Post-traumatic growth experiences of parents of children with congenital deafness: a qualitative study

Post-traumatic growth experiences of parents of children with congenital deafness: a qualitative study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Post-traumatic growth experiences of parents of children with congenital deafness: a qualitative study Ting Wu, Chencheng Zhu, Chunjing Zhang, Pei Liu, Yuanyuan Cui, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4936424/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Hearing disability is the most common of the five major disabilities in China, and hearing disability seriously affects human health and quality of life. A child's diagnosis of deafness is an intensely traumatic event for parents, who have to bear multiple pressures and burdens in the process of caring for their child. However, it is crucial for parents to draw good meanings from the traumatic incident and to create new insights into life, which is important for their own physical and mental health and that of their child. Methods Using purposive sampling, 15 parents of congenitally deaf children admitted to the Department of Otolaryngology, Head and Neck Surgery of a tertiary-level hospital in Hefei City from April to July 2023 were selected for semi-structured interviews, and Colaizzi's seven-step analysis method was applied to analyze the data and refine the themes. Results Six main themes and fourteen sub-themes were summarized in this study: (1) changes in outlook on life, (2) enhancement of health concepts, (3) increased personal strength, (4) change in relationships with others, (5) perceived social support, and (6) positive coping styles. Conclusion Parents of children with congenital deafness can experience multifaceted growth in the process of caregiving. Medical staff should pay full attention to the psychological experience of parents of children with congenital deafness, explore their strengths and potentials, increase the degree of social support, and promote coping positively with the level of post-traumatic growth, to enhance the quality of care and the rehabilitation effect of the children. Congenital deafness Parents of children Post-traumatic growth Qualitative research Background Congenital deafness is one of the most frequent birth disorders in human beings, which is a hearing loss that arises at or shortly after birth, primarily sensorineural deafness [1]. It occurs in roughly 0.1–0.3% of normal newborns, and up to 2–4% of preterm infants and newborns resuscitated in the intensive care unit (ICU) [2]. According to a survey, China has the largest number of persons with hearing disabilities in the world, and the number of persons with hearing disabilities ranks first among the five major disabilities, with nearly 30,000 new deaf children added every year, facing serious hearing health challenges [3]. If deaf children do not receive timely and effective hearing and speech intervention, it can disrupt the development of their linguistic system. This disruption can also impact the normal development of their emotional well-being, cognition, social skills, and other abilities, the long-term consequences of this disruption can have a significant impact on their mental health, academic performance, professional life, and overall integration into mainstream society [4]. The advent of cochlear implants has ushered in a new era in the treatment of deafness, which is now widely recognized as a standard method for treating severe and profound sensory neural deafness globally [5]. However, the impact of multiple negative life events, such as immense economic pressure, discriminatory attitudes from society, strong concerns about unknown prognoses, and heavy caregiving burdens, leads to significant physical and mental stress on parents of deaf children, resulting in poor psychological conditions [6]. Research has indicated that parents of children often experience a certain degree of post-traumatic growth in their caregiving role. This growth not only enhances their quality of life and sense of well-being, but also plays a crucial role in the healthy development of their children's physical and mental health [7]. Tedeschi defines post-traumatic growth (PTG) as the positive psychological changes experienced by individuals in the process of struggling with traumatic events, which is mainly manifested in five aspects: interpersonal relationship, personal strength, new possibilities, appreciation of life, and spiritual change [8]. With the rise and vigorous development of positive psychology, more and more scholars have begun to pay attention to the influence of positive psychology on individuals. Despite the negative psychological effects of traumatic events, individuals can also experience changes in values such as valuing family and health, actively confronting setbacks, and redefining the meaning of life [9, 10]. Therefore, PTG holds significant practical value and benefits for the psychological adjustment of parents of deaf children. However, existing research predominantly concentrates on the negative psychological experiences of parents with deaf children, often neglecting to explore their potential for positive psychological transformation [11, 12]. Notably, there is a dearth of studies investigating the post-traumatic growth (PTG) experiences of parents raising children with congenital deafness. This oversight fails to adequately address and foster the positive psychology of these parents, potentially hindering their children's healthy physical and mental development. It is imperative not only to focus on the needs of deaf children but also to extend active concern to the significant cohort of parents who have them. This study seeks to delve into the authentic PTG experiences of parents raising children with congenital deafness, aiming to provide fresh perspectives and theoretical underpinnings for future psychological intervention strategies. Aim This research examines the lived experiences of parental post-traumatic growth in children with congenital deafness, aiming to provide insights into bolstering the psychological well-being of these parents. This information is crucial for formulating intervention strategies that are culturally and societally appropriate for China. Methods Design Parents of children diagnosed with congenital deafness, who were receiving treatment at a tertiary-level hospital in Hefei City, Anhui Province, between July and November 2023, were selected for this study using purposive sampling. The research adopted a phenomenological qualitative approach, employing face-to-face interviews to investigate the post-traumatic growth experienced by these parents. Participants The inclusion criteria for the children were as follows: (1) a clinical diagnosis of congenital deafness, and (2) having undergone cochlear implantation. The exclusion criteria were: (1) the presence of other severe diseases, such as those secondary to other cancers or cerebral palsy, and (2) any other mental disorders. The inclusion criteria for parents were: (1) assuming primary responsibility for the child's care, (2) scoring ≥ 60 points on the Post-traumatic Growth Inventory(C-PTGI), (3) possessing normal listening, reading, writing, and communication skills, and (4) voluntarily participating in this study. The exclusion criteria were: (1) undergoing psychiatric-psychological treatment, (2) experiencing other traumatic events within the past six months, such as car accidents, the death of a loved one, or cancer, and (3) suffering from a chronic mental illness. Instruments Post-traumatic Growth Inventory The scale was developed by Tedeschi et al.[13], and the Chinese version revised by Wang Ji Translation was adopted in this study. The scale has a total of 20 items, including 5 dimensions: life perception (6 items), personal strength (3 items), new possibilities (4 items), relationship with others (3 items), and self-change (4 items). The Likert 6-level scoring method was adopted. The higher the score, the higher the level of post-traumatic growth. The Cronbach's α coefficient of the scale was 0.82, and the Cronbach's α coefficient of each dimension was 0.61 ~ 0.796. Data collection Before a formal interview, according to the purpose of the study, relevant literature was reviewed, and the opinions of two otologists and one psychologist were combined to formulate a preliminary interview guide, which was repeatedly revised after pre-interviews with three parents of the children to determine the final interview guide. The final interview outline was as follows: (1) How did you feel when your child was diagnosed with congenital deafness? (2)What were your experiences and feelings when your child was treated and recovered after the diagnosis? (3) What were your most profound feelings and experiences in caring for your child? (4) Have you experienced any positive changes or new insights after experiencing your child's illness? (5) What do you think made a difference in how you felt? (6) How did you cope with difficulties and stress during this time? A phenomenological research methodology was employed to gather data through one-on-one semi-structured face-to-face interviews conducted by a single researcher (the first author). Interviews were completed after the child's cochlear implantation and up to the day before discharge. Prior to initiating the investigation, the researcher undertook courses related to qualitative research and acquired knowledge on interview methodologies and techniques. Before the formal interview, the purpose of the study, the methodology and the interview process were explained to the respondents, stressing that the principles of harmlessness and confidentiality were strictly implemented in this interview, and the questionnaires were distributed after obtaining the consent of the respondents and signing the informed consent form. A simple and easy-to-understand unified guide was used to explain the questionnaire to them effectively, informing them of the precautions to be taken in filling out the questionnaire, and the questionnaire was filled out independently by the subjects, and for those who had difficulty in writing or reading, the researcher read them one by one and filled them out truthfully according to the answers of the subjects. After the questionnaire was completed, it was collected on the spot and checked for missing items. The interview was conducted in a private, tranquil office setting, with agreed upon timing and a controlled duration of 30–45 minutes. The entirety of the interview was recorded, with particular attention paid to observing the facial expressions, body movements, and emotional fluctuations of the participants. Additionally, write interview notes as a supplement to the interview data. The sample size for this study was determined based on data saturation, resulting in a total of 15 parents of children who were interviewed, all of whom remained in the study. Data analysis To minimize recall bias, the audio recordings of the conversations were transcribed into text by two researchers using Nvivo 12 software within 24 hours of the interview. Any missing information was followed up with the child's parents. The data were analyzed using Claizzi's seven-step analysis [14]. (1) read all the interviews carefully; (2) analyze statements of significance; (3) code the extracted information; (4) compile the coded ideas; (5) provide detailed descriptions of the ideas based on the interviews; (6) integrate and refine the descriptions to sublimate the themes; and (7) return to the subjects of the study to verify the evidence. Ethical considerations This study was approved by the Ethics Committee of the First Affiliated Hospital of Anhui Medical University (Approval: No. PJ2023-13-56). Prior to the commencement of interviews, all participants were duly informed of their right to freely participate or withdraw. They were assured that all participant information would be anonymized, with numerical codes replacing names, and that the research data would solely be utilized for this specific study, without any other purposes. The trust and cooperation of the participants were obtained. All participants voluntarily participated in this study and signed an informed consent form. Rigor To ensure the rigor of this study and to adhere strictly to qualitative research standards, all researchers undertook a comprehensive study of knowledge related to qualitative research methodologies. To enhance the credibility of the findings, the researchers maintained active listening during interviews, refrained from guiding or implying responses, remained neutral, avoided subjective judgments, and adjusted the interview strategy and question order in response to the parents' answers. At the conclusion of each interview, the researcher reflected on the questioning approach, interview content, and analysis of the data, documenting these reflections in a reflective diary to identify issues and make timely corrections. The data analysis was performed by two researchers who independently analyzed and extracted meaningful statements consistent with the parents' post-traumatic growth experiences. These statements were then summarized and refined. In instances of disagreement, a group meeting was convened for discussion, and the final theme was determined by consensus among team members. Finally, the analysis results were randomly fed back to the three interview subjects to verify the authenticity of the content, which increased the dependability of the research results. Results A total of 15 parents of children, numbered from N1 to N15, were interviewed in this study. Among them, 3 were fathers and 12 were mothers, their ages ranged from 22 to 51 years, with a mean of (34.27 ± 8.80) years. The general characteristics of the children and their parents are displayed in Tables 1 and 2 , respectively. Six main themes and fourteen sub-themes were summarized