Transformation of mothers’ values through an online multidisciplinary group consultation on pregnancy and childcare: The Trajectory Equifinality Approach

doi:10.21203/rs.3.rs-3228204/v1

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Transformation of mothers’ values through an online multidisciplinary group consultation on pregnancy and childcare: The Trajectory Equifinality Approach

https://doi.org/10.21203/rs.3.rs-3228204/v1

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In Japan, developing concrete support for mothers facing child-rearing difficulties and anxiety has become an important social issue. Moreover, with the onset of the COVID-19 pandemic, the availability of support previously received by mothers had become limited. To address this issue, an online group consultation involving multidisciplinary specialists was conducted at the Osaka University. This study aimed to examine how participants’ childcare anxiety and child-rearing difficulties experienced prior to group consultation changed after their participation, and to identify the factors that facilitated this transformation. Semi-structured interviews were conducted with group consultation participants and analyzed using the Trajectory Equifinality Approach. The findings revealed a process whereby mothers who harbored worries regained their confidence and raised their children with peace of mind, through the affirmation they received from professionals and other participants. Additionally, mothers who held values emphasizing perfection and correctness in child-rearing experienced these transformed into values that brought personal fulfilment. These findings indicate that such group consultations can function as a platform to foster peace of mind and confidence in parenting.

parenting

group-consultation

mother-support

online-support

Trajectory Equifinality Approach

Current state of child rearing in Japan

The perinatal period is one of significant physical and mental changes that often result in psychosocial crises. In Japan, the Ministry of Health, Labour and Welfare (2019) pointed out that mothers tend to raise their children in isolation. In a report on maternal loneliness, 26% of mothers caring for their first infant were lonely at one month postpartum, 38% at six months postpartum, and 37% at 12 months postpartum (Nohara & Nakata, 2019). Many mothers raise their children in an environment that is disconnected from society. However, support from spouses is crucial to mothers’ mental health. Studies have found that mothers are less likely to experience depression when husbands are more involved in childcare and provide greater support (Terami, 2015). However, a 2019 survey by the Japanese Trade Union Confederation found that working fathers spend an average of 6.2 hours per week on housework and 9.3 hours per week on childcare, and only 7.2% of men took childcare leave, indicating that few mothers received sufficient support from their husbands. Therefore, formulating effective support programs for mothers experiencing childcare difficulties and anxiety is essential. The Ministry of Health, Labour and Welfare has implemented the “Infant Family Whole-Home Visit Program” and “Childcare Support Visit Program”; however, considering the weakening of child-rearing functions and support in local communities, there is a limit to the support that local governments can provide.

Parenting in the COVID-19 pandemic

One issue that arose was the difficulty in accessing support services available prior to the COVID-19 outbreak. Mothers' mental health was likely affected by the reduced support available to them due to limited opportunities to connect with society, including the cancellation or postponement of motherhood classes and limited access to childcare centers. Brown et al., (2020) discovered that many parents exhibited symptoms of cumulative stress, depression, and anxiety during the COVID-19 pandemic. They also revealed that perceived stress related to the pandemic was linked to incidents of child abuse; a contributing factor to this issue was the lack of social support provided by schools and childcare facilities. Similarly, in a meta-analysis by Hessam et al., (2022), pregnant women were affected, showing a significant increase in scores on the Edinburgh Postnatal Depression Scale (EPDS) and State-Trait Anxiety Inventory (STAI) during the COVID-19 pandemic, compared with pre-pandemic scores. This suggests that pregnant women as well as parents are affected by stressors specific to the COVID-19 pandemic.

Aim of the study

To address these challenges, it is important to increase mothers' confidence in their parenting abilities and help them realize their maternal potential. Therefore, the Child-Rearing Support Research Group at Osaka University launched an online parenting class involving interprofessional relationships. The aim of this group consultation was to ameliorate the sense of isolation among participants, enhance their self-efficacy and resilience, and foster a greater sense of security by facilitating connections with other participants. Group consultations were conducted nine times in 2021.

