ERIC EJ1137406: Parenting Experiences of Mothers Who Are Blind in Iran: A Hermeneutic Phenomenological Study

2017·0.11 MB·English

by  ERIC

Parenting Experiences of Mothers
Who Are Blind in Iran: A Hermeneutic
Phenomenological Study
Zahra Behboodi Moghadam, Shahrzad Ghiyasvandian,
Samira Shahbazzadegan, and Mahmood Shamshiri
Structured abstract: Introduction: Mothers, who often serve as primary care-
givers for their offspring, play a crucial role in the development of children.
Understanding the parenting experiences of mothers who are blind can be
valuable and beneficial for professional educators and health care workers who
wish to provide holistic and appropriate services to both mothers who are blind
and their children. This study aimed to explore the experience of mother-child
integration by mothers who are blind living in Iran. Methods: A hermeneutic
phenomenologyapproachwasadoptedtoconductthestudy.Congruentwiththis
approach, Van Manen’s (1990) method consisted of six interplay activities that
helped the researchers in the process of the study. Semistructured in-depth
interviewswereperformedtoproducequalitativedatawithninemotherswhoare
blind. The thematic analysis introduced by Van Manen was used to isolate and
extract the meaning units, subthemes, and the main theme hidden in the lived
stories of the participants. Results: “Close nurturers” was the overarching theme
extractedfromtheexperienceofmotherswhoareblind,whichemergedfromsix
themes: monitoring by alternative senses, monitoring by careful calls and staying
vigilant, loving by heart and imagining in mind, discovering the child’s intentions,
parentinganxiety,anddeficitsincommunication.Discussion:Blindnesschangesthe
mothering behaviors of women who are blind to the extent that they often adopt a
close-mothering approach in caring for their children. This approach helps them to
cope with their limitations and thereby decrease their level of child-related anxiety.
Health professionals should consider the concept of close nurturers to better under-
stand the behaviors of mothers who are blind. Implications for practitioners: Un-
derstanding the lived experiences of mothers with blindness can generate valuable
knowledge that can be used to provide appropriate health care and other support
services for these women and their children.
I
nmanycultures,themotheristheprimary Mother-child interaction is fundamental for
person who interacts with and cares for thechild’sdevelopmentandalsoforthegrat-
her child, especially in the early years of ification of the mothering role for mothers
growth and development (Freiburger, 2010). (Rogers-Cook, 2011). Through daily inter-
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actions with mothers, children start to showed that the prevalence of visual im-
communicate and learn many skills. In- pairment ranged from 1.8% in people
teraction involves a process in which a younger than 20 years to 28% in subjects
person does or says something to convey aged 60 years and over (Hashemi, Kha-
a meaning and receives responses. Suc- bazkhoob,Emamian,Shariati,&Fotouhi,
cessful interaction depends on the clear 2012).Giventhisconsiderableprevalence
expression of intention in a way that the of vision loss, it is likely that there are
other person can understand it (Chiesa, women who are severely visually im-
Galati, & Schmidt, 2015). paired who are raising children in Iran.
The sense of vision is the primary way Motherhoodandmother-childinteraction
in which human beings perceive the can be compromised when the mother is
world, and in many societies it is even visually impaired (Shackelford, 2004).
considered as the best gift of God to hu- For a mother who is severely visually
man beings (Shamshiri, 2014). Sighted impaired, communicating with the child
mothers primarily rely on visual signs is crucial to discovering the child’s de-
such as facial expressions to perceive sires, intentions, and needs. However, a
their children’s needs and mood changes mother who is blind may not use typical
and to respond to them. Mothers who are ways to interact with and care for her
blind, on the other hand, cannot commu- child (Chiesa et al., 2015). Shackelford
nicate easily with their children compared (2004) reported that mothers who are
to sighted mothers (Gutman, 2005). Seem- blindsuccessfullyinteractwiththeirchild
ingly, mothers who are blind are not com- and used multiple strategies to read their
pletely aware of the visual cues; therefore, child’s cues and to respond sensitively to
theymayuseothermethodstodiscoverthe their child’s signals.
requests or needs of their children (Shack- Still, a gap exists in the research and
elford, 2004). literature concerning blind parents rais-
According to the latest estimates of ing sighted children. Findings of such
the World Health Organization (WHO, research can help organizations to gain
2014), 285 million people are visually new insight into the unique experiences
impaired worldwide. Among them, 39 ofblindmothersandprovideservicesin
million are blind and 246 million have a format that supports parenting effi-
low vision (Pascolini & Mariotti, 2012). cacy (Shackelford, 2004).
