Not stated	1 (6)
Location, n (%)
Victoria	14 (87.5)
New South Wales	2 (12.5)

3.2. Participants: The executives

Executive participants consisted of nine women and three men, and six reported having children (Table 2). In terms of participant characteristics, executives had varying understanding of the needs of their PPP employees, for example some executives discussed how few members of their team had been pregnant and others felt they were not up to date with current medical recommendations to support health during the PPP periods. Executives also expressed concern around maintaining well‐being of PPP employees in a crisis environment and the difficulty in not knowing whether employees were either planning a pregnancy or currently in the early stages of pregnancy.

TABLE 2.

Demographic information of the executives (N = 7) ^a

Variable	Participants
Age, mean (range), years	53 (47–65)
Children, n (%)
Yes	6 (85.7)
No	1 (14.3)
Number of children
Mean (range)	2.4 (2–3)
Median	2
Employment status, n (%)
Full time	6 (85.7)
Part time	1 (14.3)
Location, n (%)
Victoria	6 (85.7)
Western Australia	1 (14.3)

^a Five of the 12 executive participants did not complete the demographic questionnaire.

3.3. Themes

Barriers and enablers to healthy lifestyle practices and well‐being were developed and organised into six main themes. Theme three, ‘The Nature of Community Services Work’, also had two sub‐themes.

3.4. Barriers to employees' perspectives

3.4.1. Theme 1: Blurring of the role and work environment

The blurring of the role and work environment theme described the intersection between the role of employees and their work environment, and how the two affected healthy lifestyles and self‐care practices, and well‐being (Table 3). Many employees spoke of the emotional demands placed on them by exposure to a high‐stress work environment. Some described the needs and experiences of the families and young people they worked with as overwhelming and how this left them worried or anxious on a daily basis. Others discussed how constant pressure meant they operated in a reactive space and how this could easily lead to burnout.

TABLE 3.

