Female Athletic Training Students' Perceptions of Motherhood and Retention in Athletic Training

Research Design

We borrowed principles from an exploratory case study design as well as a general inductive approach to data collection and analysis. Following the guidelines for developing a methodologically sound case study, we generated a series of questions to guide the data-collection procedure, used a purposeful sampling method, and approached the data with a systematic analysis.^17,18 The exploratory nature allowed us to gain a holistic understanding of the female ATSs' perspectives on motherhood and a career in athletic training. We also established boundaries that bind the case, as is necessary with case study design; these consisted of sex and certification status (student enrolled in an educational program).

Data collection was guided by asynchronous online interviewing, a popular method in qualitative research studies because it facilitates confidentiality, greater time for reflection, and ease of communication between researcher and participant.¹⁹ Missing are the personal interactions between the interviewer and interviewee; however, rich data can be generated from online interviewing, which provides time for the participant to reflect without having to respond immediately to the interviewer's question.¹⁹ Compared with a semistructured interview, online interviewing is more structured: The participant responds only to questions developed before data collection.

Participants

A total of 18 female ATSs volunteered to participate. They were all enrolled in 1 Commission on Accrediting Athletic Training Education (CAATE)–accredited athletic training program and represented 3 levels of academic study (sophomores = 5, juniors = 6, seniors = 7). The average age of the participants was 21 ± 1 years. All participants were full-time students taking full academic loads in athletic training, which included a clinical practicum experience. The 7 seniors and 6 juniors had at least 1 clinical education experience at the secondary school level, whereas the sophomores had more limited exposure to the secondary school setting. In addition, the juniors and seniors had exposure to the rehabilitation clinical setting, but the sophomores had yet to gain experience within that setting.

Only 1 of the 18 female ATSs indicated an interest in pursuing a career outside athletic training upon graduation. The remainder noted professional goals, including full-time employment in a secondary school or collegiate clinical setting. Individual demographic data for each participant are provided in Table 1. Each participant was identified by a pseudonym.

Table 1. Participants' Demographic Data

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Recruitment

Female ATSs formally enrolled in a CAATE-accredited program were recruited by the researchers for participation. Students were purposefully recruited based upon the following criteria: (1) sex, (2) formal enrollment in the accredited program, and (3) engagement in clinical education experiences. Participants were recruited by e-mail using both convenience and snowball-sampling procedures.^20,21 Recruitment was guided by data saturation,²¹ which was accomplished with 18 female ATSs. An additional group of female ATSs was recruited to help establish data credibility despite data redundancy.

Data Collection

Before participant recruitment and data collection, we received institutional review board approval for the study. Basic demographic data (age, academic standing, graduation date) and consent were obtained before the interview. The interview followed a structured format: The participants were asked to respond to a series of questions, which were posted on a secure data-tracking Web site (SurveyMonkey, Palo Alto, CA). After consenting to the interview, each student was sent an e-mail with specific instructions. Online interviewing has become a popular qualitative method for multiple reasons, including the ease of participation, increased sense of confidentiality and anonymity, and popularity of technology.¹⁹ Several researchers^9,12,14,15 in athletic training have capitalized on this method to help increase participation among ATs, who work long hours and for whom this method is more accommodating. Moreover, online methods appear to be more appealing to college students, who are well versed in today's technology and have the freedom to share their experiences and opinions without having to engage in a phone or in-person interview with a previously unknown researcher.

The female ATSs were asked a series of questions regarding their perceptions of work–life balance in athletic training, retention of women within the profession, and methods to help retain women in the profession (Table 2). The 9 questions were generated by the researchers to reflect existing literature on work–life balance,^3,4,12,14 retention,⁸ and mothering.^6,16 A female AT with experience in qualitative methods was asked to review the structured interview guide for clarity, interpretability, and content. Changes to correct grammar and improve flow of the interview questions were made based upon the feedback provided by the review. The participants were instructed to journal their thoughts and opinions, without a space or word-count limitation.

Table 2. Interview Guide

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Data Analysis and Trustworthiness

All data were copied and pasted directly from the online system for analysis, and responses were grouped. The analysis followed the general inductive process, a common method used in health and social science research.²² This method of analysis was selected to help uncover the most dominant themes from the data as they related to the specific aims of the study. All transcripts were thoroughly and carefully reviewed several times by 1 researcher. Following the specific objectives established at the outset, labels were assigned to similar or shared thoughts and experiences. Once this stage was complete, the researcher shared the dominant themes with a peer, who reviewed the transcripts, researcher's notes, and assigned labels. Agreement was reached, and the data were categorized into 3 themes, as discussed in the “Results” section.

