COPING STRATEGIES OF PARENTS WITH PHYSICALLY AND MENTALLY CHALLENGED CHILDREN IN ENUGU URBAN SOUTHEAST NIGERIA

TABLE OF CONTENT

Title – – – – – – – – – – i
Approval – – – – – – – – – – ii
Certification – – – – – – – – – iii
Dedication – – – – – – – – – – iv
Acknowledgement – – – – – – – – – v
Table of content – – – – – – – – – vi
List of Appendices – – – – – – viii
List of tables — – – – – – – – – – ix
List of figures – – – – – – – – – – ix

List of Boxes – – – – – – – ix

Abstract – – – – – – – – – – x
CHAPTER ONE
Introduction – – – – – – – – – – 1
• Background to the study – – – – – – – 1
• Statement of problem – – – – – – – – 4
• Purpose of the study – – – – – – – – 5
• Specific objectives of the study – – – – – – 5
• Research questions – – – – – – – – 6
• Significance of the study – – – – – – – 6
• Scope of the study – – – – – – – – 7
• Operational definition of terms – – – – – – 7
CHAPTER TWO
Literature review
• Conceptual review – – – – – – – – 10
• Stress – – – – – – – – – – 10
• Family stress – – – – – – – – – 11
• Coping strategies – – – – – – – – 12
• Coping resources – – – – – – – – 14
• Ineffective/ maladaptive coping — – – – – – 20
• Coping and socio demographic variables – – – – – 21
• Physically challenged – – – – – – – – 23
• Mentally challenged – – – – – – – – 24
• Parents of physically and mentally challenged children — – – 26
• Theoretical framework – – – – – – – 27
• Empirical studies on coping strategies – – – – – 32
• Summary of literature review – – – – – – – 38
CHAPTER THREE
Research Methods
• Research design – – – – – – – – 40
• Area of study – – – – – – – – – 40
• Population of study – – – – – – – – 41
• Sample – – – – – – – – – – 42
• Sampling Procedure – – – – – – – – 42
• Instrument for data collection – – – – – – 43
• Validity of the instrument – – – – – – – 45
• Reliability of the instrument – – – – – – – 45
• Ethical clearance – – – – – – – – 45
• Procedure for data Collections – – – – – – 46
• Data Analysis – – – – – – – – – 48
CHAPTER FOUR
• Presentation of findings – – – – – – – 49
• Summary of findings – – – – – – – – 61
CHAPTER FIVE
• Discussion – – – – – – – – – 62
• Summary of the study – – – – – – – – 67
• Implication of the study to nursing practice – – – – – 68
• Suggestion for future research – – – – – – – 70
• Limitation of the study – – – – – – – – 70
• Conclusion – – – – – – – – – 71
• Recommendations – – – – – – – – – 71
References – – – – – – – – – – 73
Appendices – – – – – – – – – – 78

LIST OF APPENDICES
• Appendix i Calculation of sample – – 78
• Appendix ii Distribution of sample size across the schools – – 79
• Appendix iii Questionnaire – – – – – – 80
• Appendix iv Family strategy Interview guide – – – – 83
• Appendix v SPSS13 Results – – – – – – 85
• Appendix vi Application for ethical approval – – – – 93
• Appendix vii Ethical certificate – – – – – – 94
• Appendix viii Letter of identification from the Head of Nursing Dept. – 95
• Appendix ix Permission letter from Therapeutic Day Care Centre – 96
• Appendix x Permission letter from Government School for the Deaf and Dumb – – – – – – – 97
• Appendix xii Informed consent form – – – – – 98
• Appendix xi Questionnaire ( Igbo Version ) – – – – – – – 100

LIST OF TABLES
Table 1: Showing the demographic variables of respondents – – 50
Table 2: Identified coping strategies and their utilization by both
groups of parent – – – – – – – 51
Table 3: Showing mean usage of coping strategies by respondents – – 51
Table 4: One-way MANOVA summary on parents’ use of coping strategies – 52
Table 5: Showing three way MANOVA on age, income
and Education differences in the use of the four coping strategies – 54
Table 6: Showing means and standard Deviation of age and education
Interaction on Denial – – – – – – 55
Table 7: Showing resources/strength utilized by the respondents
that have been helping them to care for their children – 57
Table 8: Showing additional strategies that have been of help
to the respondents – – – – – – 58

LIST OF FIGURE
Figure 1: Theoretical frame work (Calister Roy’s Adaptation Theory – – 30
Figure 2: Theoretical frame work (ABCX model) – – – – 32 Figure 3: Interaction between age and education – – – 56

Box 1: Sub-themes for closeness to God – – – – 59
Box 2: Sub-themes for personal strength – – – – 59
Box 3: Sub-themes for support network – – – – 59
Box 4: Sub-themes for financial empowerment – – – 59
Box 5: Sub-themes for information and communication – – 59

