How Iranian Mothers Raise Their Adolescent Children: A Qualitative Content Analysis

Background Most parents consider adolescence to be the most dicult stage of parenting. The parental practice is a determining factor in adolescents’ academic achievement, self-esteem, independence attainment, social adjustment, and risky behaviors reduction. The main role of parenting in many societies is played by mothers. The present study aimed at explaining the Iranian mothers’ practice in parenting an adolescent child. Methods This qualitative conventional content analysis was conducted in 2019 in Kashan, in the central part of Iran. Totally, 20 in-depth semi-structured interviews with mothers of adolescent children were performed using a purposive sampling method. Interviews continued until data saturation was reached. Data collection and analysis were performed simultaneously using MAXQDA10 software. Results Regarding the study purpose, six main categories and two themes were identied. The theme of ‘laying the groundwork for upbringing’ was detected by two main categories: ‘meeting the needs’ and ‘effective interaction with the adolescent’ and the theme of ‘individual-social capacity building’ was explained by four main categories: ‘helping to gain independence’, ‘modeling individual-social behavior’, ‘socializing the adolescent’, and ‘preparing to accept future roles’. Conclusions A deeper understanding of maternal practice can help health professionals, especially family nurses, develop parenting programs to promote maternal literacy and adolescent health.


Background
The parental practice is a determining factor in adolescents' academic achievement, self-esteem improvement, independence attainment, social adjustment, and high-risk behaviors reduction [1]. Most parents consider their child's adolescence period to be the most di cult stage of parenting [2].
Adolescence is the stage of transition from childhood to adulthood and moving towards achieving identity and independence, new social roles, and responsibility in various areas of life. This transition can be challenging for adolescents and their families [3]. The emergence of modernity which were accompanied by welfare improvement, tendency toward higher education, and delay in employment and marriage have led to a longer period of adolescence and, consequently, the possibility for a greater parental in uence on adolescents. Modernization is a powerful and in uential factor in raising adolescents due to creating widespread social change [4,5]. However, it is still these are the parents who play a key role in adolescents' lives [6]. Contrary to the popular belief that adolescents are aliens to their parents, it has been shown that they have a deep relationship and strong attachment to their parents, especially their mothers [7].
The main role of parenting in many societies is played by mothers [8]. In Iran, parents consider themselves responsible for their children throughout their lives (regardless of their age), and children live with their parents sometimes even after marriage [9]. Women play a key role in managing the home and raising children [10]. Besides, in Iran, families are deeply in uenced by religious teachings [9], and motherhood is one of the most important roles of a woman according to Islamic culture; to properly tend to the motherly role, many social duties and economic burden have been taken away from women, and the main task of them as mothers is to raise good children [11]. The level of fathers' interaction with children is lower compared to mothers due to job responsibilities, social norms, and role expectations.
Mothers interact more directly with their children and are more accessible to them; therefore, they are more involved in their training and have more responsibility [12]. Stanhope and Lancaster (2019), community health nursing experts, stated that most individuals have not been trained in parenting and have learned it through experience and observation, accordingly, they need to obtain information from external sources, especially health professionals [13]. Nurses have high capacity and apt opportunity to educate parents at the community level, schools, health clinics, and care centers [14]. Home visits are also a great opportunity to continuously educate and support parents [13].
Nurses can have a profound impact on the functional outcomes of parents and adolescents by teaching parenting techniques and preparing parents to deal with the normative challenges of adolescent development [15]. Qualitative research focusing on maternal practice has been rather limited on this topic; therefore, to explain different aspects of the complex phenomenon of parenting that is strongly in uenced by cultural norms [16], present researchers have designed and conducted a study with the aim of explaining the Iranian mothers' practice in parenting the adolescent child.

Methods
This qualitative conventional content analysis was conducted with the participation of 20 mothers between July 2018 and November 2019.

Settings, sampling
Middle aged women with at least one adolescent child (12 to 18 years old) participated in the study. The inclusion criteria included lack of mental disorders, willingness to participate in the study and express their experiences, and the ability to understand and speak in Persian language. Sampling was done by purposive method until data saturation was reached. Data were collected using semi-structured individual interviews. The interviews, based on qualitative research, were implemented in real and natural places accessible to mothers, including school, home, park, or o ce.

