Volume 28, Issue 3 (7-2020)                   Avicenna J Nurs Midwifery Care 2020, 28(3): 171-180 | Back to browse issues page

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Ghaljaei F, Fooladi S, Jamali A, Mahmoodi N, Zarei B. The Effect of Peer Support of Mothers of Children with Acute Lymphoblastic Leukemia on Quality of Life of Patients. Avicenna J Nurs Midwifery Care 2020; 28 (3) :171-180
URL: http://nmj.umsha.ac.ir/article-1-2122-en.html
1- Associate Professor, Community Nursing Research Center and Pediatric Department, Faculty of Nursing and Midwifery, Zahedan University of Medical Sciences, Zahedan, Iran
2- MSc in Pediatric Nursing, Faculty of Nursing and Midwifery, Zahedan University of Medical Sciences, Zahedan, Iran
3- MSc in Pediatric Nursing, Faculty of Nursing and Midwifery, Zahedan University of Medical Sciences, Zahedan, Iran , jamaliazam94@gmail.com
4- Instructor, Community Nursing Research Center, Faculty of Nursing and Midwifery, Zahedan University of Medical Sciences, Zahedan, Iran
5- Instructor, Department of Nursing Education, Faculty of Nursing and Midwifery, Birjand University of Medical Sciences, Birjand, Iran
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Quality of life for children with cancer is a multidimensional concept that includes the social, physical and emotional functions of the children and their family. The quality of life should be measured from the perspective of the child and the family, and the stages of growth and development of the child should also be considered [7].
Caring for a child with cancer can be deeply frustrating for parents with high levels of anxiety and psychological distress. Parents who suffer from high psychological stress have poorer performance in the family and health-related quality of life in their children is significantly lower.
Among parent support programs, the Peer Support Program seems to have a positive impact on the quality of life of children with Acute Lymphocytic Leukemia (ALL).
Hartman et al. (1992) suggested that peer support for parents is an effective coping tool for parents of children with special needs. Because in the peer support program, parents can create a space full of trust by sharing their experiences, talking freely about their worries and feelings, and thus improving their ability to manage challenges and increase their self-confidence [18].
Since mothers are more involved in child care than fathers and take on more responsibilities [9], it is obvious that the implementation of interventions on the mother can be associated with better results for all family members. As far as we know, no study has been conducted to determine the effect of peer support on mothers and the quality of life of children with ALL in Iran, therefore, the present study aimed to determine the effect of peer support on these mothers.


Materials and Methods

This is a quasi-experimental study which was performed on 74 mothers of children with ALL hospitalized in Hematology ward of Ali ibn Abi Talib Hospital in Zahedan in 2017. Convenience sampling was used to recruit the participants in accordance with the inclusion criteria. The subjects were randomly assigned to the control and intervention groups. Peer group training was then conducted for the intervention group for five days. KID-KINDL questionnaire to parent report was completed before intervention, immediately and two months after intervention for both intervention and control groups. Data were analyzed using descriptive and inferential tests at the significant level P-value<0.05.



Before intervention, the mean score of total quality of life and its dimensions were not significantly different between the two groups (P>0.05). Analysis of variance with repeated measures indicated that the mean scores of total quality of life and its dimensions in the intervention group were significantly increased over time (P<0.001).

