Revista de Salud Pública

With the begining of lockdown procces after the first COVID-19 case in Turkey (1,2), a new period has begun for children and adults; their contact with their peers is reduced, and all their connections with the outside are minimized (3,4). The lockdown period, in which children and their parents in the COVID-19 pandemic are at home for a long and indefinite duration and their daily and domestic routines change, affects people individually while also possibly affecting family life and parent-child relationships within the family (5,6). Parental attitudes are known to be associated with factors such as the education level of the parents, age, socio-economic and socio-cultural conditions, whether the parents are ready for parenthood, and the state of the relations between the spouses in the period before becoming parents (7). Research conducted prior to the pandemic indicated a strong correlation between the positive mood of family members and warm family interactions. Conversely, negative moods were linked with withdrawal from family interactions (8,9). A study during the pandemic period showed that parents, especially mothers, represented the most anxious group, and being a parent was a risk factor for fear and anxiety, especially for the safety of children, compared to non-parents (10). While a multitude of studies have delved into the ramifications of the COVID-19 pandemic on the physical and mental well-being, as well as the lifestyle, of individuals (11,12), there is a conspicuous gap in the literature concerning the impact of adult parental roles during the pandemic (13,14).

Furthermore, there is a lack of published research examining the differences in parenting attitudes among mothers of preschool-aged children before and during the COVID-19 pandemic. Specifically, We hypothesize that there will be alterations in mothers' parental attitudes during the COVID-19 pandemic as opposed to the pre-pandemic period. This study aims to compare parental attitudes—specifically, democratic, authoritarian, overprotective, and permissive attitudes—among mothers of preschool children in the periods before and during the pandemic (BPanP and DPanP). Identifying variations in parenting attitudes during the pandemic can inform the development of support programs for mothers in future outbreak periods.

MATERIALS AND METHODS

This observational study consists of two parts, BPanP and DPanP. In the BPanP section, mothers of preschool children who applied to the Hacettepe University Ihsan Doğramacı Children’s Hospital between January and May 2019 were included in the study by face-to-face interview, while in the DPanP section in January 2021, 10 months after the onset of the pandemic, mothers who had preschool children were included in the study with an online survey including a family information form and a questionnaire by the snowball sampling method. Volunteer mothers with at least one child between the ages of 2-6 and who had a nuclear family (consisting of a mother, father, and children) were included in the study. Single-parent or extended-family children and their mothers were not included in the study. The survey was requested to be filled out for the younger child by those who had more than one child in the 2–6 age range. The online survey was preferred during the pandemic period by volunteers to minimize the risk of virus transmission.

In BPanP period, mothers completed informed consent form prior to their enrollment in the study. During the pandemic period, participants completed an online informed consent form. The research followed the guidelines set forth in the Declaration of Helsinki, and it received approval from the ethics committee at Hacettepe University (2021/10-29).

Sample size for two phase study, effect size (d): 0.3, alpha error: 0.05, power: 0.95, and allocation ratio: 1/1, and two tail comparison; 304 participants for each period was calculated (G*Power 3.1.9.4).

Both the written and online surveys comprised three identical parts. The first part consisted of an informed consent section obtained from parents who agreed to participate in the study. The second part was a self-completion family information form, while the third part consisted of the parents' attitudes scale. The family information form comprised 15 questions, covering various aspects including parental age and education, family type, total number of children, and the age and gender of the youngest child in the family, who was between 2 and 6 years old, as well as details regarding their childcare arrangements during the pandemic. The questionnaire was completed voluntarily by participating parents. Parental age was categorized into two groups: <35 years and ≥35 years, while parents' education levels were divided into <12 years and ≥12 years. Mothers completed the Parent Attitude Scale (PAS) as part of the third segment of the online survey.

The PAS questionnaire comprises a 46-item Likert-style scale. Each item assesses parental behavior and is rated on a five-point Likert scale, ranging from one (never) to five (always). The questionnaire is structured into four subdimensions, encompassing 17 items for democratic parenting, 11 for authoritarian parenting, 9 for overprotective parenting, and 9 for permissive parenting. (15) Among the 4 subdimensions we questioned in the PAS, the democratic parent subdimension aims to encourage the child to develop an independent personality and express his ideas clearly while accepting the child as a separate individual; the authoritarian parenting attitude, thinking that the parent is the owner of the child and that the child is not a separate individual, accordingly, one-way communication from the parent to the child and the child's unconditional compliance with the rules set by the parent; overprotective parental attitude, believing that the parent should constantly protect the child because the child can not be self-sufficient by avoiding giving responsibility to the child; on the other hand, the permissive parent subdimension includes allowing more freedom than normal to the child's behavior by tolerating everything the child does (15). Achieving high scores indicates a tendency towards the behavior represented by the corresponding subdimension.

