Confidence and Readiness in Child-rearing Among Heterosexual Adults

Samilin, Hero L.

Samorio, Mark Lawrence B.

San Diego, Kristen Gabrielle S.

Santiago, Prancheska Abigayle P.

Santos, Jobelle B.

Santos, Shane Ann Rose L.

Santos, Mary Stephanie Anne P.

Siasat, Nicole C.

Siros, Arianne Moira A.

Sta. Ana, Audrey Jann C.

Tajanlangit, Francine Gabrielle C.

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Chapter 1

BACKGROUND OF THE STUDY

In today's rapidly evolving world, significant attention has been given to the

changing landscape of contemporary family structures and parenting responsibilities.

The understanding of child development has undergone a profound

transformation.The critical role of parents in early childhood is highlighted in laying

the foundation for a child's holistic development.

“A child’s brain is built, not born ” (Britto, 2017). Studies show that a child's

early years are crucial as it builds a foundation for the holistic well-being and

development of a child for the later years. However, It is vital that a parent or an adult

is present to actively participate in nurturing during the formative years, often referred

to as the child-rearing period. In order to realize positive development, the child must

experience an environment that is caring, responsive, and safe within the early years

in order to thrive. (Britto, 2017). Problems related to a child’s growth arise due to the

inadequate knowledge and preparation from both male and female adults and in

becoming parents (Pratiwi,R & Junaida, R., 2021). Unpreparedness results in negative

parenting and affects a child’s brain, nutrition, ability to grow, learn and have lower

incomes as adults. (Britto, P.,2017). While positive parenting results to lower risk of

social-emotional deficits, and developmental delays in early childhood (Yamaoka, Y.

et al., 2019)

Child-rearing from infancy to adulthood encompasses the different

techniques, and methods employed in nurturing a child. Although the approaches

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parents employ in child-rearing differ worldwide, research has shown that a strong

sense of self-assurance and preparedness can lead to more positive parenting

outcomes, including enhanced child development, improved parent-child

relationships, and increased parental satisfaction. (Touro University, 2023). In

addition, parents who show a high level of confidence in their parenting role are more

likely to provide a positive child and parent relationship (Vance et al., 2020) and an

Intensive parenting approach during child-rearing demands and involvement in high

level of parental time, and financial and emotional investment (Fam, 2021)

Recent studies have revealed mostly focusing on the readiness and confidence

of mothers in childrearing overlooking the parental involvement of fathers in the

children's growth and education (Kong & Yasmin, 2022). A study revealed that

adolescent expectant mothers in Ghana reported a need for assistance with child

rearing and had little understanding of childbirth (Dordunu et al., 2021). Another

study noted that antenatal mothers lack the necessary skills and practices when it

comes to being prepared for complications and giving birth (Girma et al.,

2022).Therefore, these gaps indicate the need for additional study in the aspect of

child rearing in male and not just females and the emergence of interventions to

increase adult parenting readiness and confidence giving emphasis to the stage of

“child rearing”.This study will also explore the difference between the age of

readiness for childrearing in male and female adults and the factors that affect it.

I. Purpose of the Study

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The primary purpose of this study is to investigate and assess the levels of

confidence and readiness among heterosexual adults in the context of child-rearing.

Specifically, our objectives are to identify the age group within the heterosexual adult

population that demonstrates the highest level of confidence in child-rearing and to

explore the influence of sociodemographic factors, including age, gender, and income,

on individuals' confidence and readiness for the responsibilities of child-rearing. It

also provides additional perspectives in addressing family planning within the nursing

profession.

II. Statement of the Problem

The study aims to determine the confidence and readiness in child-rearing

among heterosexual adults with the age of 22 to 44 at Bonifacio Global City Taguig,

Metro Manila.

Specifically, it attempts to respond to the following questions:

1. What are the demographic profiles of the respondents in the following terms:

a) Age

b) Sex

c) Marital Status

2. What age group of heterosexual adults that exhibits the highest level of

confidence and readiness in child-rearing?

a) Young Adult

b) Middle Adult
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3. What factors affect the respondents confidence and readiness?

a) Financial

b) Security

c) Structure

4. Is there a significant relationship between different genders in child rearing?

a) Male

b) Female

c) xzGay

d) Lesbian

5. Is there a correlation between confidence and readiness?

III. Significance of the Study

Nursing Practice

The present study is significant to nursing because it impacts the practice of

nurses to offer more individualized, patient-centered care on having a better

understanding of factors affecting parental readiness and confidence. This approach

follows the principles of individualized care by focusing on the particular

requirements of each patient; nurses can utilize evidence-based assessments to

identify persons who are at risk for having low confidence or readiness (Ajibade,

2021).
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Nursing education.

The focus of nursing education programs can be on acquiring the abilities

needed to gauge and address the preparedness of adults. This could entail teaching

nursing students how to empower adults and improve their readiness for parenthood

through good communication, counseling, and educational initiatives. This also

promotes evidence-based practice in nursing education as well. In order to give

families the best treatment possible, students can understand how crucial it is to

incorporate the most recent research into their clinical decision-making.

Nursing Research

Nursing researchers may work alongside with psychologists, social workers,

and other experts to develop a comprehensive understanding of the elements affecting

parental readiness and confidence, or any topic linked to it. Also recognizing these

variables helps us to have a more comprehensive understanding of the psychosocial,

cultural, and personal aspects that affect child rearing. Understanding these factors

may lead to a population of heterosexual adults that has confidence and readiness in

child rearing.

IV. Scope and Limitation

This research project employs a descriptive correlational design to investigate

the levels of confidence and readiness in child-rearing among a targeted group of

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heterosexual single working adults in the Bonifacio Global City Taguig, Metro

Manila. The study narrows its focus to individuals within the age categories of early

adulthood (22-34 years) and early middle adulthood (35-44 years), primarily located

within office settings, with a potential research site at Shearwater Health. Data

collection involves a sample of 50 respondents, selected using a stratified random

sampling technique to ensure representation from various subgroups within the

population. It is essential to recognize that the scope of the study is restricted to this

specific demographic and geographic location, and its findings may not be

extrapolated to other populations or regions. Additionally, the research takes place

over a 2-month period from January to February and employs a descriptive

correlational design, which allows for the exploration of relationships between

variables but does not establish causation.