Barriers to health and well‐being

Themes and sub‐themes	Barriers	Representative quotes
Preconception, pregnant and postpartum (PPP) employees
Theme 1: blurring of role and work environment	High‐stress and high‐pressure roles Managers feel they need to absorb team stress Requires commitment and flexibility Emotionally demanding Minimal downtime and breaks Personal connection to service users and families results in emotional stress or concern Not being able ‘to switch off’ Feeling guilty for prioritising yourself (gendered associations) Duty of care to perform the role Work targets and expected outputs Heavy workloads Hotdesking (where individuals have use of a desk as needed or on a rota system, rather than having a desk of their own) affects ergonomic setup Role incompatibility with pregnancy and parenting Long periods of sedentary behaviours Unhealthy coping mechanisms Activities to relieve stress may have the opposite effect Quality of available food in residential care	I think maybe on three occasions staff said to me, ‘do you have kids?’ And I said, ‘no’. ‘No, of course, you couldn't, you wouldn't have kids … with the role that you do’. And I was quite taken aback by that … [and] that put it in my head that I couldn't have kids, because the work is so demanding. (Interview 1) If you're doing this type of work, it's not sustainable, because of the requirements put on you. And I guess it's always the majority women in this work and majority women with children, the requirements put on you to meet the targets set by the funding agencies aren't realistic. (Interview 2) I've worked before with a family … with a 17‐year‐old who's miscarried quite late. And we were, I was pregnant at the same time. And I was really anxious about how that 17‐year‐old would feel, once she started to see my bump growing … and that I would lose that relationship. (Interview 1) The pressure comes from … a lot of further up the chain than just my manager … the pressure's coming from maybe not even just MacKillop, but external to MacKillop. And … [the] school's only available this day, child protection's only available this day to do meetings … there's not a lot of flexibility. We're the ones who were expected to be flexible with all the other organisations because of our roles. (Focus Group 2) It almost feels like when work is difficult, everyone starts to eat badly, everybody stops exercising. So you can always tell the pattern is coming … (Interview 3) When I came back with my first, I actually didn't return to out of home care, I went into another area of MacKillop, which I think was … the best decision for being a working mum. (Focus Group 3) I feel limited in how much time I could take for those sorts of activities. And even if it was sanctioned by the organisation, unless somebody was backfilling the work that needed to occur, I would feel guilty about not doing it. (Focus Group 2)
Theme 2: clarity and equity in policy and entitlements	Some supports are not well advertised Not knowing about a policy or support Not being offered information about a policy or support No written policy (e.g. returning to work) Entitlements linked to role type (e.g. paid maternity leave) Entitlements/policy interpretation varies between managers Gap between policy and practice Inconsistent access to resources (e.g. standing desk) Funding cuts Team‐driven initiatives	There are some managers who are way more rigid around that, you know, you've taken that time, and it's going to be as your sick leave … I've had experiences with other managers who were like, ‘no, you can make up that time.’ And that's way less stressful … I can make up that time when I put my kids to bed, or whatever. So I think that really impacts on your experiences of being pregnant in the workplace. (Focus Group 3) All the little things like, when do I apply for maternity leave? Who can I speak to for maternity leave? And what are my options? … And I never even knew that I could take half pay and be off for longer … I never even knew that was an option … because it sits in HR in a file somewhere in a folder and in a policy. (Interview 1) Certain teams do it better than others … certain teams are sort of more cohesive, and like supportive groups, and others, I guess, are more solo working or yeah, just don't have that team environment. (Focus Group 1) If you're only getting 6 week's pay, I guess people might come back way before … they're ready. And then not be able to sort of function in both aspects of their life and feel like missing out emotionally on important milestones and things like that as well. (Focus Group 1)
Executives
Theme 3: the nature of community services work	Occupational violence Physically demanding roles High stress 24–7 environment Emotional labour of role Exposure to traumatic incidents	The needs of someone, who's you know, an expectant mother in our finance department, the need is going to be different from the expectant mother who's working overnight shifts in a residential care house. (Executive Interview 10) A lot of the services we provide are quite high risk for pregnant women … But what often happens in practice is that when someone is pregnant in a role like that, it actually becomes quite unsafe for them to be in that role. So we have to look at redeploying them into something else. (Executive Interview 7)
Subtheme: selfless work	Altruism of employees Heavy workloads Working after hours Not taking breaks Taking work home Not taking holidays or leave Giving priority to crisis and emergency situations	When you're working in the out of home care sector, I think staff do feel a strong sense of obligation to … fill in work overtime, not take breaks, not take up holidays, because of the high risk, high reactivity, the burden of … caring for the most traumatised kids. (Executive Interview 9) It's a double‐edged sword that this sector kind of often attracts the kind of altruistic types out there … there's people that … want to work to better others. And I think that … the sharper end of that, is that sort of self‐sacrifice, self‐silencing, and the sort of emotional labour that's put on the back burner of the work … it's a bit of a well, my needs are subordinate to the … horrible circumstances of the people I'm working with. (Executive Interview 9) We sometimes work in very pressured crises, with limited resources … that it kind of confines us just to the basics. It's like mental hierarchy … that their minds that time can go to the next level of flexibility because there's such a crisis happening. And I think that is probably the nature of … Community Services … We hear about [miscarriages] where staff, and they're back on shift again, you know … if you've carried a baby for a period of time, and you lose your baby, the implication that you had mentally and how you could struggle … (Executive Interview 12)
Subtheme: limited resources	Limited workplace support for PPP employees Well‐being HR staff are stretched ‘Extra’ supports rely on individuals to organise Policies to optimise employee health and well‐being are lacking HR is predominantly reactive Approach to well‐being is limited to the ‘basics’ Government funding Limited resources	We would have to have structural policies set so that if someone was having to go to in vitro fertilisation (IVF) treatment, or whatever [what] might be the right way through that … Or are they going to have to take sick leave every time they do that? And how can that be negotiated? And is there space for that to maybe negotiated? (Executive Interview 6)
Theme 4: individual responsibility for health	Personal choice Lack of knowledge about nutrition or smoking Poor coping mechanisms Unhealthy habits Too busy Lack of self‐efficacy	Sometimes it's knowledge, sometimes it's attitude, sometimes it's time poor. You know, knowledge around good nutrition, they might be smoking, they might be drinking Coke, instead of water, you know … they might be overweight. And so nutrition. So using food to comfort as compensation … compassion fatigue is real, secondary PTSD is real … our staff are vulnerable to that. So, sometimes the maladaptive coping strategies [they] have had at the point of conception and pregnancy, you know, it's really important … (Executive Interview 5) I guess I'm a fairly health‐conscious person too … And I exercise every morning and walk twice a day as well and swim and things like that … Wellbeing is about keeping yourself, looking after yourself. (Executive Interview 11) You just have to cope with the, you know, the usual things that come up, you know, morning sickness, that continues for the length of the pregnancy, where they feel quite unwell, tiredness, juggling I think as well as a demanding job. Often some will have chocolate, so those basic life balance issues. (Executive Interview 7)