In this study, an interview survey was conducted with group consultation participants to elucidate changes in their childcare anxiety and sense of difficulty before and after participating in the roundtable discussions. This study aimed to help supporters understand what is necessary to alleviate mothers' anxiety and difficulties in child-rearing by examining the participants’ experiences. The survey also provides useful insights for supporters in terms of interprofessional relationships and online parenting support.

A parenting group consultation

The target audience for the roundtable sessions included parents with children from gestational age to one year old, and several professionals, including clinical psychologists, pediatricians, obstetricians, midwives, medical anthropologists, and childcare application creators, who participated in providing parenting support. Most participants were mothers, but some fathers were also present. Participants in group consultations were recruited via the Internet. After registering for the growth record application, the participants were invited to group consultations via social networking services and e-mail. The system was designed to allow people to register their interest in participating through invitations.

The group consultations were conducted online via ZOOM and lasted approximately 2 hours, with 5 to 20 participants each time. The participants were free to turn the camera on and off, enabling them to leave the room for childcare duties. The group consultation was structured as follows: first, a self-introduction and icebreaking session was conducted. Then, the experts joined the discussion and a 30-minute question-and-answer session followed. The experts then gave lectures on topics related to child-rearing, and there was another question-and-answer period to resolve questions from participants who attended the lectures. The parents were allowed to participate in the roundtable sessions as many times as they wished, as long as they met the requirements for participation.

Trajectory Equifinality Approach

This study employed a Trajectory Equifinality Approach (TEA; Sato et al., 2009) to trace the various paths of the participants from before to after their participation in the group consultations and to perform a detailed analysis of the transformations that occurred among them. According to Yasuda et al. (2015a), TEA is a model for thinking, analyzing, and describing the diversity and complexity of human development and life paths over time, capturing and visualizing historical, cultural, and social backgrounds. First, a Trajectory Equifinality Model (TEM) was used to capture the processes and occurrences in pregnancy, childbirth, and parenting experienced by the parents before and after their participation in the group consultations. TEM is a conceptual framework that incorporates the concept of “equifinality” in the fields of culture and developmental psychology. It aims to capture the temporal transformations of the diversity and complexity of human development and its pathways. This model of analysis and thinking is built on original ideas proposed by Valsiner (2001). TEM is depicted in two dimensions: time on the horizontal axis and events on the vertical axis. Next, the three-layer model of genesis (TLMG) was utilized to capture changes in each mother's values after participating in group consultations. The TLMG elaborately describes a person's internal transformation in selectively obtaining information from the environment at a juncture (Tagaki, 2021). The first layer, the personal activity level, represents actual behavior; the second layer, the sign level, shows the state of incorporating information and aligning it with past experiences; and the third layer, the belief/value level, shows a significant change in beliefs/values. The changed beliefs/values are externalized.

Participants

TEA uses the concept of historically structured investing to select survey targets; this is based on the idea that people have different experiences in historically structured contexts and are invited to participate in the study when narratives from the perspective of the research collaborators are considered for the study (Yasuda et al., 2015a). In this study, the criteria for participation were those who could provide consent to participate in the study through a questionnaire sent after the group consultations. Survey participants were categorized into two groups: those who participated in group consultations during pregnancy, and those who participated after giving birth. Five participants participated in the interview survey. Although there was no limit to the number of group consultations, the participants attended an average of two to three sessions. A summary of the survey participants is presented in Table 1.

Table 1

Outline of research participants and interview schedule
ID	Ages	Number of children	Number of times interviewed
A	20s	1	2
B	40s	1	2
C	30s	2	2
D	30s	1	1
E	30s	1	2

Data collection

Interview data were collected using ZOOM. One participant was interviewed only once because of unavailability, while the remaining four participants were interviewed twice. Semi-structured interviews were employed for the first interview and conducted according to an interview guide. The second interview was conducted after the TEM diagrams were completed. The interviewer reviewed the TEM diagrams with the participants and asked additional questions. The first round of interviews lasted 45–60 minutes, and the second round lasted approximately 30 minutes. Interviews were conducted between February and July 2022. The interviews were recorded with the consent of the participants and transcribed later.