A number of provincial studies have re- Areviewoftheliteratureshowedalack
ported the prevalence of visual impair- of research about the mothering experi-
ment and blindness in Iran, but no na- ences of visually impaired women who
tionaldataareavailable.Basedonastudy provide care for their children in the
in the Yazd province of Iran in 2015, the Iranian society. However, there are some
standardized prevalence of blindness and studiesaboutlifeforwomenwhoareblind.
low vision were 0.7% and 4.4%, respec- Shamshiri(2014)showedthatwomenwho
tively. It is notable that these values were are blind are faced with challenges within
higher for females (Katibeh, Pakravan, Iranian society. His study discerned some
Yaseri, Pakbin, & Soleimanizad, 2015). important themes, including living with
Another study, in the city of Shahrood, shame and personal stigma, social stigma,
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Table1
VanManen’smethodanditsapplicationsinthestudy.
Sixmethodicalactivitiesproposedby
VanManen Theresearchers’activitiesinthecurrentstudy
Turningtothenatureoflivedexperience Thinkingandsensitizingtovisuallyimpairedmothers,
expressingthephenomenologicalquestionssuch
as:Howisthemotheringexperiencedbyblind
mothers?
Investigatingexperienceasweliveit Prolongedengagementwiththeblindmothers,
conductingin-depthinterviews
Reflectingonessentialthemes Listeningtheinterviews’audios,readingthe
transcripts,immersingindata,conductingthematic
analysis
Hermeneuticphenomenologicalwriting Writingthetranscripts,writingaboutthemes,writing
tocreateaphenomenologicaltext
Maintainingastrongandorientednursing Discussingthethemesinrelationtomothering
relationtothephenomenon science
Balancingtheresearchcontextby Movingbetweentranscriptsandthemes,relatingthe
consideringpartsandwhole findingstotheliterature
underestimation,inequity,andmarginaliza- that researchers should consider from be-
tion,thathavebeenexperiencedbywomen ginning the study until reporting its find-
whoareblind.Theseexperiencestakeplace ings(VanManen,1990).Themethodand
within a cultural context and can affect ad- its application in this study have been
justment and the social and developmental shown in Table 1.
roles of women, such as marriage and
mothering (Shamshiri, 2014). PARTICIPANTSANDSETTING
Certainly, understanding the lived ex- The study setting was the urban and rural
periences of visually impaired mothers area in the city of Ardabil. Ardabil is the
can generate valuable knowledge that center of Ardabil province in the north-
would be useful in providing appropriate west of Iran, with a population of about
health care and educational services for 1.5 million. To find participants, the ad-
women who are blind and their children. dresses and phone numbers of mothers
Regarding cultural and family relation- with visual impairments who had the
ships and support, and differences among potentialtoparticipateinthestudywere
Iranian society and other communities, obtained from the primary health care
this study was planned to understand the support office of the Social Welfare
mother-child interaction experiences of Organization in Ardabil. The partici-
mothers who are blind in caring for their pants who met the study’s criteria (be-
children in Iran. ing totally blind with no functional vi-
sion, being a first-time mother, being 18
Design and methods
years of age or older, and having no
A hermeneutic phenomenology approach additional disabilities) were invited to
wasusedtoconductthisstudy.Congruent participate in the study. Upon the
withthisapproach,themethodintroduced participants’ verbal agreement, the
by Van Manen (1990) was adopted. This researcher asked them to attend an in-
method suggests six circular activities dividualpreparatorysession.Duringthe
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Table2
Sociodemographiccharacteristicsoftheparticipants.
