The present study was a randomized clinical trial (RCT), with two groups of parallel and two-stage design (pre-test and post-test). The research protocol was approved by the Ethics Committee of Shiraz University of Medical Sciences, Shiraz, Iran (code: IR.SUMS.MED.REC.1399.369). Also, while pointing out the confidentiality of the participants’ information, they have given written consent to participate in the research.
The study population was all the mothers with hearing-impaired children under training at the Family Rehabilitation Center in Soroush, Shiraz.
Criteria for inclusion of mothers in the study were: Persian language, a child with hearing loss in the age range of 3 to 7 years, and no psychiatric disorder requiring medication.
Conventional simple sampling was performed through the available samples. A total of 57 eligible individuals were included in the study.
First, the necessary information about confounding variables about each participant was collected through performing interviews, referring to the child’s file, and completing a questionnaire. These variables were: mother’s age, mother’s level of education, father’s level of education, father’s role, socioeconomic level of the family, family type, city of residence, number of children, child’s age, child’s gender, order of birth, comorbid disorders, severity of hearing loss, and type of hearing aid (Tables 1,2).
Participants were randomly assigned and divided into two groups (group A including 29 subjects and group B including 28 participants) using a table of random numbers.
Then, the relevant data were entered into SPSS software, and the means of confounding variables were compared using the independent t-test at a significance level of 0.05. According to Table 1, no significant difference was observed at the baseline between the two groups. Therefore, the two groups had the same conditions at the baseline concerning the confounding variables.
Also, to collect data related to the study-related variables, including the mother’s general health status, authoritative parenting style, careless parenting style, authoritarian parenting style, and life skills, first the authors sent the relevant questionnaires to be completed by the mother. Then the data were analysed by a psychologist. In this regard, the mother’s general health status was determined using the GHQ questionnaire, the mother’s parenting style was determined using the PSDQ questionnaire, and life skills were determined using the life skills questionnaire. Then, the relevant data were entered into SPSS software, and the means of dependent variables were compared using the independent t-test at a significance level of 0.05. No significant difference was observed at the baseline between the two groups. Therefore, the two groups were in the same status at the baseline concerning the dependent variables. (Tables 1, 2)
In the next step, the type of intervention in each group was determined randomly, which was the intervention assigned to group A being through parenting education and the intervention assigned to group B being through life skills training. Using the Kiddie Schedule for Affective Disorders and Schizophrenia-Present version (KSADS-P) in a psychiatric interview by the centre’s clinical psychologist, mothers with children with possible disorders were excluded. The validity and reliability of this tool have been reported to be acceptable in Iran.
Parenting Styles and Dimensions Questionnaire–Short Form
The parenting style of the participants in both groups was quantitatively determined through a short questionnaire of Robinson, Parenting Styles and Dimensions Questionnaire – short form (PSDQ), which was validated in the Iranian population and its reliability and validity were confirmed. The data obtained from this questionnaire were entered into SPSS software. This questionnaire consists of 32 items that cover questions related to all three styles of authoritarian, authoritative, and permissive parenting (12 questions regarding the authoritative style, 15 questions regarding the authoritarian style, and 5 questions regarding the permissive style). For each question, 5 options are designed (1. Never, 2. Sometimes, 3. Almost half of the time, 4. Many times, 5. Always); for each option, a score equal to its number is considered. For analysis of the data of this the questionnaire, at first, the questions were separated according to parenting style; after calculating the score for each style, they were entered into a comparative analysis.
Life Skills Questionnaire
The life skills of mothers participating in the group were assessed through the life skills questionnaire of Saatchi et al. Its validity and reliability were confirmed, and the data of this questionnaire were entered into the relevant software. This questionnaire contains 40 items that are scored based on a five-point Likert scale (very low, low, to some extent, high, very high). They are listed in options 1 to 5, respectively, each of which having a numerical value equivalent to its option. As a result, test scores range from 40 to 200.
General Health Questionnaire-28
The level of mental health of the participants in both groups was measured through a general health questionnaire. The validity and reliability of this questionnaire has already been confirmed in Iran, and the relevant data were entered into the software. This questionnaire consists of 28 items for each of the four options. The options have a numerical value of 0 to 3. A lower score indicates a better level of mental health. The scores on this questionnaire also range from 0 to 84.
Due to the implementation of this project during the Covid-19 pandemic and as a result of the impossibility of holding a face-to-face workshop, the training course was held in the form of a virtual workshop online via WhatsApp due to its no-cost, availability, ease of use, and popularity among mothers.
Training in both groups was done by a female psychologist with a master’s degree.
The intervention included ten 120-minute workshops held twice a week.
The structure of each session on the appointed day and time was to first review their assignments of the previous session, extract practice exercises, provide feedback, introduce the content of the current session, teach a new topic, practice, and determine the practice of the next session.
To improve the training process, on days other than the main meetings, if any ambiguity or question arose for any of the members, it was raised in the group and the answer was provided with the participation of others.
Parenting training workshop
Parenting education was done through the Triple P - Positive Parenting Program, in which parents were introduced to parenting techniques, designed by professors at the University of Queensland in Australia, based on a memorandum of understanding between the Cognitive Sciences Research Institute (Iran), the Iranian Child and Adolescent Psychiatric Association, and Triple P International, which is in charge of distributing this program. The license was issued to implement the program in Iran.
Life skills training workshop
The life skills training program was held based on the life skills components of the World Health Organization, including ten skills: decision-making ability, problem-solving ability, creative thinking ability, critical thinking ability, effective communication ability, interpersonal relationship ability, self-awareness ability, empathy ability, the ability to cope with emotions, and stresses.
At the end of the intervention, questionnaires on parenting style, life skills, and general health were completed again by participants in both groups. After analysing the relevant data by a psychologist, these data were entered into SPSS software and the means of dependent variables were compared by independent t-test at a significance level of 0.05.
Exclusion from the study
During the course, 8 participants withdrew from the study, 4 of them due to their illness or that of a family member, 2 people due to the death of a family member due to Covid-19, and 2 people left the project due to cancellation. After completing the course, 3 participants were excluded due to uncompleted questionnaires, and after analyzing the data, 2 participants were excluded due to incorrect scores.