in this study: (1) changes in outlook on life, (2) enhancement of health concepts, (3) increased personal strength, (4) change in relationships with others, (5) perceived social support, and (6) positive coping styles. The themes in the interviews are presented in Table 3 . Table 1 General demographic date of the caregivers(N = 15) Code Role Age (years) Educational Level Occupation C-PTGI(points) N1 Mother 31 Bachelor’s degree Teacher 83 N2 Mother 46 Primary school Workless 62 N3 Mother 47 High school degree Company worker 90 N4 Mother 37 College Workless 81 N5 Father 26 College Company worker 71 N6 Mother 31 Bachelor’s degree Lawyer 86 N7 Mother 25 College Company worker 72 N8 Mother 34 High school Self-employed 80 N9 Mother 31 Master’s degree Doctor 84 N10 Father 51 Primary school Self-employed 62 N11 Mother 36 Junior high Workless 82 N12 Mother 26 Bachelor’s degree Civil servant 74 N13 Father 29 High school Worker 69 N14 Mother 42 Junior high school Workless 76 N15 Mother 22 Junior high school Workless 75 Table 2 Demographic date of the children with congenital deafness Variable N F(%) Gender Male 8 53.3 Female 7 46.6 Age(year) <3 6 40 4–10 3 20 11–16 6 40 Cochlear implant type Unilateral implantation 8 53.3 Bilateral sequential implantation 7 46.6 Table 3 Summary of themes and sub-themes Themes Sub-themes The change of outlook on life Acceptance of the child's illness Lower expectations Look forward to the future Enhancement of health concepts Caring for the body Actively learning about hearing health knowledge Personal empowerment Increased self-efficacy The rigidity and tenacity of a mother's love Changes in relationships with others Clarification of roles and responsibilities Strong spiritual resonance Perceived social support Thank the medical staff for their help Grateful for the support of family and friends Positive coping style Seek support from the Disabled Persons' Federation and the Government Downward comparison Effortful self-adjustment Theme 1: changes in outlook on life Acceptance of the child's illness Among the novel congenital deaf cases in China annually, approximately 90% originate from households with normal hearing and no familial deafness history [1]. The parents of the children who participated in this interview are adults with normal hearing and no family history of deafness. While the birth of a child is typically a cause for celebration, the diagnosis of congenital deafness can be a profound shock to both parents and families. "At the beginning of the examination, the doctor said that he (the child) had a hearing problem, I couldn't believe it, his brother and sister have normal hearing, no one in our family is deaf, and he is the only one who is deaf, how can it be." (N12) "When the test results came back, I couldn't believe my son was deaf." (N7) Many parents of affected children said that they began to face reality actively after some internal reconstruction, and gradually pulled themselves together to actively seek treatment. "When I was first diagnosed, I was at home in tears every day, then I thought I couldn't cry every day, my child's problems couldn't be solved, I started to comfort myself and slowly pulled myself together." (N2) "Sad to be sad, but to solve the problem ah, we take the child behind to Shanghai and Beijing to check the ear, trying to find a good way to treat the child." (N1) Lower expectations The illness of their children has made their parents think more about life and health, and many of them say that they only want their children to be healthy and that everything else is secondary. "I used to think that my child has to study well to go to university, but since he has had these operations, I just think that he can be well and not get sick, I don't have such high expectations." (N2) "Ever since my child was tested for hearing problems, I quit my job and taking care of him and learning to talk like a normal child was the important thing." (N4) look forward to the future Children are parents' expectations for the future life, giving parents hope in many aspects, although experienced this traumatic event, but parents are still full of hope and expectations for the future of children. "I hope my son will be able to communicate like a normal person in the future, find a good job and support himself, and I will be satisfied." (N3) "She won several trophies in singing and dancing competitions organized by the Disabled Persons' Federation, and photos of her competitions are still hanging on the exhibition wall of the Federation, so I support whatever she likes, and I hope that she can develop these specialties in the future as well." (N14) Theme 2: enhancement of health concepts Caring for the body After experiencing their children's illnesses, the parents of the children realized the importance of good health and started to adopt a healthy lifestyle and care for their bodies more. "It is only when I am sick that I can realize how happy I am to have a healthy body. I will exercise every day from now on and eat green and healthy food to have a good physique."(N3) "The body is the capital of the revolution, I have to take good care of my body from now on, and I can't stay up late every day anymore."(N12) Actively learning about hearing health knowledge Parents of the children took the initiative to learn about ear and hearing protection through various means to enhance their health awareness. "In the past, I didn't even know that there were so many classifications of deafness, now I am learning a lot of ear-related content on the Internet, and I have learned a lot of ways to prevent hearing loss."(N13) "I often watch popular science videos on my mobile phone about hearing protection, and I have learned that this knowledge is not only beneficial for the protection of my children's hearing but also for myself as well as my family and friends around me."(N8) Theme 3: personal empowerment Increased self-efficacy Parents of children exhibiting high self-efficacy demonstrate resilience to stress, maintain emotional stability, and effectively counteract the impact of negative emotions following trauma, leading to post-traumatic growth [15]. "After dropping her off at rehabilitation schools every morning, I started going to hourly jobs and doing all kinds of part-time work, and now I work out doing everything all by myself and not being afraid." (N14) The child's rehabilitation outcome is not solely dependent on the rehabilitation institution; parents also play a pivotal role in long-term rehabilitation training [16]. "After I came home from the rehabilitation school, I had to teach her to say a word, a phrase, a sentence over and over again at home, and I was so happy and proud to watch her learn to say it little by little." (N2) "My child didn't learn well in the rehabilitation school, so I let the teacher teach me the method, and when I went home, I looked for videos on the internet to teach my child to pronounce words and speak, and I taught her over and over again at home, and now she hears very well." (N6) The rigidity and tenacity of a mother's love Upon becoming a mother, a woman is imbued with an indomitable spirit attributable to her maternal instincts. Throughout the child-rearing process, the mother in question draws upon her fortitude, enduring each challenging step along the way. "I divorced her father and I brought her to the hospital by myself for the operation and the hospitalization was all under my care here, for the sake of the child, and I wasn't tired and it wasn't that hard." (N8) "His dad works in Shanghai all year round, we live in our hometown, I take care of him and my sister by myself, and usually have to do my sister's rehab in the city, and I've come through on my own." (N6) Theme 4: change in relationships with others Clarification of roles and responsibilities The parent-child relationship represents the most profound emotional bond in human existence. This bond transcends biological ties, establishing a deep emotional connection between hearts that encompasses boundless love and companionship. Parents of affected children endeavor to provide the best possible care for their offspring. "I got pregnant with him by accident, and since I chose to have him and he came into my family, I am responsible for him." (N11) "As soon as I learned that she was deaf, her grandmother asked me to send her to the orphanage, this is my child, won't her life be ruined if she is sent to the orphanage! (Tears)" (N8) Another mother of a child said that she would still give her responsibility and love even if it was not her biological child. "She was adopted by me, and then I didn't realize until she was over a year old that she had a hearing problem. My family told me to give the baby back, so how could I do that? Since I chose to adopt her, I'm sure I'll take good care of her." (N12) Strong spiritual resonance During the hospitalization period, parents of children frequently interact with one another, thereby gaining insights into each other's shared experiences. This interaction facilitates a deeper understanding of the emotions experienced by parents of other children, enabling them to offer heartfelt support to their peers. "The mother of the child across the bed from me, her son came in for surgery a month after he was first diagnosed (with deafness), she probably couldn't take it at once, and she was downcast every day, so I advised her, 'Don't be sad anymore, now that it's happened, work it out to make it better.' I also came from that stage of her life, and it was hard for me to see her like that." (N3) Theme 5: Perceived social support Thank the medical staff for their help After the child's diagnosis, his parents traveled to many different places in search of the best treatment plan. Each interaction with medical professionals provided solace and reassurance during the most distressing and helpless moments, while also facilitating the acquisition of the most pertinent treatment recommendations at that juncture. "When we were examined in the hospital in Shanghai, that doctor said to me, don't run around to get examined anymore, there are only a few kinds of treatments at present, now you need to hurry up and choose one, if your child misses the best age for treatment, even if the cochlear implant is implanted, the effect is not ideal. After hearing what he said, the heart was settled." (N11) "When my child was diagnosed, I was completely distraught, but the audiologist and nurse who examined us comforted me, and I am very grateful to them." (N12) Grateful for the support of family and friends The support from family and friends has been a great encouragement to the parents of the children. "A good friend of mine, ever since she knew my son was in the hospital, has been sending me messages every day asking me if I've eaten and how I'm doing today... These simple words have also touched me, feeling that someone has been caring about you and helping you." (N9) "Since the baby's illness, the family has been concerned about us, asking us whether we lack money, to give us the money, it is a friend in need." (N1) Theme 6: positive coping styles Seek support from the Disabled Persons' Federation and the Government Social support refers to the spiritual and material assistance that parents of children with hearing impairments receive through social connections, which can reduce their sense of helplessness in difficult situations. The cost of cochlear implants is high, making it difficult for most families to afford. It is only through proactively seeking policy support from organizations such as the Disabled Persons' Federation and the government that parents have obtained this precious opportunity for surgery. "My son's first side of the cochlear implant was the only surgery that was done because the Disabled Persons' Federation had a funded program, and since he had his first side of the cochlear implant, I've been keeping an eye on the Disability Alliance to see if there are any new programs, waiting for the next opportunity to get a cochlear implant on that side." (N13) "What good policies does the country have for people with disabilities now, he and her sister were both given cochlear implants through a state-funded program, and we only spent about 10,000 RMB ourselves, otherwise how could a family like mine afford to give the two children (cochlear implants), and the state and society have been so helpful to us." (N6) Downward comparison The parents of the child can temporarily alleviate their anxiety and unease by comparing downwards, but instead discover a comforting side. "My child's first side cochlear implant was done early, and now her hearing ability is quite good, unlike some children who had the surgery at a good age, and after the surgery, the result was not good and her speech was not clear." (N8) "I've heard that the kind of children who have had cochlear implants with greater vestibular (large vestibular aqueduct syndrome, LVAS) don't do particularly well, and thankfully my child doesn't have those (inner ear malformations, IEM) yet, which I think has been a blessing." (N13) Some mothers of children have also expressed the psychological comfort of knowing that their children have benefited from advances in medical technology and social development. "Nowadays, there is this technical method of cochlear implant surgery, and it's already very good, in the past, in our time, such a disease like this is not deaf and dumb, and that's it for the rest of his life." (N2) Effortful self-adjustment When coping with trauma and negative emotions, parents of children relieve their psychological pressure and improve their emotional state through positive thinking and emotional management, to better adapt to the present. "I sometimes just think that this might just be an ordeal that God has given me, and I just have to get through it, and it's okay." (N12) "How could I accept my child's deafness before, I cried every day at home, now I