Using at least 2 credibility strategies, as discussed, promotes methodologic rigor,²⁰ and allowing data saturation to guide participant recruitment has been recommended to prove credibility.²¹ In addition to peer review, participant checks²¹ were used to help establish credibility of the data. The interpretative participant check was completed in 2 phases and is a form of member checking²¹ that enables the participant to provide credibility and authenticity to the data by confirming the researcher's analysis. First, after data analysis and peer review were complete, 2 female ATSs reviewed the themes. Both students agreed with the final presentation of the dominant themes. Second, 4 more female ATSs, each from a different athletic training education program, were asked the same questions as the initial participants, and the data were analyzed to confirm the emergent themes derived from the initial cohort. The 4 female ATSs in the second phase had comparable demographics (age, clinical experience) with the initial pool of students and were recruited based upon convenience and fulfilling criteria.²⁰

Clinical Setting

The participants discussed how persistence in the profession after starting a family depended upon working in a clinical setting that was conducive to the role of mother. For example, Laura said, “Once I have started a family, I would need to find a job that has a schedule that would work with my family lifestyle.” Palmer wrote, “I would need a job with more structured hours.” Amber shared, “It may require having a modified schedule, where it [is] more 9 to 5.” One participant-check member felt similarly regarding the structure of a 9-to-5 job. She commented, “A female athletic trainer who did work a 9–5 AT [athletic training] job at a clinic or as a physician extender would have a much greater ability to maintain a stable family life.” Many participants felt that the secondary school level would be more amenable than the collegiate setting to having a family and balancing the roles of mother and AT. Karen described her opinion on the best clinical setting for having a family: “I think the high school setting would make it easier to have a family as well. The overall school atmosphere is more welcoming to children. Also, there is very limited travel involved, unlike the college setting.” Gillian echoed Karen's thoughts, saying “being at the high school level would be easier, compared to the professional or college level, as the hours are longer, [and] travel time can be gruesome at those levels.” The transition to a position within the secondary school setting after starting a family was supported by another participant-check member, who noted, “Then once I am ready to settle down with someone and start a family, I would want to be an athletic trainer at a high school.” Her rationale for this position change was that “[it is] a low-key setting.”

Work hours and travel appeared to strongly influence the participants' impressions of the high school setting and why it would be a more suitable work environment to balance motherhood and athletic training duties. Emma agreed with Gillian and Karen: “I think the easiest way for females to persist in athletic training once they start a family would be to work at a local high school. There they would not be required to travel with a team and the schedule would be a lot more regulated.” Several participants also mentioned working in a clinical setting that afforded more structured working hours, such as a nontraditional setting. Sam reflected, “Some female athletic trainers may seek alternate settings such as the clinic/hospital [or] industrial to gain a more traditional work schedule. It would help with scheduling.” Despite the discussions related to clinical setting, all but one indicated professional goals that included full-time positions working as ATs. Furthermore, only 3 students wanted a career as an AT in a clinical setting (eg, high school), which was identified earlier as more family friendly.

Mentorship

The female ATSs felt strongly that a female mentor who had children would greatly benefit the profession, as well as them personally, in modeling that motherhood is possible in athletic training. Quinn wrote, “I think that mentorship is critical to keep female athletic trainers in the profession. If you observe a woman [who is] maintaining both aspects of her life [family and career] and is happy, then it makes you want to do the same, taking pointers from her [success].” Payton shared the same beliefs: “I believe having a mentor or seeing another female athletic trainer successfully balance both starting a family and working can/will motivate females and give them comfort knowing that it is possible.” Another student mentioned the importance of seeing other women not being overworked and managing both family and job responsibilities in reasonable time periods. Rhoni stated, “As a young professional, it is vital to see that you don't have to work 80 hours a week to maintain your professional status as an athletic trainer.” A participant-check member supported the claims of mentorship: “MOST DEFINITELY. Seeing is believing, so they say. Hearing someone's ‘story' would go a long way and would be very motivating [for me to persist].”

Although mentorship was cited as an important retention factor, only 2 participants were able to receive mentorship directly from a female AT with children who was employed in the collegiate clinical setting. Three additional students were able to gain mentorship and supervision from mothers employed in the secondary school setting; however, overall exposure to female ATs who were married with children was limited for this group of participants. One participant believed that direct mentorship would be of greater value than reading a case study or having discussions with a current clinical instructor. Catie wrote, “Having a female mentor who successfully has started a family, while also maintaining an athletic training position at the college/professional level, would positively influence my impression. It is easy to read stories of how women have managed or succeed but to actually witness it, that would be very interesting and more persuading.”

