|Year : 2019 | Volume
| Issue : 3 | Page : 126-131
The effects of time use training on the level of stress among the mothers of female children with intellectual disabilities
Sanaz Arzhangi1, Meimanat Hosseini1, Samaneh Hosseinzadeh2, Mansoureh Zagheri Tafreshi3
1 Department of Community Health Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
3 Department of Nursing Management, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
|Date of Web Publication||1-Aug-2019|
Shahid Beheshti University of Medical Sciences School of Nursing and Midwifery, Vali Asr Ave., Niayesh Cross Road, Niayesh Complex, Tehran
Source of Support: None, Conflict of Interest: None
Background: The parents of children with intellectual disabilities may have problems in effective use of their time and hence, suffer from varying levels of stress. Objectives: This study aimed to evaluate the effects of time use training on stress among the mothers of female children with intellectual disabilities. Methods: In this experimental study, eighty mothers of school-age female children with intellectual disabilities were selected through cluster random sampling from two schools in the west of Tehran, Iran. They were randomly allocated either to a control or an intervention group. A six-hour time use training workshop was held for participants in the intervention group, while their counterparts in the control group did not receive any time use training. Data on participants' time use and stress were collected before and six weeks after the intervention using the Mothers' Time Use Questionnaire and the Questionnaire on Resources and Stress, respectively. The Chi-square, paired-sample t, and independent-samples t tests were used for data analysis. Results: The mean score of time management quality in the intervention group significantly increased from 42.10 ± 6.46 to 46.80 ± 6.98 (P = 0.003) and the mean score of stress in this group significantly reduced from 29.3 ± 4.46 to 26.38 ± 5.67 (P = 0.007). However, none of these mean scores significantly changed in the control group (P > 0.05). Conclusion: The mothers of children with intellectual disability may benefit from time use training programs.
Keywords: Intellectual disability, Stress, Time management, Training program
|How to cite this article:|
Arzhangi S, Hosseini M, Hosseinzadeh S, Tafreshi MZ. The effects of time use training on the level of stress among the mothers of female children with intellectual disabilities. Nurs Midwifery Stud 2019;8:126-31
|How to cite this URL:|
Arzhangi S, Hosseini M, Hosseinzadeh S, Tafreshi MZ. The effects of time use training on the level of stress among the mothers of female children with intellectual disabilities. Nurs Midwifery Stud [serial online] 2019 [cited 2019 Sep 16];8:126-31. Available from: http://www.nmsjournal.com/text.asp?2019/8/3/126/263865
| Introduction|| |
Intellectual disability (ID) is one of the most common disabilities worldwide and its prevalence ranges from 1% to 3%. Children with ID have functional limitations and are usually dependent on others for fulfilling their needs. Thus, the birth of a disabled child can drastically affect the entire family including the child, parents, and siblings and requires the reconsideration of family roles and functioning. A child with functional limitations and long-term dependence significantly changes parental responsibilities and puts a lot of pressure on caregivers, especially the mother. ID of a child causes parents different problems such as disturbed sleep, physical complaints, marital conflicts, financial strains, reduced quality of life (QoL), long-term exposure to stress, and time limitation., Moreover, they are overwhelmed by the feelings of social isolation and lack of support.
Intellectually disabled children have a wide variety of special needs which should mostly be fulfilled by their parents. For instance, their mothers should regularly attend their schools and take care of them because of the improper physical structure of the schools. The fulfilment of such wide variety of needs faces parents with time limitation and challenges in effective time use and thereby, places a heavy strain on them, dissatisfies them with life, and causes them, especially the mothers, high levels of stress., A study showed that these parents experience nearly twice as much stress as the parents of the healthy children. Therefore, they need to learn how to effectively use their time and manage their stress.
