Predictors of filial responsibility toward older parents: A cross-sectional study of Iranian adults

Predictors of filial responsibility toward older parents: A cross-sectional study of Iranian adults | 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 Predictors of filial responsibility toward older parents: A cross-sectional study of Iranian adults Leila Tagharrobi, Zahra Tagharrobi, Nasibeh Zanjari, Ahmad Delbari, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8223986/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Filial responsibility toward older parents impacts the quality of family relationships, the quality of elder care, the reluctance to send older adults in nursing facilities, and the health and care costs imposed on governments. This study aimed to examine this phenomenon and its predictors in a group of Iranian adults. In this cross-sectional study, 500 adults were selected through multistage random sampling in 2025 in Kashan, Iran. Data were collected using the Persian version of the Filial Responsibility Scale (P-FRS) and a questionnaire on potential predictors. Data were analyzed using SPSS-22 with One-Way ANOVA, Independent t-test, Pearson and Spearman–Brown correlation coefficients, and multiple linear regression. The mean filial responsibility score was 51.69 ± 6.35 (95% CI: 51.13–52.25). The simultaneous presence of three variables—degree of opposition to institutionalization of older parents, psychological well-being, and age—was significant (R² = 0.088, F = 15.982, p < 0.0001). Greater opposition to institutionalization of older parents (Beta = 0.228) and better psychological well-being (Beta = 0.120) were associated with higher filial responsibility; while older age (Beta = − 0.148) was associated with lower filial responsibility. The filial responsibility score toward older parents was relatively high. Health policy planners in the field of geriatric care should consider age, psychological well-being, and attitudes toward nursing facilities when designing effective interventions to enhance filial responsibility in adults. It is recommended that future investigations of this phenomenon not rely solely on attitude assessments and self-report methods, but also incorporate objective measurement tools. Filial Responsibility Older Parent Adult Iran Background Declining functional capacity, increasing incidence of chronic diseases, and greater care needs in the elderly heighten their dependence on others, particularly their children(Dziechciaż & Filip, 2014 ). Adult children are identified as the primary source of care for aging parents(Aghajani et al., 2018 ). It is estimated that more than half of individuals aged 50 and older undertake the responsibility of caring for their older parents(hosseinabbasi & Aghaamiri, 2023 ), and such unpaid services annually result in billions of dollars in government cost savings(Kaufman et al., 2024). The relationship between adult children and older parents is considered one of the most important and complex forms of reciprocal family relationships(Aggarwal et al., 2017 ). With increasing life expectancy, the duration of reciprocal interaction between adult children and aging parents is rising substantially(Bao et al., 2022 ). Moreover, alongside the growth in the elderly population and declining birth rates, the number of caregiving children is decreasing(Wongkongdech et al., 2024). Therefore, maintaining and improving this reciprocal relationship is of great importance. Among the factors that can help preserve and enhance the relationship between adult children and elderly parents, and greatly prevent the institutionalization of older adults, is the commitment of adult children to the concept of filial responsibility toward their aging parents(Aires, Mocellin, et al., 2019 ). Filial responsibility reflects the obligations that define the social role of adult children in caring for their parents throughout the aging process(Gans & Silverstein, 2006 ). Filial responsibility has been introduced as a norm across various societies and cultures(Phillips et al., 2010 ) and, regardless of the benefits it brings to older parents and society(Aires, Dal Pizzol, et al., 2019 ), existing evidence indicates that it often yields positive outcomes for adult children, such as a sense of pride(Wang et al., 2023 ) and psychological well-being(Liu et al., 2020). Filial responsibility is dynamic and influenced by certain social factors(Liu et al., 2024 ). In Asian countries, cultural expectations dictate that elderly individuals should be cared for by their family members(Aghajani et al., 2018 ). Iran, as an Asian country, is culturally influenced by