make myself smile more every day, happier luck will be better, maybe the child can recover faster!." (N2) "When you meet this calamity, you can only comfort yourself and have a peaceful mind so that you can be in a better mood every day and take better care of your child." (N13) Discussion This study found that parents of children with congenital deafness had characteristic traumatic reactions such as "negative emotional experiences" and "cognitive conflicts" at the early stage of diagnosis. After self-adjustment and adaptation, parents gradually accepted the fact that their children had the disease and began to seek medical treatment to achieve the best results. Cochlear implantation brings a ray of hope to both the child and the parents, but also a heavy burden of care and finances. Nonetheless, over time, regular and effective auditory-verbal rehabilitation training enabled the children to develop listening and speaking skills, leading to ongoing progress. Their parents showed positive emotions and experienced multifaceted growth, which is consistent with the theory of post-traumatic growth research proposed by Tedeschi and Calhoun [8]. As a special group, children are not yet capable of self-care and are dependent on their caregivers in all aspects. Parents, as the closest people to the child, are the first health resource for the child's recovery and are one of the factors that maximize the outcome of the child's recovery [16]. If the parents cannot get rid of the suboptimal state as soon as possible, and the psychological state cannot be adjusted in time, it will not only affect the communication with the medical staff, and the choice of treatment decisions, and even hinder the implementation of the medical advice, but also produce a kind of potential pressure on the child, which will have a direct impact on the child's rehabilitation effect and healthy growth, which is more harmful than the disability itself [17]. Therefore, it is suggested that medical staff should promptly explore the inner feelings of parents of children with congenital deafness, pay attention to the psychological experience, and take effective interventions such as self-disclosure, mindfulness therapy, and cognitive behavioral therapy [18] to alleviate the psychological pressure of the parents to alleviate the psychological pressure of the parents, reduce the sense of guilt, and promote post-traumatic growth. The greatest feeling that the 12 mothers of the children who participated in this interview gave the researcher was that "women are naturally weak, but as mothers, they are strong."These mothers often display incredible willpower, unleashing a powerful personal force to cope with the current difficulties. Relevant studies have shown that self-efficacy is not only an important predictor of the quality of life and mental health of parents of children with disabilities, but also that high levels of self-efficacy can help these parents adopt positive coping strategies, effectively reduce parenting stress, alleviate negative emotions [19, 20], and post-traumatic growth is positively correlated with self-efficacy [21]. Surgery is only the initial step in implanting an artificial cochlear device. Post-operatively, children require regular auditory rehabilitation training to rebuild their hearing and subsequently foster speech function development. This process requires parents to learn how to care for early post-operative wounds, correctly use the artificial cochlear device, optimize its settings, and maintain it regularly to ensure that their child receives the best possible sound quality. They also need to participate in their child's auditory language rehabilitation process. Parents must be prepared to invest a significant amount of time and effort. Therefore, medical staff can equip parents with pertinent knowledge and skills related to auditory speech cognitive development associated with artificial cochlear implantation at various stages of their child's illness. This can be done through various mediums such as mobile medical apps, WeChat public accounts, and WeChat groups. The methods of using and maintaining the artificial cochlear device can be explained according to the different cultural levels and acceptance levels of the parents. Furthermore, by providing online consultations and answering complex questions, parents can be encouraged to actively learn about post-operative recovery knowledge, accumulate parenting experience, enhance parenting ability and self-efficacy, achieve positive family recovery, increase caregiving enthusiasm, and reduce caregiving burden [22]. In this study, various proactive and effective coping strategies adopted by the parents of children with congenital deafness, such as seeking support from the Disabled Persons' Federation and government, downward comparison, and self-adjustment efforts, are significant facilitators for post-traumatic growth in these parents. Quantitative research results indicate that positive coping strategies are important predictors of post-traumatic growth [23]. Adopting positive coping strategies helps alleviate the physical and mental stress caused by traumatic events, encourages parents to bravely face the challenges brought about by their child's treatment and recovery, and actively seek solutions and social support, thereby leading to a high level of growth experience. Conversely, negative coping strategies cause parents to choose to avoid and retreat when facing traumatic events, which not only exacerbates negative emotions such as anxiety and depression but also affects the treatment and recovery effects on their child, thereby affecting post-traumatic growth [24, 25]. This underscores the need for medical staff to promptly identify parents who employ negative coping strategies, guide them to face their child's illness positively and encourage an optimistic attitude towards the present. By sharing successful treatment and recovery cases, including those who have integrated into mainstream schools, as well as current achievements and new projects in the treatment of congenital deafness, parents can be empowered to believe that their child can successfully overcome the disease. The Chinese have always advocated the concept of "family disgrace should not be spread abroad". This sentiment is often reflected in parental reactions when their child is afflicted with a disease, many choose to withdraw from society, handling their struggles alone and bearing immense emotional burdens [26]. However, sharing inner feelings, expressing emotions, and seeking help can help alleviate negative emotions, enhance psychological adjustment capabilities, and better cope with environmental changes and stress. Therefore, it is essential to guide parents of sick children to accurately recognize and accept their negative emotional responses, teach them emotion regulation strategies, and learn to effectively manage emotions. Additionally, methods such as music therapy and meditation can be used to relieve tension and anxiety. Parents are informed that when negative emotions cannot be self-regulated or relieved, they should actively seek help from doctors or professional psychological counselors. Research has shown that positive psychological cues have a significant positive impact on an individual's psychological activity and behavior [27]. When communicating with parents of children, medical staff reminds them to use more positive psychological cues, such as "Believe in yourself and your child", "Everything will get better", "Things are not as bad as I thought" etc., in order to alleviate psychological pressure, enhance inner potential, and promote positive coping. Currently, the cost of imported cochlear implants ranges between 100,000 and 200,000 RMB. Post-operatively, children require long-term standardized auditory-verbal rehabilitation in specialized institutions, a process often unaffordable for many families. In this study, two mothers of children with congenital deafness reported that their children had bilateral cochlear implants and successfully entered a rehabilitation institution, relying solely on government subsidy policies. The parents have benefited significantly from the national healthcare policy, which has substantially alleviated their financial burden, increased their confidence in treatment, and fostered a high level of post-traumatic growth experience. Concurrently, emotional support and encouragement from family and friends have enhanced the parents' ability to cope with stress, motivated them to adopt a positive outlook, reduced the impact of negative emotions, and fostered a new philosophy of life, which is in line with the results of previous studies [28]. Social support plays a crucial role in buffering and regulating an individual's stress response, not only promoting early stage post-traumatic growth but also facilitating its long-term development [29]. Therefore, medical staff should inform other family members of the child about the importance of good social support for the mental health of the child's parents and the improvement of the child's treatment and recovery effects, and call on them to provide corresponding emotional and material support to the child's parents. The government should introduce more preferential policies for deaf children and their families, such as medical subsidies, educational grants, rehabilitation subsidies, etc., to reduce the economic burden on families. Strengthen legal protections to ensure that deaf children and their families enjoy equal rights and interests in employment, education, medical care, etc. Encourage the child's parents to actively seek financial support from the disabled association and the government. For economically disadvantaged families, help them obtain support from public welfare foundations, charitable organizations, government departments, etc., to achieve early auditory intervention for children with congenital deafness. At the same time, provide continuous care services for the child's parents after discharge, achieve a better transition from hospital to home recovery, and make the child's parents feel the care and support of medical staff during home recovery. Establish a community support network for the child's parents, the community should become an important support force for deaf children's families. Through organizing various activities, such as parent-child activities, rehabilitation lectures, experience sharing meetings, etc., to enhance communication and cooperation among deaf children's families. By using media publicity, charity events, etc., a tolerant and understanding social atmosphere can be created, raising public awareness and sense of identification with deaf children and their families, making them feel the warmth and care of society, thereby facilitating their post-traumatic growth. Limitations This study only interviewed parents of children from the same hospital, with a relatively homogenous sample source, potentially limiting the reference value of the research. Furthermore, due to the influence of the traditional Chinese concept of family, mothers bear the main task of caring for their children, and we seldom meet the fathers of children in hospitals. Therefore, the majority of interviewees were mothers of children, with only 3 fathers included, leading to insufficient representativeness of the sample and an inability to clearly distinguish and compare the roles of fathers and mothers in the traumatic growth experience. Future research could include more fathers of sick children to further explore the authentic experiences of fathers during post-traumatic growth. Conclusion In this study, we conducted semi-structured interviews with parents of 15 children with congenital deafness and concluded that the post-traumatic growth experiences of parents of children with congenital deafness included six themes: change in outlook on life, enhancement of health concepts, increased personal strength, change in relationships with others, perception of social support, and positive coping styles. Medical staff should guide the parents from a positive perspective, develop targeted interventions to relieve their psychological stress, enhance their sense of self-efficacy, and promote positive coping and post-traumatic growth, thereby promoting the quality of life and well-being of the children and their parents. Declarations Acknowledgements The authors thank the participants in this study for sharing their experiences. Author contributions WT and ZCC designed the study, WT, ZCC and ZCJ collected data. WT, ZBX, ZCC, LP, and CYY analyzed the data. WT and ZCC wrote the original draft. ZBX and LP review & editing the manuscript. All authors have read and approved the final manuscript. Funding No founding was obtained for this study. Data Availability No datasets were generated or analysed during the current study. Ethics approval and consent to participate This study was conducted in accordance with the Declaration of Helsinki. We confirm that all methods were performed in accordance with the relevant guidelines and regulations. Ethical approval was granted by the Ethics Committee of the First Affiliated Hospital of Anhui Medical University (Approval:No. PJ2023-13-56).Informed consent was signed by each participant before being interviewed and was coded to maintain anonymity Consent for publication Written informed consent for publication was obtained from all participants. Competing interests The authors declare no competing interests. Clinical trial number Not applicable References Renauld JM, Basch ML. Congenital Deafness and Recent Advances Towards Restoring Hearing Loss. Curr Protoc. 2021,1:e76. Cozza A, Di Pasquale Fiasca VM, Martini A. Congenital Deafness and Deaf-Mutism: A Historical Perspective. Children (Basel). 