Some employees mentioned that their own pregnancy or family life could instil feelings of guilt or anxiety when presented with the loss and grief of those in their care, for example when a service user experiences a termination, miscarriage or death of a child. Employees also spoke of how they could be exposed to physical danger or to their clients' trauma, in the form of family violence and sexual assault. Despite the emotional demands of the role, some employees felt guilty when taking a sick day or ‘mental health day’. One employee maintained she had a duty of care to support service users through crises and to meet their needs, despite the personal mental health costs.

There's really high burnout in this area of work … It's not … something that you can say, I will not do it, because there's a vulnerable person needing your support. You cannot just turn off your computer if a client's having a crisis in front of you. You … have a duty of care to perform your role (Employee, Interview 2)

Several employees iterated how pressures relating to work targets and expected outputs were often driven by multiple external stakeholders including government bodies, schools and volunteers. Employees felt that expected outputs, particularly within the OoHC sector, were often unrealistic, with targets exceeding standard work hours, norms around responding to crises on days off and limited scheduling flexibility.

In some instances, employees discussed how periods of stress or exposure to challenging circumstances at work impacted their coping mechanisms and led them to make unhealthy food choices or exercise less. Employees also mentioned how the work environment could be quite sedentary, requiring long periods of time spent driving or sitting at a desk, and how limited budgets, shift work or access to less healthy foods in residential care contributed to unhealthy eating behaviours. Similarly, the incorporation of well‐being (e.g. walking meetings) into common work tasks (e.g. supervision meetings requiring documentation) was perceived as challenging. Several employees noted that workplace well‐being activities to alleviate stress could often have the opposite effect, as they did little to lessen their workload.

Multiple employees spoke of the difficulties around taking breaks at work. Most viewed lunch breaks as a ‘bonus’ and felt that there was little opportunity to take time for lunch. Some worked through lunch to have the flexibility to pick up their children after work, others discussed how they worked solo night‐time shifts, had back‐to‐back meetings or how they were occupied with young people all day. One employee mentioned how these challenges impacted her ability to express at work.

Some employees questioned whether certain work roles within MacKillop were compatible with pregnancy or parenting. They discussed how the crisis orientation of the work could be challenging for mothers who may not be able to respond to situations immediately, out of hours or on their days off; how colleagues had stated that OoHC was not conducive to having children; that stress associated with their role or environment may inhibit conception or IVF success and how the work may not be sustainable for those with children. Two employees had left their jobs in OoHC as they could not envisage adapting their roles to their changed circumstances.

3.4.2. Theme 2: Clarity and equity in policy and entitlements

The clarity and equity in policy and entitlements theme identified how many employees felt policies and entitlements were either unclear, unavailable or applied inequitably. A number of employees felt that they were unaware or uncertain of policies and entitlements relating to working from home, parental leave, returning to work, miscarriage and well‐being activities. In some instances, employees discussed how supports were not always well advertised (e.g. check‐in days during parental leave) that they were unsure of where to find a particular policy, or that nobody had communicated the availability of policies or entitlements to them. Several employees spoke of a gap between policy and practice within the organisation. Employees perceived that a lack of clear policy guidance for management or the inaccessibility of policies may contribute to this gap. Some employees emphasised that although they felt supported by their manager, an absence of clarity around policy and entitlements made them unsure whether their PPP requests were reasonable.