Time use relates to the ability to perform activities, enjoying life, and having an adequate sleep. Effective use of time has long been considered an important factor behind personal achievement. Analyzing how a mother of a family uses her time can provide valuable insight into the function and well-being of her family and helps understand her feelings and perceptions in performing her daily tasks. However, despite the significant role of mothers in caregiving to their children, there are limited studies addressing time use among caregiving mothers. A study into the time demands of caring for children with cerebral palsy reported that the mothers of these children daily spent about 6 h in weekdays and 8.3 h in holidays on caregiving to their children. Another study also found that compared with the mothers of healthy children, the mothers of disabled children spent more time on caregiving to their children and less time on leisure activities. Contrarily, a study reported no significant difference between the mothers of children with and without disabilities respecting their use of time and enjoyment from activities. Besides these contradictory findings, no study had yet investigated time use among the mothers of children with ID in Iran. Moreover, time use is greatly affected by the immediate context as well as people' physical and living conditions and hence, findings of studies done in context cannot easily be generalized to the other contexts. Thus, it is still unknown how the mothers of children with ID use their time and copes with the stress associated with caregiving to their children and fulfilling their care needs.
It is supposed that the effective time use can positively affect the people's QoL, and as nurses are responsible to sought strategies for enhancing the people's QoL, this study aimed to evaluate the effects of time use training on stress among the mothers of female children with ID.
| Methods|| |
Design and participants
This experimental study was conducted in 2016. The study population comprised the mothers of the female students with ID who attended public special primary schools in Tehran, Iran. To enter the study setting, an introduction letter was obtained from Shahid Beheshti University of Medical Sciences, Tehran, Iran, and provided to the Exceptional Education Department in Tehran. Then, the department provided permission for the study and introduced four girls' primary schools with ID-afflicted students in the west of Tehran. The study was conducted in only one geographical area, i.e., the west of Tehran, to recruit participants with similar sociocultural status. Two schools were randomly selected using cluster random sampling and were randomly assigned to either a control or an intervention group through coin toss. The reason behind choosing girls' schools was to remove the effects of gender, and the reason behind conducting the study in two separate schools was to minimize the probability of between-group information leakage. Inclusion criteria were living in a nuclear family, having an educable mentally disabled child with an intelligent quotient of 50–70 and an age of 6–13, no other serious health problems in the child (such as blindness or deafness), being the main caregiver of the child, no chronic physical or mental illness among other children, and no simultaneous care-giving to another person with disability in the family. Mothers were excluded if they did not regularly attend the time use training program or voluntarily withdrew from the study. In each of the selected schools, sixty mothers were eligible, and 48 of them were randomly selected using a random number table.
Using the results of an earlier study and with a type I and II errors of, respectively, 0.05 and 0.15, a standard deviation of 7, and a d of 7, the total sample size was calculated to be 96 (48 per group).
The study intervention was a 6-h educational workshop on effective time use. The components of the workshop were the definition, principles, and rules of time management, its barriers, management of time wasters, and management of the stress resulting from time pressure. Educational materials were provided to participants through the lecture and the group discussion teaching methods. Besides, participants in the intervention group were provided with educational pamphlets which contained the same materials provided in the workshop. Before and 6 weeks after the intervention, all participants filled out study questionnaires at the presence of the first author in the study setting.
Data were collected using a demographic questionnaire, the Mothers' Time Use Questionnaire, and the Questionnaire on Resources and Stress. The Mothers' Time Use Questionnaire consists of three parts. The first part requires mothers to categorize their activities of a typical day, from 05:00 to midnight, into sleep/rest, childcare, household (including all activities except for childcare), and leisure activities. This part also contains items on the importance of one's job, the quality of its performance, enjoyment in it, and satisfaction with the ability of balanced time use. The two other parts of the questionnaire pertain to leisure time and quality of time management. Ahmadi Kahjough et al. translated this questionnaire into Persian and reported that it had content validity index of 0.92 for relevance, 0.88 for clarity, and 0.88 for simplicity.
The Questionnaire on Resources and Stress was developed by Friedrich et al. With 52 items, it measures stress in the families of children with intellectual or other disabilities or chronic illnesses. Jalili et al. assessed and confirmed the validity and reliability of the Persian version of this questionnaire and reported that its content validity index was 0.95 for relevance, 0.95 for clarity, and 0.95 for simplicity. The total score of the questionnaire varies in the range of 0–52, with higher scores reflecting higher stress.
