Occupational balance in parents of pre-school children: Potential differences between mothers and fathers

Abstract

Background

Parents of young children are a vulnerable group with an increased risk of stress-related health problems compared to adults without children. Low occupational balance has been identified as a risk factor for stress-related disorders.

Aim

The study aimed to describe occupational balance in parents of pre-school children and to explore potential differences between mothers and fathers.

Method

Data were collected by a web-based survey based on the Occupational Balance Questionnaire (OBQ11). A total of 302 working parents (200 mothers and 102 fathers) with at least one child under seven years of age were included in the study.

Findings

Mothers reported lower occupational balance than fathers with a median value of 10 for mothers and 12 for fathers (p = 0.029). Mothers rated significantly lower than fathers in three items; ‘Balance between work, home, family, leisure, rest and sleep’, ‘Having sufficient time for doing obligatory occupations’ and ‘Balance between doing things for others and for oneself’.

Conclusion

The results indicate that caring for pre-school children may negatively impact both parents, impacting mothers’ occupational balance to a greater degree.

Significance

Occupational therapists’ knowledge could be utilised to increase awareness of the importance of occupational balance within health services and improve mothers’ occupational balance.

Keywords:

• Cross-sectional study
• occupational balance questionnaire (OBQ11)
• working parents in Sweden

Introduction

Becoming a parent is a major change in life with many new commitments that can affect their self-perceived mental well-being [1,2]. Parents of young children (≤8 years old) run a higher risk of sick leave and poor perceived health compared with parents of older children and adults without children [3–5]. This increased risk is seen among those who have several children in the household and where the youngest child is between two and seven years old [6]. One possible explanation for this high risk among parents of young children is that combining the parental role with work can lead to an increased burden [7] and high perceived stress related to insufficient time for relaxation [4]. Other explanations are related to Western notions of a ‘good parent’ and ‘the child’s best interest’ that suggest that parents need to make time for and spend time with their child by minimizing working hours, giving up hobbies, and self-sacrifice [8]. Further, gender ideologies (i.e. traditional, transitional, and egalitarian) shape parental attitudes related to domestic and paid occupations, informing individuals’ perception of role expectations, their engagement in certain occupations, and the degree of their participation [1,9]. Consequently, the representation of a ‘good parent’ (i.e. prevalent in social media, policy, social norms) rooted in Western social expectations of what a mother and a father should do, shape parents’ choices and involvement in gendered occupations in ways that may differently impact their well-being and balance [10].

Several studies indicate that working mothers are usually more responsible for childcare, do more household tasks than fathers, and are more likely to experience self-report ill-health [11,12]. This is often associated with ‘intensive mothering’ or the assumption that children require intensive attention from mothers, who need to privilege childcare over employment, potentially restricting women’s occupational repertoire [10]. Based on this assumption, mothers are more likely to experience self-report ill-health or the so-called ‘double burden hypothesis’ that suggest a higher work-family conflict for women than men [13,14] and the underlying expectation that mothers should balance domestic work and labour without much help from their partners or society [10]. However, these engendered assumptions have received limited scholarly support because they should not apply to egalitarian countries [11], such as Sweden, where considerable resources have been spent to support fathers’ involvement in domestic work, particularly in childcare [12].

In Sweden, both parents have the right to take parental benefit or temporary parental benefit to be able to stay at home with their children instead of working or studying. Parental benefit is 480 days, and it is distributed between parents, according to their needs, during the first years of the child’s life (i.e. 96 days can be saved and taken until the child turns 12 years old) [15]. Parents also have the right to reduce their working hours by up to 25% until the child reaches the age of eight or has completed his or her first school year. Yet, most parents of young children in Sweden work full time (i.e. 38–40 h/week) and do not share parental benefits equally. In 2020, a report from the Swedish Social Insurance indicated that mothers accounted for about 70% of the parental leave days and fathers for about 30% [16]. Paradoxically, in Sweden, a country with one of the most generous parental leave policies oriented towards facilitating a gender-equitable approach to work and parenting, mothers’ sick leave during the child-rearing years is twice as high as fathers [12,17]. This paradox has received little attention especially regarding potential differences between working mothers and fathers’ balance between domestic and paid occupations.