Data analysis

The transcribed interview data were separated and categorized using semantic grouping. Each segment was coded to represent its underlying meaning. The segments were categorized into behavioral and emotional segments and chronologically reorganized, and TEM diagrams were generated by identifying the branching point. An arrow representing irreversibility is shown at the bottom of Fig. 1 to clearly indicate that the process is captured in irreversible time (for the items utilized in the TEM diagrams, please refer to the legend at the bottom of Fig. 1). In addition, we identified a second layer of signals that occurred before and after the bifurcation point. In the third layer, changes in values and beliefs are shown in the TEM diagram along the time axis. For all layers, the figures were grouped and integrated after each of the five figures was created.

Reliability and validity

The TEM diagram was checked by the research collaborators during a second interview, and the diagram was added to and revised. In addition, the participants were asked to elaborate on the factors that led to the branching-point event, and the contents were further analyzed. The validity of data analysis was enhanced through the confirmation and supervision of a clinical psychology researcher at the first author’s graduate school.

The analysis was based on interviews with participants from pregnancy through childbirth to present-day parenting. We discussed: (1) how each participant experienced pregnancy, childbirth, and group consultation and (2) the changes in perceptions and values they gained as a result of their participation in the group consultation. TEM diagrams were created to analyze (1), and a TLMG was applied to (2). The TEM diagrams were divided into two categories: one with participant B, who participated in the group consultation during the pregnancy period, and the other with all the remaining participants who attended after the birth of their child (Fig. 1, Fig. 2).

Equifinality point

The equifinality point (EFP) is based on the idea that, regardless of the path each individual follows, there is a point that is reached equally over time (Yasuda et al., 2015a). In addition, the EFP is the setting of the research theme itself, and it is crucial to identify a meaningful isochronous point in the life story of each participant (Yasuda et al., 2015b). In this study, as the purpose of the group consultation was to increase the self-efficacy and resilience of the parents themselves and to help them feel more secure, we set the first EFP as “I can raise my child with peace of mind.”

Moreover, during our analysis, we found that the 0th EFP was at a point prior to the originally set EFP. It became clear that the participants had reached a point where they could identify themselves as mothers before they felt safe raising their children. For example, participant A said, “I had been losing confidence because of all the things I couldn't do, but now I feel like I can do normal things like talking to people”; participant B said, “I feel like what I have been doing is not a mistake,” and participant E said, “I feel like I don't have to work so hard.” Based on the above, we set the 0th EFP of agreement as “to recognize myself as a mother.”

Trajectory Equifinality Model

After creating a TEM diagram for each participant, commonalities and similarities among the five TEM diagrams were determined. Bifurcation points (BFPs) and obligatory passage points (OPP) were discussed, and the TEM diagrams were integrated. Consequently, the value transformation process in parenting was divided into three categories. During the period from pregnancy to BFP1, as marked at the beginning of the TEM diagram, the participants were confronted with various concerns related to child-rearing and struggled to overcome them. The first period was defined as a period of worry and anxiety. In the next period, from OPP1 to BFP2, the participants expected to solve their problems and relieve their anxieties by searching and applying for group consultations on their own, using the Internet. The second period is defined as the expected period. In the last period, from BFP2 to the first EFP, the participants learned from experts and shared their concerns with other participants, which stimulated their sense of value and restored their confidence. The third period was defined as the period of changing values and confidence recovery.

Social guidance and social direction

In the path of the TEM diagram (Fig. 1, Fig. 2), individuals have a variety of choices and events, and there are junctures as their life paths split. When a choice is made at a branching point, the one that acts as a helping force is called social guidance (SG). Conversely, when its action affects the choice as an inhibiting or restraining one, it is called social direction (SD). First, there were a total of five SDs involved in this study. One SD acted from OPP1 to BFP1, whereas the remaining four SDs affected each participant in BFP1.