The validity and reliability analyses of PAS revealed Cronbach's alpha coefficients of 0.83 for the democratic subdimension, 0.76 for the authoritarian subdimension, 0.75 for the overprotective subdimension, and 0.74 for the permissive subdimension (15), in another study the Cronbach alpha reliability coefficients were reported as 0.84, 0.78, 0.80, and 0.73, respectively (16). In the present study, Cronbach's alpha values were calculated as 0.90 for the democratic subdimension, 0.78 for the authoritarian dimension, 0.81 for the overprotective dimension, and 0.75 for the permissive dimension for the face-to-face PAS in BPanP group and 0.94 for democratic subdimension, 0.85 for authoritarian subdimension, 0.81 for overprotective subdimension, and 0.74 for permissive dimension for online PAS in DPanP group. These values were similar in BPanP and DPanP groups and consistent with the literatüre (15,16).

RESULTS

The BPanP survey was confirmed by 344, and 403 mothers confirmed the DPanP survey with children between 2 and 6 years old. The questionnaires which were fully completed and met the inclusion criteria in 303 questionnaires for BPanP and 344 questionnaires for DPanP were included in the study.

General characteristics of mother-child dyads of BPanP and DPanP

The parent-child characteristics of the BPanP and DPanP groups are shown in Table 1. While 64.7% of the mothers in the BPanP group had 12 years or more of education and 55.1% were working, these values were 76.7% and 64.0%, respectively, in the DPanP group (respectively; p=0.001, 0.022). Mothers with children in the BPanP group were 30.4%, while 40.4% in the DPanP group had a single child, and this difference was statistically significant (p=0.029). Other parent-child factors (mother's age, child's age, father's age, child's gender) of the BPanP and DPanP groups were similar. Giving care to the child during the day has differed in groups (p<0.001). Among PAS subdimensions, the median scores of democratic and overprotective attitudes were similar in groups from two phases, while the median scores of authoritarian and permissive attitude were higher in the DPanP group (p=0.014, p<0.001, respectively, Table 1).

Table 1.: General characteristics of mother-child dyads of BPanP and DPanP

Values were given as mean ± SD or n (%) or mean [95%CI]; BPanP: Before Pandemic; DPaP: During Pandemic.

Parental attitude subscale scores according to pandemic period and mother-child characteristics

PAS scores in BPanP group and DPanP group according to pandemic period and parent-child characteristics are shown in Table 2. When mother-child characteristics included in generalized lineer models (GLM), a statistically significant change was seen in the median scores of permissive PAS with the pandemic period variable; the median scores of permissive attitude was higher in the DPanP compared to BPanP group (p=0.001).

Among mother-child characteristics, GLM revealed higher authoritarian scores with having children more than one, and mother and nursery care than counterparts (p<0.001, p=0.012, respectively). Higher permissive scores were detected during pandemic period, in low maternal education and permissive scores decreased with child age (p=0.001, p=0.002, p<0.001, respectively).

Table 2.: Parent Attitude Scale scores according to variables; pandemic period and mother-child characteristics, Generalized linear models

*mean [%95 Wald CI]; BPanP: Before Pandemic; DPaP: During Pandemic; ^abThe values in the same column are different, p<0.05.

Correlations between PAS scores and mother-child age and child number

The correlation between parental attitude subscale scores and mother-child age and number of children was analyzed in BPanP and DPanP groups, seperately (Table 3). The negative correlation between democratic parental attitudes and authoritarian and permissive attitudes before the pandemic period continued only between democratic and authoritarian attitudes during the pandemic period, while there was a new positive correlation between democratic and overprotective attitudes. The positive correlation between authoritarian and permissive attitudes before the pandemic continued unchanged during the pandemic period. The negative relationship between the child's age before the pandemic and the mother's permissive attitude did not change during the pandemic period. The negative relationship between maternal age and overprotective attitude before the pandemic disappeared during the pandemic period. The relationships between the number of children and democratic and authoritarian attitudes were not detected during the pandemic period. During the pandemic, the previously observed negative correlation between the number of children and democratic attitude, as well as the positive correlation between the number of children and authoritarian attitude, disappeared.

Table 3.: Correlations between Parent Attitude Scale scores and mother-child age and child number, r (p)

BPanP: Before Pandemic; DPaP: During Pandemic.