Occupational balance is a core concept in occupational therapy and occupational science [18,19]. As an overarching concept, it entails more than other balance concepts used among occupational therapists such as ‘work-family conflict’ which denotes conflict where work interferes with family or vice versa, and ‘work-life balance’ which focus on the time spent working or outside working [12]. Occupational balance refers to a subjective experience of having the right amount and variation among ‘all’ activities regardless of whether the activities are related to paid or unpaid work [18,19]. Lack of occupational balance or the experience of occupational imbalance has been associated with low self-rated health, high perceived stress [4,20], and an increased risk of stress-related mental health problems [21]. Other conditions, such as workaholism, burnout, and sleep disorders have also been considered as indicators of occupational imbalance, and subsequently leading to illness [22]. Few studies have focussed on working parents and occupational balance in occupational therapy. A previous Swedish study showed associations between organizational factors such as positive attitudes towards parental leave among colleagues and managers with a higher level of occupational balance among parents with young children [10]. Another study showed that cohabitating working parents who experience satisfaction with the division of domestic work tend to experience high occupational balance [23]. No study appears to have addressed how working parents perceive their occupational balance and if there are considerable differences between mothers and fathers.

Research in this area is limited and to develop the best possible occupational therapy interventions targeting this group who run a high risk of sick leave and poor perceived health, it is of great importance to gain further knowledge of mothers and fathers’ occupational balance. This knowledge can support occupational therapists in the development of interventions that respond to gendered-specific needs for support. Furthermore, this knowledge can support occupational therapists that for instance work with parents on long-term sick leave and return-to-work programs in rehabilitation settings [24]. Therefore, the aim of this study was to describe occupational balance in parents of pre-school children and to explore potential differences between mothers and fathers.

Materials and methods

The present study has a descriptive cross-sectional design and data were collected with a web survey.

Study population

The inclusion criteria for the study were being a parent and having at least one child younger than seven years old living at home full-time or part-time. The exclusion criteria were having children with disabilities and being on/having a partner on full-time parental leave. The exclusion criteria were chosen based on the findings of previous studies that show that parents of children with disabilities have an increased risk of mental health problems [25] and that the risk of stress-related mental health problems is lower while one parent is on leave [17].

Data collection

Data collection was conducted between February and March 2020. Through a computer-based randomization process, 74 preschools were randomly selected to take part in the study from a list of 981 preschools published on the Stockholm Region website. Three preschools for children with disabilities were excluded based on the exclusion criteria and one pre-school was excluded as it only offered childcare during inconvenient working hours and it can be assumed that children have another pre-school placement in parallel. Invitations to take part in the study were sent to directors of these 74 pre-schools who were asked to distribute the web survey by email to parents with children attending these preschools.

Of the selected preschools, 30 declined participation for various reasons, and 20 did not respond. One possible explanation for declining to participate was the outbreak of covid-19 in Sweden which coincided with the data collection period of this study. For example, two pre-school directors declined to forward the survey to avoid an additional burden to parents as they had already sent out an unusual amount of information due to the new guidelines for preventing the spreading of the virus.

In total, 24 directors accepted to distribute the invitations to parents with children attending their pre-school. It was not a requirement that both parents of the same child/children answered the questionnaire, or that those who answered were living together. Among those 392 individuals who started answering the web survey, 60 were excluded since they had a partner or were themselves on full-time parental leave. Another 30 individuals were excluded due to incomplete answers and one individual who answered ‘do not want to state’ on the question of gender was also excluded because the study focuses on potential differences between women and men. Thus, a total of 302 participants’ answers were included in the data analysis.

The web-survey

The questionnaire contained questions regarding occupational balance and demographic factors. To control the user-friendliness of the questionnaire [26], it was piloted twice by 20 non-participants after which some of the demographic questions were slightly adjusted. The pilot group was similar in age to the target group and most of them were mothers or fathers.

Demographic factors

The questionnaire included questions regarding gender, age, educational level, level of employment, living with a partner, number of children living at home and whether the parent lived with the child/children full-time or part-time. Age was dichotomized according to a median cut to form high and low groups (i.e. younger versus older groups), which can then be compared with respect to their means on the dependent variable [27]. Educational level was dichotomized into college/university versus other (high school/primary school/no formal education). Level of employment was trichotomized into work/studies full-time, work/studies part-time, and full-time sick leave. The number of children living at home (i.e. including both own and bonus children) was dichotomised into one child vs. two children or more.