Although all SDs emerged in the wake of the COVID-19 pandemic, two categories of content were highlighted. The first was the consequences of the reduced face-to-face communication. For example, SDs including “unable to go out for COVID-19,” “no face-to-face parenting events,” and “no opportunity to talk to anyone other than their husbands” fall into this category. These SDs seem to have caused mothers to feel a sense of helplessness in their parenting, as evidenced by their reported feelings of “difficulty in child-rearing” and “not knowing what to do.” The second was “information in parenting books and on the Internet.” The participants tried to solve their parenting problems by utilizing the information disseminated to the public. However, participants C and E struggled because of a lack of useful information on their specific parenting concerns, while participant A felt that her confidence was undermined by comparing herself to the glowing parenting experiences of others posted on social media.

Whereas, there were five SGs: two that acted on OPP4, “online face-to-face” and “able to turn off the camera,” and three that acted on BFP2, “relaxed and casual,” “at-home atmosphere,” and “experts answering questions based on evidence.” The SGs that acted on OPP4 showed a positive evaluation of the group consultation format. Participants were able to join from their homes and easily participate in group consultations without having to take their children outside. They also appreciated the ability to turn off their cameras and leave temporarily for childcare. The SG that acted on BFP2 expressed appreciation for the atmosphere of the group consultation and the trust placed in experts. Participants expressed that the atmosphere was conducive to asking questions, and that the experts had the perspective of experienced fathers. The warm and empathetic attitude of the organizers toward the participants played a pivotal role in the branching point as an SG. As a result of the influence of SGs, participants felt that the discussion forum was trustworthy, leading them to choose the proactive behavior of asking questions in the BFP2.

Phase I: Period of worry and anxiety

During this period, the participants spoke of their anxieties and concerns about pregnancy or raising a child. For example, B, who was pregnant at the time of the group consultation, expressed the feeling that her own information about life after childbirth was biased. Participants raising their children talked of concerns about breastfeeding (C and E) and their children's weight (A and D). In particular, A stated, “I asked my pediatrician questions at my child's one-month checkup, but I still felt anxious,” and continued to feel anxious despite having asked and received answers from a specialist. D also noted a lack of mental capacity, “I have to find my own way to rest,” and C talked about the anxiety inherent in the COVID-19 pandemic, saying that she was worried about the COVID-19 vaccination. At BFP1, mothers had difficulties or concerns about childcare, such as “loss of confidence (B)” and “anxiety about postpartum (C),” which led them to apply for the group consultation. Furthermore, SDs were also observed at BFP1, where SDs were primarily related to COVID-19 for participants A, B, and C, while participant D mentioned “information on the Internet” and participant E expressed “having no one to talk to except my husband.”

Phase II: Period of heightened expectations

Although each participant had her own sense of anxiety and difficulty, few of them focused on it. There were two methods to register for group consultations. The first was to follow the personal accounts of organizers on social networking sites and obtain information from them. The second was to obtain an application from Mircare Corporation, which disseminates information about the group consultation, and receive the required information. It is postulated that each participant used the Internet to gather information regarding pregnancy and childcare, and subsequently encountered information about group consultations. After signing, all participants stated that they had high expectations from the group consultation. Expectations included wanting to hear from a medical expert (A, B, and C), “it would be meaningful to participate” (D), and “I thought I could praise myself for participating” (E).

Phase III: Transformation of values and recovery of self-confidence

The main comments on the day of the group consultation were that it was fun (A and E) and the atmosphere was good (B, C, and D). Each participant perceived a positive and welcoming atmosphere from the roundtable organizers. This atmosphere functioned as a SG, leading to BFP2. At BFP2, all participants were “able to consult with experts” about their problems and questions. Although this was an online roundtable that allowed for passive participation, participants chose to actively engage in communicative behaviors, such as asking questions. Consequently, the mothers had the opportunity to be told by experts that they could be just the way they were (A, C, and E) and they felt affirmed as mothers (D). B also mentioned that she was able to imagine herself after childbirth because she was able to obtain advice from other participants regarding the questions she had asked. When asked about the reason behind her feeling that everything was correct, A said, “I was able to hear from a consultant who is a doctor about his experience in seeing him for infant check-ups and also his personal experience in child-rearing” and “He answered other people's questions appropriately,” Meanwhile, C said, “I was told the source of the information,” and “ the doctor had a likable personality.” E valued the individuality of the experts’ responses, saying, “I was able to get information from the experts that was not in the parenting books,” and further described familiarity with the experts, saying, “I was able to hear interesting experiences from the senior dads.”