I'm pretty sure anything I would have asked my supervisor for she would have said yes … But I have to ask, and sometimes that can be a barrier because you don't want to be a pain … you don't want to be overstepping in what you asked for … (Employee, Focus Group 2)

A number of employees discussed the variability of access to initiatives or entitlements across the organisation. Some employees felt that management often varied in their response to requests for flexibility (e.g. attending pregnancy appointments), with some indicating that employees take the time as sick leave and others allowing their employees to make up for lost time. Several employees mentioned that access to workplace health and well‐being initiatives was often dependent on the individual manager or team, rather than organised centrally through HR or a particular policy.

Employees also discussed how parental leave entitlements varied across the organisation, depending on the work role. Although employees were entitled to a year of unpaid parental leave, paid parental leave within the organisation varied from 6 weeks to 3 months at full pay. Upon hearing of the difference, one employee remarked, ‘that's amazing, I should change my job’. One employee spoke of how financial pressures removed the choice of taking longer parental leave, whereas other employees remarked that inadequate leave could affect postpartum health goals or cause them to miss out on important milestones in their child's development.

3.5. Barriers from the executives' perspective

3.5.1. Theme 3: The nature of community services work

This theme described the inherent traits of the wider community services sector and how these pose challenges to health and well‐being. Two subthemes were constructed within the main theme: ‘selfless work’ and ‘limited resources’.

As with the PPP employees, executives perceived that the work environment and work role presented specific challenges to the health and well‐being of employees. Barriers included exposure to occupational violence and high‐risk environments, particularly for pregnant women; the high‐intensity, 24–7 environment and exposure to emotionally distressing or potentially triggering circumstances. However, these barriers were typically framed as intrinsic to the community services sector, rather than specific to the organisation. Within this framing, it seemed that difficulties were unavoidable and inevitable. Indeed, many of the proposed solutions focused on either removing the woman from the challenging setting through redeployment or helping staff to cope by providing programs to help process trauma. Further, roles separated from ‘frontline’ services, that is office workers, were not seen to present any specific barriers to the well‐being of employees. When questioned about barriers for these employees, one executive replied that ‘nothing comes to mind’ (Executive Interview 2).

Subtheme: Selfless work

Executives emphasised how the sector attracted and fostered the altruistic nature of employees, which led them to make personal sacrifices for their job. Executives often spoke of how emergencies and crises took precedence over everything else, and that workplace culture involved going the extra mile and giving ‘all’ to your role. Executives discussed how employees would work after hours, not take breaks, take work home and not take holidays to prioritise the needs of those they worked with rather than themselves. Executives acknowledged that there was a human cost to this, where employees' own well‐being, emotional needs during pregnancy and work–life balance were sidelined to look after the children and families in their care.

So we have this culture of … you give everything … people are really passionate and … when people work really hard at MacKillop … often people are saying, ‘I'll just stay behind and do that’ … but … it can impact on your work‐life balance. (Executive Interview 6)

Subtheme: Limited resources

Executives discussed the barriers and implications of limited funding, staff resourcing or policy gaps. Several executives spoke of how finite government funding contributed to a more highly pressurised environment with limited resources. It was felt by some executives that this limitation confined workplace well‐being ‘just to the basics’, which in turn presented challenges when asking employees to respond appropriately to workplace crises or when combining their own personal circumstances (e.g. miscarriage), with work.

The HR well‐being response was perceived as often ‘reactive’, rather than having the scope to focus on more holistic and ongoing aspects of health promotion, such as education and awareness. One executive suggested the need to further employee health and well‐being, rather than rely on current ‘broad brush’ approaches, that is the employee assistance program, and another spoke of how HR well‐being staff were ‘stretched’ and how this may limit protection against workplace stress. Executives also discussed how policies to optimise well‐being or those specific to pregnancy were often indicative of ‘permission’ rather than support and spoke of how they could be better clarified,

I'd go back to policy again, because you know, having some set, these are the expectations that we have of all executives or all managers not just hoping that people are being nice. (Executive Interview 6)

Policy gaps led to a reliance on individual management and interpretation of procedures (e.g. payment of sick pay), and provision of extra supports, such as celebrations.