Data collection
Each interview began with a general question, "explain what you do for your adolescent," and based on the type of answers, interview was followed by other questions such as "How is your relationship with your adolescent? And how do you get along with him/her? How do you introduce him/her to their responsibilities?" To get deeper information, in-depth questions, such as "What do you mean? Explain more! Can you give an example?" were also used. All interviews were conducted by the rst author, who was trained in conducting qualitative interviews. Each interview lasted on average 55 minutes. All interviews (20 interviews in total) were recorded with the consent of the participants, and at the earliest opportunity, they, along with nonverbal cues, gestures, and moods, were typed in the Microsoft Word, word-by-word.

Data analysis
After typing the text, all interviews were entered into MaxQDA software version 10 to facilitate data organization. Simultaneously with data collection, the analysis was performed using the conventional content method. The text of each interview was read and reviewed several times. To analyze the data, Zhang and Wildemuth's proposed model was used. To this end, after preparing the text, regarding the research question, meaning units were identi ed, and for each of them, appropriate codes were written.
After the implementation of three interviews, the primary codes were categorized based on conceptual similarities, and subcategories were named. After reviewing, modifying, and approving the subcategories by the research team, the process of data collection and analysis continued. The subcategories were compared to each other and placed in the main groups, which were more abstract (categories). The main categories were then classi ed and given a more abstract concept (theme). Finally, the study method and ndings were reported.

Rigor and trustworthiness
To ensure the ndings rigor, Lincoln and Guba's four criteria were used [17]. In order to con rm the credibility of the ndings, more than a year was devoted to data collection and analysis. To verify the con rmability of the ndings, the interview texts, codes, and extracted categories were peer checked and approved by the rst and second authors and an outsider faculty member. In order to ensure the dependability of the ndings, the steps and research processes were recorded and reported as accurately and step-by-step as possible. In this study, efforts were made to have a variety of participants in terms of age, job, education, and number of children, which in addition to credibility, helped to con rm the transferability of the ndings.

Ethical considerations
Written Informed consent for participation in the study was obtained from the mothers after explaining the purpose and the method of the study. Mothers were also assured of the con dentiality of the information and audio les, and it was stated that they could withdraw from the study at any stage with no harm. No participant expressed reluctance to cooperate before or during the interview. This study was approved by the Ethics Committee of the Tarbiat Modares University Code of ethics: 1397.027.

Results
The participants' demographic characteristics are shown in Table 1. After conducting 20 interviews with participants, 980 primary codes, 30 subcategories, and 6 main categories were extracted, out of which the two themes of 'laying the groundwork for upbringing' and 'individual-social capacity building' were extracted ( Table 2).

Laying the groundwork for the upbringing
The theme laying the groundwork for upbringing consisted of two categories: 'meeting needs' and 'effective interaction with the adolescent'.

1-1 Meeting needs
Meeting the adolescent's needs included meeting emotional and nancial needs and efforts to maintain adolescent's health. Mothers stated that they used verbal and nonverbal expressions of affection to meet the adolescent's emotional needs.
"We express our love mostly by kissing or, for example, warm greetings (A 53-year-old mother, bachelor's degree)." They also considered maintaining the adolescent's physical and mental health.
"I am careful about my sons' weight. I signed both of them up for a swimming training class. I'm sensitive about their food and nutrition. Or, for example, when I see my son is anxious during exam days, I talk to him and calm him down, and when he's worried, I pay more attention to him (A 53-year-old mother, bachelor's degree).
Moreover, mothers indirectly met adolescents' nancial needs by providing facilities and nancial support.
"After their father's death, I tried to make sure that my children had the same material facilities as before." (A 45-years-old mother, bachelor's degree).