During the path from BFP2 to the EFP, participants reported that although their concerns themselves did not decrease, their anxiety was reduced by approximately 10% initially and continued to decrease with each subsequent group consultation (as per participant A). Additionally, they mentioned that their problems were not necessarily resolved, but they were able to relax emotionally and accept that they could only observe the situation for the time being (as reported by participant E). In other words, there was a shift in their perceptions and attitudes toward their problems, even though the problems still remained.

Additionally, C was able to resolve her doubts about the COVID-19 vaccine, stating that “I was grateful to receive information that I couldn't choose on my own.” In other words, through BFP2, participants received words of encouragement from others, which led to a change in their perspective on the problems they were facing, which, in turn, led them to the EFP of “being able to raise their children with peace of mind.”

In this study, five participants were recruited for the interviews; Yasuda et al. (2015a) suggested that setting the number of participants to 4 ± 1 can clarify both the divergent and convergent aspects of the data. This tendency was also observed in the present study. For example, in the pathway leading up to the application for group consultation, it was evident that the participants were struggling with various conflicts such as postpartum anxiety and concerns about their child's weight gain. At BFP1, the influence of SDs appeared to have contributed to the expression of difficulties such as “I can't do it” and “I don't understand.” However, from the point of applying for the group consultation, through participation in the discussion and BFP2, where they were able to ask the experts questions and receive reassurance, it seems that all participants followed a similar pathway. After BFP2, changes were observed in their perspectives toward the conflicts and difficulties they originally experienced, and it became clear that they ultimately reached the EFP.

Transformation of values

How did the participants' experiences and struggles from pregnancy to the EFP impact their values? Because diverse changes were observed in the participants, we examined each transformation individually.

Prior to participating in the group consultation, participant A expressed feelings of loneliness due to the challenges of caring for a newborn and the lack of social interaction due to the COVID-19 pandemic. She reported being unable to go out during the day because of midnight feedings, which further isolated her from others. She was also anxious that she had to do everything perfectly “according to the child-rearing book” and that she did not know if her child-rearing methods were correct. Through spontaneously asking questions about her concerns regarding her child's weight gain and receiving reassurance from experts that it was normal, she was able to feel a connection with others: “Maybe I can try,” “I feel okay now,” and “We're all in this together.” Consequently, she gained a sense of security and her parenting anxiety was gradually relieved.

B had concerns about herself and her child, such as “I might have postpartum depression,” “I was worried about my relationship with my parents because I was going to have a home birth,” and “What if my child had a congenital disease?” During the group consultations, she mentioned that hearing about other participants' episodes of postpartum depression and home birth helped her realize what she would prefer in the future. She then took action to anticipate her own postnatal changes, such as registering for public services before birth and informing her parents in advance of her wishes regarding how they should treat her and her baby.

C often took her first child outside to play, but when her second child was born, she was unable to take him out due to the COVID-19 pandemic. While she was breastfeeding her second child, a coupon for the COVID-19 vaccine was distributed, but she was hesitant to get vaccinated.

D experienced anxiety regarding her child’s weight and frustration with her husband’s parenting. She also resisted talking to others about her childcare concerns. She initially intended to only participate passively in the group consultations. However, she eventually introduced herself, saying, “I was nervous, but gradually my nervousness dissipated,” and showed an active attitude by asking the experts and other participants questions about her own anxieties and frustrations, and received “positive words” from the experts. In addition to relieving her anxiety, participation in the group consultations had a transformative effect on the way she had previously thought about communication, for example, “self-disclosure facilitates communication.” In the group consultations, a male expert shared his perspective on fatherhood and childcare, which was “quite acceptable” to D. As a result, she was able to deepen her understanding of her husband and decrease her previous feelings of irritation toward him.