Occupational balance

Occupational balance was measured using the Swedish instrument Occupational Balance Questionnaire (OBQ11) [28] which is a revised version of OBQ which shows good content validity, good internal consistency, and sufficient test–retest reliability with classical test theory [29], The OBQ11 has shown good construct validity [28] The OBQ11 contains 11 items (Table 3) rated on four-graded ordinal scales; completely disagree (0); tend to disagree (1); tend to agree (2); completely agree (3). A higher rating indicates a higher occupational balance, but the instrument has no specific cut-off value for what is classified as low or high occupational balance. Versions in other languages have also been developed [30–32]. The instrument allows results to be presented as a summarised total score (scale 0–33) and/or analysed separately for each item [28] and both methods were used in the present study.

Statistical analysis

Demographic differences between mothers and fathers were analysed using statistical methods. The Chi-Square test is considered a suitable method for analysing distribution at nominal scale level [33], and therefore, it was used to test for differences in educational level, living with a partner or not, number of children living at home and whether the parent lived with the child/children full-time or part-time. Age differences were analysed using the Independent Samples T-test which is considered advantageous for analysing differences between groups in normally distributed data at the ratio scale level [34]. Differences in level of employment were analysed using Fisher’s exact test since it is valid for analysis of small samples [35].

To compare differences in occupational balance between mothers and fathers, as well as other demographic groups, Mann–Whitney U-test was used. To further analyse differences in occupational balance between mothers and fathers, each item was analysed separately. Median values and quartiles for both mothers and fathers were calculated. All statistical analyses were performed using the Statistical Packages for the Social Sciences version 25 and the level of significance was set as p < 0.05.

Ethical considerations

Participants received information via email regarding the purpose of the study, and inclusion and exclusion criteria. The email also contained information regarding confidentiality, voluntary participation, and the possibility to withdraw participation at any time. Consent to participate in the study was obtained through the first question in the questionnaire. A Swedish web service that followed the General Data Protection Regulation (GDPR) was used for the design of the survey and data collection. The study followed international recommendations for research ethics [36].

Results

A total of 302 parents participated in the study, 200 mothers and 102 fathers. Most of them had two or more children, had their children living with them full-time, lived with a partner, had a college or university education, and worked/studied full-time. The only significant demographic difference between mothers and fathers was age, where the fathers were older (Table 1).

Table 1. Participant demographics.

	Total (n = 302)	Mothers (n = 200)	Fathers (n = 102)	p-value
Age
mean	37.7	36.7	39.5	<0.001^b*
min-max	21–53	21–49	23–53
Age, ≤37 vs. ≥38, n (%)
≤37 years	152 (50)	113 (56)	39 (38)	0.003^c*
≥38 years	150 (50)	87 (44)	63 (62)
1 child vs. 2 children or more, n (%)
1 child	108 (36)	70 (35)	38 (37)	0.699^c
2 children or more	194 (64)	130 (65)	64 (63)
Children full-time vs. part-time, n (%)
Full-time	284 (94)	189 (95)	95 (93)	0.636^c
Part-time	18 (6)	11 (5)	7 (7)
Living with a partner, n (%)
Yes	271 (90)	176 (88)	95 (93)	0.164^c
No	31 (10)	24 (12)	7 (7)
Educational level, n (%)
College/University	258 (85)	172 (86)	86 (84)	0.694^c
Other^a	44 (15)	28 (14)	16 (16)
Work/Studies/Sick leave, n (%)
Work/studies, full-time	233 (77)	149 (74)	84 (82)	0.185^d
Work/studies, part-time	65 (22)	47 (24)	18 (18)
Sick leave, full-time	4 (1)	4 (2)	0 (0)

^aHigh school, elementary school, or no formal training/education.

^aIndependent Samples T-test.

^bChi-square.

^cFisher's exact test.

*p < 0.05.

The participants’ summed total score of occupational balance varied over the entire range from 0 to 33 with a median of 11. Fathers had significantly higher occupational balance than mothers. Significantly higher occupational balance was also found among younger parents, those having only one child and those with children living with them part-time (Table 2).