1-2. Effective interaction with the adolescent
The category of effective interaction with adolescents included establishing a heartfelt intimate relationship, as well as, a calm and logical attitude toward adolescents, respecting adolescents' privacy, indirect supervision of their social relations and activities, giving conditional freedom to adolescents, educating them to empathize with their parents, building trust in adolescents, managing their inappropriate demands, and having a constructive conversation with adolescents.
The majority of mothers stated that they were trying to create a friendly atmosphere, in which the adolescent could be comfortable sharing his/her problems with them.
"We are very friendly. My children can easily speak their heart out with me. We don't do anything in secrecy, or don't fear each other." (A 42-year-old mother, elementary degree) In di cult situations, for coping with the adolescent, mothers used the techniques of interactive conversation, silence, and mediation between the father and the child. They respected their adolescent's privacy by providing solutions such as not imposing their opinions on them and keeping their secrets.
"Some moms, in front of the teacher and the other kids, say: hey, my kids are annoying me. They talk about everything in front of the kids. But, I manage to resolve the issues between ourselves at home. I try not to let our secrets leak. (A 40-year-old mother, master's degree) Mothers stated that they used indirect monitoring strategies, setting sensible limitations, and restrictions on freedom to control adolescents. They drew the adolescents' attention to the parents' situation and its limitations and tried to gain their trust by adapting their words and behavior and keeping the promise. Faced with adolescents' inappropriate demands, depending on the situation, they used a variety of techniques, such as avoiding immediate reaction, taking a direct, and clear stand against the inappropriate demands, and considering a rational delay in responding to the adolescents' requests.
"I give my idea directly and try to resist his demands as much as possible. But if I see that he is very insistent, I don't leave him alone. I take care of him indirectly." (A 45-year-old mother, Ph.D.) Mothers tried to establish a constructive conversation with the adolescent and convince him/her using the reasoning technique as well as attracting the father's cooperation in managing the challenging situations.
"I say to them what they want is not practical for the family. I give them reasons." (A 45-year-old mother, bachelor's degree)

Individual -social capacity building
The theme of the individual-social capacity building included four categories: helping to gain independence, modeling individual-social behavior, socializing, and preparing to accept future roles.

2-1. Helping to gain independence
The category of helping to gain independence included developing independence, assigning responsibility, and boosting adolescent self-con dence. The mothers stated that they gave independence to the adolescents in proportion to their age and tried to respect the adolescent's freedom of making decisions and to avoid excessive support.
"At the age of puberty and adolescence, children want to be independent. This is an inherent matter that children have. It's gradually forming inside them. We shouldn't prevent it. I really didn't prevent it." (A 48- year-old mother, Ph.D.) To boost adolescents' self-con dence, they used strategies such as encouraging them, not comparing them with their peers, and informing adolescents about individual differences.
"I say to him that exam scores mustn't be so important to him. Not all people are the same. One gain higher score in one occasion and the other lower score, and it may turn reverse next time." (A 43-year-old mother, bachelor's degree) Moreover, the mothers gave adolescents responsibilities in proportion to their abilities.
"I ask them to make a meal or iron their clothes themselves. Sometimes I send my son to do shopping." (A 42-year-old mother, elementary education)

2-2. Modeling individual-social behavior
The behavior modeling category included modeling individual behavior, social-citizenship behavior, and modeling how to interact with others. Mothers stated that they trained their adolescents by becoming a role model for individual, social, and citizenship behaviors.
"Well, kids see everything, for example, what their mother does, or what their father does. Most of the time, there's no need to say it. My mother-in-law had surgery. I was the only one who was there from the beginning to the end. My daughter sees that I dress her wound and clean her house every day." (A 47-yearold mother, bachelor's degree) "Well, I observe a lot of ethical issues when I am spending time outdoor or with others, so they follow them too." (A 53-year-old mother, bachelor's degree) In addition, they tried to be a role model for the adolescent by showing good conduct and effective communication with others.
"I wear make-up, I dress well, I try to be very polite to everyone, in spite of the fact that my husband is in prison and I'm not in a good mood, though. My children see me and consider me as a role model." (A 44year-old mother, elementary education)