E described a very high level of stress in her life with her child before participating in the roundtable, saying that she felt she might become depressed. She held values such as “there is no one to help me” and “housework and childcare is my job.” After participating in the group consultations, E was able to shift her focus toward her own well-being. She also recognized that she had someone to support her by asking questions of the specialist and was reassured by his words, “Don't worry, it's okay.” She stated that the experts' advice did not directly solve her problems but provided her with emotional relief. This was because it helped her let go of her preoccupation with child-rearing.

Prior to participating in the group consultation, the participants valued pursuing perfection and correctness, which caused them to experience stress and anxiety when confined within such a framework. However, the participants felt connected to the experts and other participants and were able to recognize themselves by affirming who they were as mothers. The results indicated that they transformed into values with which each felt comfortable (see Fig. 3).

Participants' transformation process through group consultations

This study aimed to determine how childcare anxiety and difficulties experienced by the participants changed after participating in group consultations, and to identify the factors that supported this change. During pregnancy and after childbirth, the participants faced anxiety and frustration arising from parenting and the unique environment of the COVID-19 pandemic. Due to the challenges of accessing face-to-face parenting consultations during the COVID-19 pandemic, when events such as maternal classes were restricted, there were decreased opportunities for communication among mothers. In addition, many hardworking mothers feel that they must raise their children “correctly” and “perfectly.” Factors such as the nuclear family and overflow of information may be cited as reasons for this.

Although participants attempted to address their parenting anxiety and difficulties by gathering general information on the Internet targeting a mass audience, individualized parenting concerns remained unresolved. It is assumed that SD amplifies negative emotions among mothers, such as confusion about how to proceed and loss of confidence. The emergency situation of the COVID-19 pandemic seems to have brought to light the difficulties and anxieties of mothers that do not surface in normal circumstances. In other words, mothers manage to navigate the challenges of child-rearing by sacrificing their own needs in ordinary circumstances. However, this study revealed that such difficulties and hardships of mothers have been overlooked by society. Subsequently, each survey participant obtained information about the group consultation through online information gathering and applied to participate with the expectation that it might alleviate their parenting anxieties and concerns. Group consultations were structured to create an environment conducive to the participation of parenting mothers, such as being held online and allowing participants to turn off their cameras. These features serve as a form of SG that makes it easier for mothers to participate. Group consultations were designed to provide a supportive environment that was easy for mothers who were parenting to participate in, including the ability to participate online and turn off cameras. They felt a sense of connection with other attendees and speakers and enjoyed the comfortable atmosphere of the group consultation.

Moreover, the “homely atmosphere” and the expert's appropriate responses to their questions functioned as SG. One factor that contributed to SG was the participation of multidisciplinary experts in group consultations. Parenting concerns are remarkably diverse, encompassing topics such as the physical and mental development of children, physical and mental concerns of mothers, breastfeeding, and infectious diseases. It was difficult for the participants to categorize their concerns and consider whom to ask about them. However, in the group consultations, several experts were able to answer questions related to childcare appropriately. Participants felt that they could trust the experts because they saw how each expert spoke and appropriately answered the other participants’ questions. The survey participants took the active step of asking their own questions and felt that they could trust the forum. Consequently, they asked questions themselves. Through the sincere and reassuring responses of the experts to their questions, mothers who had lost confidence and experienced anxiety in parenting were able to demonstrate their inherent strengths. Consequently, these participants underwent a transformation in their values, ultimately leading to self-acceptance of their roles as mothers. In addition, these mothers reached the first EFP of raising their children with confidence and peace of mind. This change in values had a practical impact on their behavior, such as registering for public child-rearing services or going out for lunch with friends. After reaching the first EFP, the paths diverged again because of the diverse range of worries and anxieties the participants had before the group consultations. It can be argued that the paths diverged further as each participant addressed their own concerns.

Recovery of mothers' self-confidence

The factors that encourage participants to change their values are discussed. To identify the factors that facilitated participants' transformation, it was necessary to consider the promoter sign within the second layer of the TLMG. As previously mentioned, it seems that the verbal interactions directed toward mothers, including experts and other participants, served as promoter signs and influenced transformative shifts in values. Among them, four out of five survey respondents mentioned that the experts told them “you can be just the way you are,” which acted as a promoter sign, leading to the restoration of confidence. However, why does a single statement from an expert have a significant impact on regaining confidence?

