Understanding Parental Role in Children's Participation in Decision Making during Hospitalisation: An Ethnographic Study in Malaysia

Introduction

Despite a growing recognition internationally that children have a right to participate in matters that affect their lives, they are not always involved in decision-making processes concerning their health care. There is a lack of information on how parents influence children's participation in this decision making. This study explored the roles parents assume in processes regarding their children's participation in communication exchanges and decision making in a paediatric oncology unit in Malaysia.

Methods

This study adopted a focused ethnography design within a constructivist research paradigm. Participant observations and semi-structured interviews were conducted with 21 parents, 21 children and 19 nurses in a paediatric oncology unit in Malaysia. All observation fieldnotes and interview recordings were transcribed verbatim. A focused ethnographic data analysis technique was performed to analyse the data.

Results

Three themes emerged regarding parents' roles in the communication and decision-making processes involving their children: i) facilitators of communication; ii) communication brokers and iii) communication buffers.

Conclusion

Parents controlled decision-making processes concerning their children, while children preferred and welcomed parents as consultants in the decision-making processes regarding their health care.

Mothers' and fathers' views on the importance of play for their children's development: Gender differences, academic activities, and the parental role

BACKGROUND

Play is a main driver of children's cognitive and social development and is crucial for educational success (Paediatrics, 119, 2007 and 182). In recent years, however, parents and schools are under pressure to prioritize academic targets over play.

AIMS

The current research investigated parents' views about three aspects of their children's play and academic activities.

SAMPLE

Predominantly highly educated UK parents (109 mothers and 49 fathers) were recruited via social media.

METHOD

Participants were asked to complete an amended online version of the Preschool Play and Learning Questionnaire (International Journal of Behavioral Development, 28, 2004 and 97). The questionnaire consisted of 25 items covering three themes: the importance of play for children's development, the importance of academic activities, and the importance of parents' role in their children's development. The independent variables were the gender of the parent, the gender of their child, and the age group of their child (4-7 years, or 8-11 years).

RESULTS

Parents rated play higher than academic activities or their own roles, but the difference was not noteworthy. However, fathers rated academic activities and the parents' role significantly higher than mothers did. In addition, parents of girls rated academic activities and their own role significantly higher than parents of boys.

CONCLUSIONS

The findings of the current research highlight gender divisions between parents and towards boys and girls regarding the importance of education. Gender roles appear to influence the way parents think about the academic activities their children partake in.

Guilt and Regret Experienced by Parents of Children Born Extremely Preterm

OBJECTIVES

To explore decisional regret of parents of babies born extremely preterm and analyze neonatal, pediatric, and parental factors associated with regret.

STUDY DESIGN

Parents of infants born <29 weeks of gestational age, aged between 18 months and 7 years, attending neonatal follow-up were enrolled. Hospital records were reviewed to examine morbidities and conversations with parents about levels of care. Parents were asked the following question: "Knowing what you know now, is there anything you would have done differently?" Mixed methods were used to analyze responses.

RESULTS

In total, 248 parents (98% participation) answered, and 54% reported they did not have regret. Of those who reported regret (n = 113), 3 themes were most frequently invoked: 35% experienced guilt, thinking they were responsible for the preterm birth; 28% experienced regret about self-care decisions; and 20% regretted decisions related to their parental role, generally wishing they knew sooner how to get involved. None reported regret about life-and-death decisions made at birth or in the neonatal intensive care unit. Impairment at follow-up, gestational age, and decisions about levels/reorientation of care were not associated with regret. More mothers reported feeling guilt about the preterm birth (compared with fathers); parents of children with severe lesions on ultrasonography of the head were less likely to report regret.

CONCLUSIONS

Approximately one-half of the parents of infants born extremely preterm had regrets regarding their neonatal intensive care unit stay. Causes of regret and guilt should be addressed and minimized.