Work–Life Balance Strategies

While discussing the probability of persisting in athletic training, many female ATSs mentioned developing strategies for fulfilling work–life balance, including a work environment that allowed integration, time-management skills, strong communication skills, and support from a spouse or supervisor (or both). Jane noted the need for integration and support in a work setting: “Having a supportive partner, then it can be possible to work things out. Also if you have day care near your work [to visit during the day] or to have the chance to have your child or husband come to work for lunch or what not, that can help a female persist.” Payton commented, “Females can remain in whichever setting they are working in if they have the support from their supervisors, administrators, peer athletic trainers, and spouse.” Rhoni felt it was simple: “Time management is very important in the balance of work and family.”

Sadie said that sharing responsibilities with her spouse could greatly enhance her ability to find a balance. She wrote, “I feel like the best way to persist for me once I have a family would to be have a balance of family duties with my spouse. If you have a husband who is willing to help, it just becomes that much easier to support a family.” The idea of having a supportive, understanding partner or spouse was conveyed by all 4 members of the participant check. For example, one revealed, “In order to persist in the profession of athletic training, a woman needs to have support to help her with her family. She needs a boyfriend/husband who helps out so she has time to do what she needs/wants to do [at work and at home].” Palmer noted that communication was essential to feel a sense of balance between the roles. She shared, “Communicate with your supervisor to let them know the certain times you may need to attend to family or personal needs.” Sadie, too, felt that communication is helpful in creating a family-friendly work environment, saying, “Asking in advance for certain times/days off to attend family events is important [to create a family atmosphere].” Lindsay summarized the most important elements for fulfillment of work–life balance for the female AT: “Females must have understanding partners, an understanding employer that allows for flexibility of one's schedule and, if appropriate, is all right with children/partner occasionally being in the athletic training room or at events.”

Clinical Setting

Athletic trainers who are employed in the National Collegiate Athletic Association Division I clinical setting are subject to working long hours (>40 per week), which can significantly affect the time available for family, friends, and personal obligations.⁶ The time commitment associated with the AT role has been a major catalyst for conflicts between work and home, as well as attrition from the clinical setting and the profession.^4,12 Although the AT employed in the secondary school setting is susceptible to work–family conflict,⁹ this cohort of students perceives the setting as offering a more supportive, favorable environment for the working mother. This perception was based upon the work schedule, including lack of travel, as well as the impression that coaches and administrators are more supportive of family integration. The students' insights reflect the limited existing literature on the ability of the secondary school AT ability to find a balance within this setting.⁹ Furthermore, empirical data indicate the female AT moves away from the collegiate setting⁶ due to work–life balancing concerns⁹ and the profession entirely for a myriad of reasons.⁸

A family-friendly workplace is often established through coworker support and job sharing.^12,15 However, at the secondary school setting, this may not always be possible because often only 1 AT is employed by the school. Even so, the female ATSs seemed to feel that this work environment provides more viability when it comes to parenting and work–life balance. Control over their work schedule or a more structured work schedule was the dominant reason for this belief, which echoes the results of Pitney et al,⁹ who demonstrated that ATs who had more control over their work schedule experienced fewer problems balancing their roles. Furthermore, ATs employed within the clinic or rehabilitation setting have a more structured, typical 9-to-5 workday compared with those who work in the more traditional setting at the collegiate or professional sports level.²⁴

Regardless of the clinical setting, it is important to note that a family-friendly workplace can be created. Many organizational policies exist to help establish a family-friendly workplace environment, including the most popular: providing flexibility in one's workday.²⁵ As illustrated by several recent investigations in athletic training,^10,14,24 other factors that contribute to a family-friendly workplace include supervisor support, professional autonomy and control over one's work schedule, and the implementation of personal work–life balance strategies. Communication with coworkers, supervisors, and spouses is also important, as mentioned by this group of students, because it allows the AT to capitalize on time management, prioritize daily responsibilities, and maintain a sense of balance. Effective communication was emphasized by a female AT employed at the collegiate setting as key to her ability to find a balance in life, because it enabled her to negotiate a better work schedule and capitalize on her professional strengths as an AT.¹⁶ Our findings from the perspectives of the female ATSs align with those for other health care providers in managing work–life balance and suggest the need for a supportive workplace environment, protection of personal time, and control over an individual's work schedule.^25,26