2-3. Socialization
The socialization category included educating social -citizenship order, education of order in personal affairs, educating social norms, training to help the needy people, educating to respect adults, educating to interact well with others, and creating opportunities for interacting with society.
Mothers advised adolescents to protect the environment, observe environmental health, and care for the law and order in society.
"I told him that he couldn't drive until he got his driver's license. I told him to respect the people on the street and, also, told him he must stay in line when he wants to buy bread. We're not different from others. They must put the trash outside door on time." (A 47-year-old mother, bachelor's degree).
The mothers said they taught self-discipline to their adolescents by emphasizing the importance of maintaining order at home and advising them on planning for meeting their daily needs. They encouraged teenagers to follow the norms of society, and also advised them to help needy people.
"I tell them that they have to help the needy. We must not enclose ourselves in a world of our own." (A 48year-old mother, Ph.D.) Talking of older adults' expectations from younger ones, they taught adolescents to care for and respect the elderly.
"If their grandfather gets angry at them, I tell my children that this is relating to his age and they shouldn't talk back, at all. He's old, and they should consider his age." (A 42-year-old mother, elementary education) By advising to be tolerant and treat people well, put oneself in others' shoes, not to judge others, help others without expecting the same response, and not to retaliate others' misbehavior, they taught adolescents the right way to interact with people. They also created the proper conditions for adolescents to interact with their peers by providing enough opportunities for peer interactions.
"My daughter has cut her relationships with most of her friends. She says this one talks like this, or that one is talking like that. But I told her that she must talk to everyone based on her/his condition." (A 54year-old mother, Ph.D.)

2-4. Preparing to accept future roles
This category included preparing adolescents for marriage, teaching about religion, training on nancial management, motivating them to study, and fostering adolescents' judgment ability.
The mothers did prepare their adolescents for marriage by stating key criteria for choosing a life partner and guiding them on how to deal with their spouse in future.
"For example, sometimes I say my daughter how a wife must love her husband. Or I say to her be careful and get ready for your future." (A 51-year-old mother, bachelor's degree) Without trying to impose their views, mothers tried to teach religious matters and discuss them with their adolescent children.
"Most of the time, we have a running discussion on religion. But I can never force them on religious issues." (A 41-year-old mother, elementary education) In addition, through involving the adolescent in family economic situation and affairs and educating them how to keep the balance between income and expenses, mothers emphasized the importance of nancial management. They also reinforced the adolescent's motivation to study by emphasizing the value of science and knowledge and prioritizing education.
"I always encourage them to study so that they can better understand the world and have a better job position in society. Telling them, look at how useful some people are." (A 40-year-old mother, master's degree)