Islamic perspectives. In Islam, numerous recommendations emphasize kindness and devotion to one’s parents(Aghajani et al., 2018 ). Consequently, for Iranian families, providing in-home care for aging parents has long been considered an undeniable duty(Abdollahpour et al., 2012). However, in recent years, social changes—such as increasing individualism, migration of children to large cities, economic challenges, smaller housing spaces, declining birth rates, and the growing tendency of women to work outside the home—may have altered perceptions, attitudes, and behaviors related to filial responsibility in various societies, including Iran(Aghajani et al., 2018 ; Aires, Pizzol, et al., 2017 ). It is evident that over time, a shift in attitudes toward filial responsibility may lead to an increase in the institutionalization of elderly parents, resulting in dissatisfaction and lower quality of life among older adults(Aires, Mocellin, et al., 2019 ), as well as creating challenges for families and societies, including imposing substantial financial burdens on both families and governments(Kaufman et al., 2024). To prevent or at least mitigate the secondary problems arising from these attitudinal and behavioral changes toward filial responsibility for older parents, it is essential to plan and provide the necessary infrastructure for appropriate elder care by adult children and to strengthen their sense of responsibility. The first step in this regard is to assess the current status of filial responsibility and the factors in the adult population. Some studies have examined the status of filial responsibility and certain related factors, such as life satisfaction, psychological well-being, opposition to institutionalization of the older adults, gender, and number of children(Aires, Mocellin, et al., 2017 ; Leung & Shek, 2024 ; Miyawaki, 2017; Mocellin et al., 2019; Van der Pas et al., 2005). Some of these studies have even reported contradictory findings(Funk et al., 2013 ; Pan et al., 2022 ). To the best knowledge, no study has yet addressed this topic specifically in Iran; however, some investigations have explored related issues, such as family social support for older parents or parental expectations of their children(Nouri & Farsi, 2018 ; Shamsikhani et al., 2021 ). Overall, although some findings have suggested that the status of filial responsibility toward older parents, or characteristics associated with it, is at a moderate or relatively desirable level in certain societies(Miyawaki, 2017), the influence of time and ongoing changes in social structure make it an undeniable necessity to examine this phenomenon. Therefore, given the limited number of related studies in recent years, negligence of this subject by researchers in the field of geriatric health in Iran, and the presence of contradictory findings in related research, the present study was conducted to investigate the status of filial responsibility toward older parents and its predictors in a group of Iranian adults. Methods Study design and sampling This cross-sectional study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement(von Elm et al., 2007 ). The study population comprised adults aged 18 years and older who were covered by urban comprehensive health centers affiliated with Kashan University of Medical Sciences in 2025. The sample size was calculated using Cochran’s formula, based on a standard deviation of 2.7(Aires, Mocellin, et al., 2017 ) and a margin of error of 0.27 (10% of the standard deviation), yielding an estimated 384 participants. To account for a 9% nonresponse rate and a design effect of 1.2, the final sample size was set at 500 participants. Considering the importance of the age variable (Older adults vs. non- older adults), 250 participants were allocated to each of two age groups: under 60 years and 60 years and older. Inclusion criteria were age 18 years or older, Iranian nationality, ability to communicate in Persian, no severe psychiatric disorders and cognitive impairment as documented in the individual’s health center records, having at least one living elderly parent for participants under 60 years, and having at least one living adult child for participants aged 60 years or older. Exclusion criteria included non-cooperation, withdrawal during questionnaire completion, and incomplete completion of the Filial Responsibility Scale. A multistage random sampling method was employed. The city of Kashan was stratified into five socioeconomic levels: poor, lower-middle, upper-middle, good, and very good. From each stratum, three urban comprehensive health centers were randomly selected as clusters. Within