ABSTRACT
The Purpose of this study was to examine the coping strategies utilized by parents who have physically or mentally challenged children in Enugu Urban. The study surveyed 154 consenting parents who have children enrolled in Therapeutic Day Care Center Enugu and Government School for the Deaf and Dumb Ogbete Coal Camp, Enugu using descriptive survey research design. Purposive sampling was used for this study to select 2 schools out of the 3 special schools in Enugu Urban, while convenience sampling was then used to reach the respondents. Parents coping strategy questionnaire (PCSQ) was used to identify the coping strategies of parents. Focus Group Discussion (FGD) was also organized using Family Coping Strategy Interview Guide (FCSIG) in order to identify other strategies not captured through the questionnaire. Descriptive statistics (Means and Standard Deviation) were computed for the demographic variables and the various coping subscales. Statistical analysis was done using MANOVA with alpha set at 0.05. The results showed that parents with physically and mentally challenged children used a combination of coping strategies. The data analysis revealed that the most frequently used coping strategies were; Spiritual Coping strategy (M = 4.67), Personal/Family resources coping strategy (M = 3.85) and External Social Support (M = 3.49). The least coping strategy used by parents was Denial coping strategy (M = 2.98). Parent’s of physically challenged children significantly used external social support more (F(1,152) = 10.59, p < .01) than parents of mentally challenged children. Significant interaction effect was found between age and education in the use of denial coping strategies (F( 1, 142 = 4.96, p < 0.5). These results suggest that parents used a wide range of coping strategies which appeared more helpful to them than any one single strategy. Also, the fact that parents of physically challenged children appear to significantly use external social support more than parents of mentally challenged children suggest that parents of the physically challenged are more connected to others and more ready to disclose their problem to people. It is therefore recommended that professionals in this special area should organize and establish association of parents of children who are physically or mentally challenged. This will create an avenue for interaction with one another, exchange of ideas, and expression of feeling which will lead to better coping.

CHAPTER ONE
Introduction
Background to the Study
The contemporary world is filled with a never ending array of challenges and numerous factors are responsible for that, (Bennibor 2007). One of such challenges is the burden of caring for a physically or mentally challenged child. The birth of a normal child can have a significant effect on the family dynamics. For this reason, parents and other children in the family must undergo a variety of changes to adapt to the pressure of a new member (Hussain and Juyal 2007). More profoundly, the birth of a physically or mentally challenged child to a family constitutes a serious burden that poses obvious challenges to parents. These challenges could include the time required for extra care, increased financial demand, stigmatization, psychological and social burden among others.

Dykens (2000) described physical challenge or disability as lack of ability relative to a personal or group standard or norm which may involve physical impairment such as sensory impairment limiting sensory function, or motor impairment limiting mobility. Such physical disabilities include; deafness and dumbness, blindness, being crippled, or the malfunctioning of some parts of the body which limits the effectiveness with which a child can cope with the academic, social and emotional expectations of the school and community. Mental challenge on the other hand according to Hodapp and Dykens (2001) is a form of mental retardation marked by I Q (intelligent quotient) score of less than 75 and limited ability to carry out daily living skills. It includes children with Down’s syndrome, cerebral palsy, autism among others. A person is mentally challenged if he is unable to dress, feed, or otherwise care for himself or herself, to hold a job or carry out most of other tasks needed to get through an ordinary day.

Looking at the prognosis of physically and mentally challenged children, Stanley (1998) stated that parents of physically challenged children know what their goals for a child should be. Based on that, they can draw on his or her many capabilities to help him or her achieve those goals. According to him, the motor and sensory systems are not the only capabilities children have and parents of physically challenged children can take advantage of even limited motor ability. A child, who has one arm that is working well, can reach for things and show what he wants. Even without good functioning arms, the child can convey ideas verbally or with signals if he has sensory deformities. He or she can be meaningfully engaged to enjoy life within the limits of his or her disabilities resulting in a good prognosis. The prognosis for children with mild to moderate mental retardation is also said to be usually good since these individuals can often become self sufficient to some degree. However, they may require some educational, community, social, family and vocational support in order to establish routines that will help them to function within the limits of their challenges. The outcome is less promising for those with severe to profound mental retardation. Those that survive, sometimes lack the ability to perform basic routine activities like (toileting, bathing, feeding or dressing themselves including basic academic skills like reading, writing and arithmetic) indicating that the prognosis is poorer than for those children with physical challenges.

The presence of a physically or mentally challenged child in a family can lead to family disintegration if not properly handled, even in the happiest of families. It can cause a clash between parents, siblings, and individuals within a family to the extent that family cohesiveness may be threatened or even destroyed. Ambert (1999) stated that the everyday task of feeding, toileting, traveling and communicating are much more physically and emotionally demanding for parents who have children who are physically or mentally challenged. These challenges require that parents should adjust or cope using different coping strategies in order to be able to handle the situation or reduce the weight of the burden.

Coping involves using psychological resources and strategies that help to eliminate, modify, or manage a stressful event or crisis situation (Mc Cubbin & Patterson 1983). It is the process of managing tasking circumstances, expending effort to solve personal and interpersonal problems and seeking to master, minimize, reduce or tolerate stress or conflict. The coping ability of parents with physically or mentally challenged children depends on several factors such as the amount and severity of pressure from individuals and the society, body constitution, culture, educational background, economic status, health predisposition, presence of social support system and religious background (Hargreaves & Tizard, 1999). Kwai-Sang Yau and LI- Tsang (1999) added that parents’ ability to cope with the stresses of raising their children with special needs depends on the family’s interpretation of the crisis event, family’s sources of support, resources available and family structure. Parents need to adopt coping strategies that will enable them manage the challenging situation of caring for their physically or mentally challenged children. Coping Strategies according to John and MacArthur refers to specific efforts, both behavioural and psychological, that people employ to master, tolerate, reduce or minimize stressful events. They are behavior, thought and feelings that helps us to function better in a given situation. The coping strategies utilized by parents was considered in four dimensions; Personal/family support coping strategy, external social support coping strategy, spiritual support coping strategy and denial coping strategy. Pritzalaff (2001) stated that Personal/Family support coping strategy is the ability of individuals and families to actively engage in acquiring support from themselves and family members (e.g.having confidence in oneself and maintaining cooperation and oneness with partner). External social support means acquiring support from friends, neighbors, extended family, agencies, church group and institutions. Spiritual support is finding comfort in a higher supernatural belief system (e.g. having faith in God). Denial coping strategy includes efforts to deny, minimize or escape the stressful situation (e.g. I try to deny the existence of the problem).

Statement of the Problem