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Chapter 2

REVIEW OF RELATED LITERATURE

A. Confidence in Childrearing

Adults require confidence in child rearing to provide a suitable parenting

technique because confidence provides a lot of factors in nurturing a child physically,

psychologically, and emotionally. Parenting confidence, or parenting self-efficacy, is a

parent's belief in their ability to raise and nurture their children. It influences their

interactions, choices, and overall well-being. A strong parenting confidence fosters

healthy development and positive family relationships, shaped by experience and

support systems. (Ashlee V. and Debra B., 2018). Low parental confidence has been

linked to unstable parenting and mother depression. This has a detrimental influence

on the parent-baby bond and the infant's development (Khajehei, M., & Lee, A.,

2019).

Adolescents’ confidence in their ability to have children is influenced by a

variety of factors including their decision-making autonomy, financial security,

cultural and socioeconomic background, and education attainment (Oshrieh et al.,

2020). Further factors include the standard of maternity care, characteristics of the

health system, effective communication, availability of continuity of care models for

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midwives, and good service integration (Hall et al., 2022). The confidence of adults in

raising children is also impacted by their attitudes toward children, such as affection

and stress (Wolf et al., 2023). Thus, parenting styles play a pivotal role in the journey

of child rearing and its impact on child outcomes. Positive parenting involves parents

fostering their children's psychological development through competencies that

strengthen protective factors, reduce risk, and positively impact child development. It

is essential for every parent to have skills in parenting to avoid the practice of

education and discipline, as poor parenting can lead to poor outcomes (Hariawan et

al., 2019). Authoritative parenting styles, characterized by setting clear rules and

expectations while also being responsive to children’s needs, have been linked to

positive child behavior and mental health. On the flip side, authoritarian and

permissive parenting styles have been associated with negative behaviors and

aggression in children (Liu & Merrit, 2018). Thus, as adolescents ponder their future

roles as parents, their understanding of effective parenting styles becomes a critical

factor in shaping their confidence.

Indeed, parental confidence is an essential ingredient for raising happy and

healthy children. This confidence is positively associated with a range of child

development outcomes, spanning social-emotional development, academic

achievement, and physical health(Alias et al. 2023) ( Marsiglio and Cacioppo, 2019).

On the other hand, in the study of Brown and Biring (2018) there is a positive

correlation between parental confidence and essential parenting dimensions like

warmth, responsiveness, and discipline, and highlighted the moderating role of social

support from partners and family members. The rationale behind this correlation lies

in the fact that confident parents are more likely to create a warm and supportive
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environment for their children, which is integral for optimal child development. A

child's development is influenced by how their parents nurture them. developmental

psychologists believe that children's social worlds and cognitive and emotional

development are crucially dependent on child-rearing methods (Atout et al., 2021).

Lopez et al. (2020) support the idea that parents who are confident in their skills are

more likely to use positive parenting practices, producing a healthy environment for

their children. Conversely, they are less likely to resort to harsh or neglectful

parenting strategies, which can harm their children’s development. Furthermore,

Hoffman and Rowe (2019) highlight interventions that help parents boost their

confidence in parenting abilities, such as parenting education programs, cognitive-

behavioral therapy (CBT), and support groups. These programs equip parents with the

knowledge and skills to navigate the complex child-rearing process, enhancing their

own confidence and promoting their children's well-being.

Parenting knowledge, attitudes, and practices are influenced by various

factors, including children's characteristics, parents' experiences and circumstances,

expectations from social networks, and cultural systems. It underscores the role of

community support, institutional assistance, and policies that impact the availability

of supportive services in shaping parenting practices (Breiner H. et al., 2018). Rearing

styles play a crucial role in determining children's mental well-being through

intergenerational transmission, often characterized by responsiveness and

demandingness. Responsiveness involves parents' warmth and support for their child's

individuality and self-assertiveness, while demandingness refers to their

confrontational control to ensure the child's social adjustment. The Parental Bonding

Instrument (PBI) assesses parenting styles on two dimensions: care and

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overprotection. Low care and high overprotection are linked to offspring's depression,

addiction, and conduct issues, emphasizing the importance of understanding how

these styles are passed down through generations (Nao S. et al., 2022).

As they navigate the complexities of early adulthood, these factors shape their

perceptions of parenthood. However, adolescent pregnancy and childbearing come

with challenges and risks that extend beyond mere confidence. Studies have shown

that young maternal age in Sub-Saharan Africa is linked to increased risk of

complications for both the mother and child, including low birth weight,

preeclampsia/eclampsia, preterm birth, and maternal and perinatal mortality (Gronvik

& Sandoy, 2018). Postpartum mother confidence and child-rearing stress directly

affect older primiparas' child-rearing difficulties, while parenting resilience lowers

these feelings through good physical status, sleep, stress, contentment, and maternal

confidence (Watanabe et al., 2022). Furthermore, with the modernization of society

and the widespread use of technology, remote parental assistance might be beneficial.

Remotely administered parenting treatments for normally developing children appear

to be more successful than conventional care or no intervention distantly provided

parenting treatments yielded favorable outcomes, suggesting that distantly assisted

therapies can effectively assist families in navigating the hurdles of caring for their

children (Solis-Cordero et al., 2022).

Synthesis

Confidence in Child Rearing" underscores the pivotal role of parental

confidence in shaping successful parenting and child development. Adolescents'

ability to become parents is influenced by various factors such as autonomy, financial

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stability, cultural background, and education levels. Maternity care quality, health

system characteristics, and effective communication also play a significant role.

Parenting confidence, often referred to as "parenting self-efficacy," is vital for

creating a nurturing environment that fosters children's well-being and healthy family

relationships. Parental attitudes towards children, parenting styles, and

intergenerational influences further contribute to the complexity of child rearing. The

literature emphasizes that confident parents are more likely to provide a supportive

environment and employ positive parenting practices, which, in turn, influence child

development positively. Moreover, interventions like parenting education programs

and support groups are identified as valuable tools for enhancing parental confidence,

ultimately promoting child well-being. In essence, the synthesis of this research

review underscores the significance of parental confidence as a key factor in nurturing

healthy and thriving families.

B. Readiness in childrearing

The journey to motherhood, as described by Itai et al. (2022), is significantly

facilitated by continuous childcare assistance. This transition involves proactive

participation in pregnancy, childbirth, and child-rearing. Itai et al.(2022) highlight the

need for mothers to remain healthy, form new bonds, and respect local customs when

raising children. The support mothers receive helps them embrace their new roles and

engage with parenting while understanding their place in society. A multifaceted

approach to supporting mothers during this transition is essential, promoting both

their well-being and their parenting readiness.