each cluster, quota sampling was performed according to age group (under 60 years and 60 years or older). Within each age group, participants were randomly selected in proportion to the eligible population covered by each center and the required sample size. In cases of non-cooperation, another individual from the same center and age group was randomly selected. Data collection After obtaining permission from the Department of Research at Tehran University of Social Welfare and Rehabilitation Sciences and Kashan University of Medical Sciences, sampling was conducted over a two-month period from early January 2025 to early March 2025 at the selected urban comprehensive health centers. The first author (T. L.) made arrangements with the managers of each selected center, compiled a list of eligible individuals for each of the two age groups (under 60 years and 60 years or older), and contacted the selected participants by telephone. After explaining the study objectives, confirming eligibility, and obtaining verbal consent, arrangements were made for an in-person meeting at a location of the participant’s choice (home, health center, park, etc.). During the in-person meeting, written informed consent was obtained, and both the questionnaire on potential predictors and the Persian version of the Filial Responsibility Scale were completed. A unique identification code was assigned to each participant. For individuals who were illiterate, semi-literate, or visually impaired, the questionnaires were administered through face-to-face interviews conducted by the first author. Measurement instruments Questionnaire on potential predictors of filial responsibility : The questionnaire comprised 21 variables, including: gender, education level, education in religious sciences, employment status, spouse’s employment status, marital status, having children, basic and supplementary health insurance coverage, economic status, housing status, living arrangements, known underlying disease, opinion regarding placement of older parents in long-term care facilities, age, number of children (daughters and sons), ability to perform activities of daily living, level of religious beliefs, and psychological well-being. Content validity was confirmed by a panel of 10 faculty members specializing in gerontology, geriatric nursing, psychology, and sociology. Reliability was assessed using a test–retest method (20 adults, two-week interval). Agreement for quantitative variables was calculated using the intraclass correlation coefficient (ICC), and for categorical variables using Cohen’s kappa. For personal variables, all responses were identical in both tests; the ICC for other quantitative variables was at least 0.89, and the kappa for categorical variables was at least 0.92. Psychological well-being, as a potential related factor, was measured using the five-item World Health Organization Well-Being Index (WHO-5), which includes five statements scored from 0 to 5. This tool assesses mental well-being on a scale of 0 to 25, with higher scores indicating better well-being. The content validity of the Persian version of this instrument has been confirmed, and its reliability has been reported as 0.89(Dehshiri & Mousavi, 2016 ). In the present study, its reliability was calculated with a Cronbach’s alpha coefficient of 0.915. Persian version of the filial responsibility scale (P-FRS): The original instrument was developed in 1990 by Hamon and Blieszner in Pennsylvania in English, consisting of 16 items to assess filial responsibility toward aging parents(Hamon & Blieszner, 1990). The Persian version (P-FRS) was translated and culturally adapted by Tagharrobi et al. ( 2025 ). The P-FRS contains 15 items across two subscales: “socio-emotional responsibilities” (9 items) and “physical responsibilities” (6 items). Each item is rated on a 4-point Likert scale from 1 (strongly disagree) to 4 (strongly agree). The tool measures filial responsibility toward older parents within a range of 15 to 60, with higher scores indicating higher levels of filial responsibility. The Persian version’s validity was verified through factor analysis and known-group comparison, and its internal consistency was confirmed using Cronbach’s alpha and McDonald’s omega coefficients, reported as 0.912(Tagharrobi et al., 2025 ). Data analysis The collected data were analyzed using SPSS v.22. The filial responsibility score was determined on a 15–60 scale and its range was estimated in the target population with 95% confidence. To assess data normality, skewness and kurtosis were used (a range of ± 2 was considered indicative of normality). Stepwise multiple linear