3.5.2. Theme 4: Individual responsibility for health

Several executives put forward the perspective that the individual is responsible for their own health practices and that poor healthy lifestyle behaviours were the result of limited skills or personal choices. Some executives mentioned that unhealthy habits or patterns, such as comfort eating, were employed as a means of coping with vulnerabilities or emotionally demanding workplace challenges. One executive described how their own choices and identity drove their healthy lifestyle practices and that of their children.

Some executives discussed how a lack of knowledge or attitudes could impact diet or smoking behaviours and others suggested that busy lifestyles and ‘basic life balance issues’ could contribute to these behaviours. One executive suggested that supervisors may not wish to discuss unhealthy coping mechanisms with staff as lifestyle and self‐care issues seemed to be more of a ‘personal’, rather than a ‘professional’ matter.

Sometimes it's a barrier, that people are a bit scared to go there, if somebody is overweight, or drinking too much … smoking half of the day or whatever, that that seems to be personal, rather than part of the supervisory professional sort of dialogue … (Executive Interview 5)

3.6. Enablers from preconception, pregnant and postpartum employees' perspectives

3.6.1. Theme 5: Tiered levels of support

The tiered levels of support theme explored how employees might benefit from multiple sources of support for their health and well‐being, including policy, management, social relationships and funding (Table 4).

TABLE 4.

Enablers to health and well‐being

Themes and sub‐themes	Enablers	Representative quotes
Preconception, pregnant and postpartum (PPP) employees
Theme 5: tiered levels of support	Organisation or policy‐level support Hands‐on leadership to support well‐being Acknowledgement and understanding from management Communication with management and leadership Providing ‘space’ for well‐being at work Access to healthy food and exercise opportunities Well‐being funding Positive team relationships Colleague relationships	What was helpful was having a handful of female staff that I could speak with early on, staff that I could speak confidently with and know that they would support me, if needed. And rather than having to share it with people, like your line manager … and that's fine to do, but having people that day to day, can check in on you or make sure that everything's okay or just to know that you're being supported. (Interview 1) [My manager] was actually really supportive and … did whatever she needed to do to ensure that I could have a space to breastfeed and take those breaks without feeling bad that it was impacting on my work. That I needed to take … a half an hour break in the morning to be able to express and a half an hour break in the afternoon to be able to express to maintain my supply. (Focus Group 3) …for example, I'm doing IVF. So, I guess just support in terms of knowing I've had a really hard week, something has gone wrong, I don't want to go to work, or … I need a break from my shifts, or I need to stop working nights, can I work days? Just sort of like that support knowing that, that's available, that communication is open. (Interview 3) I was the third or fourth pregnancy in as many years in our office, so I've had colleagues similar age [to] me who have … had their pregnancy … gone off on maternity leave and returned. To be able to have those informal conversations … around ‘should I ask my supervisor’ … ‘Do you think this is okay?’ … I suppose I was very lucky to have all those conversations in our office … one of my colleagues came back maybe 2 or 3 months before I went on leave, and just chatting to her about the process of coming back to work. I'm feeling a lot more confident with that. (Focus Group 2) I guess it's sort of like that halfway between the things that you can do at home, but the things that you kind of have to be aware of also at work, like in terms of eating healthy, having access to breaks if you need them, having access to longer breaks, like … food, break, resting, sleeping … having those personal things as well, at work … and enough time to have a proper break to sit down and eat nutritious [food] … (Interview 3)
Executives
Theme 6: a management‐driven culture of awareness and support	Providing access to tangible supports (e.g. support for loss a grief during pregnancy) Resourcing to support well‐being Commitment and genuine desire to support staff Focus on the Sanctuary Framework Mindfulness of how work stress or health concerns impact staff Understand that PPP may aggravate mental health concerns Managers understand their role in supporting PPP women Open communication with staff Linking staff to the health and well‐being team Facilitating connection and belonging Catch‐ups with staff Listening to needs Drawing on personal experience of PPP or raising a family Modelling health and well‐being‐related behaviours Manager education and training (e.g. mental health first aid) Believing that women's health is important Ensuring workloads are fair and reasonable	I think that education, awareness, but then also practice and policy, to give the framework for managers to be able to provide those options of what can be available for employees and to be able to give them, you know, direction towards information, as well … It's not just about pregnancy it's about the holistic version of this person. And I think, ‘what are our leaders within that?’ Being broad in their way of looking at adaptability and flexibility around these situations. (Executive Interview 13) Focus sessions where people come together … We're great at coming together at MacKillop and having community meetings or … you know the community of practice and then we've got little hubs, where we come together and get together and yarn … to just talk about what's important. People would appreciate that. People love that, actually. (Executive Interview 2) I think that's part of the culture generally here … it's possibly part of Sanctuary … which really does create a culture of openness, in terms of, you know, open communication and social responsibility, and I think people just generally feel comfortable having those conversations that might be considered tricky or off limits in other workplaces. (Executive Interview 4) I guess being a bit proactive in this area, as somebody who's, you know, has worked most of my life and had a family so has been through been through these issues and pretty successful and done that whole family, family, and work life balance while maintaining a healthy, a healthy life. And a happy life. (Executive Interview 2) We need to look after our people … There are so many levels that if you can get [in] early [into] the preconception and pregnancy and then postpartum phase and that transition into parenthood going well, you set people up for a lifetime. (Executive Interview 5)