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Curtis et al. (2019) conducted a study underscoring the impact of income on

infant birth weight. Their findings reveal a direct correlation between lower income

and the likelihood of giving birth to infants with low birth weight. Akee et al. (2018)

further emphasize the importance of household income, demonstrating its influence

on a child's emotional and behavioral health. Income interventions prove to enhance

parental relationships, fostering a nurturing environment for children.

The unprecedented challenges posed by the COVID-19 pandemic, as explored

by Toran and Ozden (2022), resulted in shifts in maternal child-rearing attitudes. The

study found that mothers' attitudes oscillated between democratic and authoritarian

parenting styles, influenced by the duration of quarantine. De Sousa et al. (2022)

focus on a unique challenge, the care of children with chronic kidney disease (CKD),

requiring sophisticated care and independence while managing daily household and

parenting responsibilities. The essence of "readiness parenting" lies in transforming

life-limiting conditions into a well-functioning life for both parents and children,

necessitating negotiations around parental duties.

Parents raising visually impaired children, as studied by Boldinova et al.

(2022), require a distinct readiness, involving enhanced familial relationships and

parental competence. Pratiwi (2022) underlines the importance of parenting self-

efficacy and its predictive role in shaping parenting practices, recognizing its

significant influence on parenting readiness.

Furthermore, Sansuwito et al. (2023) identify parenting self-efficacy as a

crucial factor influencing parenting readiness, with various factors like age
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influencing this self-efficacy. The study by the Indonesian Ministry of Health (2018)

indicates that older mothers tend to exhibit higher parenting self-efficacy.

Proctor et al. (2018) delve into parental readiness, particularly in addressing

disruptive child behavior, and the complex interplay between readiness and effective

parenting practices. Kil et al. (2020) explore the role of parental attributions in

treatment readiness, with a focus on parent-causal attributions and their impact on

readiness for treatment.

An article by the Central Penn Business Journal (2018) highlights the

declining birth rates among Millennials due to the increased cost of child-rearing

relative to their income. Millennial parents prioritize financial independence,

considering it a marker of readiness for parenthood. In contrast to traditional gender

roles, a study by Rosenbaum et al. (2021) underscores the vital role of fathers in

childcare, with education and working hours impacting paternal involvement.

Parental readiness, encompassing emotional, motivational, and cognitive

aspects, plays a pivotal role in effectively raising children, especially in the case of

children with intellectual disabilities, as revealed by Buinyak and Myronova (2021).

Various theories have attempted to outline disparities in parenting styles

between mothers and fathers. According to psychoanalytic theory, mothers typically

function as the primary attachment figures for children, while fathers often maintain a

more distant role. In contrast, gender and role theory link these parenting differences

to perceived male and female characteristics, casting mothers in nurturing roles and
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fathers in authoritative provider roles. However, a study by Sofie Kuppens and Eva

Ceulemans in 2019 provides compelling evidence that challenges these notions.

Despite modest correlations between mothers' and fathers' self-reported parenting

styles, the study identified more similarities than differences in how mothers and

fathers approach parenting. These shared parenting styles may be influenced by

partner selection processes and socialization, shaping common views on child-rearing.

Notably, the few distinctions that did emerge mainly pertained to positive parenting

practices and rule setting. These findings resonate with previous research that

underscores the consistency of parenting styles exhibited by both mothers and fathers,

particularly concerning self-reported parental warmth, albeit with some divergence

when considering adolescents' perspectives.

While parenthood presents distinct challenges for medical students, the

existing body of research is often confined to specific medical specialties and

frequently overlooks holistic well-being. In addressing this issue, our examination

encompassed perspectives from diverse medical professions, revealing consistent

connections between parenting, stress, and burnout within the medical community.

Notably, Spruce et al. (2021) highlight that a substantial proportion of medical

trainees aspire to start families; however, time and financial constraints compel many

to delay parenthood. The additional responsibility of child-rearing exacerbates the

already demanding nature of medical training, amplifying stress, financial burdens,

and the risk of burnout. As a potential solution, extending child care support to

medical students, residents, and even service members training at civilian medical

facilities emerges. This support could serve to alleviate stress, mitigate burnout, and

contribute to the overall well-being of aspiring medical professionals. Furthermore,

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the U.S. military is uniquely positioned to address these challenges and set an

example for civilian graduate medical education programs nationwide by bolstering

existing resources and pioneering innovative approaches to support medical

professionals juggling their training with parenthood.

Parental readiness, a critical aspect of child-rearing, is influenced by various

factors, and these dynamics can differ across cultures. In the context of Japanese

society, adolescents often struggle with enhancing their parental readiness due to

limited community relationships, resulting in diminished parenting skills. This lack of

readiness is notably linked to factors such as living independently, the desire to have

children, previous experiences in interacting with children, and the aspiration to

emulate their own parents' child-rearing methods, as identified in Kit et al.'s study

(2020). The interaction between individuals and children significantly affects one's

preparedness for parenthood. Furthermore, cultural norms play a significant role in

the timing of parenthood. In many Asian societies, marriage is commonly seen as the

precursor to starting a family. However, assessing the readiness of newlyweds for

parenthood is essential as it influences their prioritization of children. Various

motivations drive the choice to have children, including family and societal pressures,

strengthening marital bonds, providing companionship in later life, religious and

cultural influences, the aspiration to be good parents, and a genuine affection for

children, as outlined by Girindra (2019).

Parental readiness is a multifaceted concept influenced by a range of factors.

Family structure significantly impacts an individual's transition to parenthood and

informs how they approach disciplining their children. As Holden (2019) highlights,
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parents' understanding of parenting unexpectedly influences their children. Research

on family-of-origin determinants of parenting has traditionally focused on the

generational transfer of parental attitudes, disciplinary techniques, and attachment

styles. Moreover, parents exert both direct and indirect effects on their children's

development, influencing the formation of healthy attitudes and behaviors. They also

play a pivotal role in nurturing their children's talents.

Cognitive readiness, as discussed by Sommer et al. (2019), emerges as a

crucial construct for adolescent parenting models, complementing the prevailing

emphasis on personality and social support in nurturing skills. Understanding the role

of cognitive readiness, including parental knowledge, in the development of parenting

interventions can be especially effective for teenage mothers during early

adolescence.