For internal consistency assessment in the present study, we administered the questionnaires to fifteen eligible mothers who were not included in the study sample. The Cronbach's alpha values of the Mothers' Time Use Questionnaire and the Questionnaire on Resources and Stress were 0.86 and 87, respectively. The same 15 mothers recompleted the questionnaires 2 weeks later. The test-retest correlation coefficients of these two questionnaires were 0.98 and 0.99, respectively.
The protocol of this study was approved by the Ethics Committee of Shahid-Behesthti University of Medical Sciences, Tehran, Iran (code: IR.SBMU.PHNM.1394.201). The study was also registered in the Iranian Registry of Clinical Trials (code: IRCT20180924041110N1). All participants were assured about the voluntary nature of their participation and confidentiality of their personal information and also were asked to read and sign the informed consent form of the study which contained information about the study aim and the benefits and voluntariness of participation. Moreover, participants could contact us in case of any problem or question during the study.
Data analysis was performed using the SPSS v. 16.0 (SPSS Inc., Chicago, IL, USA). Mean, standard deviation, and frequency measures were used for data description. All continuous variables had a normal distribution, and hence within- and between-group comparisons were made through the paired- and the independent-samples t-tests. Moreover, categorical variables were analyzed using the Chi-square-test. The significance level was set at <0.05.
| Results|| |
In total, 96 mothers were recruited to the study. Sixteen participants (eight in each group) withdrew from the study and hence, the data collected from eighty participants (forty in each group) were used in the final analysis [Figure 1]. The means of participants' and their children's age were 40.40 ± 7.17 and 11.05 ± 2.17 in the intervention and 39.85 ± 9.97 and 9.93 ± 3.49 in the control group. Most mothers in both groups were housewives and had secondary education. Only 31% of mothers in the intervention group and 17% in the control group were employed. Around 56.25% of participants in the intervention group and 61.25% in the control group were the first child of their families. Moreover, respectively 48.8% and 53.8% of mothers in the intervention and the control groups had 2–3 children. There were no significant differences between the groups with regard to participants' demographic characteristics [Table 1].
|Table 1: Demographic characteristics in the intervention and control groups|
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The mean score of mothers' satisfaction with time management significantly increased in the intervention group (P = 0.001) but remained significantly unchanged in the control group (P = 0.799) [Table 2]. Moreover, although the mean score of mothers' time management quality significantly increased in the intervention group (P = 0.003), it remained significantly unchanged in the control group (P = 0.921) [Table 3]. The levels of childcare-related activities and household activities in the intervention group also significantly increased after the intervention (P = 0.037). However, the levels of sleep-rest, leisure, and work-related activities showed no significant change in this group (P > 0.05). Moreover, none of these mean scores significantly changed in the control group [P > 0.05; [Table 4].
|Table 2: Between- and within-group comparisons regarding the mean scores of satisfaction with time management|
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|Table 3: Between- and within-group comparisons regarding the mean scores of time management quality|
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|Table 4: Pre- and post-test mean scores of the duration of daily activities in both groups|
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As shown in [Table 5], the total score of resources and stress in the intervention group significantly decreased after the study intervention (P = 0.007). However, no statistically significant change was observed in the mean score of resources and stress in the control group (P < 0. 355).
|Table 5: Between- and within-group comparisons regarding the mean scores of stress|
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| Discussion|| |
The study results showed that the mothers of children with ID spent a substantial amount of their time on caregiving activities. This may make them unable to balance their daily activities. The resultant imbalance may, in turn, lead to physical and emotional distress and affect their mental health. Obviously, the mothers of children with ID need to spend more time with their ill children than the mothers of healthy children. School-related activities of their children also increase the amount of time they need to spend with their children. Two earlier studies also reported the same findings., However, despite the significant roles of mothers in caregiving to their disabled children, few studies have examined the relationship of their mental health problems with the time they spend on caregiving.,
At the beginning of the study, participants had low levels of satisfaction with their time management. Similarly, an earlier study indicated that the mothers of children with special needs always have challenges in the effective use of their time and hence, feel dissatisfaction with life. This finding may be due to their lack of knowledge about how to manage their time. After the study intervention, satisfaction with time management significantly improved in the intervention group. This finding suggests that knowledge improvement through time use workshops can improve mothers' time management ability and their satisfaction with time management. Of course, many different factors, such as financial status, can affect satisfaction with time management.
