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Figure 3. Scatterplot summarized the correlation between stress score and depression score

Figure 3. Scatterplot summarized the correlation between stress score and depression score

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decreased 2.89 point for each level of education. Depressions, duration of marriage

and education level were significant predictors of parenting stress score.

4.7. Chapter summary

Among 171 participants, 79.53% were asthmatic child’s mother. Generally,

the age of participants was relative young with 77.19% were under 39 years of age.

Most of respondents (94.15%) were married and lived with their spouses. There

were 38.01% participants who had length of marriage lasted from 5 to 10 years and

36.26% had lived together with their spouses more than 10 years. The education

level of most of participants was not high with the proportions of participants who

completed elementary school or secondary schools and participants who completed

high school were 30.41% and 42.11%, respectively.

There were 65.5% asthmatic children under 5 years of ages in this study. The

age of acquiring asthma of children was mainly under 5 years as well (81.29%).

Based on severity assessment, most of children had mild intermittent and mild

persistent (65.5% and 27.49%, respectively).

Informal support was the most frequent support that participants received

with the mean score of 1.31 ± 0.59, and a range varied from 0.43 to 3.86 score.

Respondents received less supports from formal and informational sources (0.22 ±

0.33 and 0.52 ± 0.63). Consequently, the mean score of total support was only

0.68 ± 0.37.

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The results showed that the mean total parenting stress score among parents

of asthmatic children was 39.17 ± 9.69 with a range varied from 21 to 58 point.

The mean depression score among parents was 10.08 ± 7.32. Based on

classification of PHQ-9, there were 27.49% parents not having depression, 38.6%

parents having depression from mild to moderate and 33.88% parents having

depression from moderate severe to severe

Only education level, duration of marriage, number of children, total

support, and depression had statistical significant associations with parenting

stress. Amultiple linear regression showed that parenting stress score increased

0.35 point for each point of depression, decreased 0.26 point for each of years of

marriage and decreased 2.89 point for each level of education. Depressions,

duration of marriage and education level were significant predictors of parenting

stress score.



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Chapter five.Discussion and conclusion



5.1. Introduction

In this chapter, all findings of the studied would be discussed. Discussions

about demographic characteristics, social supports, parenting stress and depression

status of parents of children with asthma were displayed in next sections. The

relationship between demographic characteristics and social supports, parenting

stress, and depression were also discussed in this chapter. Furthermore, correlations

between social supports, parenting stress, and depression were mentioned as well.

Finally, a conclusion was necessary to summary what had been found in the

study.Contribution and implications of the study mentioned to demonstrate the

ability of application of the study in practical settings. Limitations those always

exist in any study would describe as well.

5.2.1. Demographic characteristic of participants and asthmatic children

5.2.Demographic characteristics of participants



Of the participants, 79.53% were mothers. The finding was consistent with

other previous studies in which mothers were the main caregiver of asthmatic

children (Howard, 2009; Kumari, Gupta, Piplani, Bhatia, & Upadhayay, 2011a; Mc

Quaid, et. al., 2001). In Vietnamese society and other cultures mothers always play



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an important role in feeding, nursing and caring children, while fathers play a role

as a money earner to keep and meet daily needs in families.

Generally, the age of parents was relative young with 77.19% were under 39

years of age. This result was appropriate with the data from 2009 National

Population and Housing Census in which more than 81% male and female adults

under 39 years had married and gave births (National Statistic Division, 2009).

Many studies from different countries also documented the younger trend of

parents of asthmatic children. Kumari et al. (2011b)conducted a study in India

showed that mean age of parents of childrenof bronchial asthma was 33.48 ± 6.40

years.A Japanese study conducted by Nagano (2010)revealed that the average age

of the mothers was 36 years.

Most of respondents (94.15%) were married and lived with their spouses.

There were 38.01% participants who had duration of marriage lasted from 5 to 10

years and 36.26% had lived together with their spouses more than 10 years.

Traditionally, Vietnamese families often maintain their core structure including

mother, father and children in long period of time. However, recently the

proportions of divorced or separated couples in younger age groups have been

increasing. For example, 2009 National Population and Housing Census showed

that the proportions of divorced or separated coupled in age group of 25-29 was

0.34% in male and 0.9% in female, but these figure have increased up to 1.5% in

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male and 3.06% in female regarding age group of 40-44 (National Statistic

Division, 2009).