Parental involvement in their children's education, defined by Bartolome,

Mamat, and Masnan (2020), varies across cultures and social contexts. In Western

nations, it is actively encouraged. The influence of social and cultural factors on

parents' engagement and expectations for their children's growth and learning is

explored in a substantial body of literature. As Philippine culture places great

significance on parenting, recognizing cultural differences in parental engagement is

essential, considering the changing social circumstances that Filipino families have

encountered in recent years. With education evolving to align with 21st-century

learning paradigms, parents play a unique role in ensuring their children's education

aligns with their individual learning needs, taking place in diverse settings. Thus,
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studies on parental engagement in children's education continue to represent only

partial facets of parents' roles in their children's learning experiences.

The structure of a family is a significant factor influencing parental readiness,

as it reflects the dynamics, values, and ethics within the family. Past relationships and

parenting evolution also play a crucial role in shaping how individuals approach

child-rearing. Research by Vafaeenejad et al. (2019) underscores that parents' past

interactions with their own parents can impact their future interactions with their

children. Past experiences, including mental health issues, can affect parenting skills.

Insecure attachments may reduce a parent's capacity for effective parenting,

potentially posing a risk for future parenting. Conversely, individuals who had

positive childhood experiences with stable attachments to their parents are better

equipped for parenthood. Additionally, traumatic experiences such as childhood

abuse, whether physical, sexual, or emotional, have been shown to influence

parenting practices. These traumas can lead to emotional and social impairments and

disruptions in parent-child interactions, influencing parents to adopt unfavorable

parenting practices.

Synthesis

This chapter takes a comprehensive approach to fulfill the committee's

mandate, primarily focusing on the identification of fundamental parenting attributes

that foster positive parent-child interactions and support the healthy development of

children aged from birth to eight. It acknowledges the dynamic nature of these

attributes, which can vary based on the unique characteristics of both the child and the

parent. Understanding child development is underscored as a pivotal factor

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influencing parenting behavior, with research consistently demonstrating that parents

with knowledge of child development are more likely to engage in behaviors that

promote their children's healthy growth and establish high-quality parent-child

relationships. This insight equips parents with informed decision-making abilities,

particularly in adopting evidence-based parenting strategies that prioritize children's

physical well-being and safety. While limited empirical research exists on how this

knowledge directly impacts service adoption and child outcomes, available evidence

reinforces the critical role of parental awareness and informed decision-making in

promoting child well-being from birth through early childhood. In a broader context,

parental readiness for child-rearing proves to be a multifaceted concept influenced by

various factors and cultural contexts. Japanese adolescents, for instance, encounter

specific challenges in enhancing their parenting readiness due to limited community

relationships, with cultural norms significantly influencing the timing of parenthood.

Family structure also emerges as a crucial element that impacts the transition to

parenthood and shapes approaches to child discipline. On the other hand, cognitive

readiness takes center stage in adolescent parenting models. Cultural variations in

parental involvement in children's education hold substantial importance, particularly

as education aligns with 21st-century learning paradigms. Past relationships and

traumatic experiences have a lasting influence on parenting practices, highlighting the

enduring impact of these factors. Throughout these diverse dynamics, the central role

of parental readiness in nurturing children's well-being remains evident, transcending

various cultural contexts and underscoring the need for multifaceted support systems

to empower parents in their journey towards effective child-rearing.

C. Adult Age of Childrearing

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The pressure to have children has always been present in adulthood, however,

it has been harder in countries that have been categorized as low birth rate, especially

for millennial women who have spent recent years concentrating on advancing their

careers. It's clear that more women in developed nations are delaying motherhood

until their late thirties and beyond. These women report varying degrees of supportive

and unsupportive care from healthcare professionals, with nulliparous women of

advanced maternal age making a variety of preparations in the hopes of having a

positive childbirth experience (Nottingham-Jones et al., 2020). In an additional study

conducted in the USA, it had been found that the average age of first-time mothers

has risen from 21 to 26 while the average age of first-time fathers has risen from 27 to

31. This problem not only affected America, but women in other developed nations

are delaying the process of childrearing; the typical first birth occurs for new mothers

at age 31 (Stahl, 2020). Furthermore, a study by Molina-Garca et al. (2019) stated

that the fertility rate in European nations including Norway, Spain, and the United

Kingdom is decreasing, findings from the study showed that women in stable

relationships become mothers at later ages of 31 years old than those who were not.

The average age of women who put off having children for medical reasons was 34

years of age, compared to 27 years for other reasons and 30 years for personal ones.

Results from the study show delaying childbirth was medical and delaying parenting

was linked to a harder time getting pregnant and more anxiety. In the Asian regions,

the number of women delaying childbearing until or past 30 has dramatically

increased over the past three decades as a result of the advancement of modern

societies.
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Maternal age is an important aspect of childbearing and childrearing. Women

should be mindful that they are unable to bear a baby after menopause. The usual age

of menopause is 51, and most people will experience a significant drop in hormones

in the years leading up to menopause. A study of Villines (2020), stated that while

fertility falls with age, most healthy women are biologically capable of having a baby

until menopause, and most healthy men are still fertile in their 60s and 70s. Certain

risks linked with pregnancy and birth grow as people age. In addition, a new study

concludes that too young or advanced maternal age may raise the danger of fetal

growth. The best age to have a child is between the ages of 23 and 32, because the

odds of certain birth abnormalities are lowest at that maternal age. There is a clear

increase in risk for very young or advanced maternal age, or both, for some non-

chromosomal congenital anomalies (NCAs), with the specific age ranges depending

on each disease. Congenital problems of the head, neck, ears, and eyes were among

the defects that only affected the fetuses of older women and showed a doubling rise

(by 100%), which was significantly larger in pregnancies over the age of 40 (Pethő et

al., 2023.) .Additionally, the study of Cantalini et al. (2020) stated that children born

to young mothers are more likely to have low birth weight and preterm birth, stunting

in infancy. This negative link can be explained rather than just by young mothers'

reduced investment in human capital as a result of early motherhood, but also by their

poorer maturity at childbearing and lack of parenting abilities, which impair their

children's outcomes. While the favorable benefits of later parenthood on children's

outcomes may stem from increased readiness and pleasure with childbearing among

older fathers and, notably, women, which may translate into better parenting

practices..The majority of participants agreed that public awareness of preconception

health and care needs to be improved within society. Among the 21 participants ages
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18-45; the findings illustrated a lack of awareness of guidelines surrounding

preconception health (for both sexes) and disparity between males and females

regarding sources of support for preconception health which is supported by a study

by McGowan et al., (2020)which emphasizes the need for improved awareness and

education on preconception health among males and females aged 18 to 45 in the UK.