Many employees commented on the value of team initiatives and colleague relationships. Team initiatives, such as having lunch together, yoga, morning teas, grounding exercises or self‐care discussions at meetings, barbecues, informal meetups and keeping in contact with colleagues on leave, were considered important aspects of team well‐being, achieving ‘balance’ and maintaining the connection to others. Some employees felt that integrating well‐being into existing workplace processes (e.g. incorporating well‐being into team meetings) was important to encourage participation and to alter the perception that well‐being was an extra ‘task’.

Several employees indicated that their colleague and team relationships helped navigate their pregnancy or postpartum needs with work and that knowing other women in the organisation who have gone through pregnancy helped set expectations and assisted with the return to work. It was felt that connecting with other women with children helped to create excellent working relationships.

All employees remarked on the important role played by MacKillop leadership or management. Employees discussed how organisation‐level support and entitlements such as clear policy guidance (e.g. attending pregnancy appointments), access to flexible working arrangements (e.g. attending IVF appointments, miscarriage, caring for children), support with return‐to‐work (e.g. children often become sick in childcare, breastfeeding support, awareness of needs during the transition) and providing access to well‐being opportunities (e.g. healthy foods in residential homes, funding for exercise classes and to support the purchase of healthy foods, removing unhealthy foods, being able to participate in physical activities offered to the young people in care) could facilitate their needs. Some employees also spoke of the need to create a ‘space’ for well‐being at MacKillop, where employees not only had access to opportunities but were actively encouraged to avail of them. Further, it was felt that employees should also be able to continue with their personal health needs at work, for example having access to proper breaks to sit and eat healthy food or maintain physical health.

3.7. Enablers from the executives' perspectives

3.7.1. Theme 6: A management‐driven culture of awareness and support

The final theme, a management‐driven culture of awareness and support (Table 4), examined how management and executives at MacKillop might enable and support the health and well‐being of their employees.

Executives discussed how open communication fed into workplace culture and allowed employees to feel their needs were acknowledged, facilitated connections beyond normal collegial interaction and provided protective mechanisms against workplace stress. It was felt that having open conversations and ongoing catchups with staff enabled them to ask for support when needed, including when having discussions that may be ‘off limits’ in other workplaces.

Several executives talked about the significance of making employees feel valued and spoke of their commitment to caring for employee well‐being. Some executives demonstrated awareness of the specific challenges that working pregnant women might face, for example the potential for pregnancy to aggravate existing mental health issues. Executives emphasised that MacKillop was a family friendly and supportive workplace, that took a holistic and genuine interest in employee well‐being.