Table 2. Differences in OBQ ratings between demographic groups.

	Min-max (Total 0–33)	Median	Q1-Q3	p-value^c
Total sample (n = 302)	0–33	11	6–16
Mothers (n = 200)	0–32	10	5–16	0.029*
Fathers (n = 102)	1–33	12	8–16
Age, ≤37 vs. ≥38
≤37 years (n = 152)	0–33	12	6–17	0.044*
≥38 years (n = 150)	0–32	9	6–14
1 child vs. 2 children or more
1 child (n = 108)	0–32	12	8–18	0.001*
2 children or more (n = 194)	0–33	9	5–15
Children full-time vs. part-time
Full-time (n = 284)	0–33	11	6–16	0.003*
Part-time (n = 18)	6–32	16	12–19
Living with a partner
Yes (n = 271)	0–33	11	6–16	0.874
No (n = 31)	0–32	12	6–16
Educational level
College/University (n = 258)	0–33	11	6–16	0.094
Other^a (n = 44)	1–32	13	7–18
Work/Studies^b
Full-time (n = 233)	0–33	11	6–16	0.821
Part-time (n = 65)	0–31	11	6–18

^aHigh school, elementary school, or no formal training/education.

^bParticipants on full-time sick leave (n = 4) have been left out of the analysis.

^cMann–Whitney U-test.

*p < 0.05.

Regarding the individual items, the most common answer for both mothers and fathers was ‘tend to disagree’ (1). Significant differences were identified in three individual items where mothers rated lower than fathers: ‘Balance between doing things for others and for oneself ’, ‘Balance between work, home, family, leisure, rest, and sleep’, and ‘Having sufficient time for doing obligatory occupations’ (Table 3).

Table 3. Mothers’ and fathers’ ratings of the individual items.

Item	Mothers, median, Q1-Q3^a	Fathers, median, Q1-Q3^a	p-value^b
1. Having just enough to do during a regular week	1 (0-2)	1 (1-2)	0.081
2. Balance between doing things for others and for oneself	1 (0-1)	1 (1-2)	0.006*
3. Time for doing things wanted	1 (1-1)	1 (1-2)	0.194
4. Balance between work, home, family, leisure, rest, and sleep	1 (0-1)	1 (1-2)	0.005*
5. Having sufficient time for doing obligatory occupations	1 (1-2)	1 (1-2)	0.010*
6. Balance between physical, social, mental, and restful occupations	1 (0-1)	1 (0-1)	0.187
7. Satisfaction with how time is spent in everyday life	1 (0-1)	1 (1-1)	0.502
8. Satisfaction with the number of activities during a regular week	1 (1-2)	1 (1-1)	0.978
9. Balance between obligatory and voluntary occupations	1 (0-1)	1 (0-1)	0.756
10. Balance between energy-giving and energy-taking activities	1 (0-1)	1 (1-2)	0.058
11. Satisfaction with time spent in rest, recovery, and sleep	1 (0-1)	1 (0-2)	0.574

^aRatings: [0] completely disagree; [1] tend to disagree; [2] tend to agree; [3] completely agree.

^bMann–Whitney U-test.

*p < 0.05.

Discussion

The aim of this study was to describe occupational balance among parents of pre-school children and to explore potential differences between mothers and fathers. The OBQ11 does not yet provide a specific cut-off score between high and low levels of occupational balance [28]. Thus, in line with previous studies [3,23,37,38], the choice was made to use a total score over the sample’s median as high occupational balance and a total score below or equal to the median as low occupational balance. The median of the summed occupational balance score in this study was 11. The OBQ11 has been used in a recent study that investigates the associations between sleep and occupational balance among Swedish women [37] in which the median of the total occupational balance score was 12, and in a study of Swedish occupational therapists’ occupational balance [38] in which the median was 13. In this study, the median of the occupational balance score in mothers was 10 and in fathers 12.

Occupational balance among parents of pre-school children

It is worth noticing that it was not a requirement in this study that both parents of the same child/children answered the web-survey, or that those who answered were living together. Based on the aim of this study, parents of young children who had a partner that was not on full-time parental leave, who was working part- or full-time, and answered the web-survey were included. This implies that unlike previous studies on cohabitant working parents’ perception of occupational balance [1,4,23], this study focussed on the individual perception of being a working mother or father of young children. Since cohabitating parents may influence each other’s perception of occupational balance [23], it was important to focus on their individual perceptions.