Lastly, the study by Delbaere et al. (2020), emphasizes the importance of educating

individuals about the impact of age on fertility, as many people underestimate the

decline in fertility with advancing age. It was stated that when a woman is younger

than 30, she has an 85% chance to conceive within 1 year. At the age of 30, there is a

75% chance to conceive in the first 12 months. This chance declines to 66% at the age

of 35 and 44% at the age of 40. Additionally, miscarriages are more common in older

women than in younger women (27% of pregnancies result in a miscarriage at age 40

compared to 16% at age 30 or younger).

With that being said, Li et al. (2022) was conducted to identify the trend in

delayed childbearing and its detrimental effects on pregnancy outcomes. Based on

maternal education and employment, the trend in advanced maternal age (AMA 35

years) increased by 75% between 2011 and 2019. Higher-educated women saw a

130% increase in the AMA trend. AMA was significantly linked to a higher risk of

gestational hypertension and other related risks for pregnancy after controlling for

confounding variables. Its results demonstrate a sharp rise in postponed childbearing

and its unfavorable correlation with pregnancy outcomes. Furthermore, early

childbirth is linked to negative health outcomes for both mothers and children,

especially in South Asia, where early marriage is common. Efforts to address this
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issue should primarily focus on delaying marriage, often achieved through female

education. However, it remains uncertain how much education is necessary to delay

marriage until the legal age of 18, or what factors influence marriage age among

uneducated women. In relation, this critical concern is also prevalent in the Terai

region of Nepal, which has a high number of out-of-school children and early

marriages. Marphatia et al. (2020) conducted a study of 6,406 women in this region

and found that women needed to complete at least grade 9, preferably 11, to

significantly increase their chances of marrying after 18. While education helped

delay marriage, the age of the first pregnancy was mostly determined by when women

married, and education had a minimal additional effect. The study highlighted the

need to ensure girls attend school and complete secondary education to delay

marriage and prevent early childbearing.

However, despite the numerous studies that suggests the negative effects of later

age for childbearing, the “proper” age remains subjective as qualitative study of

Lebano & Jamieson (2020) was designed to contribute, by purposively selecting

Italian and Spanish women from various socioeconomic backgrounds who are

partnered, childless and aged 30 to 35. Results discussed that most participants want

children but “not now” or are deferring the decision whether to have children.

Confidence about their ability to conceive and flexible norms about "the right age"

encourage them to postpone.

In connection, with the new trend in parenting age, parenting styles and

strategies have also changed. New parenting styles were studied by Ceulemans et al.
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(2018) involving 600 Flemish families found naturally occurring joint parenting

styles, including authoritative, positive authoritative, authoritarian, and uninvolved

parenting styles. The study found that authoritative parents had the most favorable

outcomes, while authoritarian parents had the least favorable outcomes. Intrusive

parents were associated with poorer child outcomes. Accounting for parental

psychological control did not yield additional parenting styles but enhanced

understanding of the pattern among the three parenting dimensions within each

parenting style and their association with child outcomes. Furthermore, a study by

Delvecchio E. et atl., (2020) investigates the relationship between authoritative and

authoritarian parenting styles and a child's difficulties. The results showed that

authoritative parenting was associated with less maladjustment, while authoritarian

parenting showed the opposite association. The study suggests that parenting styles

have a significant effect on a child's difficulties.

With the parents increasingly play a vital role in supporting their children's

upbringing and helping maintain work-life balance for the younger generation. This

generational transition typically starts in the fifth decade of life, with over 80%

becoming parents by the age of 50, as indicated by a survey across the United States

and 23 European countries. Among Asian Americans, parents responsible for raising

their children are typically in their 50s, but notable physical and mental health

changes begin in their fifties. The demands of providing child-rearing assistance, or

parenting, may lead to increased burdens for this group, particularly those with

custodial responsibilities. However, a study reveals that grandmothers engaged in

non-daily care maintain you a healthy level of physical activity and overall well-

being, suggesting that non-routine caregiving can benefit parents' health (Yumiko E.
 24

et al., 2023). Moreover, another parenting strategy have been researched by

Benedetto and Ingrassia (2020). Their study revealed how digital media has

significantly impacted communication, entertainment, information acquisition, and

problem-solving between parents and children, particularly in the context of COVID-

19 home confinement. Young children's early digital engagement presents new

challenges to parent-child relationships and parental roles. The chapter introduces the

concept of "digital parenting" and reviews empirical research on parental mediation

practices, adjusting them based on the child's characteristics and the parent's media

competence and beliefs. It also discusses the impact of youths' social involvement,

communication, self-disclosure, and digital skills on parents' beliefs and practices.

The chapter concludes by discussing implications for parent education and preventing

risks for early and excessive exposure to digital technologies.

Synthesis

For young adults planning for their future, children are more often than not in that

plan, the age of the first pregnancy was mostly determined by when women married,

and education had a minimal additional effect Marphatia et al. (2020). The study

shows the most optimal statistical ways on conceiving children, raising them, and how

to make them the best they can be. Although most people nowadays prefer to further

their career first before trying for children, the study shows that the time window for

conceiving closes and closes as you grow older. It already shows the decline that at

the age 30, you get a 75% chance of conceiving within a year, and as you get to 40

this decreases to 44% (Delbaere et al., 2020). The best age to have a child is between

the ages of 23 and 32, because the odds of certain birth abnormalities are lowest at

that maternal age. There is a clear increase in risk for very young or advanced
 25

maternal age, or both, for some non-chromosomal congenital anomalies (NCAs), with

the specific age ranges depending on each disease (Pethő et al., 2023). Time is really

of the essence when it comes to family planning. While everyone has their reasons,

may it be personal or medical, the results of the study show that you must take into

careful consideration at which age you plan to conceive (Molina - Garcia et al., 2019).

Not only that but also your parenting style. Everyone has different ways of raising

their children, while no two can be properly compared, the study tries to take on a

more objective approach by using the child’s class participation as the main point of

study. It resulted in authoritative parents having the best outcome while authoritarian

parents had the worst (Catalini et al., 2020). Parenting and family planning is no small

thing, every choice and decision we make affects not only the parents but more

importantly, the children. Each person must wisely plan and choose in order to make

the best future possible for them and their children.

