Research On The Construction Of A Resilience Development Model For Parents Of Children With Leukemia

ObjectivesTo understand the progress and main influencing factors on resilience of parents of children with leukemia.To explore the psychological adjustment process and analyze the characteristics of resilience of parents of children with leukemia.This thesis constructed a resilience development model for parents of children with Leukemia so as to improve their resilience and provide academic evidence for targeted interventions and trainings.MethodsThis study employed a simultaneous mixed methods（parallel design）in mixed methods research.In the quantitative study,a cross-sectional survey design was used.A questionnaire survey was conducted among 351 parents of children with leukemia who were hospitalized in the children’s blood ward of four tertiary A-level hospitals in Sichuan province from March 2021 to September 2021.The instruments include the general information questionnaire,10-item Connor-Davidson resilience scale（CD-RISC-10）,Chinese short version of depression-anxiety-stress scale（DASS-C21）,Caregiver Strain Inventory（CSI+）,General Self-Efficacy Scale（GSES）,trait coping style questionnaire（TCSQ）,perceived social support scale（PSSS）.The research data was analyzed by SPSS26.0 statistical software to conduct descriptive statistics,univariate analysis,correlation analysis and multivariate analysis.The qualitative study used phenomenological research methods to conduct semi-structured interviews with the parents of 24 children with leukemia who were hospitalized in the children’s blood ward of a tertiary hospital in Sichuan province from March to September 2021.The method of Colaizzi was used to organize and analyze data.Then,a structural equation modeling of the influencing factors of psychological resilience of parents of children with leukemia were constructed and the path analysis was conducted by AMOS 28.0 statistical software on the basis of these studies.Finally,a resilience development model for parents of children with Leukemia was constructed based on these researches and theoretical literatures.Results1.A total of 351 parents of children with leukemia were included in this study,and their resilience score was（24.80±7.05）.The relationship with children（Z=-2.093,P=0.036）,parents’age（Z=-2.058,P=0.040）and the place of live（F=3.270,P=0.021）of parents of children with leukemia were statistically significant from those of their resilience scores（P<0.05）.2.The resilience of parents of children with leukemia was positively correlated with self-efficacy,positive coping and social support,and the correlation coefficients r-values were 0.547,0.518 and 0.352（P<0.01）.Resilience of the parents was negatively correlated with depression,anxiety,stress,caregiver burden and negative coping,and the correlation coefficients r-values were-0.318,-0.262,-0.332,-0.190 and-0.265（P<0.01）.3.Residence（provincial capital cities/municipalities）,self-efficacy and coping style（positive coping and negative coping）were the predictors of the resilience level of parents of children with leukemia（P<0.05）,which could explain R~2=36.0%of the total variance.The standardized regression equation is:Resilience=10.059+2.481*resides in provincial capital cities/municipalities+0.346*self-efficacy+0.345*positive coping﹣0.173*negative coping.4.The qualitative research has summarized 5 major themes of parental care experience of children with leukemia:（1）Complex psychological changes and coexistence of positive and negative emotions;（2）Heavy care burden and insufficient coping ability;（3）Strong desire for knowledge and lack of series of training;（4）Limited social work and difficulty in returning to life;（5）Worrying about the growth of multiple children and need psychological support.5.Path analysis of the structural equation modeling showed that self-efficacy has positive effects on positive coping（β=0.407,t=8.270,P<0.001）and resilience（β=0.361,t=6.200,P<0.001）.Caregiver burden has a positive effect on negative coping（β=0.529,t=5.491,P<0.001）.Social support has a positive effect on positive coping（β=0.150,t=6.174,P<0.001）but a negative effect on negative coping（β=-0.094,t=-3.509,P<0.001）.Negative coping had a negative effect on resilience（β=-0.185,t=-3.953,P<0.001）,while positive coping has a positive effect on resilience（β=0.338,t=6.082,P<0.001）.6.A developmental model of resilience of parents of children with leukemia was constructed.It systematically analyzed the resilience’s characteristics and psychological adjustment process from three aspects:general factors,internal factors,external factors,and two dimensions of protection/promoting factors and risk/impeding factors,which is proposed to explain the relationship between resilience and various influencing factors.Conclusion1.Parents of children with leukemia have a low level of psychological resilience.The psychological resilience of fathers of children with leukemia was significantly higher than that of mothers.Parents over 40 have higher levels of resilience than those under 40.Resilience of the parents whose family resides in provincial capital cities/municipalities was significantly higher than those living in rural areas,townships/counties and prefecture-level cities/autonomous prefectures.2.Resilience of parents of children with leukemia was positively correlated with self-efficacy,positive coping,and social support,while negatively correlated with depression,anxiety,stress,caregiver burden,and negative coping.3.Residence（provincial capital cities/municipalities）,self-efficacy and positive coping style can positively predict the resilience level of parents of children with leukemia,while negative coping can be a negative predictor.4.Qualitative research results show that positive and negative emotions,healthy behaviors,knowledge/skills and resources,past adversity,interpersonal/social and work situations,family functions,caregiving burden,parenting stress,counseling,peer support,external distractions（social media）,and public health emergencies（COVID-19）are the factors influencing the resilience of parents of children with leukemia.The emotional changes of parents of leukemia children are dynamic and complex.The process of psychological adjustment is affected by many factors and it does not move in one direction.5.Positive coping and negative played a mediating role between resilience and the variables:social support,self-efficacy,and caregiver burden.Positive coping and negative coping are both direct and mediate variables for resilience.6.The resilience development model of parents of children with leukemia explains that the relationship between resilience and various influencing factors is a cyclic and dynamic process based on the discovery,use and development of the interaction between the inner self and the external environment.