This quasi-experimental study was conducted in 2020. The entire study protocol was accessed at Aja University of Medical Sciences.
Participants and setting
This study of three groups (two experimental groups and one control group) was performed in four hospitals of an organization in Tehran, Iran. This organization has eight hospitals in Tehran. A researcher’s assistant placed the name of eight hospitals in a container. Before taking the name of the hospitals out of the container by the researcher’s assistant, the researchers decided that the name of the first, second, and third hospitals that is taken out consider for the multimedia, social media, and control groups, respectively. After sampling, the number of nurses in the second hospital was not enough, so the fourth hospital was also selected as a social media group according to the previous method. Sixty female nurses with children aged 2-5 years were recruited by the convenience method. The sample size was calculated with a 95% confidence interval, 90% test power, and based on the previous study (33), and considering a 10% probability of attrition, 20 nurses were recruited in each group.
One nurse from the multimedia group and two nurses from the social media group were excluded from the study due to COVID-19 disease and unwillingness to continue participating in the study. Finally, 19 nurses in the multimedia group, 18 nurses in the social media group, and 20 nurses in the control group were studied. Inclusion criteria included informed consent to participate in the study, not attending the same educational groups at the study time, not receiving simultaneous individual psychological treatment, not receiving psychiatric drugs in the mother and her children, having at least one child in the age group of 2-5 years, at least a bachelor's degree in nursing. Exclusion criteria included not responding to the two text messages of the researchers regarding reading educational content in the multimedia group, and not reading content in two sessions (not sending the phrase “Was studied”) for the social media group.
The research tools were 1) demographic characteristics questionnaire (mother's age, spouse's age, mother's education level, number of children, child's age, child's gender, mother's shift work, history of using information resources in the field of parenting). 2) Parenting Stress Index (PSI-SF: Parenting Stress Index) developed by Abidin. This questionnaire has 36 items from 3 sub-scales: “parental distress”, “parent-child dysfunctional interaction”, and “difficult child characteristics”. The “parental distress” sub-scale (items 1 to 12) indicates the level of stress due to individual factors, and the degree of depression or conflict with the spouse due to the limitations that they have for raising a child. The “parent-child dysfunctional interaction” sub-scale (items 13-24) indicates dissatisfaction with the parent-child interaction in cases where the parent does not approve of the child. The “difficult child characteristics” sub-scale (items 25-36) measures the parent's perception of the child's self-regulatory ability. Scoring on a 5-point Likert scale ranges from (1) strongly disagree to (5) strongly agree (34). The range of scores in all three sub-scales is (12-60) and the total range of scores of the questionnaire is (36-180). The sum of the scores of the sub-scales shows the overall stress score, the higher the score, the more parenting stress. The previous study confirmed the validity and reliability (Cronbach's alpha coefficient: 0.92) of the PSI (35). Also, Iranian researchers confirmed the validity and reliability (Cronbach's alpha coefficient: 0.90) of this tool (34). Then, the demographic characteristics questionnaire and PSI were completed by all nurses.
Firstly, the researchers prepared the educational content of reducing parenting stress. For this purpose, they searched valid electronic and print literature related to parenting stress. Also, one of the researchers referred to psychology and psychiatric nursing professors in the field of family and child. Then, the researchers prepared titles and educational content for a booklet related to parenting. Then, seven professors and specialists (Doctor of Clinical Psychology, Psychologist, Master of Psychiatric Nursing, Doctor of Nursing, and Doctor of Medical Education) confirmed the validity of the educational content. The final content consisted of two parts, parenting skills and lifestyle methods for mothers.
In the multimedia group, twenty educational sessions were prepared in voiced PowerPoint along with related images and it was recorded on Digital Versatile Discs (DVDs). The duration of each DVD included 5 training sessions of 90 minutes. One DVD was given to the nurses every week for one month. A total of 4 DVDs with a training duration of 6 hours were delivered to them. The researcher sent a weekly text message to the participants. It was a notification for studying the educational content. Also, the phone number of the researcher was provided to the nurses and their questions were answered.
In the social media group, the researcher installed an Iranian messenger called Rubica on the nurses’ smartphones and taught them how to work with it. The important features of this messenger include the possibility of installation on a smartphone, the possibility of exchanging messages and educational clips, movies and music, and a low-consumption Internet messenger. The researcher created a social group in the installed software so that everyone in the group could receive the content, and it was possible for everyone in that group to exchange opinions. She was the group admin. The researcher sent the educational materials in voiced PowerPoint (each 15-20 minutes) for four weeks. They were sent in the form of 5 training content per week at a specific time. Totally, 20 Power Points were sent by Rubica. The training content provided to both experimental groups was the same. Nurses could discuss any questions or ambiguities with the admin.
In the control group, no intervention was performed by the researchers. Two weeks after the intervention, the PSI was completed again by the nurses of the three groups (Figure 1). Intervention and data gathering was performed from September to December 2020.
The data analysis was performed using the SPSS software package (ver. 21), particularly descriptive (i.e., mean, SD, frequency, and percentage) and analytic tests, including paired t-test, Fisher’s exact test, Chi-Square test, Median test, Kruskal–Wallis, and one-way ANOVA. Kolmogorov-Smirnov test was utilized to check the normality of the data, considering the significance level of P>0.05. The statistical analyst was blinded to the control and intervention groups.
The Ethics Committee of Aja University of Medical Sciences approved this study (ID: IR.AJAUMS.REC.1398231). In the present study, the Helsinki Declaration was observed (36). The researcher explained the purpose and method of study to the nurses. Then, they signed the informed consent form that was approved by the ethics committee of Aja University of Medical Sciences. The nurses were allowed to voluntarily participate in the study, and withdraw whenever they liked. Nurses were assured that all information would be kept confidential. Researchers protected the participants from physical, psychological, and financial harm. The educational content was provided to the nurses in the control group after the study. In addition, the Committee on Publication Ethics principles were met.