Trajectory of Parenting Confidence among Parents of Infants with Complex Chronic Conditions

Duke University, Durham NC

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Abstract

Significance: Technological advances in health care have increased the survival rates and prevalence of infants with complex chronic conditions (I-CCC). I-CCCs are defined as those infants with increased caregiving needs due to their complex chronic condition, often requiring specialized care, significant functional limitations, and high healthcare utilization. Parents of I-CCCs develop parenting skills and confidence within the hospital environment and are expected to master complex treatment regimens, navigate multiple healthcare, rehabilitative and social service systems. A major contributor to effective parenting is their parenting confidence (PC), which is defined as a parent's belief or judgment about their ability to be successful in their parenting role. PC is strongly correlated with effective parenting behaviors, and supports a parents' ability to manage caregiving demands associated with having an I-CCC. Confident parents have a greater sense of empowerment and perceive the management of complex caregiving demands as less stressful. Several important contextual factors such as family centered care, family functioning, and infant caregiving complexity are hypothesized to foster the development of PC. Understanding the development of PC is critically important given the intense caregiving demands of parents with an infant diagnosed with a CCC. Purpose: The purpose of the proposed study is to examine the development of parenting confidence over time and the influence of contextual factors on PC development among parents of I-CCCs. Methods: A longitudinal multi-method exploratory design will be conducted to examine the trajectories of PC and effects of contextual factors on PC development. The primary focus of the study will be to report stability and variation in PC across three time points and identify how contextual factors influence the pattern of development. Parent self-report measures will be collected at infant's diagnosis of CCC, discharge, and 3 months post-discharge. Qualitative interviews will be conducted at 3 months post-discharge to further understand parents' perceptions of PC. Parent self-report measures will be used to collect data on PC, family functioning, and family centered care practices. Chart review and parent report will be used to collect infant data. Summary: Confident parents respond more effectively to parenting challenges, feel more equipped to meet their child's needs, which in turn positively impacts infant health and development. Yet, we have limited knowledge about PC trajectories and how salient factors contribute to the successful development of parenting confidence. This study will be one of the first to identify confidence trajectories and the salient contextual factors influencing development.