I think we came up with a really holistic service … it's the only place I've ever worked with, where I feel there is a genuine desire to support staff wellbeing … it feels very personable … (Executive Interview 6)

There was an awareness among some executives that MacKillop was ‘very much a female workforce’, with specific needs. The executives felt that management had to understand and address these needs by not putting too much pressure on staff, making sure workloads were reasonable, demonstrating awareness of pregnancy experiences (miscarriage, IVF, or the return to work), being aware of their own responses to pregnancy announcements, modelling the importance of health and well‐being and preparing leaders in mental health first aid. Several executives also drew on personal experiences of pregnancy or parenting as a means of understanding the needs of PPP MacKillop employees.

Finally, executives felt that they had the responsibility to provide access to meaningful support to assist staff with their health and well‐being. This support may have been in the form of generating awareness and knowledge of supports, including information on healthier lifestyles, the impact of stress and how to manage, organisational entitlements, training or PPP amenities; or through access to tangible resources, such as therapy, mindfulness practices, self‐care plans, HR employees to support well‐being, supports to deal with grief and loss, maternity leave, dedicated staff spaces for reflection or PPP needs and adequate resourcing to promote well‐being. Several executives spoke of how this approach would not only benefit employees but also future generations and the young people in their care.

4. DISCUSSION

This research explored the barriers and enablers to healthy lifestyle practices and well‐being for PPP women working at an Australian community services organisation. Notably, we sought insight from both workplace executives and PPP employees. Employees and executives perceived value in fostering well‐being in the form of open communication, connection and by accommodating life stage‐specific requirements for PPP women. Employees also raised the importance of multilevel supports for health and well‐being, including clarity of policy and entitlements, funding, leadership and team and colleague relationships.

Although there was a considerable alignment of themes between participant groups, there were some notable differences in perspective between the employees and executives. While both groups understood the difficulties of the work environment, executives often presented individual choices and attributes (e.g. selflessness or skills), as the main drivers of whether health and well‐being were prioritised by employees. Conversely, many employees emphasised how to work structure, scheduling and demands affected the choice to take a break, attend to PPP needs or avoid unhealthy lifestyle practices at work. Previous research with employers across several Australian workplaces revealed similar perspectives, whereby employee health was primarily considered through the lenses of occupational health and safety and individual responsibility (Pescud et al., 2015). Further, where employers did view the workplace as having responsibility for employee health, mental health and lifestyle practices were assigned a lesser status compared to occupational safety (Pescud et al., 2015). It is possible that the framing of ‘choice’ in the workplace may obscure the extent of organisational influence on the health and well‐being of employees and narrow the capacity of employers to address problems appropriately. Shifting from individual responsibility to an ecological approach to well‐being for PPP working women is likely a key area for health improvement (Hill, 2021).

Similarly, executives tended to perceive workplace challenges as sector‐wide rather than being specific to MacKillop, thereby emphasising the limitations of intervention and potential problem solving and highlighting the need to explore optimal methods of sector‐wide improvement. Certainly, research indicates that child protection workers experience high levels of work‐related stress, heavy workloads and excessive job demands (Johnson et al., 2019). An English longitudinal study conducted with social workers also indicated that job stress could be influenced by role, with caseload and workplace culture contributing to job stress for frontline staff and management, respectively (Johnson et al., 2019). In the present study, the extent to which the health and well‐being of PPP employees were differentially affected by the specific workplace, setting, role or sector is not entirely clear. For example, heavy workloads may have been driven by underfunding, workplace culture or a combination of the two. However, the willingness of the employees to accept the challenging nature of some community service roles was decidedly low, as evidenced by many questioning the compatibility of the work with PPP needs (e.g. conception or parenting). Employees spoke poignantly about the risk of burnout and the fact that so many indicated an inability to prioritise self‐care behaviours at work should be a concern. These factors take a toll on the psychological, emotional and physical health and well‐being of PPP employees and can detrimentally impact the health and well‐being of their children. For example, there is clear evidence of the association between maternal stress during pregnancy, fetal development and later risk of child psychopathology (Glover et al., 2018). Further, research indicates work factors may contribute to turnover, degradation of knowledge and skills at the frontline, recruitment challenges and impacted service delivery to vulnerable community members (Healy et al., 2007; Ravalier et al., ²⁰²⁰).