The education level of most of participants was not high with the

proportions of participants who completed elementary school or secondary schools

and participants who completed high school were 30.41% and 42.11%,.

respectively. It was supposed that participants who were living in Ho Chi Minh

city, but they may original come from other provinces where had high education

background.This finding was consistent with education distribution in general

population. A national surveys in 2010 showed that 28.1% people living in Ho Chi

Minh city had completed elementary school and 25% had completed high school

(Misnistry of Education and Training, 2010).

It could be said that workers and officers were two main occupations in this

study (32.75% and 22.22%, respectively), while housewives, manual labor

occupied 27.49%. Since Ho Chi Minh is a big city with lot of industrial parks and

office buildings, a large of labor force are gathering in Ho Chi Minh to find

opportunities for jobs. Furthermore, there is still a small portion of people work as

manual labor such as goods carriers and street vendors. All of these unique

characteristics make of a diverse occupational distribution in this study.

Regarding number of children, 33.33% respondents had one child and

53.22% had two children. This result was similar with the rate of reproduction in

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general population. In fact, the 2013 National Population and Housing Census

showed that each Vietnamese woman in reproductive age have an average of 2.09

children(National Statistic Division, 2013). However, there were differences

between provinces in number of children that each woman giving births.

Particularly, Northern mountainous areas has overwhelmed rate of giving births

(2.56 children per woman), while Southeastern areas including Ho Chi Minh city

have decreased rate of giving births (1.56 children per woman)(National Statistic

Division, 2013). Especially, the rate of production Ho Chi Minh city is now

declining significantly (1.48 children per woman)(Branch Division of Population

and Family Planning, 2015).

Regarding family income, the results showed that almost participants had

monthly family income over 2.5 million VDN (91%). According to Ho Chi Minh

People Committee, people who had family income less than 1.5 million VDN was

classified as poor family, while people having family income from 1.5 to 2.5

million VDN and over 2.5 million VND were classified as average and above

average families. Therefore, it could be said that the economic status of

participants was well enough for caring their children.

In Vietnam and Ho Chi Minh as well, Buddhism and Catholic were two most

popular religions among others. The number of Buddhism in the country was

6,812,318, Catholic was 5,677,086 and HoaHao, a unique religion in Vietnam, was

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1,433.252 (Wikipedia, 2015a). The finding in this study was similar with data from

general population in which the proportion of Buddhism participants was 67.84%

and Catholic participants were21.64%.

5.2.2. Characteristics of asthmatic children

There were 65.5% asthmatic children under 5 years of ages in this study and

34.5% asthmatic children over 5 years. It did mean that Vietnamese children may

acquire asthma as they are younger. Indeed, the age of acquiring asthma of children

in this study was mainly under 5 years (81.29%).Many Vietnamese studies on

children aged from 6 to 15 years showed that the proportion of children with

asthma was relative low. For example, a study in Thai Nguyen, a Northern

province, showed that only 14% children aged from 6 to 15 years had

asthma(Khong, 2009). One study in Ha Noi and two studies in HaiPhong showed

that the proportions of asthma among children with the same age group were

12.56%, 10.46% and 9.3%, respectively(H. Q. Pham & Dinh, 2002; L. T. Pham,

2005; Phung, Nguyen, & Pham, 2013). On the other hand, the statistics of Ministry

of Health showed that asthma was one of the most common respiratory diseases

among children under 5 years of age (Ministry of Health, 2011).Compared to

oversea studies on asthmatic children, asthma may occur in later phase of

children’s development. Kumari(2011b)showed that mean age of children with



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bronchial asthma was 6.65 ± 2.36. Nagano (Nagano, et. al., 2010)conducteda study

in Japan and found that the median of thechildren’s age was 6 (4-8) years.