Participant Mother’sage Child’sage Child’sgender Mother’seducation Occupation
Sara 31years 12months Male Primaryschool Housewife
Maliheh 43years 8years Female Diploma Phoneoperator
Bahar 39years 5years Female Illiterate Housewife
Mansooreh 38years 4years Female Illiterate Housewife
Tahereh 48years 7years Female Illiterate Housewife
Leyli 28years 18months Female Highschool Housewife
Shabnam 35years 9months Male Bachelorofscience Charityfacilitator
Yas 30years 2years Male Highschool Phoneoperator
Anita 28years 4months Female Diploma Phoneoperator
preparatory sessions, the interviewer DATAANALYSIS
tried to communicate and develop rap- Dataanalysiswasaconstantandongoing
portwiththeparticipantsinordertowin
activity during the study, beginning im-
their trust and to gain their consent for
mediately after the first interview. In par-
recording the interviews, and to set up
ticular, this analysis involved reflecting
appointments for formal interviews. Fi-
on essential themes, which is the main
nally, nine mothers who were totally blind
processusedinthemethodofVanManen
were interviewed. The demographic char-
(1990), to uncover the themes of interest
acteristicsoftheparticipantshavebeenpre-
hidden in the phenomenon. This method
sented in Table 2.
consistsofthreetechniques,whichcanbe
described as holistic, selective, and de-
DATACOLLECTION
tailed (Van Manen, 1990). A theme is an
Data were collected over six months,
abstract term or phrase that symbolizes
from January to June 2015. Semistruc-
some of or the whole part of an experi-
tured and in-depth interviews were con-
ence. In fact, it unifies the qualitative raw
ducted to produce qualitative data. After
data into a meaningful whole (Polit &
the aforementioned preparatory session
Beck, 2010). Audio-recorded files of the
with each of the participants, face-to-face
interviews were transcribed into text files
anddialogicalinterviewswerecarriedout
in Microsoft Word verbatim and then im-
to obtain data about their mothering ex-
ported into the text analysis software
periences.Theinterviewswerereciprocal
MAXQDA. Selective and holistic strate-
and dialogical: open-ended and close-
gies proposed by Van Manen were used
ended questions were used to capture the
livedstoriesoftheparticipants,especially toisolatethethemes.Throughthesestrat-
inrelationtocaringfortheirchildren.The egies, the essential meanings of the
starting question to initiate the interviews words, sentences, and the whole of inter-
was:Wouldyoupleasetellmeaboutyour view texts were condensed to thematic
child and how you take care of her or statements. This process continued until
him? All of the interviews were audio- the main theme emerged. Enough time
recorded and then transcribed verbatim was spent to establish a relationship
immediately after completion. or relationships between the primary
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meaning units, subthemes, and the main ality of their personal data. Participation
theme to create a comprehensive concep- was voluntary, and participants were in-
tual image of the phenomenon. formedthattheyhadtherighttorefuseto
cooperate in the study at any stage.
TRUSTWORTHINESS Anonymity was achieved by assigning a
Criteria introduced by Lincoln and Guba pseudonym for each participant in the
(1985) were used to improve the quality publication and in reporting the data.
of the study. Congruent with those crite- Aboveall,aninformedwrittenconsentin
ria, activities were undertaken during the braille was signed by literate participants
studyforthispurpose.Prolongedengage- before data collection. Verbal consent
ment with the participants was the main was taken from illiterate participants.
technique to improve the credibility of
Results
data. Researchers tried to recruit partici-
pantsfromallwalksoflifetomeettherule In-depth analysis of the participants’
of maximum variation. Member checking lived experiences about their interaction
wasakeyprocessinassuringthequalityof with their sighted children revealed six
thefindings.Forthispurpose,allthethemes themes: monitoring by alternative senses,
extracted from the data were presented to monitoring by careful calls and staying
threekeyparticipants,andalmostallofthe vigilant,lovingbyheartandimaginingin
themeswereconfirmedbythem.Aboveall, mind, discovering the child’s intentions,
themainorfirstresearchertriedtoobtaina parentinganxiety,anddeficitsincommu-
deep knowledge about the research ap- nication. These themes were condensed
proachtoviewtheexperiencephenomeno- into an overarching theme called “close
logically, albeit other authors had previous nurturers.” The main theme and its con-
sufficient experience in doing phenomeno- stitutive themes have been detailed in the
logical studies. Field journaling, careful following sections.