Table 1. Investigating the frequency distribution of demographic variables in the study groups
Variable   Groups Chi-square test (exact fisher)
Intervention (36)
Control (38)
Gender of the child Girl 15 (41.67) 13(34.21) *0.50
Boy 21 (58.33) 25(65.79)
Mother's job Housewife 33(91.67) 32(84.21) *0.26
Employed 3(8.33) 6(15.79)
Address City 16(44.44) 26(68.42) *0.06
Village 20(55.56) 12(31.58)
Marital status of the mother Married 33(91.67) 37(97.37) **0.47
Widow 3(8.33) 1(2.63)
Mother's education Illiterate 16(44.44) 15(39.47) *0.13
Elementary to high school 16(44.44) 10(26.32)
Diploma and above 4(11.12) 13(34.21)
* Chi-square
** Exact fisher
Table 2. Comparison of the mean scores of total quality of life and its dimensions in the two groups of intervention and control in the time before the intervention
Variable Group M±SD P
Physical Intervention 16.74± 60.41 0.33
Control 20.21± 50.05
Emotional Intervention 15.29± 65.97 0.29
Control 14.08± 62.36
Psychological Intervention 18.66± 65.27 0.43
Control 22.80± 61.44
Family Intervention 9.89± 54.16 0.93
Control 12.36± 53.94
social Intervention 15.04± 70.83 0.65
Control 15.91± 69.21
After school Intervention 9.37± 62.50 0.83
Control 9.82± 62.97
Hospitalization Intervention 9.96± 61.48 0.65
Control 10.24± 62.54
Total quality of life Intervention 9.46± 62.85 0.38
Control 8.65± 61.009
Table 3. Comparison of the mean score of total quality of life and its dimensions in children with leukemia, before, immediately and two months after the intervention in the intervention and control groups
Variable Group Before the intervention Immediately after the intervention Two months after the intervention Source F P
Physical Intervention 16.74± 60.41
12.13± 66.11 15.74± 77.50 group 6.90 0.01
Time 30.46 0.001>
Control 20.21± 50.05 20.86± 56.71 14.27± 64.07 group × Time 3.68 0.02
Emotional Intervention 15.29± 65.97 12.53± 68.33 10.52± 77.36 group 6.76 0.01
Time 19.77 0.001>
Control 14.08± 62.36 13.93± 62.41 12.74± 66.05 group × Time 4.61 0.001>
psychological Intervention 18.66± 65.27 16.48± 68.05 10.57± 81.94 group 4.30 0.42
Time 44.98 0.001>
22.80± 61.44 22.94± 61.95 19.56± 66.44 group × Time 12.01 0.001>
Family Intervention 9.89± 54.16 11.50± 73.61 10.19± 85.97 group 1.03 0.31
Time 349.06 0.001>
Control 12.36± 53.94 16.63± 74.07 12.55± 77.76 group × Time 9.90 0.001>
Social Intervention 15.04± 70.83 12.08± 73.05 9.69± 80.97 group 2.01 0.16
Time 23.67 0.001>
Control 15.91± 69.21 16.27± 69.73 14.77± 72.89 group × Time 4.95 0.001>
School Intervention 9.37± 62.50 9.52± 62.96 7.05± 68.47 group 0.08 0.44
Time 8.47 0.001>
Control 9.82± 62.97 10.42± 62.99 8.27± 63.10 group × Time 7.74 0.001>
Hospitalization Intervention 9.96± 61.48 9.93± 61.85 10.02± 71.48 group 0.88 0.35
Time 18.08 0.001>
Control 10.24± 62.54 10.17± 62.54 12.28± 63.77 group × Time 10.94 0.001>
Total quality of life Intervention 9.46± 62.85 7.67± 67.24 5.38± 77.25 group 8.87 0.001>
Time 133.65 0.001>
Control 8.65± 61.009 9.05± 63.69 7.42± 67.11 group ×Time 23.64 0.001>



The results of the present study showed that the mean score of total quality of life and its dimensions over time in the intervention group compared with the control group increased significantly. The results of the following studies may not be directly related to the results of the present study, but they can be important in confirming the findings.
Numerous studies have shown that peer support for parents can also affect children [17, 18, 25]. For example, the results of Ramacher (2011) study showed that peer support for parents improves parents' ability to cope with stress, increase self-confidence, awareness of available resources, the ability to effectively manage child behavior, and the ability to support children more effectively in parents [ 25]. The results of a study by Davis-Groves et al. (2007) also confirmed that peer support for parents improves children's behavior because of the benefits it brings to parents [17].
The results of another research showed that the psychological stress caused by the child's illness in some parents is such that they are unable to calm the child and refrain from using strategies that improve the quality of life of the sick child. As a result, the quality of life of the child decreases [29]. Therefore, improving the quality of life of sick children and its dimensions can be justified by providing social support to parents, such as peer support, given the numerous benefits shown in previous studies.



Using peer support program for mothers of children with ALL can improve the quality of life of children. Therefore, it is recommended to use this method alone or in combination with other methods to improve the quality of life of children with ALL.



The present study is a student dissertation approved by Zahedan University of Medical Sciences with code 8443. We hereby express our gratitude and thanks for the support of all the loved ones who helped us in this project in any way and the mothers who participated in the research.


Conflicts of Interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.


Type of Study: Systematic Review | Subject: Nursing
Received: 2020/01/3 | Accepted: 2020/03/25 | Published: 2020/05/30

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