DISCUSSION

In our study; when the parental attitudes of mothers of children aged 2–6 years before and during the pandemic were examined, it was found that democratic and overprotective attitude scores were similar. In contrast, the authoritarian and permissive parental attitude sub-dimensions were higher during the pandemic period. It was noted that this variation depended on the specific characteristics of both the mother and the child. Other studies investigating the relationship between parental attitudes and the pandemic period have demonstrated that parents face challenges in managing their children, particularly while navigating the social isolation imposed by the pandemic (17). Similar to the higher scores of authoritarian attituide of DPanP group mothers in our study, The social isolation and pressures of quarantine experienced during this period led to parents adopting a more authoritarian stance in their attitudes towards their children (18). The further analysis of the study evaluated differences in PAS scores according to pandemic period and mother-child characteristics; when family-child characteristics are adjusted, the permissive parental attitude score was found to be higher during the pandemic period. It is known that in permissive parental attitude, the parent has an overly accepting approach toward the child, and the parent's control over the child is low (19). Some studies have shown that parents who spent more time with their kids during the pandemic than usual are more likely to have parenting problems, such as picky eaters, fights between siblings, etc. (20,21). This might be a possible explanation for the higher scores of permissive parenting attitude in the DPanP group and in the futher analyses results in our study. Also, it is konwn that the closure of schools and kindergartens during the COVID-19 pandemic, coupled with the necessity to balance work and home life from within the household, significantly burden working mothers in meeting the caregiving needs of their children (22). It can be thought that the result that the percentage of mothers with job in the DPanP group in our study and the permissive scores of the mothers in this group were higher compared to the BPanP group, are parallel to these studies.

In our study, mothers with 2 or more children had higher authoritarian parenting scores comparered to having single child. A study on parenting attitudes revealed a noteworthy distinction, indicating that the presence of siblings has a significant positive association with mothers' the authoritarian child-rearing attitudes (23). Based on these findings, it can be inferred that mothers of children with siblings tend to adopt more authoritarian child-rearing attitudes. Consequently, it follows that the more children a mother has, the more authoritarian her child-rearing attitudes may become.

We discovered that when the mother is the day caregiver, the mothers' authoritarian attitude toward their child is higher compared to having child in grandparent and kindergarten care. Another study reported that grandparent involvement in child care reduced the risk of harsh parenting attitudes exhibited by mothers towards their children (24).

In the analyses, when the child is in nursery care during the day, the mothers' democratic attitude toward their child is lower than the grandparent and kindergarten care. In a study done between 100 kindergarten children and their parents, democratic parenting was the most common parenting style (25). In another study analysed the grandparent- grandchild relations, grandparents primarily employ a democratic style for their grandchildren from the child’s perspective (26). In our study, the fact that the mother exhibited a more democratic parenting when the child was under the care of the grandparent during the day than when the child was under nursery care may be due to the democratic attitude of the grandparent being an example for the mother, as this previous study suggests.

In the correlation analyses; mothers were more permissive to their younger children than the older ones in BPanP and DPanp groups. There are studies in the literature reporting that mothers with younger children are at higher risk of parenting-related exhaustion compared to those having an older child (27), and another study showed the quality of parent-child interactions with younger children might potentially be decreased during the pandemic (28). However, in our study, we found that the permissive parenting of mothers was in negative correlation with child’s age. In a study investigating the behavior problems of preschool children, it was reported that age creates a significant difference in attention deficit and mobility problems, and inattention and mobility problems are observed more in younger children. It has been stated that the reason for this may be the expectation of parents to exhibit less problematic behavior from older children (29). In our study, the negative corelation of permissive parenting attitude scores of mothers with children age might be similar to this study.

Strengths and limitations

One limitation is that it is a cross-sectional study based on maternal declarations both before and during the pandemic period. Even though it's possible that mothers try to see themselves differently than they really are or that they don't have a good enough understanding of how they act, especially during the pandemic, this is less likely now that surveys have been done online using snowball sampling. The same volunteers could not be reached during the pandemic period as a limitation, and other mother-child dyads with similar characteristics were included in the study. However, the Cronbach alpha values of the parent attitude scales made face-to-face and online during the pandemic period were similar. This showed that future researchers could study the parent attitude scale online and face-to-face.

As a limitation, the mothers included in the DPanP group during the pandemic period were more likely to be working and have an education of 12 years or more than the mothers in the BPanP group. Given that maternal education and employment status can influence parental attitudes, these variables were controlled for in subsequent analyses to assess the impact of the pandemic on parental attitudes. This suggests that when comparing studies conducted during the pandemic with those conducted before, there may be differences in participant characteristics that are accessible, thus necessitating adjustments in the analyses accordingly.

Although there are studies on the results of the relationship between the COVID-19 pandemic and the mental health and lifestyle of individuals (11,12), there are not enough studies examining the relationship between parental roles with the pandemic period and the interaction between them and their children, so the results of our study are important.

The present study showed that the permissive parenting attitude was higher during the pandemic period than before. The result obtained from the study showed that the pandemic period was added to the known influencers of parental attitudes. Even a healthy parent-child relationship that has developed under routine conditions, it will be primarily affected by parental attitudes in special situations such as pandemics, which will develop suddenly, and we will not know how long they will last or whether they will recur in the future. We enrolled the nuclear family type, and further studies are needed for single-parent and extended families ♣