The results show that most participants in this study rated a low score on occupational balance. Since most of the participants in this study (77%) worked full-time, a possible interpretation of the above-mentioned result could be that the participants face challenges combining work and family life, being over-occupied or experiencing stress which can lead to occupational imbalance [20]. If this is the case, the results of the present study would be consistent with a Swedish study that show that it is important for working parents with small children to be able to combine work and family life to experience occupational balance [23]. This also implies that participants may lean towards egalitarian gender ideologies which suggest sharing equal responsibilities and having less gender-based roles of earner and carer [39] and therefore they may feel guilty about not participating in as many childcare and work-related occupations as they are expected to have. Due to increasing social expectations and policies oriented towards facilitating a work-family life balance in Sweden, participants whose work obligations take over family time may also experience a sense of not being a ‘good enough’ parent for spending too little time with their children [40].

Further, participants that rated low occupational balance may engage in ‘too many’ obligatory or work-related occupations, and few or any occupations related to personal values and goal orientations (e.g. being ‘good’ parent). According to Wilcock’s proposal of occupations as a means to fulfil individuals needs of ‘doing, being and becoming’ [20] participants that are not able to engage in activities that are congruent with their parental values and goals are more likely to experience occupational imbalance. However, as parental values are socially and culturally constructed, engaging in occupations that are perceived as congruent with individuals’ social group values also influence their level of satisfaction with chosen/prioritized occupations, and thereby their sense of balance [39]. This implies that participants in this study may experience incongruence between their personal and/or societal values and goal orientations (e.g. being/becoming a ‘good’ parent) and their actual doing (e.g. spending too little time with children because of work obligations or vice versa). However, these are only speculations and should be further researched.

A second interesting result of this study is that older parents (≥38 years) and parents with two children or more rated a significantly lower score on occupational balance than younger parents (≤37 years) and parents with only one child. One possible explanation for this difference could be that older participants are more likely to have more children than younger participants, which requires more energy and time, making it more difficult for older parents to achieve occupational balance. According to Swedish statistics, both women and men’s age at the time of having their first child have increased (i.e. the average age was 31.2 for mothers and 34.1 for fathers in 2019). This is particularly seen in the Stockholm Region which has the oldest first-time fathers and mothers in Sweden, with an average age of almost 34 and 32.1 years, respectively [41]. Further, it is possible that older parents that have more than one child living at home could be exposed to a double-burden by caring for their children and others such as ageing parents to a greater extent than younger participants. According to the literature, parents dealing with caring for their children as well as for elderly parents, and work responsibilities, tend to experience a higher level of stress compared to those who engage in fewer role combinations [42].

Another interpretation is that younger generations of adults may have personal values congruent with egalitarian gender ideologies that reject the assumption that women are solely responsible for childcare and domestic work, and therefore being able to create or become part of supportive networks and receive support. This also implies that older parents may lean towards more traditional gender ideologies which may be incongruent with their partners' values and/or perceived Swedish social egalitarian values. If older participants experience an incongruence with personal or societal values, this conflict can diminish satisfaction with their occupational involvement even if it is based on their gender ideologies [43]. However, this is again only speculation and further studies are needed to determine the accuracy of such interpretations.

Significantly lower occupational balance was also found among those having children living at home full-time. This is consistent with the results of another Swedish study that shows that parents with children living at home rated their occupational balance lower than people without children living at home [2]. It is possible that parents having children full-time living at home may have fewer opportunities for relaxation and to combine work, domestic work, and time for their children [1,4,23], leading to a perceived occupational imbalance. Another interpretation could be that parents who live together with children at home may not be satisfied with the distribution of domestic and work obligations due to different or conflicting gender ideologies with their partners. Studies have shown how important it is for parents that live together to support each other and have compatible gender ideologies to reduce conflicts with labour division to experience occupational balance [1,19,39]. Nevertheless, there may be other explanations for why parents with children living at home experience low occupational balance that can be related to a combination of personal values, partners gender ideology (in)compatibility, and power relations, that need to be further considered.