regression analysis was employed to prioritize the questionnaire components—that is, to examine the contribution of each dimension of “socio-emotional responsibilities” and “physical responsibilities” to filial responsibility. To identify predictors, the factors were analyzed in two stages. First, univariate analysis was performed for each variable separately; to examine the relationship of filial responsibility or its dimensions with categorical variables, the independent t-test or one-way ANOVA was used, and to assess the relationship of filial responsibility or its dimensions with quantitative variables, Pearson or Spearman correlation coefficients were applied. For a more precise evaluation of relationships and to determine the contribution of each factor in explaining the filial responsibility score or each of its dimensions, stepwise multiple linear regression analysis was performed; in this stage, variables with a p-value < 0.2 in the univariate analysis were entered into the model as independent variables, and the filial responsibility score or its dimensions were entered as dependent variables. To address the multicollinearity problem, among the three variables of number of children, number of daughters, and number of sons, the number of sons was not included in the model (p < 0.05). Results Out of a total of 500 individuals, two questionnaires were excluded due to incomplete responses, and the data of 498 adults (249 individuals in each of the age groups under 60 and 60 years and older) were analyzed. The participants’ ages ranged from 18 to 99 years, with a mean of 54.47 ± 16.20 years. Of these, 38.2% were male and 12.2% were without children [Table 1 ]. Table 1 Background characteristics of the samples, Kashan, 2025 Categorized Variables (n = 498) n (%) Gender Male 190 (38.2) Female 308 (61.8) Education No Formal Education 48 (9.6) Basic Literacy (able to read and write) 46 (9.2) Primary School 99 (19.9) Middle School 54 (10.8) High School 92 (18.5) Associate or Bachelor's degree 119 (23.9) Master’s degree or higher 40 (8) Economic Status Low 44 (8.8) Lower-middle 117 (23.5) Average 268 (53.8) Upper-middle 64 (12.9) High 5 (1) Housing Situation Owned 409 (82.1) Rented 38 (7.6) Organizational 2 (0.4) Relative’s Home 49 (9.8) Employment Status Full-Time Employee (Government or Private Sector) 68 (13.7) Part-Time Employee (Government or Private Sector) 34 (6.8) Retired 109 (21.9) Unemployed (Seeking Work) 5 (1) Disabled / Unable to Work 5 (1) Self-Employed 57 (11.4) Homemaker 220 (44.2) Known Underlying Health Conditions Yes 238 (47.8) No 260 (52.2) Living Arrangements Alone 35 (7) with Spouse 135 (27.1) with Children 39 (7.8) with At least One Parent 38 (7.6) with Spouse and at least One Parent 3 (0.6) With Spouse and Child and at least One Parent 3 (0.6) with Spouse and Child and at least One Parent of Spouse 3 (0.6) with Child and at least One Parent 2 (0.4) with Spouse and Children 239 (48) with other Relatives 1 (0.2) Marital Status Married 386 (77.5) Never Married 36 (7.2) Divorced 15 (3) Widowed 61 (12.2) Having Children Yes 437 (87.8) No 61 (12.2) Employment Status of Spouse (N = 386) Full-Time Employee (Government or Private Sector) 52 (10.4) Part-Time Employee (Government or Private Sector) 30 (6) Retired 92 (18.5) Unemployed (Seeking Work) 0 Disabled / Unable to Work 4 (0.8) Self-Employed 78 (15.7) Homemaker 130 (26.1) Basic Health Insurance Status Yes 472 (94.8) No 26 (65.3) Supplementary Health Insurance Status Yes 325 (65.3) No 173 (34.7) Decision to Place Older Parents in a Nursing Home Strongly Agree 8 (1.6) Agree 14 (2.8) Neutral 39 (7.8) Disagree 82 (16.5) Strongly Disagree 355 (71.3) Quantitative Variables Mean ± SD Age (years) 54.16 ± 47.20 Number of Children (n) 2.2 ± 98.24 Number of Daughters (n) 1.1 ± 56.44 Number of Sons (n) 1.1 ± 43.39 Ability To Perform ADLs (1 to 5) 4.0 ± 81.64 Religious Beliefs (1 to 5) 4.1 ± 16.08 Mental Well-Being (1 to 5) 14.5 ± 18.93 The filial responsibility score among the studied adults, on a 15–60 scale, was 51.69 ± 6.35, which, with 95% confidence, was between 51.13 and 52.25 in the target population. The subscale score for “socio-emotional responsibilities” (on a 9–36 scale) was 32.14 ± 3.64, and the subscale score for “physical responsibilities” (on a 6–24 scale) was 19.55 ± 3.36. Regarding prioritization of the domains of the filial responsibility questionnaire, stepwise linear regression showed that the two domains of “socio-emotional responsibilities” and “physical responsibilities” explained 83.5% and 16.5% of the variance in the filial responsibility score, respectively. The item “Children who live away from their older parents should be in contact with them at least once a week” received the highest score, while the item “When older parents are unable to care for themselves, they should be able to live with one of their children” received the lowest score [Table 2 ]. Table 2 Descriptive indices of the statements of filial responsibility scale in adults visiting comprehensive health centers- Kashan 2025 (n = 498) Subscale Statement Alternatives n (%) Mean ± SD Completely disagree Disagree Agree Completely agree Socio-emotional responsibilities Adult children who live away from their parents (more than 40 kilometers/40 minutes) should be in contact with their parents at least once a week (by telephone call/video call). 