Two factors can be considered as reasons why these women regained their confidence. First, as A, D, and E stated, the experts responded to the participants' concerns from the perspective of seniors who had raised children. Baile et al. (2000) suggested that psychological support, such as physician empathy, is most important for reducing patients' isolation and calming their thoughts and feelings. This could also be attributed to the fact that the participants found the experts very approachable, which challenged the stereotypical image of doctors and reduced the psychological pressure associated with their interactions. Second, the warm atmosphere of the group consultations served as SG. Rogers (1942) stated that a counselor’s warm atmosphere and positive regard are consistently emphasized as crucial elements of psychotherapy. Empowered by this atmosphere, the participants took active steps to address their concerns and find solutions. Benedict (1946) discussed that Japan has a “culture of shame” in which individuals are consciously aware of the gaze and reactions of others, and they engage in “good” actions to avoid being ridiculed by others. In Japanese society, there exists a cultural interpretation where “standing out or being different” is considered “shameful.” Therefore, for mothers from this cultural background, speaking up during group consultations required significant courage. However, the participants were able to actively ask questions without being overly conscious of others' reactions because of the experts' behavior and the warm atmosphere of the group. Based on this, it can be inferred that it is important to create a warm and supportive atmosphere during group consultations.

The participants’ confidence appeared to have been restored when they proactively chose to ask the experts questions, and the experts provided answers that made sense to them. Amidst the challenges of child-rearing, parents may lose sight of their own positive aspects. However, by sharing their concerns with other mothers and realizing that “I am not the only one who is suffering,” participants were able to regain their inherent self-efficacy. Additionally, they were affirmed with messages such as “you can be just the way you are” from the experts and fellow participants, which likely contributed to the positive shift. This can be considered as the secondary EFP, indicating the “acknowledgment of herself as a mother.” Moreover, they realized their capacity to resolve anxieties and concerns on their own, giving rise to a positive mindset of “I will be fine.” This led to the achievement of the first EFP, which was the ability to provide parents with a sense of reassurance and peace of mind. From the above, the three points indicate what mothers need to raise their children with peace of mind: first, to feel that “I am not the only one who is troubled”; second, the opportunity to resolve questions and doubts that arise during parenting; and third, it is important to be acknowledged as a mother by someone that she feels she can trust.

The target group for this consultation was a non-clinical group. In this case, it might be possible to elicit positive aspects in mothers and restore their self-confidence through short-term support, such as group consultations, rather than through time-consuming and costly counseling methods.

Possibility of Internet use regarding childcare support

During the COVID-19 pandemic, there was a significant reduction in external connections for mothers, such as attending classes, leading to a situation in which they were more susceptible to feelings of isolation. Therefore, mothers needed to search for information to solve highly individualized child-rearing problems from general information for the masses, such as child-rearing books and information on child-rearing on the Internet. As a result, they may have experienced increased anxiety and agitation, such as “Is this OK?” and “I don't know what to do.” Hence, it can be inferred that the impact of the COVID-19 pandemic made it challenging for mothers to access individualized support, thereby intensifying their anxiety. However, although this consultation group was initiated because of the pandemic, it is a valuable opportunity for experts to address mothers’ concerns, even during normal times. It is one of the few platforms available for solving individual parenting issues. Parenting support requires assistance tailored to accommodate individual needs. Group consultations utilizing online platforms can be seen as an avenue for providing personalized support for parenting challenges. Although the COVID-19 situation is gradually improving, mothers may still face difficulty going outside amid childcare duties, which makes online support more effective. The effectiveness of conducting sessions in a group setting was also mentioned in the participants’ narratives. Participating in a group provided a sense of reassurance, as they realized that other mothers were also grappling with similar concerns. It also seems that, because others asked questions, participants felt safe enough to ask their own questions. Based on the aforementioned points, it is plausible that the benefits of group or online interventions can be more readily experienced in parenting support even without individual counseling sessions.