recording of the interviews by two voice
recorders, and reflexivity during data col- MONITORINGBYALTERNATIVESENSES
lection and analysis were other techniques The theme of monitoring by alternative
that were used to capture the phenomenon senses is representative of an important
as lived. The study process was evaluated aspect of the experiences of mothers who
by supervisors in the critical steps of the are blind, which describes their use of
study, especially when the interviews were othersensesintheabsenceofvision.Par-
conducted and as themes evolved (Polit & ticipants declared that they often use
Beck, 2010). alternativesensestoprovidecarefortheir
children. The basic and primary alterna-
ETHICALCONSIDERATIONS tives were touch and palpation. For
Ethical approval was obtained from the example, Shabnam, the mother of a
ethics committee of Tehran University of 9-month-oldboy,said:“Itrytosecuremy
Medical Sciences. Participants were fully child on my back or I cuddle him....
informed about the research and any eth- This ensures me he is protected from
ical consequences of the study. All of danger.” Another participant, Leyli, the
them were assured about the confidenti- motherofan18-month-oldgirl,said,“All
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©2017AFB,AllRightsReserved JournalofVisualImpairment&Blindness,March-April2017
thetimeIhugmychildorIlieclosetoher and assures them about the well-being of
to make sure that my child is in her cra- their children. In particular, this strategy
dle.” Another important method used by is effective when the child starts to com-
motherswhoareblindtolocatetheirchil- municate through speaking. For example,
dren was their ability to keep themselves Yas said, “My child is two years old.
readytoreacttovoicesthatmightconvey When he is some distance away, I call
hints about the location and presence of him until I hear his sound.” Also, Ta-
theirchild.Oneoftheparticipants,Bahar,
hereh, the mother of a 7-year-old girl,
themotherofa5-year-oldgirl,saidinthe
said, “I am often ready to reply to my
interview: “You are seeing with your
child because any accidents may happen
eyes, but I see my daughter with my
to her so I should find her soon.” Simi-
ears!”Sara,themotherofa12-month-old
larly, Mansooreh said, “Almost always,
boy,said:“WhenIhearhisswallowingor
my ears are ready to receive any sound
eating sounds, I ensure that he is eating
showing any request or issue from my
his food.”
child to the point that I react to cries or
Narratives of mothers who are blind
voices of other children that this [stay-
about living with their children showed
ing careful and vigilant] is bothering
some of the creative coping strategies in
for me.”
providing appropriate care for their chil-
dren.Leylisaid:“Ifeedmychildwithmy
hands, not with a spoon.... With my LOVINGBYHEARTANDIMAGINING
hands,Ifullyensurethatshehaseatenher
INMIND
food.” Also, children of mothers who are
Exploring the life stories of mothers who
blindlearnhowtoreactinconfrontingthe
areblindabouttheirattachmentwiththeir
limitations of their mothers. Mansooreh
children revealed that another manner of
said, “My child is 4 years old; she knows
connectedness was loving with their
how to convey her needs to me. For ex-
hearts and imagining their children’s vis-
ample, when she needs something she
ages in their minds. They mentioned a
tries to put it on my hand.” Leyli said in
subjective connection with their children,
the interview, “When I offer food with a
which is related to heart and mind. Ta-
spoon, my child tries to move her mouth
hereh said, “I see my child with my
toward the spoon.”
mind.”Leylisaid,“Mymindisnotblind;
MONITORINGBYCAREFULCALLS I can see my child with my mind.” Shab-
nam said, “I can imagine and see
ANDSTAYINGVIGILANT
him....In my mind I can think of my
Inquiry into the mother-child interaction
experiences of mothers who are blind child, I even plan for his future.” Yas
showed that one of the main methods said, “You are seeing with your eyes but
used by them to monitor their children I see my child with my heart and
wasthroughcarefulcallsandstayingvig- mind....NowheisinmymindIcansee
ilant. Analysis of the data showed that him and love him.” Sara said, “I made a
thisalternativetechniquecandecreasethe schematicpictureofmychildinmymind
level of anxiety of mothers who are blind and I can always recall and imagine it.”