Mentorship

Mentorship, a crucial component in helping a health care professional learn the roles, attitudes, and expectations of the profession, was identified by this group as a potential retention factor. Generally speaking, it is rare to see a female AT persist at the collegiate setting after having children, as indicated by the demographic data^3,4,6 and empirical data^6,8 linking position change, clinical setting change, and attrition from the profession to the start of a family. The lack of strong role models for young female athletic training professionals suggests it may not be possible to balance work and parenting or home life. Mentorship and role modeling have been documented as strong socializing agents for athletic training students and young professionals^27–29 that have helped the young female AT navigate challenges associated with career development and gender bias.³⁰ As more women remain in the profession while successful managing motherhood, they will be able to mentor others to do the same or at least give them an appreciation for the skills necessary to successfully assume both roles. Women who have successfully managed motherhood and employment in the collegiate setting may inspire other women to do the same.¹⁵ As pointed out by one female ATS, case study presentations are helpful, but they lack a sense of realism in that the day-to-day role modeling is missing, making them less authentic and believable. Educational programs that are preparing young athletic training professionals should seek clinical instructors who are mothers to mentor female ATSs to help them develop the necessary skill sets to be successful as both ATs and mothers. In addition, as more supervisors and administrators continue to support family-friendly work environments, more women may opt to stay in the athletic training profession instead of leaving once they have children. Conversely, however, the collegiate setting may not offer a work environment that is conducive to meeting the obligations associated with motherhood and parenting, which would indicate an organizational problem and not strictly a female concern.

Work–Life Balance Strategies

Achieving work–life balance has consistently been one of the most important retention factors, especially in the sport industry.^8,16,31,32 It makes sense that this cohort of female ATSs recognizes the importance of having strategies to achieve work–life balance. As previously discussed, the clinical setting can partially mitigate the difficulty of work–life balance for the female AT. However, as indicated by previous researchers,^12,15 the individual must also recognize which personal methods will aid her in achieving work–life balance because personal values, attitudes, and family structure can also influence one's ability to sustain a balance.³³ Similar to the findings of this study, support networks, spousal support, and time-management skills have been discussed frequently within the literature as important factors for the working professional to fulfill work–life balance.^15,34 Establishing professional and personal boundaries and priorities is also an important strategy that may help to limit problems with work–life balancing by separating the roles and allowing for task completion.^10,35 Although our cohort of female ATSs did not mention this strategy, it should be encouraged among young professionals as they begin their careers, particularly because job stressors and demands can lead to work–life balance difficulties.⁴

Balancing motherhood in a collegiate setting requires a strong support network.¹⁶ Critical to achieving a supportive work environment is a supervisor or administrator who shares family values, promotes a philosophy of integration, and encourages job sharing and teamwork among the sports medicine staff.^12,15,24 Retention in the workplace, especially for the female AT with children, has been linked to supervisor support and a family-friendly workplace.¹⁶ Sharing the workload among colleagues has been suggested as an important way to fulfill work–life balance^12,24 by allowing the AT to attend family events (planned or unexpected) despite workplace obligations. The female ATSs recognized that support at the organizational level would greatly benefit them as future mothers in affording them the chance to both be a hands-on parent and attend to the needs of their athletes and patients. Family integration has also been discussed as a means to promote more family time for the athletic trainer. This concept allows family time to be integrated into the workday. Although the secondary school level has traditionally been more open to this strategy,⁹ recent reports^15,16 have indicated that family integration is possible at the collegiate setting with supervisor and coworker acceptance.

Having support outside the workplace is also important in promoting a balanced lifestyle, as identified by this group of women as well as by current AT-parents.¹⁶ Shared responsibilities in the home, as in the workplace, can help to alleviate some of the workload for the mother, allowing her to successfully meet her patient care needs and administrative responsibilities as well as her family obligations. Several participants also discussed the need for planning, communication, and time-management skills to succeed at both roles; these qualities are often associated with being an AT and a mother. Time-management skills, without a doubt, are necessary for any individual to be productive and diligent in completing tasks and maintaining a balanced lifestyle.¹²

Limitations and Future Research

The data presented in this manuscript reflect the opinions of only a small number of female ATSs. Although they represent 3 academic levels, the results cannot be generalized to all female ATSs. Future researchers should study all academic levels, including students who have not yet begun athletic training-specific coursework and clinical education experiences, because the socialization process may have a profound influence on their opinions and eventual career intentions. Moreover, this cohort represents students enrolled in an accredited program housed within a Division I university. They were exposed to clinical experiences in a variety of settings; however, their experiences may represent only those students at large universities with significant resources and may reflect a biased opinion toward that setting. Many of the students alluded to the fact that the collegiate setting, especially at the Division I level, was less supportive of a female AT trying to raise a family. Future investigators may want to examine whether clinical education experiences at the various levels affect women's perceptions of work–life balance. Last, because mentorship appeared to be one of the most valuable tools for persistence in the profession, future authors should evaluate female students who have had female mentors with children. Our specific cohort lacked this experience, because only a few ATSs were able to work directly alongside a female AT with a family, especially at the collegiate level.