2023,11:51. Li J-N, Chen S, Zhai L, Han D-Y, Eshraghi AA, Feng Y, et al. The Advances in Hearing Rehabilitation and Cochlear Implants in China. Ear Hear. 2017,38:647–52. Topcu O, Senli FD, Batuk MO, Kilic S, Sennaroglu G. Social competence in children with cochlear implants: is it possible to catch up with their peers? Eur Arch Otorhinolaryngol. 2021,278:2775–80. Pavani F, Bottari D. Neuroplasticity following cochlear implants. Handb Clin Neurol. 2022,187:89–108. Jean YQ, Mazlan R, Ahmad M, Maamor N. Parenting Stress and Maternal Coherence: Mothers With Deaf or Hard-of-Hearing Children. Am J Audiol. 2018,27:260–71. Wang F, Zhang S, Liu C, Ni Z. Post-traumatic growth and influencing factors among parents of premature infants: a cross-sectional study. BMC Psychol. 2023,11:388. Tedeschi RG, Calhoun LG. The Posttraumatic Growth Inventory: measuring the positive legacy of trauma. J Trauma Stress. 1996,9:455–71. Koliouli F, Issari P, Andrianakou M. Lived experiences, perceived positive outcomes, and post-traumatic growth among parents with children with epilepsy: A qualitative study. Epilepsy Behav. 2022,134:108862. Beckmann NB, Dietrich MS, Hooke MC, Gilmer MJ, Akard TF. Parent Caregiving Experiences and Posttraumatic Growth Following Pediatric Hematopoietic Stem Cell Transplant. J Pediatr Oncol Nurs. 2021,38:242–53. Gunjawate DR, Ravi R, Driscoll C. Stress among Parents of Children with Hearing Loss and How They Deal with It: A Systematic Review. Int Arch Otorhinolaryngol. 2023,27:e166–77. Continisio GI, D’Errico D, Toscano S, Maldonato NM, De Falco R, Nunziata F, et al. Parenting Stress in Mothers of Children with Permanent Hearing Impairment. Children. 2023,10:517. Tedeschi RG, Calhoun LG. TARGET ARTICLE: “Posttraumatic Growth: Conceptual Foundations and Empirical Evidence.” Psychological Inquiry. 2004,15:1–18. Sanders C. Application of Colaizzi’s method: interpretation of an auditable decision trail by a novice researcher. Contemp Nurse. 2003,14:292–302. Lu W, Xu C, Hu X, Liu J, Zhang Q, Peng L, et al. The Relationship Between Resilience and Posttraumatic Growth Among the Primary Caregivers of Children With Developmental Disabilities: The Mediating Role of Positive Coping Style and Self-Efficacy. Front Psychol. 2022,12:765530. Balakrishnan S, Thangaraj M. Parental Support for Post Operative Intervention of Children with Cochlear Implantation. Indian J Otolaryngol Head Neck Surg. 2023,75:1958–67. Guo L-Y, Sun H, Hu M, Jiang Y-H, Luo Z-H. Mental health status of parents of young patients with high myopia. J Int Med Res. 2020,48:300060519873474. Faghani F, Choobforoushzadeh A, Sharbafchi MR, Poursheikhali H. Effectiveness of mindfulness-based supportive psychotherapy on posttraumatic growth, resilience, and self-compassion in cancer patients: A pilot study. Wien Klin Wochenschr. 2022,134:593–601. Li N, Cheng H, Lv L. The relationship between posttraumatic growth, self-efficacy, and social support in burn patients: A cross-sectional study. Burns. 2022,48:1626–31. Lu W, Xu C, Hu X, Liu J, Zhang Q, Peng L, et al. The Relationship Between Resilience and Posttraumatic Growth Among the Primary Caregivers of Children With Developmental Disabilities: The Mediating Role of Positive Coping Style and Self-Efficacy. Front Psychol. 2021,12:765530. Jian Y, Hu T, Zong Y, Tang W. Relationship between post-traumatic disorder and posttraumatic growth in COVID-19 home-confined adolescents: The moderating role of self-efficacy. Curr Psychol. 2023,42:17444–53. Feng Y, Zhou X, Qin X, Cai G, Lin Y, Pang Y, et al. Parental self-efficacy and family quality of life in parents of children with autism spectrum disorder in China: The possible mediating role of social support. Journal of Pediatric Nursing. 2022,63:159–67. Wu C, Liu Y, Ma S, Jing G, Zhou W, Qu L, et al. The mediating roles of coping styles and resilience in the relationship between perceived social support and posttraumatic growth among primary caregivers of schizophrenic patients: a cross-sectional study. BMC Psychiatry. 2021,21:58. Farhadi A, Bahreini M, Moradi A, Mirzaei K, Nemati R. The predictive role of coping styles and sense of coherence in the post-traumatic growth of mothers with disabled children: a cross-sectional study. BMC Psychiatry. 2022,22:708. He M, Shi B, Zheng Q, Gong C, Huang H. Posttraumatic Growth and its Correlates Among Parents of Children With Cleft Lip and/or Palate. Cleft Palate Craniofac J. 2024,61:110–8. Du N, Wang Y, Huang Y-T. Parental Depression and Self-Stigma Among Chinese Young People Living With Depression: A Qualitative Study. Qual Health Res. 2024,:10497323241232352. Zhang Y, Tang R, Bi L, Wang D, Li X, Gu F, et al. Effects of family-centered positive psychological intervention on psychological health and quality of life in patients with breast cancer and their caregivers. Support Care Cancer. 2023,31:592. Xiong T, McGrath PJ, Stewart SH, Bagnell A, Kaltenbach E. Risk and protective factors for posttraumatic stress and posttraumatic growth in parents of children with intellectual and developmental disorders. Eur J Psychotraumatol. 2022,13:2087979. Meral B, Bulut HK. Predictors of Moderate-High Posttraumatic Growth in Parents of Children With Cancer: A Cross-sectional Study. Cancer Nurs. 2024. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4936424","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":348767572,"identity":"6480f57f-8d10-46fc-88b8-e15192303852","order_by":0,"name":"Ting Wu","email":"","orcid":"","institution":"Anhui Medical University","correspondingAuthor":false,"prefix":"","firstName":"Ting","middleName":"","lastName":"Wu","suffix":""},{"id":348767575,"identity":"4dc5c118-8bc9-4ac3-af90-ba501924a324","order_by":1,"name":"Chencheng Zhu","email":"","orcid":"","institution":"Anhui Medical University","correspondingAuthor":false,"prefix":"","firstName":"Chencheng","middleName":"","lastName":"Zhu","suffix":""},{"id":348767576,"identity":"4b70c1cd-1eba-4873-a2c7-14152e022a6d","order_by":2,"name":"Chunjing Zhang","email":"","orcid":"","institution":"First Affiliated Hospital of Anhui Medical University","correspondingAuthor":false,"prefix":"","firstName":"Chunjing","middleName":"","lastName":"Zhang","suffix":""},{"id":348767577,"identity":"531fb78f-d656-40e8-87ff-fcfb5df1114b","order_by":3,"name":"Pei Liu","email":"","orcid":"","institution":"Anhui Medical University","correspondingAuthor":false,"prefix":"","firstName":"Pei","middleName":"","lastName":"Liu","suffix":""},{"id":348767578,"identity":"4e206451-b984-450a-9034-e57f0ebdb0c5","order_by":4,"name":"Yuanyuan Cui","email":"","orcid":"","institution":"Anhui Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yuanyuan","middleName":"","lastName":"Cui","suffix":""},{"id":348767579,"identity":"de94cae8-fb7f-46c6-a1f3-1a681002f4e5","order_by":5,"name":"Biaoxin Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0UlEQVRIiWNgGAWjYBACeWbmg49/8EjI2R9vPkCcFsP2tmRjBhkLY4YzxxKItObMGTNpBpuKRIYbOQbE6WCckZZsXJAjkcDYkPPxxhsGOzndBgJa2CWSDz6ecUYij5nh7GbLOQzJxmYHiLDFgLdHopiNsXebNA/DgcRthLQAvWAmwftPIrGHmecZkVpA3ufhkUicwcbDRpwWUCAbzuCRMDbgYTO2nGNAhF9AUfngA0+dnIH844c33lTYyRHUggIkeIiMGmQtpOoYBaNgFIyCEQEAXMNAzSZ5misAAAAASUVORK5CYII=","orcid":"","institution":"First Affiliated Hospital of Anhui Medical University","correspondingAuthor":true,"prefix":"","firstName":"Biaoxin","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2024-08-19 06:51:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4936424/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4936424/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":76189019,"identity":"8e6bd444-e7e8-462b-bef3-8f58b7eeb621","added_by":"auto","created_at":"2025-02-13 09:09:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":992692,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4936424/v1/490f2c27-a84e-4fd7-93dc-61f2d32c31bb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Post-traumatic growth experiences of parents of children with congenital deafness: a qualitative study","fulltext":[{"header":"Background","content":"\u003cp\u003eCongenital deafness is one of the most frequent birth disorders in human beings, which is a hearing loss that arises at or shortly after birth, primarily sensorineural deafness [1]. It occurs in roughly 0.1\u0026ndash;0.3% of normal newborns, and up to 2\u0026ndash;4% of preterm infants and newborns resuscitated in the intensive care unit (ICU) [2]. According to a survey, China has the largest number of persons with hearing disabilities in the world, and the number of persons with hearing disabilities ranks first among the five major disabilities, with nearly 30,000 new deaf children added every year, facing serious hearing health challenges [3]. If deaf children do not receive timely and effective hearing and speech intervention, it can disrupt the development of their linguistic system. This disruption can also impact the normal development of their emotional well-being, cognition, social skills, and other abilities, the long-term consequences of this disruption can have a significant impact on their mental health, academic performance, professional life, and overall integration into mainstream society [4]. The advent of cochlear implants has ushered in a new era in the treatment of deafness, which is now widely recognized as a standard method for treating severe and profound sensory neural deafness globally [5]. However, the impact of multiple negative life events, such as immense economic pressure, discriminatory attitudes from society, strong concerns about unknown prognoses, and heavy caregiving burdens, leads to significant physical and mental stress on parents of deaf children, resulting in poor psychological conditions [6].\u003c/p\u003e \u003cp\u003e Research has indicated that parents of children often experience a certain degree of post-traumatic growth in their caregiving role. This growth not only enhances their quality of life and sense of well-being, but also plays a crucial role in the healthy development of their children's physical and mental health [7]. Tedeschi defines post-traumatic growth (PTG) as the positive psychological changes experienced by individuals in the process of struggling with traumatic events, which is mainly manifested in five aspects: interpersonal relationship, personal strength, new possibilities, appreciation of life, and spiritual change [8]. With the rise and vigorous development of positive psychology, more and more scholars have begun to pay attention to the influence of positive psychology on individuals. Despite the negative psychological effects of traumatic events, individuals can also experience changes in values such as valuing family and health, actively confronting setbacks, and redefining the meaning of life [9, 10]. Therefore, PTG holds significant practical value and benefits for the psychological adjustment of parents of deaf children.\u003c/p\u003e \u003cp\u003eHowever, existing research predominantly concentrates on the negative psychological experiences of parents with deaf children, often neglecting to explore their potential for positive psychological transformation [11, 12]. Notably, there is a dearth of studies investigating the post-traumatic growth (PTG) experiences of parents raising children with congenital deafness. This oversight fails to adequately address and foster the positive psychology of these parents, potentially hindering their children's healthy physical and mental development. It is imperative not only to focus on the needs of deaf children but also to extend active concern to the significant cohort of parents who have them. This study seeks to delve into the authentic PTG experiences of parents raising children with congenital deafness, aiming to provide fresh perspectives and theoretical underpinnings for future psychological intervention strategies.\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eThis research examines the lived experiences of parental post-traumatic growth in children with congenital deafness, aiming to provide insights into bolstering the psychological well-being of these parents. This information is crucial for formulating intervention strategies that are culturally and societally appropriate for China.\u003c/p\u003e \u003c/div\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eDesign\u003c/h2\u003e \u003cp\u003eParents of children diagnosed with congenital deafness, who were receiving treatment at a tertiary-level hospital in Hefei City, Anhui Province, between July and November 2023, were selected for this study using purposive sampling. The research adopted a phenomenological qualitative approach, employing face-to-face interviews to investigate the post-traumatic growth experienced by these parents.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eThe inclusion criteria for the children were as follows: (1) a clinical diagnosis of congenital deafness, and (2) having undergone cochlear implantation. The exclusion criteria were: (1) the presence of other severe diseases, such as those secondary to other cancers or cerebral palsy, and (2) any other mental disorders.\u003c/p\u003e \u003cp\u003e The inclusion criteria for parents were: (1) assuming primary responsibility for the child's care, (2) scoring\u0026thinsp;\u0026ge;\u0026thinsp;60 points on the Post-traumatic Growth Inventory(C-PTGI), (3) possessing normal listening, reading, writing, and communication skills, and (4) voluntarily participating in this study. The exclusion criteria were: (1) undergoing psychiatric-psychological treatment, (2) experiencing other traumatic events within the past six months, such as car accidents, the death of a loved one, or cancer, and (3) suffering from a chronic mental illness.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eInstruments\u003c/h2\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003ePost-traumatic Growth Inventory\u003c/h2\u003e \u003cp\u003eThe scale was developed by Tedeschi et al.