Limitations and future prospects

This study revealed the process by which mothers who participated in online roundtables discussions regained their confidence in child-rearing. However, it is important to discuss the study’s limitations and future research prospects. The first limitation was in the process of recruitment; participants were limited to those who responded to the post-survey and agreed to cooperate in the study. Thus, recruitment may have been biased toward those who had a positive perception of group consultations. Second, the content of the interviews may have been skewed toward positive perceptions. Furthermore, only a qualitative analysis was conducted. This study revealed the process by which mothers regain lost confidence and demonstrated the potential of group consultations to function as a support for mothers. However, these findings cannot be generalized. In the future, it would be desirable to increase the number of participants and conduct a quantitative study to examine the effects of group consultations on mothers.

Regarding future prospects, the first is to expand the number of group consultation participants. Currently, group consultations are only held at Osaka University, which limits the number of participants. Therefore, we hope that the scope of these group consultations will be expanded so that they can be held in each municipality as well. It is necessary to engage in detailed discussions on specific information that mothers may require and discuss how professionals can be involved so that mothers can truly feel supported.

This study examined how mothers who participated in multidisciplinary online group consultations experienced the group during their pregnancy, childbirth, and parenting phases, and the factors that promoted the transformation of their values. The mothers had diverse and highly individualized problems related to parenting, which they attempted to address on their own by seeking solutions through publicly available sources, such as the Internet and parenting books. However, these issues remain to be resolved. The participants experienced a warm atmosphere and a sense of connection with other participants during the group consultations. They also experienced the affirmation that “it is alright” to be a mother. They also experienced acknowledgment of themselves as mothers. As a result, they were able to demonstrate their inherent self-efficacy as mothers and reached the first EFP as “I can raise my child with peace of mind.” Thus, this study suggests that, in supporting mothers, it is crucial for them to feel a connection with others in similar situations, have their questions resolved, and be affirmed as mothers by someone they can trust.

In Japan, the problems of mothers raising their children in isolation have been highlighted, influenced by the shift to nuclear families and declining birthrates. To solve these problems, it is imperative to build a system that is easily accessible to many mothers and provides them with substantial support, starting with group consultations such as the one described in this study.

Acknowledgments

We appreciate all the research participants who agreed to be interviewed.

Funding　

This study was supported by the Project Supporting Research Centers for Realization of Society 5.0, Grant J210304001, from the Ministry of Education, Culture, Sports, Science, and Technology.

Data Availability Statement

Not applicable.

Ethical Considerations

Participants were informed that participation in the study was voluntary and could be discontinued at any time. Furthermore, the purpose of the study, data storage and handling procedures, and measures to ensure privacy protection and confidentiality were explicitly explained, and verbal consent was obtained from the participant at the beginning of the interview.

This study was approved by the Institutional Review Board of the Osaka University Hospital (No. 19290(T2)-4) and the Ethics Committee of the Graduate School of Human Sciences, Osaka University (No. 21013). In the data description, anonymization was performed by replacing individual identities with letters of the alphabet, such as “A” and “B,” to the extent that it did not compromise the study results.

Conflicts of Interest

The authors declare no conflicts of interest associated with this work.

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Transformation of mothers’ values through an online multidisciplinary group consultation on pregnancy and childcare: The Trajectory Equifinality Approach

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Abstract

Figures

Introduction

Current state of child rearing in Japan

Parenting in the COVID-19 pandemic

Aim of the study

Methods

A parenting group consultation

Trajectory Equifinality Approach

Participants

Data collection

Data analysis

Reliability and validity

Results

Equifinality point

Trajectory Equifinality Model

Social guidance and social direction

Phase I: Period of worry and anxiety

Phase II: Period of heightened expectations

Phase III: Transformation of values and recovery of self-confidence

Transformation of values

Discussion

Participants' transformation process through group consultations

Recovery of mothers' self-confidence

Possibility of Internet use regarding childcare support

Limitations and future prospects

Conclusions

Declarations

References

Additional Declarations

Status:

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