Discussion
This study was conducted to explain the role of maternal parenting in raising adolescents in Iranian culture. The ndings showed that the mothers make efforts to lay the groundwork for the upbringing and build the individual-social capacity of their adolescents. Meeting adolescents' needs re ects mothers' responsibility to them [18]. The emotional need is one of the most important needs of children; Mothers strengthen adolescents' con dence and social growth by expressing love, respect, and instilling a sense of security in them [19]. A close look at the literature shows that adolescents have reported the need for emotional support as one of the basic needs for maintaining their health [18]. Parents' close and intimate relationship with adolescents leads to their high social-psychological adjustment and attainment of positive identity, reduces depression and high-risk behaviors in them, and is an effective factor in reducing the effects of peers' negative inductions [18,20,21]. Effective interaction with adolescents is one of the parenting skills that has been emphasized in optimal parenting styles. Findings from several studies have shown that parents who use the authoritative parenting style with dual characteristics of responsiveness (discipline, supervision, control) and demandingness (acceptance, friendliness, support, and parental involvement) raise more successful adolescents [22,23]. On the other hand, authoritarian parents would like their children to obey them and approve and use punitive methods; Permissive parents do not have a clear boundary for desirable and undesirable behaviors and refrain from control. Even though authoritative parents impose strict restrictions, their approach is warm and nurturing. They prefer reasoning compared to compulsion [24]. In this study alike, the mothers used reasoning in interaction with their adolescents; Reasoning is a method of control in which parents clarify their expectations, respect the adolescent's perspective, justify their authority, and reduce the adolescent's aggressive behavior [6]. The use of violent and severe punitive behaviors, as well as, strict parental control and discipline toward adolescents, often leads to behavioral problems ranging from conduct disorder to depression and low self-esteem, aggression, substance abuse, and delinquent behavior [6,25]. In the study by Simbar et al. (2012), adolescents considered the need for freedom under family supervision to be essential to their health. Adolescents emphasized the necessity of moderation in parental behavior and the indiscernible monitoring of their actions by them [18]. Direct parental control contradicts the adolescents' growing need for independence [26], while proper supervision facilitates mutual trust and creates an atmosphere of honesty between the parent and the child [27]. From adolescents' point of view, parents' active control is considered an invasion of their privacy, leading to increased con ict, secrecy, delinquency, and increased risk of compliance with peers [27,28]. Applying logical restrictions, not imposing opinions, and respecting privacy provide a good ground for boosting the adolescent's selfcon dence and independence [29]. In this study, the mothers tried not letting a contradiction emerge between their words and behaviors to gain the adolescent's trust. Such contradiction poses serious problems to the child [30] and leads to the loss of trust in their parents. Building trust in adolescents increases the likelihood of compliance with the mother and prevents the adolescent from taking refuge in peers who, due to lack of experience, are not good counselors for them [27]. According to the mothers' experiences of laying the groundwork for adolescents' upbringing, it can be inferred that their practice in parenting was based on the authoritative method, while in most Asian countries, families act in an authoritarian manner [2,16]. Mothers are considered an important source of nurturance and support for child independence [31]. In a survey in the United States, 97% of parents used at least one strategy, such as providing more options for adolescents (86%) and involving their children in certain activities (74%), to help adolescents' independence development. However, one-fourth of these parents identi ed themselves as the main obstacle to adolescents' access to independence [32].
The type of parenting practice supporting independence is in contradiction to collectivist values such as self-sacri ce, loyalty, respectfulness, maintaining harmonious relationships, and prioritizing group interests [31,33]. Culturally, Iran, similar to other Middle Eastern countries, is a collectivist society [10]. In collectivist cultures, the authoritarian parenting style is more common [2,34]. Loyalty to the family takes precedence over personal wishes, and independence is not a high level priority and value [24]. Some research has shown that the individual's independent performance is a negative predictor of adolescent self-esteem in some collectivist societies [31,33]. However, in Western individualistic societies, values such as individual freedom, independent decision-making, and self-esteem are more emphasized, and low levels of control and high levels of reasoning, along with parental affection and acceptance, are usually applied [24]. Despite the fact that Iranian society has a collectivist culture [10], the practice of mothers in our study was in line with the development of adolescent independence. The reason for this contradiction might be the fact that Iranian society is on the path to modernity [10]. Modernization-the expansion of urbanization, literacy, and the use of mass media-has led individuals to change their behavior according to changes in the social context, leading to a decline in some values and their replacement by new ones. As society becomes more modern, individuals tend to act more individualistic [35].
Researchers have emphasized the importance of parental practices as role models, especially in adolescence [36]. In a descriptive study, 89.4% of adolescents followed at least one role model [37]. Adolescents imitate peers in terms of social activities such as their taste in clothing or music, yet for future planning, values, ethics, and marriage, they imitate their parents [38,39]. As previously showed, parental behavior is a major factor of value transfer and more effective than the words [30] and family members, especially mothers, are role models for adolescents [36]. In one study, 60 percent of alcoholic adolescents had alcoholic parents [40]. Higher hopefulness, self-esteem, and self-regulation, and reduced risky behaviors are some of the consequences of having a positive role model [37].