[13], and the Chinese version revised by Wang Ji Translation was adopted in this study. The scale has a total of 20 items, including 5 dimensions: life perception (6 items), personal strength (3 items), new possibilities (4 items), relationship with others (3 items), and self-change (4 items). The Likert 6-level scoring method was adopted. The higher the score, the higher the level of post-traumatic growth. The Cronbach's α coefficient of the scale was 0.82, and the Cronbach's α coefficient of each dimension was 0.61\u0026thinsp;~\u0026thinsp;0.796.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eBefore a formal interview, according to the purpose of the study, relevant literature was reviewed, and the opinions of two otologists and one psychologist were combined to formulate a preliminary interview guide, which was repeatedly revised after pre-interviews with three parents of the children to determine the final interview guide. The final interview outline was as follows: (1) How did you feel when your child was diagnosed with congenital deafness? (2)What were your experiences and feelings when your child was treated and recovered after the diagnosis? (3) What were your most profound feelings and experiences in caring for your child? (4) Have you experienced any positive changes or new insights after experiencing your child's illness? (5) What do you think made a difference in how you felt? (6) How did you cope with difficulties and stress during this time?\u003c/p\u003e \u003cp\u003eA phenomenological research methodology was employed to gather data through one-on-one semi-structured face-to-face interviews conducted by a single researcher (the first author). Interviews were completed after the child's cochlear implantation and up to the day before discharge. Prior to initiating the investigation, the researcher undertook courses related to qualitative research and acquired knowledge on interview methodologies and techniques. Before the formal interview, the purpose of the study, the methodology and the interview process were explained to the respondents, stressing that the principles of harmlessness and confidentiality were strictly implemented in this interview, and the questionnaires were distributed after obtaining the consent of the respondents and signing the informed consent form. A simple and easy-to-understand unified guide was used to explain the questionnaire to them effectively, informing them of the precautions to be taken in filling out the questionnaire, and the questionnaire was filled out independently by the subjects, and for those who had difficulty in writing or reading, the researcher read them one by one and filled them out truthfully according to the answers of the subjects. After the questionnaire was completed, it was collected on the spot and checked for missing items. The interview was conducted in a private, tranquil office setting, with agreed upon timing and a controlled duration of 30\u0026ndash;45 minutes. The entirety of the interview was recorded, with particular attention paid to observing the facial expressions, body movements, and emotional fluctuations of the participants. Additionally, write interview notes as a supplement to the interview data. The sample size for this study was determined based on data saturation, resulting in a total of 15 parents of children who were interviewed, all of whom remained in the study.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eTo minimize recall bias, the audio recordings of the conversations were transcribed into text by two researchers using Nvivo 12 software within 24 hours of the interview. Any missing information was followed up with the child's parents. The data were analyzed using Claizzi's seven-step analysis [14]. (1) read all the interviews carefully; (2) analyze statements of significance; (3) code the extracted information; (4) compile the coded ideas; (5) provide detailed descriptions of the ideas based on the interviews; (6) integrate and refine the descriptions to sublimate the themes; and (7) return to the subjects of the study to verify the evidence.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003e This study was approved by the Ethics Committee of the First Affiliated Hospital of Anhui Medical University (Approval: No. PJ2023-13-56). Prior to the commencement of interviews, all participants were duly informed of their right to freely participate or withdraw. They were assured that all participant information would be anonymized, with numerical codes replacing names, and that the research data would solely be utilized for this specific study, without any other purposes. The trust and cooperation of the participants were obtained. All participants voluntarily participated in this study and signed an informed consent form.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eRigor\u003c/h2\u003e \u003cp\u003eTo ensure the rigor of this study and to adhere strictly to qualitative research standards, all researchers undertook a comprehensive study of knowledge related to qualitative research methodologies. To enhance the credibility of the findings, the researchers maintained active listening during interviews, refrained from guiding or implying responses, remained neutral, avoided subjective judgments, and adjusted the interview strategy and question order in response to the parents' answers. At the conclusion of each interview, the researcher reflected on the questioning approach, interview content, and analysis of the data, documenting these reflections in a reflective diary to identify issues and make timely corrections. The data analysis was performed by two researchers who independently analyzed and extracted meaningful statements consistent with the parents' post-traumatic growth experiences. These statements were then summarized and refined. In instances of disagreement, a group meeting was convened for discussion, and the final theme was determined by consensus among team members. Finally, the analysis results were randomly fed back to the three interview subjects to verify the authenticity of the content, which increased the dependability of the research results.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 15 parents of children, numbered from N1 to N15, were interviewed in this study. Among them, 3 were fathers and 12 were mothers, their ages ranged from 22 to 51 years, with a mean of (34.27\u0026thinsp;\u0026plusmn;\u0026thinsp;8.80) years. The general characteristics of the children and their parents are displayed in Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, respectively.\u003c/p\u003e \u003cp\u003eSix main themes and fourteen sub-themes were summarized in this study: (1) changes in outlook on life, (2) enhancement of health concepts, (3) increased personal strength, (4) change in relationships with others, (5) perceived social support, and (6) positive coping styles.\u003c/p\u003e \u003cp\u003eThe themes in the interviews are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eGeneral demographic date of the caregivers(N\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" style=\"width: 7.4713%;\"\u003e\n \u003cp\u003eCode\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 9.5785%;\"\u003e\n \u003cp\u003eRole\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 15.5172%;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 24.3295%;\"\u003e\n \u003cp\u003eEducational Level\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 21.8391%;\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" style=\"width: 21.2644%;\"\u003e\n \u003cp\u003eC-PTGI(points)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 7.4713%;\"\u003e\n \u003cp\u003eN1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.5785%;\"\u003e\n \u003cp\u003eMother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 15.5172%;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 24.3295%;\"\u003e\n \u003cp\u003eBachelor\u0026rsquo;s degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 21.8391%;\"\u003e\n \u003cp\u003eTeacher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 21.2644%;\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 7.4713%;\"\u003e\n \u003cp\u003eN2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.5785%;\"\u003e\n \u003cp\u003eMother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 15.5172%;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 24.3295%;\"\u003e\n \u003cp\u003ePrimary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 21.8391%;\"\u003e\n \u003cp\u003eWorkless\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 21.2644%;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 7.4713%;\"\u003e\n \u003cp\u003eN3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.5785%;\"\u003e\n \u003cp\u003eMother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 15.5172%;\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 24.3295%;\"\u003e\n \u003cp\u003eHigh school degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 21.8391%;\"\u003e\n \u003cp\u003eCompany worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 21.2644%;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 7.4713%;\"\u003e\n \u003cp\u003eN4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.5785%;\"\u003e\n \u003cp\u003eMother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 15.5172%;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 24.3295%;\"\u003e\n \u003cp\u003eCollege\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 21.8391%;\"\u003e\n \u003cp\u003eWorkless\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 21.2644%;\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 7.4713%;\"\u003e\n \u003cp\u003eN5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.5785%;\"\u003e\n \u003cp\u003eFather\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 15.5172%;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 24.3295%;\"\u003e\n \u003cp\u003eCollege\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 21.8391%;\"\u003e\n \u003cp\u003eCompany worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 21.2644%;\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 7.4713%;\"\u003e\n \u003cp\u003eN6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.5785%;\"\u003e\n \u003cp\u003eMother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 15.5172%;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 24.3295%;\"\u003e\n \u003cp\u003eBachelor\u0026rsquo;s degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 21.8391%;\"\u003e\n \u003cp\u003eLawyer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 21.2644%;\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 7.4713%;\"\u003e\n \u003cp\u003eN7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.5785%;\"\u003e\n \u003cp\u003eMother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 15.5172%;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 24.3295%;\"\u003e\n \u003cp\u003eCollege\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 21.8391%;\"\u003e\n \u003cp\u003eCompany worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 21.2644%;\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 7.4713%;\"\u003e\n \u003cp\u003eN8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.5785%;\"\u003e\n \u003cp\u003eMother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 15.5172%;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 24.3295%;\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 21.8391%;\"\u003e\n \u003cp\u003eSelf-employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 21.2644%;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 7.4713%;\"\u003e\n \u003cp\u003eN9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.5785%;\"\u003e\n \u003cp\u003eMother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 15.5172%;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 24.3295%;\"\u003e\n \u003cp\u003eMaster\u0026rsquo;s degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 21.8391%;\"\u003e\n \u003cp\u003eDoctor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 21.2644%;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 7.4713%;\"\u003e\n \u003cp\u003eN10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.5785%;\"\u003e\n \u003cp\u003eFather\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 15.5172%;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 24.3295%;\"\u003e\n \u003cp\u003ePrimary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 21.8391%;\"\u003e\n \u003cp\u003eSelf-employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 21.2644%;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 7.4713%;\"\u003e\n \u003cp\u003eN11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.5785%;\"\u003e\n \u003cp\u003eMother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 15.5172%;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 24.3295%;\"\u003e\n \u003cp\u003eJunior high\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 21.8391%;\"\u003e\n \u003cp\u003eWorkless\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 21.2644%;\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 7.4713%;\"\u003e\n \u003cp\u003eN12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.5785%;\"\u003e\n \u003cp\u003eMother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 15.5172%;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 24.3295%;\"\u003e\n \u003cp\u003eBachelor\u0026rsquo;s degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 21.8391%;\"\u003e\n \u003cp\u003eCivil servant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 21.2644%;\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 7.4713%;\"\u003e\n \u003cp\u003eN13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.5785%;\"\u003e\n \u003cp\u003eFather\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 15.5172%;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 24.3295%;\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 21.8391%;\"\u003e\n \u003cp\u003eWorker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 21.2644%;\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 7.4713%;\"\u003e\n \u003cp\u003eN14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.5785%;\"\u003e\n \u003cp\u003eMother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 15.5172%;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 24.3295%;\"\u003e\n \u003cp\u003eJunior high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 21.8391%;\"\u003e\n \u003cp\u003eWorkless\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 21.2644%;\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 7.4713%;\"\u003e\n \u003cp\u003eN15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 9.5785%;\"\u003e\n \u003cp\u003eMother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 15.5172%;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 24.3295%;\"\u003e\n \u003cp\u003eJunior high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 21.8391%;\"\u003e\n \u003cp\u003eWorkless\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" style=\"width: 21.2644%;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic date of the children with congenital deafness\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eVariable N F(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge(year)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u0026ndash;16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCochlear implant type\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnilateral implantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBilateral sequential implantation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of themes and sub-themes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThemes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSub-themes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eThe change of outlook on life\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcceptance of the child's illness\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLower expectations\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLook forward to the future\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEnhancement of health concepts\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCaring for the body\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eActively learning about hearing health knowledge\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePersonal empowerment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncreased self-efficacy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe rigidity and tenacity of a mother's love\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eChanges in relationships with others\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClarification of roles and responsibilities\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStrong spiritual resonance\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePerceived social support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThank the medical staff for their help\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrateful for the support of family and friends\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePositive coping style\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSeek support from the Disabled Persons' Federation and the Government\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDownward comparison\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEffortful self-adjustment\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eTheme 1: changes in outlook on life\u003c/h2\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003eAcceptance of the child's illness\u003c/h2\u003e \u003cp\u003eAmong the novel congenital deaf cases in China annually, approximately 90% originate from households with normal hearing and no familial deafness history [1]. The parents of the children who participated in this interview are adults with normal hearing and no family history of deafness. While the birth of a child is typically a cause for celebration, the diagnosis of congenital deafness can be a profound shock to both parents and families.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"At the beginning of the examination, the doctor said that he (the child) had a hearing problem, I couldn't believe it, his brother and sister have normal hearing, no one in our family is deaf, and he is the only one who is deaf, how can it be.\" (N12)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"When the test results came back, I couldn't believe my son was deaf.\" (N7)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e Many parents of affected children said that they began to face reality actively after some internal reconstruction, and gradually pulled themselves together to actively seek treatment.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"When I was first diagnosed, I was at home in tears every day, then I thought I couldn't cry every day, my child's problems couldn't be solved, I started to comfort myself and slowly pulled myself together.\" (N2)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Sad to be sad, but to solve the problem ah, we take the child behind to Shanghai and Beijing to check the ear, trying to find a good way to treat the child.\" (N1)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eLower expectations\u003c/h2\u003e \u003cp\u003e The illness of their children has made their parents think more about life and health, and many of them say that they only want their children to be healthy and that everything else is secondary.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I used to think that my child has to study well to go to university, but since he has had these operations, I just think that he can be well and not get sick, I don't have such high expectations.\" (N2)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Ever since my child was tested for hearing problems, I quit my job and taking care of him and learning to talk like a normal child was the important thing.\" (N4)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003elook forward to the future\u003c/h2\u003e \u003cp\u003e Children are parents' expectations for the future life, giving parents hope in many aspects, although experienced this traumatic event, but parents are still full of hope and expectations for the future of children.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I hope my son will be able to communicate like a normal person in the future, find a good job and support himself, and I will be satisfied.\" (N3)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"She won several trophies in singing and dancing competitions organized by the Disabled Persons' Federation, and photos of her competitions are still hanging on the exhibition wall of the Federation, so I support whatever she likes, and I hope that she can develop these specialties in the future as well.\" (N14)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eTheme 2: enhancement of health concepts\u003c/h2\u003e \u003cdiv id=\"Sec18\" class=\"Section3\"\u003e \u003ch2\u003eCaring for the body\u003c/h2\u003e \u003cp\u003e After experiencing their children's illnesses, the parents of the children realized the importance of good health and started to adopt a healthy lifestyle and care for their bodies more.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"It is only when I am sick that I can realize how happy I am to have a healthy body. I will exercise every day from now on and eat green and healthy food to have a good physique.\"(N3)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"The body is the capital of the revolution, I have to take good care of my body from now on, and I can't stay up late every day anymore.\"(N12)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eActively learning about hearing health knowledge\u003c/h2\u003e \u003cp\u003eParents of the children took the initiative to learn about ear and hearing protection through various means to enhance their health awareness.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"In the past, I didn't even know that there were so many classifications of deafness, now I am learning a lot of ear-related content on the Internet, and I have learned a lot of ways to prevent hearing loss.\"(N13)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I often watch popular science videos on my mobile phone about hearing protection, and I have learned that this knowledge is not only beneficial for the protection of my children's hearing but also for myself as well as my family and friends around me.\"(N8)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eTheme 3: personal empowerment\u003c/h2\u003e \u003cdiv id=\"Sec21\" class=\"Section3\"\u003e \u003ch2\u003eIncreased self-efficacy\u003c/h2\u003e \u003cp\u003eParents of children exhibiting high self-efficacy demonstrate resilience to stress, maintain emotional stability, and effectively counteract the impact of negative emotions following trauma, leading to post-traumatic growth [15].\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"After dropping her off at rehabilitation schools every morning, I started going to hourly jobs and doing all kinds of part-time work, and now I work out doing everything all by myself and not being afraid.\" (N14)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e The child's rehabilitation outcome is not solely dependent on the rehabilitation institution; parents also play a pivotal role in long-term rehabilitation training [16].\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"After I came home from the rehabilitation school, I had to teach her to say a word, a phrase, a sentence over and over again at home, and I was so happy and proud to watch her learn to say it little by little.\" (N2)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"My child didn't learn well in the rehabilitation school, so I let the teacher teach me the method, and when I went home, I looked for videos on the internet to teach my child to pronounce words and speak, and I taught her over and over again at home, and now she hears very well.\" (N6)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eThe rigidity and tenacity of a mother's love\u003c/h2\u003e \u003cp\u003eUpon becoming a mother, a woman is imbued with an indomitable spirit attributable to her maternal instincts. Throughout the child-rearing process, the mother in question draws upon her fortitude, enduring each challenging step along the way.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I divorced her father and I brought her to the hospital by myself for the operation and the hospitalization was all under my care here, for the sake of the child, and I wasn't tired and it wasn't that hard.\" (N8)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"His dad works in Shanghai all year round, we live in our hometown, I take care of him and my sister by myself, and usually have to do my sister's rehab in the city, and I've come through on my own.\" (N6)\u003c/em\u003e \u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eTheme 4: change in relationships with others\u003c/h2\u003e \u003cdiv id=\"Sec24\" class=\"Section4\"\u003e \u003ch2\u003eClarification of roles and responsibilities\u003c/h2\u003e \u003cp\u003eThe parent-child relationship represents the most profound emotional bond in human existence. This bond transcends biological ties, establishing a deep emotional connection between hearts that encompasses boundless love and companionship. Parents of affected children endeavor to provide the best possible care for their offspring.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I got pregnant with him by accident, and since I chose to have him and he came into my family, I am responsible for him.\" (N11)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"As soon as I learned that she was deaf, her grandmother asked me to send her to the orphanage, this is my child, won't her life be ruined if she is sent to the orphanage! (Tears)\" (N8)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAnother mother of a child said that she would still give her responsibility and love even if it was not her biological child.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"She was adopted by me, and then I didn't realize until she was over a year old that she had a hearing problem. My family told me to give the baby back, so how could I do that? Since I chose to adopt her, I'm sure I'll take good care of her.\" (N12)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eStrong spiritual resonance\u003c/h2\u003e \u003cp\u003eDuring the hospitalization period, parents of children frequently interact with one another, thereby gaining insights into each other's shared experiences. This interaction facilitates a deeper understanding of the emotions experienced by parents of other children, enabling them to offer heartfelt support to their peers.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"The mother of the child across the bed from me, her son came in for surgery a month after he was first diagnosed (with deafness), she probably couldn't take it at once, and she was downcast every day, so I advised her, 'Don't be sad anymore, now that it's happened, work it out to make it better.' I also came from that stage of her life, and it was hard for me to see her like that.\" (N3)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eTheme 5: Perceived social support\u003c/h2\u003e \u003cdiv id=\"Sec27\" class=\"Section4\"\u003e \u003ch2\u003eThank the medical staff for their help\u003c/h2\u003e \u003cp\u003eAfter the child's diagnosis, his parents traveled to many different places in search of the best treatment plan. Each interaction with medical professionals provided solace and reassurance during the most distressing and helpless moments, while also facilitating the acquisition of the most pertinent treatment recommendations at that juncture.