Theoretical Framework

The theoretical framework utilizes the psychosocial theory of Erikson's

Intimacy vs. Isolation stage and the Self-Determination Theory to provide a thorough

understanding of what parental readiness entails. According to Erikson's Intimacy vs

Isolation that early adulthood is the time when people seek for genuine, intimate

relationships with others. This is the era of intimacy versus isolation. Building solid

relationships based on commitment, love, and trust is essential for the successful

resolution of this stage. Meanwhile, SDT contends that people have three

fundamental psychological needs: relatedness (a sense of connection and belonging),

autonomy (a sense of choice and control), and competence (a sense of efficacy and

mastery).
 26

Considering the relationship between intimacy versus isolation and SDT in the

context of parents' readiness for making a child, we can focus on the psychological

need for relatedness within SDT. The term "relatedness" describes the desire for

belonging, connection, and deep connections. In SDT, it has been found that a sense

of relatedness is essential for people's motivation, wellbeing, and adaptive

functioning.

Applying this to the preparation of parents to have children, we might

speculate that those parents who have successfully navigated the stages of intimacy

and isolation are more likely to feel a deeper sense of relatedness and have their desire

for connection and belonging satisfied. Their preparedness and motivation to start the

process of becoming parents may be influenced by this feeling of relatedness.

In summary, the researchers and practitioners can examine and evaluate an

individual's readiness for parenthood by evaluating the characteristics of parental

readiness. It presents a framework comprehending the psychological and interpersonal

elements that may affect successful parenting. Furthermore, it helps in comprehending

the relationship between parenting readiness and good parenting practices, as well as

child development and general family well-being. In general, the theoretical

framework of parental readiness offers an organized method for comprehending,

evaluating, and improving someone's readiness for the challenging and fulfilling duty

of parenting.
 27

Figure 1: Parenting Readiness related to Erik Erikson’s Intimacy vs Isolation and

Self-Determination Theory

Research Paradigm

Input Process Output

Demographic
Profile
> Age (22-44 > Descriptive
yrs) Correlational > Confidence in
>Gender Design Childrearing
>Marital Status
> Stratified > Readiness in
Theoretical Random Childrearing
Framework Sampling
> Erikson's > Childrearing
Intimacy vs. > Questionnaire Practice
Isolation stage (Pen and Paper)
> Self-
Determination
Theory

Figure 2: Confidence and Readiness of Child-rearing Among Heterosexual Adult

 28

This figure shows the interplay of key components within the research

paradigm aimed at understanding 'Confidence and Readiness in Child-rearing Among

Heterosexual Adults.' The input stage encompasses demographic data, including age

(22-44 yrs), gender, and marital status, as well as intricate connections between two

foundational theoretical frameworks: Erikson's Intimacy vs. Isolation stage and the

Self-Determination Theory, and their impact on child-rearing among heterosexual

adults. Through the lens of a descriptive correlational design, complemented by

stratified random sampling to ensure diverse respondent representation, data is

collected via a pen-and-paper questionnaire. The research output culminates in three

significant variables: 'Confidence in Child-rearing,' 'Readiness in Child-rearing,' and

'Child-rearing Practice.' Together, this paradigm aims to explore how demographic

factors and theoretical frameworks relate to individuals' child-rearing attitudes and

behaviors, shedding light on the intricate dynamics of parenthood readiness.

Research Hypotheses

 There is no significant relationship in Confidence and Readiness in Child-

rearing Among Heterosexual Adults

 There is a significant relationship between different genders in child-rearing

 There is a significant correlation between confidence and readiness

Definition of Terms

The following key terms are conceptually defined. Some are operationally defined for

better understanding of the relevance of these terms in the present study.

 29

1. Socio-Demographic Profile. Refers to the data of the respondents that include

the following:

1.1 Age - refers to the respondents’ with 20 - 40 of age at the time of the study.

1.2 Sex - refers whether the respondents is heterosexual female or male.

1.3 Marital Status - refers whether the respondents is single or married.

2. Confidence. It refers to an individual who feels satisfied and confident with

their nurturing and who knows where to go for help in the best situation to

think about child related concerns. They are better prepared to take in

information about how to work on their child's wellbeing, prosperity and

instructive results (Parenting Research Centre, 2018).

2.1 Financial - refers to the financial confidence of an individual when it

comes to child-rearing. He/she is confident that he/she can provide all the

child's needs that requires money. He/she is confident because he/she has the

resources to succeed in this aspect.

2.2 Security - refers to an individual who is confident that he/she can provide

the basic needs for the child such as food, shelter, clothing, and protection

because he/she will have the support and necessary means that are needed to

achieve it.
 30

2.3 Structure - refers to an individual who has the capacity to teach his/her

child about values and ethics in the family. An individual is confident that

he/she can discipline his/her child in maintaining structure in the family.

3. Readiness. It refers to an individual providing guidance and appropriate care

for children (Ahernandez, 2023).

3.1 Financial - refers to the financial readiness of an individual when it comes

to raising a child. He/she knows that he/she is prepared and has the capacity in

aiding the child in the financial aspects in life.

3.2 Security - refers to an individual who has been preparing to provide

security for his/her child. An individual is ready to ensure that security will be

given to a growing child because he/she has already equipped himself/herself

with the essential aspects to achieve this.

3.3 Structure - refers to an individual who is ready to impart knowledge and

discipline his/her child about the values, core, and ethics of a family.

4. Heterosexual. It refers to sexual orientation wherein two individuals of the

"opposite" sex and gender experience significant emotional, romantic, and/or

sexual desires and attraction for one another (Poole, 2017).

 31

5. Child Rearing. Parents duty to guide and encourage healthy socializing

techniques for children in their care (Lang, 2020).

CHAPTER 3

Research Methodology

Research Design

The researcher used quantitative research, specifically descriptive correlational

design to know the reason what factors affect the confidence and readiness of

heterosexuals when it comes to child-rearing. This design entails looking at and

explaining how variables relate to one another without changing the variables. In

order to provide a picture of the current relationships, it seeks to find associations or

patterns between variables in a natural situation. Descriptive correlational studies lack

 32

control over factors and intervention, in contrast to experimental approaches. To

examine and characterize the correlations between variables of interest, researchers

gather data via surveys, observations, or already-existing data (Bhat, 2023). The

researchers conducted a survey which will help them to examine the factors affecting

the confidence and readiness in terms of child-rearing. Quantitative research methods

are methods dealing with numbers and anything that is measurable in a systematic

way of investigating phenomena and their relationships. It is used to answer questions

on relationships within measurable variables with the intention to explain, predict, and

control a phenomenon.