Both groups referred to the female‐dominated workforce and how this predominance extended to the leadership team. However, executives tended to focus heavily on the needs of pregnant women, specifically, over those with preconception, postpartum or parenting needs. This was likely due to concerns over the increased risk to pregnant women when exposed to occupational violence and the difficulty and uncertainty associated with accommodating their needs with limited resources. The view that only front‐line PPP staff faced particular workplace barriers to health and well‐being likely reflected this. Conversely and perhaps due to the fact that many of our participants had children, PPP employees spoke less of concerns over workplace violence and pregnancy and more about how the rigid work structure impacted their need for flexibility. While our previous research also highlighted the importance of flexibility for PPP working women (Madden et al., 2021), the structuring of child protection work, including low control over decisions and workflow, limits access to this essential workplace entitlement and contributes to poor retention rates and work stress (Healy et al., 2007). The present research also suggests that the return‐to‐work period is an especially salient time for many women, in terms of work–family integration and readjustment to their work role. Research has indicated that the return‐to‐work is a stressful time for working women and that women may be more inclined to feel guilty for prioritising family over work, compared to men (Arena et al., 2021). Specific supports to assist PPP employees with the transition (e.g. preparation towards the end of parental leave, management support, reduced work hours, greater flexibility, re‐induction and confidence‐building activities) would likely be beneficial.

4.1. Strengths and limitations

Strengths of this research include the review of this paper by MacKillop participants to support the validity of our results. Including both PPP employees and MacKillop executives often provided unexplored insight (Pescud et al., 2015) and allowed us to compare the perspectives of both groups. This paper fills a gap by exploring the perspectives of PPP employees working in a community services organisation, thereby helping to uncover setting and role‐specific influences on health and well‐being. However, there were also some limitations to this study. While MacKillop operates across several Australian states, most participants were based in Victoria, meaning the unique barriers or facilitators of those working elsewhere may not have been uncovered. Further, the purposeful sampling of the executive group may limit the breadth of findings; however, this aimed to maximise the roles represented within the organisation while also selecting individuals who were likely to contribute comprehensively to the insight gained. Despite this, demographic information was not available for the five executive participants. Due to the organisational focus on frontline work with families and young people, some of the challenging circumstances associated with ‘less demanding’ roles, may have been underexplored. Both limitations relate to the recruitment challenges associated with conducting research in a crisis‐oriented workplace.

5. CONCLUSION

Open communication and opportunities for connection with teams and management seemed highly supportive of PPP employees in this context. However, community service organisations likely present specific challenges to the healthy lifestyle practices and well‐being of PPP employees. Our findings suggest that executives would benefit from a broadened understanding of the needs and challenges associated with preconception, postpartum and parenting, in addition to pregnant women. Organisations that utilise an ecological approach to facilitate the health and well‐being of PPP employees, by addressing structural sector‐specific barriers to flexibility and underresourcing, may improve retention and service delivery concerns.

AUTHOR CONTRIBUTIONS

Conceptualisation: SKM, BH, HS; Methodology: SKM; Investigation: BH, SKM; Formal Analysis: SKM, CB; Resources: BH, HS; Data Curation: BH, SKM; Writing—Original Draft: SKM; Writing—Review and Editing: SKM, CB, BH, AOC, DM, HS; Visualisation: SKM, CB; Supervision: BH, HS; Funding Acquisition: HS. All authors have read and agreed to the published version of the manuscript.

CONFLICT OF INTEREST

Professor Helen Skouteris (Editor‐in‐Chief of Health and Social Care in the Community) is a co‐author of this work. The authors declare that they have no other known conflict of interest that may have influenced the work presented in this paper.

Supporting information

Table S1.

Madden, S. K. , Blewitt, C. , Hill, B. , O’Connor, A. , Meechan, D. , & Skouteris, H. (2022). ‘It's just the nature of the work’: Barriers and enablers to the health and well‐being of preconception, pregnant and postpartum working women in a community service organisation. Health & Social Care in the Community, 30, e6475–e6486. 10.1111/hsc.14093

DATA AVAILABILITY STATEMENT

Due to the nature of this research, participants did not agree for their data to be shared publicly. Therefore, supporting data are not available.