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"When we were examined in the hospital in Shanghai, that doctor said to me, don't run around to get examined anymore, there are only a few kinds of treatments at present, now you need to hurry up and choose one, if your child misses the best age for treatment, even if the cochlear implant is implanted, the effect is not ideal. After hearing what he said, the heart was settled.\" (N11)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"When my child was diagnosed, I was completely distraught, but the audiologist and nurse who examined us comforted me, and I am very grateful to them.\" (N12)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eGrateful for the support of family and friends\u003c/h2\u003e \u003cp\u003eThe support from family and friends has been a great encouragement to the parents of the children.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"A good friend of mine, ever since she knew my son was in the hospital, has been sending me messages every day asking me if I've eaten and how I'm doing today... These simple words have also touched me, feeling that someone has been caring about you and helping you.\" (N9)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Since the baby's illness, the family has been concerned about us, asking us whether we lack money, to give us the money, it is a friend in need.\" (N1)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003eTheme 6: positive coping styles\u003c/h2\u003e \u003cdiv id=\"Sec30\" class=\"Section3\"\u003e \u003ch2\u003eSeek support from the Disabled Persons' Federation and the Government\u003c/h2\u003e \u003cp\u003eSocial support refers to the spiritual and material assistance that parents of children with hearing impairments receive through social connections, which can reduce their sense of helplessness in difficult situations. The cost of cochlear implants is high, making it difficult for most families to afford. It is only through proactively seeking policy support from organizations such as the Disabled Persons' Federation and the government that parents have obtained this precious opportunity for surgery.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"My son's first side of the cochlear implant was the only surgery that was done because the Disabled Persons' Federation had a funded program, and since he had his first side of the cochlear implant, I've been keeping an eye on the Disability Alliance to see if there are any new programs, waiting for the next opportunity to get a cochlear implant on that side.\" (N13)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"What good policies does the country have for people with disabilities now, he and her sister were both given cochlear implants through a state-funded program, and we only spent about 10,000 RMB ourselves, otherwise how could a family like mine afford to give the two children (cochlear implants), and the state and society have been so helpful to us.\" (N6)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec31\" class=\"Section2\"\u003e \u003ch2\u003eDownward comparison\u003c/h2\u003e \u003cp\u003eThe parents of the child can temporarily alleviate their anxiety and unease by comparing downwards, but instead discover a comforting side.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"My child's first side cochlear implant was done early, and now her hearing ability is quite good, unlike some children who had the surgery at a good age, and after the surgery, the result was not good and her speech was not clear.\" (N8)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I've heard that the kind of children who have had cochlear implants with greater vestibular (large vestibular aqueduct syndrome, LVAS) don't do particularly well, and thankfully my child doesn't have those (inner ear malformations, IEM) yet, which I think has been a blessing.\" (N13)\u003c/em\u003e \u003c/p\u003e \u003cp\u003eSome mothers of children have also expressed the psychological comfort of knowing that their children have benefited from advances in medical technology and social development.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"Nowadays, there is this technical method of cochlear implant surgery, and it's already very good, in the past, in our time, such a disease like this is not deaf and dumb, and that's it for the rest of his life.\" (N2)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec32\" class=\"Section2\"\u003e \u003ch2\u003eEffortful self-adjustment\u003c/h2\u003e \u003cp\u003eWhen coping with trauma and negative emotions, parents of children relieve their psychological pressure and improve their emotional state through positive thinking and emotional management, to better adapt to the present.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\"I sometimes just think that this might just be an ordeal that God has given me, and I just have to get through it, and it's okay.\" (N12)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"How could I accept my child's deafness before, I cried every day at home, now I make myself smile more every day, happier luck will be better, maybe the child can recover faster!.\" (N2)\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\"When you meet this calamity, you can only comfort yourself and have a peaceful mind so that you can be in a better mood every day and take better care of your child.\" (N13)\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study found that parents of children with congenital deafness had characteristic traumatic reactions such as \"negative emotional experiences\" and \"cognitive conflicts\" at the early stage of diagnosis. After self-adjustment and adaptation, parents gradually accepted the fact that their children had the disease and began to seek medical treatment to achieve the best results. Cochlear implantation brings a ray of hope to both the child and the parents, but also a heavy burden of care and finances. Nonetheless, over time, regular and effective auditory-verbal rehabilitation training enabled the children to develop listening and speaking skills, leading to ongoing progress. Their parents showed positive emotions and experienced multifaceted growth, which is consistent with the theory of post-traumatic growth research proposed by Tedeschi and Calhoun [8]. As a special group, children are not yet capable of self-care and are dependent on their caregivers in all aspects. Parents, as the closest people to the child, are the first health resource for the child's recovery and are one of the factors that maximize the outcome of the child's recovery [16]. If the parents cannot get rid of the suboptimal state as soon as possible, and the psychological state cannot be adjusted in time, it will not only affect the communication with the medical staff, and the choice of treatment decisions, and even hinder the implementation of the medical advice, but also produce a kind of potential pressure on the child, which will have a direct impact on the child's rehabilitation effect and healthy growth, which is more harmful than the disability itself [17]. Therefore, it is suggested that medical staff should promptly explore the inner feelings of parents of children with congenital deafness, pay attention to the psychological experience, and take effective interventions such as self-disclosure, mindfulness therapy, and cognitive behavioral therapy [18] to alleviate the psychological pressure of the parents to alleviate the psychological pressure of the parents, reduce the sense of guilt, and promote post-traumatic growth.\u003c/p\u003e \u003cp\u003eThe greatest feeling that the 12 mothers of the children who participated in this interview gave the researcher was that \"women are naturally weak, but as mothers, they are strong.\"These mothers often display incredible willpower, unleashing a powerful personal force to cope with the current difficulties. Relevant studies have shown that self-efficacy is not only an important predictor of the quality of life and mental health of parents of children with disabilities, but also that high levels of self-efficacy can help these parents adopt positive coping strategies, effectively reduce parenting stress, alleviate negative emotions [19, 20], and post-traumatic growth is positively correlated with self-efficacy [21]. Surgery is only the initial step in implanting an artificial cochlear device. Post-operatively, children require regular auditory rehabilitation training to rebuild their hearing and subsequently foster speech function development. This process requires parents to learn how to care for early post-operative wounds, correctly use the artificial cochlear device, optimize its settings, and maintain it regularly to ensure that their child receives the best possible sound quality. They also need to participate in their child's auditory language rehabilitation process. Parents must be prepared to invest a significant amount of time and effort. Therefore, medical staff can equip parents with pertinent knowledge and skills related to auditory speech cognitive development associated with artificial cochlear implantation at various stages of their child's illness. This can be done through various mediums such as mobile medical apps, WeChat public accounts, and WeChat groups. The methods of using and maintaining the artificial cochlear device can be explained according to the different cultural levels and acceptance levels of the parents. Furthermore, by providing online consultations and answering complex questions, parents can be encouraged to actively learn about post-operative recovery knowledge, accumulate parenting experience, enhance parenting ability and self-efficacy, achieve positive family recovery, increase caregiving enthusiasm, and reduce caregiving burden [22].\u003c/p\u003e \u003cp\u003eIn this study, various proactive and effective coping strategies adopted by the parents of children with congenital deafness, such as seeking support from the Disabled Persons' Federation and government, downward comparison, and self-adjustment efforts, are significant facilitators for post-traumatic growth in these parents. Quantitative research results indicate that positive coping strategies are important predictors of post-traumatic growth [23]. Adopting positive coping strategies helps alleviate the physical and mental stress caused by traumatic events, encourages parents to bravely face the challenges brought about by their child's treatment and recovery, and actively seek solutions and social support, thereby leading to a high level of growth experience. Conversely, negative coping strategies cause parents to choose to avoid and retreat when facing traumatic events, which not only exacerbates negative emotions such as anxiety and depression but also affects the treatment and recovery effects on their child, thereby affecting post-traumatic growth [24, 25]. This underscores the need for medical staff to promptly identify parents who employ negative coping strategies, guide them to face their child's illness positively and encourage an optimistic attitude towards the present. By sharing successful treatment and recovery cases, including those who have integrated into mainstream schools, as well as current achievements and new projects in the treatment of congenital deafness, parents can be empowered to believe that their child can successfully overcome the disease.\u003c/p\u003e \u003cp\u003eThe Chinese have always advocated the concept of \"family disgrace should not be spread abroad\". This sentiment is often reflected in parental reactions when their child is afflicted with a disease, many choose to withdraw from society, handling their struggles alone and bearing immense emotional burdens [26]. However, sharing inner feelings, expressing emotions, and seeking help can help alleviate negative emotions, enhance psychological adjustment capabilities, and better cope with environmental changes and stress. Therefore, it is essential to guide parents of sick children to accurately recognize and accept their negative emotional responses, teach them emotion regulation strategies, and learn to effectively manage emotions. Additionally, methods such as music therapy and meditation can be used to relieve tension and anxiety. Parents are informed that when negative emotions cannot be self-regulated or relieved, they should actively seek help from doctors or professional psychological counselors. Research has shown that positive psychological cues have a significant positive impact on an individual's psychological activity and behavior [27]. When communicating with parents of children, medical staff reminds them to use more positive psychological cues, such as \"Believe in yourself and your child\", \"Everything will get better\", \"Things are not as bad as I thought\" etc., in order to alleviate psychological pressure, enhance inner potential, and promote positive coping.