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DISCOVERINGTHECHILD’SINTENTIONS often uneasy about my child, particularly
The participants reported another com- when she is playing at a distance out of
munication technique. It is a type of my reach... because if something hap-
intention-reading that can help mothers pens to her, I cannot find her easily to
who are blind to discover the needs of help.” Maliheh, whose daughter was 8
their children. It often works for mothers years old, said, “I am worrying, because
who are caring for young children or in- my girl grows and becomes juvenile and
fants. With this form of communication, may watch improper channels on TV;
mothers who are blind can interpret or therefore, I can’t control her.”
detecttheirchildren’signals.Understand-
ingtheintentionsandrequestsbytrialand DEFICITSINCOMMUNICATION
errorwasthemainmethodofdiscovering This theme was current and fluid in all of
these intentions, because the mothers theabovethemes.Althoughmotherswho
could not read the visual cues of their are blind use alternative ways to commu-
child. Yas said, “When my child is cry- nicate with their children, their lived ex-
ing, I show him many things, particularly periences revealed deficits in their inter-
the milk bottle and the toys, that may actions with their children, which could
satisfy him to be calm.” Shabnam said, disturb the mothering experience. Com-
“My child cannot speak to express his municationdeficitasalimitationwastrue
needs, thus I should identify his needs, in their daily lives. According to the par-
albeit sometimes it is overwhelming.” ticipants’ statements, mother-child inter-
actions,bothverbalandnonverbal,canbe
PARENTINGANXIETY affected by visual impairment. For exam-
Exploring the words and stories of moth- ple, they cannot effectively use vision to
ers who are blind showed that they were contact or read facial expressions and
experiencing child-related anxiety. Ac- bodygesturesinthecaringandtrainingof
cording to the participants, the primary their children. Sara said, “When my baby
source of anxiety for mothers who are eats his food, I cannot completely recog-
blind originated from their visual impair- nize that he is full or not. Sometimes
ment.Forexample,Anita,themotherofa other people tell me that my baby is ask-
4-month-infant, said, “When I was in- ing for something with his hands while I
formed of being pregnant, my stress cannot see it.” Participants unanimously
started because I was thinking that I pointed out that when the children were
would not be able to provide a safe care very young, especially during infancy,
for my baby.” Leyli said, “After my baby they were unable to speak; therefore, the
wasborn,Iwasworriedabouthersafety.” mothers faced major challenges to find
In addition, some of the participants had the motives of cries, sounds, and requests
the anxiety of separation from their chil- of their children. Leyli said: “It is my
dren. For example, Sara said, “Right now daily challenge that when she cries I can-
I am uncomfortable, because if I put my not see my baby’s face to find the reason
child on the ground and she moves any immediately.” Shabnam said, “Recently
distanceawayfromme,Iworryaboutnot my baby had a fever; suddenly my sister
being able to find her.” Bahar said, “I am shouted, ‘The baby! The baby is having a
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©2017AFB,AllRightsReserved JournalofVisualImpairment&Blindness,March-April2017
seizure!’ That was a bad event when I lated to positive outcomes in health,
realized the importance of vision.” Based development, emotions, and social rela-
on the participants’ declarations, how- tionships (Jorge et al., 2014). Beyond
ever, this challenge decreases gradually helping in social development, touching
once the children learn to speak. can affect infants’ physical and cognitive
development in the first year of life (Ar-
Discussion
diel & Rankin, 2010). These benefits
This study explored the mother-child in- might be more fundamental when the
teraction experiences of a small group of mother is blind because touch is the pri-
Iranian mothers who are blind. The main
mary alternative way for blind people to
andoverarchingthemethatemergedfrom
be oriented in relation to their surround-
the data was that all the women were
ing environment. Also, attachment and
“close nurturers.” The main theme was
belongingneedsofmotherswhoareblind
extracted from six themes: monitoring by
in relation to their children can be satis-
alternative senses, monitoring by careful
fied by touch, smelling, and listening.
calls and staying vigilant, loving by heart
Generally, for women who are blind,
and imagining in mind, discovering the
motherhoodisaccompaniedbyarangeof
child’s intentions, parenting anxiety, and
psychological issues such as anxiety, de-
deficits in communication. This study
pression, and adjustment disorders (Ste-
showedthatmotherswhoareblindinteract
velink & Fear, 2016). In addition, we
with their sighted children through unique
could add the limitations imposed by
ways.