We also found that after the study intervention, mothers in the intervention group obtained significantly better time management quality scores than their counterparts in the control group. This finding denotes the effectiveness of time use training in improving mothers' time management ability. Effective time use skills help people design better plans for their activities. However, our findings revealed that time use training had no significant effects on sleep/rest activities. This finding may be because the mothers of children with ID, hyperactivity, autism, and cerebral palsy are not different from the mothers of healthy children in terms of the time they assign to their own sleep and rest.
Another finding of the present study was the insignificant effects of time use training on leisure activities. This finding is attributable to that fact that the mothers of children with serious health problems may not have well-organized plans for leisure activities. Our findings also showed that the study intervention significantly increased the amount of time the mothers in the intervention group spent on childcare and household activities. These findings are in line with the findings of two earlier studies., The mothers of children with chronic health conditions (such as ID and cerebral palsy) usually spend great amounts of time on working for their children and hence, have limited time for their other activities.,, Moreover, some health problems may make them avoid attending public places. For instance, children with attention deficit hyperactivity disorder usually have oppositional defiant behaviors and hence, their parents may prefer to limit their social and leisure activities.
Study participants spent most of their time on household activities. Although the mothers of children with special needs always have problems in the effective use of their time and are dissatisfied with their lives, most of our participants were relatively satisfied with how they managed to balance their time. Of course, more research in different populations and contexts is needed to clarify perceptions of satisfactory balance in life among the mothers of children with special needs.
Study findings also indicated a significant decrease in the mean score of stress in the intervention group and no significant change in this score in the control group. A positive outcome of effective time use is stress reduction which in turn improves intellectual abilities and physical health. In line with our findings, a former study on the mothers of children with autism and other disabilities also found improvements in life satisfaction and reductions in depression and distress after a mindfulness-based stress reduction intervention.
There are some limitations to be considered when interpreting and using the results of the present study. We collected the study data using questionnaires which assessed maternal status in the past 24 h because using more reliable data collection methods, such requiring mothers to keep daily diaries of their activities could place an extra burden on them. Moreover, some participants declined to participate due to time limitation.
| Conclusion|| |
The results of this study indicate that the mothers of children with ID may be unable to use their time effectively because they need to spend more time on childcare activities and less on recreational and leisure activities. Thus, they usually ignore their own needs and may feel lower QoL than the mothers of healthy children. As women constitute almost half of the population in all communities and play significant roles in family health, the mothers of children with ID need to be provided with quality training about effective time use and be supported for personal need fulfilment. The authorities of special schools and community health nurses are recommended to hold time use training workshops for the mothers of children with disabilities.
Our results also highlight the importance of supporting the mothers of children with ID to find and use strategies for reducing the real and the perceived negative impacts of care. The results of the present study can help nurses better understand the concepts of time use and stress management among the mothers of children with ID and thereby, enable them to provide these mothers with quality education, counseling, and support to reduce their stress and improve their mental health. Further studies are needed to examine time-related requirements of the successful parenting of children with disabilities, to assist mothers in fulfilling their competing time demands, and to promote their health and wellbeing. Moreover, time use among the fathers of children with disabilities needs to be studied.
This article was derived from a master thesis of MS with project number 8155, Shahid Beheshti University of Medical Sciences, Shahid Beheshti, Iran. The authors would like to acknowledge the research deputy at Shahid Beheshti University of medical sciences for their support. We also are thankful of all patients who participated in this study.
Financial support and sponsorship
This study was supported by research deputy at Shahid Beheshti University of medical sciences.
Conflicts of interest
There are no conflicts of interests.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]