Mothers need to lay the groundwork for adolescents' social and civic responsibility by using modeling mechanisms and providing opportunities for adolescents to practice ethical, civic, and citizenship skills such as humanity, law-abidingness, empathy, and environmentally friendly behaviors [41]. In the present study, mothers' practice concerning individual and social modeling was in line with the ndings of the previously mentioned studies. By modeling themselves, mothers prepared adolescents to be a good citizen, a good parent, and ready to accept adulthood roles.
Despite numerous resources in uencing adolescents, parents have been identi ed as the most important factor in their children's socialization [42], so parents are required to develop basic social skills such as empathy, cooperation, the ability to establish and maintain relationships with peers and adults [25]. In adolescence, the relationship with peers is an opportunity to practice social interaction skills and the adolescents are happier and have better emotional regulation if they could have positive interactions with their peers. The peers can act role models or be a source of social support [43].
A noteworthy point in the ndings of this study was the mothers' practice, emphasizing on the showing respect for adults, especially elderly, based on the Iranian-Islamic culture. In Islamic tradition, Moslem parents are persuaded to be a religious role model for their children. Collectivist cultures further encourage moral values and virtue [34,44]. Religion is a resource for resilience and strengthening adaptive coping, and religious education is a protective factor against high-risk behaviors and mental health problems [45].
Adolescents need guidance in various areas, such as nding a proper partner, applying for a job, and taking responsible behaviors [46]. During this period, parents can act as a counselor or facilitator and motivate the child to achieve growth and development. Due to adolescents' tendency to seek independence, the appropriate approach in dealing with them is guiding them [47]. Guiding parents, who set boundaries, and regulate adolescents' behaviors, play a positive role in their child's development. In the socio-cultural context of Iran, parents, even after adolescence, have a major role in monitoring and guiding their children in issues such as choosing a eld of study, a career, and a life partner, and, also, in facing life crises [18]. Education signi cantly affects an individual's success in professional life, readiness to perform civic duties, and prosperity. The level of education is associated with health and wealth: the more educated a person is, the healthier and richer he or she will likely be. The development of personal skills and talents can be enjoyable in itself, and it is an important part of a prosperous life, yet at the same time, it brings wealth and health [48]. Similarly, in our study, the mothers encouraged their adolescents to make academic progress by motivating them. Due to the present economic and social conditions of Iranian society, higher education is equivalent to more progress, more job opportunities, and higher income. In Iran, there is a more positive attitude towards educated people, and higher education is inherently a value; therefore, one of the mothers' strategies to raise successful children was to increase their motivation for formal education.
In Iran, parents feel responsible for their children's lives at all stages of life, even in their adulthood. Children live with their parents until they marry and even during their adulthood (9). Iranian culture expects adolescents to respect and obey their parents; children usually marry with their parents' permission [49]. Therefore, parents have special authority in the eld of marriage and choosing a life partner. Accordingly, the mothers in our study taught their children how to choose a partner and how to run their married life; however, they did not speci cally provide them with sexual education. Concerns, and worries about the possible negative impacts of sex education and feeling embarrassed to talk about the sex, have turned the discussion about sexuality into a socio-cultural taboo. Most parents are concerned about the negative impact of adolescent sexual awareness and believe that sexual information may lead adolescents to immoral behavior; therefore, this information need not be presented to them [50].
According to the mothers' experiences of individual-social capacity building, it is inferred that the practice of these mothers was mainly focused on developing adolescents' independence, behavioral modeling, socialization with emphasis on relationships with peers, educating them to respect adults and the elderly, and preparing them to accept future roles especially in the eld of education, profession, and marriage. In this study, the mothers showed optimal practice in laying a groundwork for the upbringing and building adolescents' individual-social capacity. They considered it their duty to raise happy and responsible adults by giving the adolescent the maximum capacity and ourishing their talents.

Conclusion
In line with the transition from tradition to modernity in Iranian collectivist society, the mothers' practice in parenting is changing from authoritarian to authoritative. For mothers, adolescents' independence, college education, career prospects, and the preparation for marriage is of great importance; however, they do not deal with issues of adolescents' sexual education, while it is one of the most important challenges during adolescence. Therefore, it is recommended to conduct more in-depth research on the mothers' practice concerning sexual education of adolescents and its barriers. Healthcare professionals, including family nurses that are in direct contact with families and mothers can help improve maternal literacy and adolescent health by developing parenting education programs, including sexual education essentials.