blindness to the issues faced by mothers
Accordingtothisstudy,blindnessforced
who are blind that disrupt mother-child
these mothers to adjust their mother-child
interaction (Marcus & Heringhausen,
interaction styles. Although vision is the
2009). Based on the findings of the cur-
primary way of discovering the external
rent study, these mothers experience anx-
world of human beings, mothers who are
iety because of their limited control over
blindusealternativewaystodiscoverand
their children. Anxiety due to deficits in
express their love and emotions to their
monitoring the child’s presence or loca-
child.Someofthesealternativeapproaches
tion was the primary challenge that both-
include touch, smell, and active listening.
ered the mothers in their daily lives. Al-
Thesewaysarevaluablechannelsusedby
though most of them implied that they
mothers who are blind to locate and dis-
used strategies such as attaching bells to
cover the needs of their children in the
absence of vision. Turning to alternative their child’s clothes or hanging a sound-
senses or abilities is an important coping producing object around their child’s
mechanism that helps these mothers in neck, they believed that these strategies
communicating and bonding with their cannot completely relieve their concerns
children (Shackelford, 2004). The use of regardingtheirchildren’ssafety.Toade-
physical touch, such as holding hands, gree, the mentioned anxiety about safety
hugging, and kissing, are primary ap- is decreased when the child is able to
proaches to express parental love. Ac- communicate with the mother by speak-
cording to previous studies, touch is re- ing. In addition, this study showed that
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JournalofVisualImpairment&Blindness,March-April2017 ©2017AFB,AllRightsReserved
mothers who are blind used a type of RECOMMENDATIONSFORFUTURE
staying on-call regarding their children. RESEARCH
Althoughthisstrategycanbestressfulfor A significant void exists regarding child-
thesemothersbasedontheirnarratives,it rearing practices of mothers who are blind.
decreases their anxieties and worries. Futureresearchdevelopedfromthisstudy’s
Discovering a child’s intentions was an findingscouldincludeanefforttostudythe
important aspect of blind mother–child in- quality of life of children with these moth-
teraction. Through a process of intention- ers. One approach could be to study the
reading, the mothers tried to discover the interaction experiences of blind children
reasonsthatcausedtheirchildtocryorto with their sighted mothers. Finally, know-
be restless (Shackelford, 2004). To better ing more about the educational status of
interpret their preverbal children’s needs, childrenwhosemothersareblindwouldbe
themothersinthisstudyusedaprocessof of great interest. Similarly, comparing the
elimination to understand what their chil- differencesbetweenmotherswhoareblind
dren were requesting. and those who are sighted in child raising
Inmanysocieties,loveisakeytermfor
across cultures would be of value.
describingmothers.Motherstypicallysee
their children through their eyes and cre- LIMITATIONS
ateanimageofthemintheirminds.Inthe
As with all qualitative studies, the results
current study, there was a common fea-
must be interpreted in relation to their con-
tureamongmotherswhoareblind,which
texts, time, and place. Difficulty in access-
was “loving by heart and mind.” They
ing suitable participants based on inclusion
understood intuitively how to be aware
criteria was another limitation of the study.
and to make an emotional connection
with their children. Using imagination to Conclusions
create a picture of their children was a
According to this study, blindness changes
cognitive process that mothers who are
parentingactivitiesandattachmentstylesin
blind used to feel close to their offspring.
mothers. The mothers who are blind who
wereinvolvedinthisstudyusedalternative
Practice implications
ways to care for their children. These ap-
Health professionals—especially nurses,
proaches helped them in coping with the
midwives, physicians, home care provid-
limitations and thereby decreased the level
ers, and social workers at any level of the
of child-related anxiety. “Close nurturers” is
healthcaredeliverysystem—shouldcare-
thecoreconceptofblindmother–childinter-
fully assess and pay special attention to
action, and health professionals and service
theinteractionchallengesofmotherswho
providers should consider this theme when
areblindwiththeirchildren.Thesemoth-
providingservicestothesemothers.
ers have their own unique style for inter-
acting and parenting their children—abil- References
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