In this study, asthma severity was measured by using questions about the

frequency of their adolescent’s asthma symptoms, frequency of nighttime

symptoms, exacerbations, missed days of school and emergency room visits

(Howard, 2009). A large portion of children had asthmatic symptoms two times a

week or less (63.16%) and two times a week or more- but less than one time each

day (29.24%). For frequency of nighttime symptoms, 62.57% children had the

symptoms two times a month or less (62.57%) and 23.39% had symptoms more

than two times a month (23.39%). About exacerbations, 81.29% children had brief

(a few hours to a few days) exacerbations with varying intensity. There were

39.77% children had no missed days of school; however, it was also noted that

25.73% children had to stay at home ten or more days due to asthma. Regarding to

emergency room visits, 39.77% children did not have any hospitalizations in the

last years and 46.78% children had admitted hospitals from 1 to 3 times last year.

Based on those data, most of children had mild intermittent and mild persistent

(65.5% and 27.49%, respectively).Howard (2009) also documented that over

70% of the adolescents had mild intermittent asthma. Nagano (2010), on the

contrast, showed that moderate or more severe disease classification by JPGL 2000



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accounted for 46%. The differences between findings in this study and those of

other studies may be due to differences in classification of asthma severity.

5.3. Social support for parents of asthmatic child

The Carolina Parent Support Scale (CPSS) (Bristol, 1979) was used as a

measureof social support in this study. Three subscales were assessed including

Informal Supports those parents received from their spouses, relative and friends,

Formal Supports those parents received from professionals institutions and

agencies, and Informational support those parents received from books, video, or

radio.

The informal support score among participants was 8.16 ± 4.12. Among

sources of informal supports, husbands or wives were the most common informal

support that participants received in their family (3.18 ± 1.19). That was obviously

since most of participants had been married with the duration of marriage from 5 to

10 years. Besides their spouses, respondents also confirmed that their spouses’

relatives and their relatives help them much in caring asthmatic children (1.99±

1.33 and 1.59 ± 1.45). In Vietnam, although there is currently an increasing shift

from traditional family structure including parents, children and grandparents to

core family structure including parents and children or single family structure

which consists of mother or father and their children, the traditional familystructure

are still predominant(Mai, 2010). In traditional family, grandparents play important

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role in taking care of children. They could feed and nurse babies, taking children to

kindergartens or schools. As children get sick or illnesses, grandparents with their

experience may support children’s mothers in caring children.

In general, participants received little supports from formal sources such as

public health services, private social services and public social services. Some

participants reported that babysitting help them in taking care of asthmatic

children, therefore the mean formal support score of babysitting was 0.56± 1.06.

Similarly, private doctors and public health services also two sources of

information toward few parents of asthmatic children, so the mean score were 0.51

± 0.88 and 0.50± 1.01. Frequently, as parents and asthmatic children visit private

doctors or public hospitals, they are often diagnosed and then received treatments

while health consultations are rarely available. For private social services, few

participants used psychological consultations from private psychological centers,

so the mean score was nearly equal to zero. In the same vein, few participants used

public social services as the formal source of supports in caring asthmatic children.

In fact, there are branches of Women Association, those could be considered as

public social services for women, in every commune across the country. The main

responsibilities of those branches are to protect women from family violence,

provide financial supports and train women for jobs(Wikipedia, 2015b).

Therefore, parent’s asthmatic child may not receive supports in caring suffered

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child from those branches of Women Association. Since the use of formal source as

caring supports of asthmatic childe was not high, the mean formal supports score

was merely 1.77 ± 2.65.

For informational supports, the main finding was that participants received

not much from those social supports. In particular, the mean score of receiving

supports from magazine and newspaper was 0.89 ± 1.04, television was 0.81 ±

1.04, and books was 0.77 ± 1.02. In several Vietnamese magazines and

newspapers, there are health corners in which health articles could be published, so

parents of asthmatic children may learn ways of caring their children from those

articles. Furthermore, some TV channels also have health shows in which doctors

are invited to provide health information about a variation of illnesses, so parents

of children with asthma learn from those TV shows as well. However, the

frequency of health articles and TV shows related to asthma may not high;

therefore parents receive not much help from those sources in caring their children.

From three subscales Informal Supports, Formal Support and Informational

Supports, the total support score of participants was not high (13.05± 7.71).No

studies or data in Vietnam revealed about social support for parents of asthmatic

children. However it could be said that parents of asthmatic children received little

supports from formal sources, especially doctors.The finding suggested that there



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Figure 3. Scatterplot summarized the correlation between stress score and depression score

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