The influence of family's cohesion and adaptability in family satisfaction of parents with a child with autism spectrum disorder

The current study examined whether there was significant relationship among family functioning (cohesion and adaptability) and overall family satisfaction in parents with a child with autism spectrum disorder. It was predicted that poor family adaptive functioning, poor family cohesion along with other family-related variables (child diagnosis, parents' marital status, and other siblings in the family) would predict lower levels of family satisfaction. 73 mothers and 27 fathers of a child with ASD participated in this study. Google forms were used in this electronic web research. Data were collected using the Family Adaptability and Cohesion Evaluation Scale (FACES-III) and the Family satisfaction scale (FSS). This study's results demonstrate that family adaptability along with a child's autism spectrum disorder diagnosis may be significant predictors of family satisfaction. Findings report the significance of identifying discrepancies in family functioning as they provide an insight into how family members not only view but also how they interact with each other which in turn can inform clinical interventions and the therapeutic work.

Fear of hypoglycemia in Italian mothers of children with type 1 diabetes: the mediating role of resilience

Objective

Fear of hypoglycemia for children with diabetes influences parental life and could increase parental stress. The present study aimed to explore the association between resilience, the self-perception of the parental role, and fear of hypoglycemia in mothers of children with type I diabetes (T1DM).

Methods

Ninety mothers (mean age: 44.20 years) of children with a T1DM diagnosis (mean age: 11.48 years) were recruited from an association for parents and completed an online self-report questionnaire packet that includes: Fear of Hypoglycemia Survey, Self-Perception of the Parental Role and Resilience Scale for Adults. Participants were recruited in 2017. Data collection lasted 10 months. Data analysis was performed using the SPSS statistical package, version 22, and the PROCESS macro program by Hayes.

Results

The analysis of the mediation model shows that resilience assumes a mediational role in the relationships between the parental role and preoccupation with hypoglycemia. In particular, the mother's perceived competence and role balance can influence the development and increase of the mother's resilience, which in turn can allow a decrease in the mother's worry about the possible hypoglycemic episode of her child.

Conclusion

The findings suggest that resilience is a significant topic to focus on in interventions designed to increase the self-perception of the parental role and reduce fear of hypoglycemia in mothers.

Psychometric Properties of the Polish Version of the Parental Feelings Inventory

Previous reports from international literature have emphasized the specific nature of the feelings experienced by parents related to their role, differentiating them from other emotional states. Researchers highlighted the role of parental emotions in parent-child interaction and child development. The aim of the present study was to create the Polish version of the Parental Feelings Inventory (PFI), which is a rating scale designed to determine parental emotions within the parenting role, and to assess its psychometric properties. The participants included 191 parents (102 mothers and 89 fathers) aged 22 to 55 years (M = 37.18, SD = 6.85), both parents of healthy children and those of children with chronic diseases or disabilities. All participants completed the translated PFI questionnaire, Parental Attitude Scale (SPR), SUPIN S20 and SUPIN C20. The results support a three-factor solution (Angry, Happy, and Anxious/Sad) and a structure of 22 items for the PFI. The internal consistency for the complete scale was α = 0.78 for mothers and α = 0.76 for fathers. Cronbach's α coefficients for individual factors for the Polish version were good: all above 0.80. The Polish PFI correlated with measures of parental attitudes and positive/negative affect; in addition, the Polish version confirms the basic psychometric criteria of the original and yields the same results. Therefore, the Polish version of the PFI is a valid and reliable tool for measuring parental feelings and can be successfully used as a measure of emotional experiences in the parenting role.

'Now she prefers jeans, like everyone else…' - Parents' experiences of group- and web-based treatment of children's obesity

AIM

Web-based interventions have shown promising results in paediatric obesity treatment with the potential to increase coverage of care. This study aimed to explore parental experiences about participating in an intervention to improve healthy behaviours and lower BMI-SDS in children with obesity.

METHODS

This was an interview study with an inductive qualitative approach. Data were collected from individual interviews with 14 parents of 5- to 13-year-old children with obesity. The respondents had participated in a family-based treatment intervention consisting of four group sessions followed by 12-week web-based support. The interviews were analysed using qualitative manifest and latent content.

RESULTS

The overarching theme 'A transformative journey of lifestyle changes for the whole family' described how the participation impacted the lifestyle of the whole family. Four categories: parental awareness, introducing new routines, negotiating family battles and a feeling of support, represented various experiences made by respondents. The parents shared predominantly positive experiences of the intervention but also expressed feelings of guilt and struggled to address their child's obesity.

CONCLUSION

Parents who participated in a study for children with obesity with a web-based component found the programme helpful for achieving healthier lifestyles for the whole family.