This study delves into the examination of confidence and readiness levels

among heterosexual adults in the context of child-rearing. Employing a correlational

design is crucial for exploring the relationships between confidence in child-rearing,

readiness for parental responsibilities, and sociodemographic factors such as age,

gender, and income. This design facilitates the measurement of the strength and

direction of associations among these variables without manipulating or interfering

with them. These include (1) age, (2) gender, (3) income, (4) stability, (5) security,

and (6) structure. By incorporating these variables, we aim to discern any variations in

confidence and readiness for child-rearing responsibilities, as well as the additional

dimensions of stability, security, and structure, across different age groups within the

heterosexual adult population. This approach allows for a nuanced exploration of how

sociodemographic factors, including stability, security, and structure, might influence

individuals' levels of confidence and preparedness for the challenges associated with

raising children.
 33

Research Locale

This research study will be conducted at a Healthcare Company in Taguig,

Philippines. The chosen workers in the healthcare company will serve as the

respondents of this study. The healthcare company, which is the Shearwater Health,

was chosen to make sure that the respondents will be accessible to the researchers.

Shearwater Health is a healthcare outsourcing company that utilizes global delivery in

order to provide specific clinical solutions to various hospitals and provide controlled

care to organizations. The researcher chose Shearwater Health because the target

participants are working individuals, so the employees of the company are a great

choice of population. In addition, the researchers have connections to workers of the

company, and it is considered as a good aspect as they will have convenience in data

collection. Furthermore, the support from the company administrators will be a big

help in conducting a research study in this research locale.

Research Instrument

The researchers will utilize three sets of questionnaires in this study.

Questionnaire number 1 will contain the demographic profile of the participants.

Questionnaire number 2 is to assess participants' readiness for child-rearing utilizing

the survey tool used from the study of Dordunu et al. (2021). Questionnaire number 3

utilizes The Self-Efficacy in the Nurturing Role (SENR) questionnaire created by

 34

Pedersen, Bryan, Huffman, and Del Carmen (1989) in assessing participants'

Confidence in child-rearing.

Readiness for Childrearing

The survey questionnaire for readiness in child rearing is adapted from the

research conducted by Dordunu, R, et al. (2021). The survey was used to assess the

readiness for child rearing in Ghana. Participants were female adolescents (including

late adolescents and early). The survey consists of 13 questions regarding their

readiness in terms of the Availability of support services for adolescent mothers,

Maternal knowledge of infant nutrition, and Maternal Knowledge of health promotion

activities.

Availability of support services for adolescent mothers

Question 1: Is there someone to support mother and child Yes

financially after birth?

No

If yes, who? Partner

Parents

In laws
 35

Question 2: Are you able to care for a child independently ? Yes

No

If no, who will help you care for the child? Mother

In-laws

Siblings

Question 3: Caring for the baby is a difficult task and should be Yes

performed by experienced persons

No

Question 4: Have you ever received counselling/ education on Yes

child- rearing
No

Source of child rearing education/ counselling Parents

In laws

Friend

Nurses

Doctors

Maternal knowledge and infant nutrition (readiness in the following)

Question 1: Exclusive breastfeeding for the first 6 months

Question 2: Complementary feeding at 6 months and above

 36

Question 3: Feeding child with food suggested at the CWC.

1 2 3 4 5

Question 4: Breastfeeding up to at least 2 years

Maternal Knowledge on health promotion activities

Question 1: Attending Child Welfare Clinic regularly

Question 2: Preventing child from home accidents

Question 3: Responding promptly to child’s basic needs

Question 4: Protecting child from extreme temperatures

Question 5: Acquiring knowledge on first aid and home management of children

with diarrhea and fever

Confidence in Childrearing

The Self-Efficacy in the Nurturing Role (SENR) questionnaire created by Pedersen,

Bryan, Huffman, and Del Carmen (1989) will be used by the researchers to assess the

level of confidence in childrearing. This 16-item test assesses adolescents'

evaluations of their ability to provide basic support for newborns. Participants rated

these items on a 5-point Likert scale, with 1 being "not at all representatives of me"

and 5 being "strongly representative of me." The measure's item scores were added
 37

together to yield a total parental self-efficacy score ranging from 16 to 80, with higher

scores indicating greater efficacy.

Using the statements below, please tell us how you feel about becoming a parent.

For each item, CIRCLE the number (1-5) that most accurately reflects your current

feelings.

Not at all Slightly Moderately Strongly Fully

representati representati representati representati representati

ve of me ve of me ve of me ve of me ve of me

I look

forward to
1 2 3 4 5
becoming a

parent with

confidence

in my role

as a parent.

I feel I can

catch on
1 2 3 4 5
quickly to

the basic

skills of

caring for
 38

my child.

I think I will

have

difficulty
1 2 3 4 5
interpreting

my baby’s

cries,

knowing

whether he

or she wants

to be fed

rather than

played with

or held.

I imagine

myself

getting
1 2 3 4 5
uptight if

my baby

becomes

fussy or

irritable for

longer than

a few
 39

minutes

I expect to

be

comfortable
1 2 3 4 5
playing

actively

with my

baby and

getting him

or her to

smile at me

I feel

unprepared

in becoming
1 2 3 4 5
a parent.

In

imagining

myself in

most
1 2 3 4 5
circumstanc

es, even

when I am

tired, able to
 40

cope well

with

meeting my

baby’s needs

Touching,

holding, and
1 2 3 4 5
being

affectionate

with my

baby will be

comfortable

and

pleasurable

for me.

I think I will

be able to

trust my
1 2 3 4 5
feelings and

intuitions

about taking

care of my

baby.
 41

I wonder if I

really can
1 2 3 4 5
understand

my baby’s

needs.

I am unsure

just how
1 2 3 4 5
much

attention I

should give

my baby.

I expect to

be able to

soothe my
1 2 3 4 5
baby easily

when he or

she is crying

or fussing.

I am

concerned
1 2 3 4 5
that my

patience

with my
 42

baby may be

limited.

I expect to

feel
1 2 3 4 5
comfortable

and

I find

nothing

unusually

complicated
1 2 3 4 5
or difficult

about the

prospect of

feeding,

playing

with, or

providing

day-to-day

care for a

child.