\u003c/p\u003e \u003cp\u003eCurrently, the cost of imported cochlear implants ranges between 100,000 and 200,000 RMB. Post-operatively, children require long-term standardized auditory-verbal rehabilitation in specialized institutions, a process often unaffordable for many families. In this study, two mothers of children with congenital deafness reported that their children had bilateral cochlear implants and successfully entered a rehabilitation institution, relying solely on government subsidy policies. The parents have benefited significantly from the national healthcare policy, which has substantially alleviated their financial burden, increased their confidence in treatment, and fostered a high level of post-traumatic growth experience. Concurrently, emotional support and encouragement from family and friends have enhanced the parents' ability to cope with stress, motivated them to adopt a positive outlook, reduced the impact of negative emotions, and fostered a new philosophy of life, which is in line with the results of previous studies [28]. Social support plays a crucial role in buffering and regulating an individual's stress response, not only promoting early stage post-traumatic growth but also facilitating its long-term development [29]. Therefore, medical staff should inform other family members of the child about the importance of good social support for the mental health of the child's parents and the improvement of the child's treatment and recovery effects, and call on them to provide corresponding emotional and material support to the child's parents. The government should introduce more preferential policies for deaf children and their families, such as medical subsidies, educational grants, rehabilitation subsidies, etc., to reduce the economic burden on families. Strengthen legal protections to ensure that deaf children and their families enjoy equal rights and interests in employment, education, medical care, etc. Encourage the child's parents to actively seek financial support from the disabled association and the government. For economically disadvantaged families, help them obtain support from public welfare foundations, charitable organizations, government departments, etc., to achieve early auditory intervention for children with congenital deafness. At the same time, provide continuous care services for the child's parents after discharge, achieve a better transition from hospital to home recovery, and make the child's parents feel the care and support of medical staff during home recovery. Establish a community support network for the child's parents, the community should become an important support force for deaf children's families. Through organizing various activities, such as parent-child activities, rehabilitation lectures, experience sharing meetings, etc., to enhance communication and cooperation among deaf children's families. By using media publicity, charity events, etc., a tolerant and understanding social atmosphere can be created, raising public awareness and sense of identification with deaf children and their families, making them feel the warmth and care of society, thereby facilitating their post-traumatic growth.\u003c/p\u003e \u003cdiv id=\"Sec34\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study only interviewed parents of children from the same hospital, with a relatively homogenous sample source, potentially limiting the reference value of the research. Furthermore, due to the influence of the traditional Chinese concept of family, mothers bear the main task of caring for their children, and we seldom meet the fathers of children in hospitals. Therefore, the majority of interviewees were mothers of children, with only 3 fathers included, leading to insufficient representativeness of the sample and an inability to clearly distinguish and compare the roles of fathers and mothers in the traumatic growth experience. Future research could include more fathers of sick children to further explore the authentic experiences of fathers during post-traumatic growth.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this study, we conducted semi-structured interviews with parents of 15 children with congenital deafness and concluded that the post-traumatic growth experiences of parents of children with congenital deafness included six themes: change in outlook on life, enhancement of health concepts, increased personal strength, change in relationships with others, perception of social support, and positive coping styles. Medical staff should guide the parents from a positive perspective, develop targeted interventions to relieve their psychological stress, enhance their sense of self-efficacy, and promote positive coping and post-traumatic growth, thereby promoting the quality of life and well-being of the children and their parents.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the participants in this study for sharing their experiences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWT and ZCC designed the study, WT, ZCC and ZCJ collected data. WT, ZBX, ZCC, LP, and CYY analyzed the data. WT and ZCC wrote the original draft. ZBX and LP review \u0026amp; editing the manuscript. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo founding was obtained for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo datasets were generated or analysed during the current study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki. We confirm that all methods were performed in accordance with the relevant guidelines and regulations. Ethical approval was granted by the Ethics Committee of the First Affiliated Hospital of Anhui Medical University (Approval:No. PJ2023-13-56).Informed consent was signed by each participant before being interviewed and was coded to maintain anonymity\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent for publication was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eRenauld JM, Basch ML. Congenital Deafness and Recent Advances Towards Restoring Hearing Loss. Curr Protoc. 2021,1:e76.\u003c/li\u003e\n\u003cli\u003eCozza A, Di Pasquale Fiasca VM, Martini A. Congenital Deafness and Deaf-Mutism: A Historical Perspective. Children (Basel). 2023,11:51.\u003c/li\u003e\n\u003cli\u003eLi J-N, Chen S, Zhai L, Han D-Y, Eshraghi AA, Feng Y, et al. The Advances in Hearing Rehabilitation and Cochlear Implants in China. Ear Hear. 2017,38:647\u0026ndash;52.\u003c/li\u003e\n\u003cli\u003eTopcu O, Senli FD, Batuk MO, Kilic S, Sennaroglu G. Social competence in children with cochlear implants: is it possible to catch up with their peers? Eur Arch Otorhinolaryngol. 2021,278:2775\u0026ndash;80.\u003c/li\u003e\n\u003cli\u003ePavani F, Bottari D. Neuroplasticity following cochlear implants. Handb Clin Neurol. 2022,187:89\u0026ndash;108.\u003c/li\u003e\n\u003cli\u003eJean YQ, Mazlan R, Ahmad M, Maamor N. Parenting Stress and Maternal Coherence: Mothers With Deaf or Hard-of-Hearing Children. Am J Audiol. 2018,27:260\u0026ndash;71.\u003c/li\u003e\n\u003cli\u003eWang F, Zhang S, Liu C, Ni Z. Post-traumatic growth and influencing factors among parents of premature infants: a cross-sectional study. BMC Psychol. 2023,11:388.\u003c/li\u003e\n\u003cli\u003eTedeschi RG, Calhoun LG. The Posttraumatic Growth Inventory: measuring the positive legacy of trauma. J Trauma Stress. 1996,9:455\u0026ndash;71.\u003c/li\u003e\n\u003cli\u003eKoliouli F, Issari P, Andrianakou M. Lived experiences, perceived positive outcomes, and post-traumatic growth among parents with children with epilepsy: A qualitative study. Epilepsy Behav. 2022,134:108862.\u003c/li\u003e\n\u003cli\u003eBeckmann NB, Dietrich MS, Hooke MC, Gilmer MJ, Akard TF. Parent Caregiving Experiences and Posttraumatic Growth Following Pediatric Hematopoietic Stem Cell Transplant. J Pediatr Oncol Nurs. 2021,38:242\u0026ndash;53.\u003c/li\u003e\n\u003cli\u003eGunjawate DR, Ravi R, Driscoll C. Stress among Parents of Children with Hearing Loss and How They Deal with It: A Systematic Review. Int Arch Otorhinolaryngol. 2023,27:e166\u0026ndash;77.\u003c/li\u003e\n\u003cli\u003eContinisio GI, D\u0026rsquo;Errico D, Toscano S, Maldonato NM, De Falco R, Nunziata F, et al. Parenting Stress in Mothers of Children with Permanent Hearing Impairment. Children. 2023,10:517.\u003c/li\u003e\n\u003cli\u003eTedeschi RG, Calhoun LG. TARGET ARTICLE: \u0026ldquo;Posttraumatic Growth: Conceptual Foundations and Empirical Evidence.\u0026rdquo; Psychological Inquiry. 2004,15:1\u0026ndash;18.\u003c/li\u003e\n\u003cli\u003eSanders C. Application of Colaizzi\u0026rsquo;s method: interpretation of an auditable decision trail by a novice researcher. Contemp Nurse. 2003,14:292\u0026ndash;302.\u003c/li\u003e\n\u003cli\u003eLu W, Xu C, Hu X, Liu J, Zhang Q, Peng L, et al. The Relationship Between Resilience and Posttraumatic Growth Among the Primary Caregivers of Children With Developmental Disabilities: The Mediating Role of Positive Coping Style and Self-Efficacy. Front Psychol. 2022,12:765530.\u003c/li\u003e\n\u003cli\u003eBalakrishnan S, Thangaraj M. Parental Support for Post Operative Intervention of Children with Cochlear Implantation. Indian J Otolaryngol Head Neck Surg. 2023,75:1958\u0026ndash;67.\u003c/li\u003e\n\u003cli\u003eGuo L-Y, Sun H, Hu M, Jiang Y-H, Luo Z-H. Mental health status of parents of young patients with high myopia. J Int Med Res. 2020,48:300060519873474.\u003c/li\u003e\n\u003cli\u003eFaghani F, Choobforoushzadeh A, Sharbafchi MR, Poursheikhali H. Effectiveness of mindfulness-based supportive psychotherapy on posttraumatic growth, resilience, and self-compassion in cancer patients: A pilot study. Wien Klin Wochenschr. 2022,134:593\u0026ndash;601.\u003c/li\u003e\n\u003cli\u003eLi N, Cheng H, Lv L. The relationship between posttraumatic growth, self-efficacy, and social support in burn patients: A cross-sectional study. Burns. 2022,48:1626\u0026ndash;31.\u003c/li\u003e\n\u003cli\u003eLu W, Xu C, Hu X, Liu J, Zhang Q, Peng L, et al. The Relationship Between Resilience and Posttraumatic Growth Among the Primary Caregivers of Children With Developmental Disabilities: The Mediating Role of Positive Coping Style and Self-Efficacy. Front Psychol. 2021,12:765530.\u003c/li\u003e\n\u003cli\u003eJian Y, Hu T, Zong Y, Tang W. Relationship between post-traumatic disorder and posttraumatic growth in COVID-19 home-confined adolescents: The moderating role of self-efficacy. Curr Psychol. 2023,42:17444\u0026ndash;53.\u003c/li\u003e\n\u003cli\u003eFeng Y, Zhou X, Qin X, Cai G, Lin Y, Pang Y, et al. Parental self-efficacy and family quality of life in parents of children with autism spectrum disorder in China: The possible mediating role of social support. Journal of Pediatric Nursing. 2022,63:159\u0026ndash;67.\u003c/li\u003e\n\u003cli\u003eWu C, Liu Y, Ma S, Jing G, Zhou W, Qu L, et al. The mediating roles of coping styles and resilience in the relationship between perceived social support and posttraumatic growth among primary caregivers of schizophrenic patients: a cross-sectional study. BMC Psychiatry. 2021,21:58.\u003c/li\u003e\n\u003cli\u003eFarhadi A, Bahreini M, Moradi A, Mirzaei K, Nemati R. The predictive role of coping styles and sense of coherence in the post-traumatic growth of mothers with disabled children: a cross-sectional study. BMC Psychiatry. 2022,22:708.\u003c/li\u003e\n\u003cli\u003eHe M, Shi B, Zheng Q, Gong C, Huang H. Posttraumatic Growth and its Correlates Among Parents of Children With Cleft Lip and/or Palate. Cleft Palate Craniofac J. 2024,61:110\u0026ndash;8.\u003c/li\u003e\n\u003cli\u003eDu N, Wang Y, Huang Y-T. Parental Depression and Self-Stigma Among Chinese Young People Living With Depression: A Qualitative Study. Qual Health Res. 2024,:10497323241232352.\u003c/li\u003e\n\u003cli\u003eZhang Y, Tang R, Bi L, Wang D, Li X, Gu F, et al. Effects of family-centered positive psychological intervention on psychological health and quality of life in patients with breast cancer and their caregivers. Support Care Cancer. 2023,31:592.\u003c/li\u003e\n\u003cli\u003eXiong T, McGrath PJ, Stewart SH, Bagnell A, Kaltenbach E. Risk and protective factors for posttraumatic stress and posttraumatic growth in parents of children with intellectual and developmental disorders. Eur J Psychotraumatol. 2022,13:2087979.\u003c/li\u003e\n\u003cli\u003eMeral B, Bulut HK. Predictors of Moderate-High Posttraumatic Growth in Parents of Children With Cancer: A Cross-sectional Study. Cancer Nurs. 2024.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Congenital deafness, Parents of children, Post-traumatic growth, Qualitative research","lastPublishedDoi":"10.21203/rs.3.rs-4936424/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4936424/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eHearing disability is the most common of the five major disabilities in China, and hearing disability seriously affects human health and quality of life. A child's diagnosis of deafness is an intensely traumatic event for parents, who have to bear multiple pressures and burdens in the process of caring for their child. However, it is crucial for parents to draw good meanings from the traumatic incident and to create new insights into life, which is important for their own physical and mental health and that of their child.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eUsing purposive sampling, 15 parents of congenitally deaf children admitted to the Department of Otolaryngology, Head and Neck Surgery of a tertiary-level hospital in Hefei City from April to July 2023 were selected for semi-structured interviews, and Colaizzi's seven-step analysis method was applied to analyze the data and refine the themes.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eSix main themes and fourteen sub-themes were summarized in this study: (1) changes in outlook on life, (2) enhancement of health concepts, (3) increased personal strength, (4) change in relationships with others, (5) perceived social support, and (6) positive coping styles.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eParents of children with congenital deafness can experience multifaceted growth in the process of caregiving. Medical staff should pay full attention to the psychological experience of parents of children with congenital deafness, explore their strengths and potentials, increase the degree of social support, and promote coping positively with the level of post-traumatic growth, to enhance the quality of care and the rehabilitation effect of the children.\u003c/p\u003e","manuscriptTitle":"Post-traumatic growth experiences of parents of children with congenital deafness: a qualitative study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-04 06:20:27","doi":"10.21203/rs.3.rs-4936424/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"12785125-4109-4378-89f2-37ba3a095c8c","owner":[],"postedDate":"October 4th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-13T09:08:19+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-04 06:20:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4936424","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4936424","identity":"rs-4936424","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}