Barriers to Behavior Change in Parents With Overweight or Obese Children: A Qualitative Interview Study

Overweight and obesity among children and adolescents are global problems of our time. Due to their authority and role modeling, parents play an essential part in the efficacy of prevention and intervention programs. This study assessed the barriers that parents of overweight/obese children face in preventive and interventional health care utilization. Sixteen parents were qualitatively interviewed. A content analysis was performed, and barriers to change were allocated to their stage of change according to the transtheoretical model. Among the main barriers is the underestimation of health risks caused by overweight/obesity in association with diminished problem awareness. Parents seem not necessarily in need of theoretical knowledge for prevention and interventions. They do however need support in evaluating the weight status of their child and the knowledge of whom to turn to for help as well as specific and hands-on possibilities for change. The results extend past studies by adding specific barriers to change that parents commonly experience. Possibilities to address these barriers, e.g., through trainings at the pediatric practice or adoption of conversation techniques, are discussed. Future studies might identify subgroups experiencing specific barriers and thus be able to address these in an individualized way.

Swedish parents' experiences of their role in treatment for children with congenital limb reduction deficiency: Decision-making and treatment support

BACKGROUND

Parents of children with congenital limb reduction deficiency have an essential role in making treatment decisions during their child's first years of life. Treatment options usually concern surgical and/or prosthetic treatment. To tailor treatment options to fit different family values and priorities, the family-centred approach indicates the importance of understanding the parental role in partnership with health care professionals. The aim of this study was to describe parents' experiences of their role in decision-making and treatment for children with congenital limb reduction deficiency.

METHODS

A descriptive design with a qualitative approach was used. Semi-structured interviews were conducted with 17 parents (12 mothers and 5 fathers) of children with upper and/or lower limb deficiency (mean age 5.9 years). The interview data were analysed using qualitative content analysis with an inductive approach.

RESULTS

Two major themes emerged from the data. The first theme, being a decision maker for someone else, was described as an ambivalent parental role, including collaboration within the family and with health care professionals. The second theme, becoming and being a treatment supporter in the child's everyday life, was made up of four categories: being a supporter of the child in everyday activities, mentoring the child to handle encounters with others, becoming a coordinator of information and being an 'extended arm' of the health care provision for the child.

CONCLUSIONS

This study enhances our understanding of the parental role in decision-making and treatment for children with congenital limb reduction deficiency. The results may contribute to the continued development of the family-centred service approach by providing guidelines for treatment programmes, with the goal of improving decision support and broadening the support for parents during treatment for these children.

Multi-Children Parents' Experiences of Parental Support by Attending Parental Group for Multi-Children Parents in Sweden

This study investigated multi-children parents’ (MCPs) experiences of support in their parental role by participating in parental group for MCPs. Focus group interviews were performed with 20 MCPs consisting of 9 mothers and 11 fathers, with a mean number of children of 2.35 per family. Each interview lasted about 1 hour, and it was analyzed by content analysis method. One theme was revealed: parental group for MCPs gives access to reflection and development on MCP issues. This related to 2 categories: support in the MCPs’ role through internal development and support in the MCPs’ role through external influences. The study’s conclusion highlights the support of MCPs in their parental role by attending a parental group for MCPs and should be offered to achieve empowerment. Clinical implications are that a mix of men and women with different numbers of children of various ages of siblings should compose parental groups for MCPs.

Postponing parenthood to advanced age and its possible consequences

The article deals with a new social phenomenon that began to emerge after 1989 - postponing parenthood to later age. Attention in text is paid to the characteristic features of contemporary parenting with an emphasis on the higher age of parents. Selected psychological contexts related to higher age of parents, especially psychological development of preschool children is outlined. The importance of individual parental care for a small child and the common time of children with their parents and changes in parental roles in the intergenerational context and the current problems of parental influence on the child are mentioned as well.

Confidence in Attachment Relationships and Marital Status as Protective Factors for Self-Perceived Parental Role and In-Person Visitation with Children Among Incarcerated Fathers

The study aimed at investigating the role of confidence in attachment relationships and marital status as protective factors for incarcerated fathers' self-perceived parental role and in-person contacts with their children. Participants included 150 inmate fathers and 145 nonincarcerated control fathers who provided background sociodemographic information and completed two self-reports, the Attachment Style Questionnaire and the Self-Perception of Parental Role. A two-phased cluster analytic plan allowed us to highlight two profiles of self-perceived parental roles, with incarceration and low confidence in attachment relationships increasing the risk of the less optimal of the two profiles. Higher confidence in attachment relationships and having a stable romantic relationship increased the likelihood of incarcerated fathers engaging in frequent contacts with their children, while the profile of self-perceived parental role had no effect. Implications for practice are discussed, and suggestions for further research are provided.