The thought

of being
1 2 3 4 5
solely
 43

responsible

for my child

is

frightening

Validity and Reliability

The instrument that the researchers will utilize in this study was derived from

the study of Dordunu et al., entitled "Assessment of Maternal Readiness for

Childbirth and Childrearing among Adolescent Mothers in Ghana," to measure the

readiness of adolescents in childbearing. This instrument has been proven to be highly

reliable in evaluating adolescents' readiness for parenthood and has been verified in

previous research. Additionally, researchers will utilize the instrument in the study of

Kerrick, Madeleine R. entitled "Refining the Role of Social Support in First-time

Mothers’ Development of Parental Self- efficacy," to measure parental self-efficacy or

confidence in child-rearing. Previous research on this scale has demonstrated its

strong internal reliability and validity, adding to the instrument's validity. The present

study will benefit from the dependability and strength of these measures in evaluating

confidence and preparation in child-rearing among heterosexual adults by building

upon validated instruments.

Sampling Method
 44

The study is intended to collect particular data from a sample of 50

heterosexual adults who work in Bonifacio Global City Taguig, Metro Manila. The

study focuses on people in their early adulthood (22-34 years) and early middle

adulthood (35-44 years), mostly in office settings, with a prospective research site at

Shearwater Health.

In order to do this, the researcher used a (snowball sampling??) research

strategy, giving survey questionnaires to adult residents of the Bonifacio Global City

Taguig, Metro Manila, who are chosen working adults. The research guarantees that

the participants in the survey are randomly chosen from the adult population of

working adults in Bonifacio Global City Taguig who meet the eligibility requirements

for taking part in the study.

Data Gathering Procedure

The goal of this quantitative study is to measure heterosexual individuals'

confidence and readiness for child-rearing.

(1) For the study to proceed, researchers sought clearance from the FEU-

IHSN Ethics and Research Committee.

(2) the researchers requested consent from Shearwater Health Philippines

in Bonifacio Global City Taguig, Metro Manila by providing a letter of

approval that was also authorized by the FEU-IHSN Nursing Ethics

and Research Committee.

 45

(3) The researchers visited the area at the scheduled visit with the

assistance of Shearwater personnel to check on the heterosexual adults

who are willing to participate and acquire their informed permission.

(4) The researchers disseminated the questions that the participants would

answer after developing communication and rapport among them.

(5) After the participants have answered the questions, their concerns and

questions will be addressed.

(6) The researchers provided their contact information to the participants

in order for them to maintain contact with them following the visit for

further concern

OBJECTIVE IDENTIFICATION measure

heterosexual individuals' confidence
and readiness for child-rearing.

ETHICAL CLEARANCE FEU-IHSN Ethics

and Research Committee.

Statistical Treatment Data

As the researchers gathered all the data that aims to determine the confidence

and readiness of childrearing among heterosexual couples. The data was assembled,

categorized, arranged, and tallied. They were statistically treated in order to answer
 46

the study's questions. The following procedures were used to interpret the data

gathered from the respondents of the study.

1. Simple percentage

The demographic profile variables of the respondents were analyzed using the simple

percentage with the following formula:

P=FN(100)

Where:

P = Percentage

F = Frequency of each category

N = Total number of respondents

100 = Constant multiplier

2. Weighted Mean

This statistical tool was used to compute the weight of the responses in the

questionnaire assigned by the respondents during the actual data-gathering procedure.

The formula for the weighted mean is as follow

Formula:

WM= ∑FWN

Where:

WM = Weighted mean

∑ = Summation symbol

F = frequency for each point

 47

W = weight of each items

N = total number of frequencies

The following are the corresponding verbal interpretations for the weighted mean.

Weighted Mean/Equivalent Corresponding Remarks

2.60 - 3.00 Fully Representative

2.20 - 2.59 Strongly Representative

1.80 - 2.19 Moderately Representative

1.40 - 1.79 Slightly Representative

1.00 - 1.39 Not at all Representative

3. Likert Scale

The following Likert Scale serves as the guide for interpreting the data

gathered.

Scal Weighted Means/Equivalent Corresponding Remarks

5 4.20 - 5.00 Fully Representative

4 3.40 - 4.19 Strongly Representative

 48

3 2.60 - 3.39 Moderately Representative

2 1.80 - 2.59 Slightly Representative

1 1.00 - 1.79 Not at all Representative

4. Spearman Product Moment Correlation Coefficient

This was used to test the correlation between the two variables involved.

Formula:

r = n∑xy - ∑x∑y [n∑x2 - (∑x)2] [n∑y2 - (∑y)2]

Where:

N = Number of Pairs

∑ = Summation Symbol

x = Score for the first variable

y = score for the second variable

5. t-Test for the Correlation Coefficient r

This was utilized to test the null hypothesis stated in this study using the computed

value of the coefficient r.

Formula:

t = r - p1 - r2n - 2 ; df=n-2
 49

Where:

t = Computed t-score

r = Correlation Correlation Coefficient

p = p-value from the table or Critical Values

n = Number of Pairs

df = Degrees of Freedom

VII. Ethical Considerations

Before starting the data collection, the researchers followed the Ethics Review

Committee's (ERC) guidelines and made the necessary amendments and submitted

the necessary paperwork. As a result, the researchers were eventually certified as

authorized to conduct research. The following guidelines were followed and

implemented during the conduct:

Informed Consent:

The researchers were responsible for informing the participants about the main

aspects of the study. As a result, informed consent forms were distributed to

participants to ensure that they were fully informed of the nature, purpose, risks, and

benefits of the study before agreeing to participate.

Confidentiality and Anonymity

 50

Identifiable information will be treated with care, and all data will be

anonymised to safeguard participants' privacy. Only the researchers will have access

to the raw data, and any published results will aggregate information to protect

individual individuals from being identified.

Beneficence and Non- Maleficence

The study aims to contribute to the understanding of the confidence and

readiness in child rearing among heterosexual adults. Nevertheless, researchers will

take steps to ensure that volunteers are not harmed or distressed. Participants who

may encounter emotional or psychological difficulties during or after the study will

have access to support networks.

Data Security

The obtained data will be made available only to the researchers and

will be kept in a secure area with limited access. To protect the rights of

participants, all data will be preserved for the stated period before being

permanently erased.

Cultural Sensitivity

Understanding the different cultural background of each volunteer

participants, The subject matter will be approached with cultural sensitivity by the

research team. Methods of communication and data gathering will be modified to

 51

reflect cultural norms and values. Any relevant cultural consequences on results

interpretation will be addressed and discussed openly in the research findings.

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