Potential differences in occupational balance between mothers and fathers

Mothers in this study rated their occupational balance statistically lower than fathers. This is in line with recent Swedish studies that show similar differences in occupational balance among working cohabitating parents with young children [3,23]. Different from previous studies on cohabitant working parents, this study reveals three specific items in which mothers rated significantly lower than fathers; ‘Balance between work, home, family, leisure, rest and sleep’, Having sufficient time for doing obligatory occupations’ and ‘Balance between doing things for others and for oneself’.

One possible explanation for the significant difference between mothers and fathers in ‘Balance between doing things for others and for oneself’ is that women may unwillingly give up previous interests and activities to care for children and work leading to a low occupational balance. Studies show that women more often than men, experienced insufficient time for leisure, relaxation, exercise, and friends, except for time for partner and children [4], while men continue to engage in leisure activities linked to previous interests after becoming a parent [44]. In egalitarian countries such as Sweden, this could be interpreted as having societal gender beliefs that encourage women to be more comfortable with using day care centres or community resources to fulfil home-and childcare demands but having to ‘administrate’ all these resources may lead to a lack of time and energy for leisure and friends. This implies that women may have conflicting gender ideologies with their partners and/or societal values [39] that perpetuates an image of women as responsible for household work. For example, working women may feel that they use day care centres or ask for support from their network with childcare to be able to have a carer but when having to care for their sick child, they may be unable to leave their workplaces [3], feeling that they cannot fulfil their expectations of their role as mother. On the contrary, they may feel unable to be a reliable employee since they need to care for sick children due to more traditional expectations in their household. Nevertheless, in both situations, women may feel that they are not able to do ‘obligatory occupations’ or ‘having sufficient time for doing obligatory occupations’ based on theirs, their partner’s, and/or societal gender expectations.

Conflicts between expected roles, personal values and societal gender ideologies are becoming more complex as expectations for mothers in Western societies include both caring for children and pursuing a career [10], regardless of their personal or household’s gender ideology. As such, working mothers may be confronted with highly diverse (i.e. personal, partners’ and societal), controversial expectations and attitudes concerning their doing and being as a mother [10], which can lead to low occupational balance. Furthermore, mothers in this study rated significantly lower than fathers in the item ‘Balance between work, home, family, leisure, rest, and sleep’. This implies that mothers may have taken more responsibility for domestic work and caring for children and could be less satisfied with this division than fathers, influencing their occupational balance. Previous studies [13,23] show that mothers perform a greater proportion of domestic work and childcare, even when both parents work full-time. It has also been demonstrated that mothers are less satisfied with the distribution of household chores than fathers [23]. Yet, this also suggests that mothers may have conflicting gender ideologies with their partners. For example, mothers in this study may lean towards egalitarian gender ideologies, feeling dissatisfaction with the division of domestic work, while adopting more traditional gender views (i.e. taking more responsibility for domestic work) to ‘please’ their partners who may have different expectations. As Wada and colleagues [39] describe, some people may have conflicting gender ideologies, having one that is usually observable based on actions/doing or ‘on-top’ while having another ‘underneath’ that may create deep feelings of incongruence and imbalance.

Another Swedish study shows that fathers in working couples with young children report being more satisfied than mothers with the division of domestic work [45]. A possible explanation of this result could be that the traditional gender ideologies are still dominant in Sweden, with mothers feeling a sense of obligation or responsibility for housework and caring for the family, while fathers are viewed as the breadwinners [8]. The ‘double-burden hypothesis’ suggests that men’s obligations to a greater extent are completed at the end of the working day, while women take care of additional occupations at home after the end of a working day [14]. Hence, having difficulties living up to gender expectations may negatively affect women’s occupational balance [39]. Low rates in the item ‘Balance between work, home, family, leisure, rest, and sleep’ has also previously been associated with an increased risk for stress-related disorders for women [21]. Further studies about working mothers of young children and occupational balance are thus important to build on previous knowledge and provide more insights about women’s risk for stress-related disorders and perceived occupational imbalance.

Strengths and limitations of the study

A cross-sectional survey design was chosen as it is relatively inexpensive and adaptable to participants needs [46]. However, since the outcome and exposure variables are measured at the same time, it is relatively difficult to establish causal inferences from this type of study. On the other hand, a cross-sectional study is useful for establishing preliminary evidence as it gives some indications of the associations that can be used in the planning of further studies [46].