Parent satisfaction with primary repair of paediatric cleft lip in Southwest China

The purpose of this study was to investigate the key factors in relation to parent satisfaction with the primary repair of paediatric cleft lip. One hundred and ninety-five children born with cleft lip and/or palate aged between 3 months and 1 year were recruited, along with their caregivers. All patients underwent primary cleft lip repair, and a telephone interview was held with their main caregivers at 3 months postoperative. The level of satisfaction with each item included in a simplified Cleft Evaluation Profile was ascertained and recorded. Patient clinical data were obtained from the medical records. One hundred and thirty-eight (71%) parents reported satisfaction with the general outcome of surgery. Parents were satisfied with the appearance of the lip and profile of the face, but were dissatisfied with the appearance of the nose and teeth. Mothers of patients showed lower satisfaction levels than fathers and grandparents. Parental satisfaction with the appearance of the lip was lower for patients without a cleft palate than for those with a cleft palate. The results of this study suggest that most Chinese parents of children who undergo primary cleft lip repair express satisfaction with the surgical outcomes. Satisfaction with the appearance of the nose and teeth is low and this needs to be improved. Other factors are likely to influence expressions of satisfaction.

Parenting Stress and Sexual Satisfaction Among First-time Parents: A Dyadic Approach

The present paper reports on longitudinal associations between parenting stress and sexual satisfaction among 169 heterosexual couples in the first year after the birth of a first child. Actor Partner Interdependence Modeling (APIM) was used to model the effects of the mother's and father's parenting stress at 6 months after birth on sexual satisfaction at one year after birth. Based on social constructivist theory and scarcity theory, two hypotheses were posed: (a) mothers' parenting stress will predict their own later sexual satisfaction whereas fathers' parenting stress will not predict their own later sexual satisfaction (actor effects) and (b) mothers' parenting stress will predict fathers' later sexual satisfaction but fathers' parenting stress will not predict mothers' later sexual satisfaction (partner effects). On average, parents were only somewhat satisfied with their sex life. The first hypothesis was supported as greater parenting stress significantly predicted lower sexual satisfaction for mothers but not for fathers. The second hypothesis was also supported as mothers' greater parenting stress significantly predicted less sexual satisfaction in fathers, whereas fathers' parenting stress did not significantly predict mothers' sexual satisfaction. We discuss how our results may be interpreted considering the social construction of gendered family roles.

Psychological and social factors in undergoing reconstructive surgery among individuals with craniofacial conditions: an exploratory study

Objective : Reconstructive surgery to improve psychological well-being is commonly offered to children with craniofacial conditions. Few studies have explored the challenges of reconstructive surgery beyond the physical risks: poor treatment outcomes, infection, brain damage, and death. This qualitative study aims to understand the psychological and social implications such interventions can have for individuals with craniofacial conditions. Design : A total of 38 individuals between the ages of 12 and 61 with such craniofacial conditions as Sturge-Weber syndrome, Treacher Collins syndrome, Möbius syndrome, cleft lip and palate, Noonan syndrome, Crouzon syndrome, and amniotic band syndrome participated in semistructured video-recorded interviews. Participants were recruited at conferences, through study flyers, and by word of mouth. Descriptive, thematic analysis was used to identify themes related to reconstructive surgery. Results : Dominant themes included undergoing surgery to reduce stigmatization, the psychological and social implications of the interventions, outcome satisfaction, parental involvement in decision making about surgery, and recommendations for parents considering surgery for their children with craniofacial conditions. Experiences with reconstructive surgery varied, with some participants expressing surgical benefits and others, disillusionment. Conclusions : The range of participant attitudes and experiences reflect the complexity of reconstructive surgery. Pediatric health care teams involved in the care of children with craniofacial conditions play an important role in advising patients (and their parents) about existing treatment options. The psychological and social implications of reconstructive surgery should be relayed to help families weigh the risks and benefits of surgery in an informed and meaningful way.