The use of a valid and reliable questionnaire such as the OBQ11 [28], enhances the validity of the study. However, a limitation is that OBQ11 does not have a specific cut-off score which can lead to an underestimation or overestimation of participants perceived occupational balance. Another limitation with the OBQ11 is that the Rasch analysis showed some gaps, that is, person locations is not optimally represented by item locations, and the OBQ11 does not measure with the same precision at these gaps [28]. Therefore, the results should be interpreted with some caution. Generalisation of the result to other groups than the target population or other countries should be made with caution since Sweden has a particular system and regulation for parental leave that needs to be considered. It should also be considered that more mothers than fathers participated in this study, and therefore the study became less sensitive to uncover significant differences in the sample. Likewise, findings may have been affected by circumstances not accounted for, for example, the early spread of covid-19 in Sweden and the fact that all participants were recruited from a large urban area. In other words, there may be more or fewer differences among mothers and fathers than were revealed, implying that the results should be viewed with caution. Similar studies are necessary to confirm the results from the present study.

Implications for occupational therapy and further studies

Significant differences were found in the self-rated occupational balance between mothers and fathers of pre-school children, implying occupational imbalance. Since occupational imbalance has been linked to an increased risk of stress-related mental health problems [21], promoting occupational balance for parents of young children should be a priority within occupational therapy settings working with parents as clients. Using the OBQ11 to map occupational balance can provide a knowledge-base for occupational therapists to increase parents’ awareness regarding how much they are doing for others and themselves, as well as how they are dividing household work between them, and their time in work, leisure, rest, and sleep. In terms of practical implications, occupational therapists could use OBQ11 together with activity diaries and/or time-geographical diaries [47] to facilitate reflections on changes in occupational balance related to patterns of daily occupations [48]. Using these methods as complementary to OBQ11 could provide further insights on the instrument results, reflecting together with clients on their perceived occupational balance and assisting them to set realistic and meaningful goals. Interventions including OBQ11 to raise awareness about the importance of occupational balance between work-leisure activities could also integrate reflection on people’s personal and societal values to examine if their doing is (in)congruent with what they would like to do or should be doing based on societal norms. To support these reflections, OBQ11 could be useful, as a first step, to examine which items are scored as low, eliciting personal perceptions of occupational balance which could then be discussed in-depth to raise awareness of personal values, resources, and perceived social expectations of one’s own and others’ needs. This type of discussion could be facilitated by occupational therapists to support a substantial improvement in people’s occupational balance. Depending on the parents’ total life situation and the cause of occupational imbalance, occupational therapy may need to be combined with other professional contributions such as counsellors, social workers, and/or psychologists. This knowledge could be integrated into secondary prevention settings where occupational therapists work identifying and addressing specific groups that may be at risk of low occupational balance, for example, those who are about to leave working life because of unemployment or retirement and those who are expecting children [49]. Considering that the findings of this study are consistent with previous studies [3,23] that indicate that Swedish mothers tend to experience a lower occupational balance than fathers, mothers of young children and expecting mothers should be specially targeted.

Recommendations for further studies using OBQ11 include examining differences between cohabiting parents and differences between single/bonus parents who have children living with them full-time or part-time. Further qualitative studies are needed to examine in-depth how parents of young children perceive occupational balance, and why mothers self-rate their occupational balance lower than fathers, e.g. exploring mothers gender ideologies or societal norms that may encourage women to do more for others than for themselves.

Conclusion

The results support that caring for pre-school children can negatively impact parents’ occupational balance. Significant differences indicate that the occupational balance of mothers is lower than that of fathers and that older parents experience a lower occupational balance than younger parents. Differences in occupational balance related to whether participants have more than one child living at home were also revealed, showing that parents that have more than one pre-school child living at home full-time self-rate their occupational balance lower than those having only one child living at home. These results should be interpreted with caution as the sample was small and based on one Nordic urban area.

Acknowledgements

The authors thank all the mothers and fathers that participated in the study.

Disclosure statement

No potential conflict of interest was reported by the authors. The authors alone are responsible for the content and writing of the paper.