4 (8) 10 (2) 139 (27.5) 345 (69.3) 3.66 ± 0.56 If adult children live near their parents after growing up, they should visit their parents at least once a week. 5 (1) 9 (1.8) 144 (28.9) 340 (68.3) 3.64 ± 0.57 Adult children should feel responsible towards their elderly parents (they should provide any help when parents need it) 1 (0.2) 9 (1.8) 157 (31.5) 331 (66.5) 3.64 ± 0.53 Adult children should support their parents emotionally 0 6 (1.2) 164 (32.9) 328 (65.9) 3.65 ± 0.5 Elderly parents and adult children should be together during holidays and special occasions (birthdays and anniversaries). 2 (0.4) 14 (2.8) 188 (37.8) 294 (59) 3.55 ± 0.657 Adult children should help their parents to learn about and use the services they are entitled to (such as health insurance and health care services) if needed. 0 5 (1) 205 (41.2) 288 (57.8) 3.57 ± 0.52 When parents are sick, adult children should take care of them by any means necessary 1 (0.2) 25 (5) 206 (41.4) 266 (53.4) 3.48 ± 0.60 Elderly parents should be able to talk with their adult children about important personal issues that affect their lives significantly. 0 24 (41.6) 207 (41.6) 267 (53.6) 3.49 ± 0.59 Adult children should give advice to their elderly parents if needed. 1 (0.2) 14 (2.8) 239 (49) 244 (49) 3.46 ± 0.56 Physical responsibilities When elderly parents are not able to take care of themselves, they should be able to live with one of their adult children. 14 (2.8) 93 (18.7) 195 (39.4) 196 (39.4) 3.15 ± 0.82 In case of emergency, adult children should provide a place (a room) for elderly parents in their home. 15 (3) 79 (15.9) 209 (42) 195 (39.2) 3.17 ± 0.80 Adult children should organize their work schedule to help their elderly parents if needed 3 (0.6) 48 (9.6) 218 (43.8) 229 (46) 3.35 ± 0.68 Adult children should arrange their family plans to be able to help their elderly parents if needed 3 (0.6) 26 (5.2) 236 (47.4) 233 (46.8) 3.4 ± 0.62 Adult children should be ready to sacrifice some of their personal freedoms to take care of their elderly parents if needed. 8 (1.6) 56 (11.2) 235 (47.2) 199 (40) 3.26 ± 0.72 Adult children should help their parents financially 6 (1.2) 78 (15.7) 216 (43.4) 198 (39.8) 3.22 ± 0.75 Total score (15–60) 51.69 ± 6.35 Socio-emotional responsibilities score (9–36) 32.14 ± 3.64 Physical responsibilities score (6–24) 19.55 ± 3.36 The filial responsibility score in the two age groups, under 60 years and 60 years and older, was 52.64 ± 5.97 and 50.74 ± 6.59, respectively, which were significantly different (p = 0.001). The socio-emotional responsibilities score was significantly higher in the group under 60 years (32.46 ± 3.43) compared to the elderly group (31.82 ± 3.82) (p = 0.047). A similar difference was observed for the physical responsibility’s subscale (20.18 ± 3.00 versus 18.92 ± 3.59; p < 0.0001). Univariate analysis showed a significant relationship between filial responsibility and the variables of education, occupation, spouse’s occupation, marital status, having children, having basic insurance, having supplementary health insurance, economic status, opinion regarding institutionalization of older parents, age, number of children, and psychological well-being status [Table 3 ]. Table 3 Filial responsibility score based on potential predictors in adults, Kashan, 2025 (n = 498) A: Filial responsibility score based on categorized variables Variable Categories Filial responsibility score SD ± mean F or t-value p-value Gender Female 51.44 ± 6.25 a-1.121 0.263 Male 52.09 ± 6.50 Education Illiterate (A) 51.04 ± 6.51 b-3.096 0.006 Pairwise comparison c Reading writing literacy (B) 50.07 ± 7.23 A,D 0.008 B,E 0.019 Elementary school (C) 50.30 ± 6.49 B,G 0.011 Junior high school (D) 53.41 ± 6.25 C,D 0.004 High school (E) 52.74 ± 5.54 C,E 0.008 Associate and bachelors’ degree (F) 51.52 ± 6.28 Masters’ degree and higher (G) 53.53 ± 5.83 Religious education Positive 51.31 ± 6.55 a-0.241 0.81 Negative 51.70 ± 6.35 Occupation Full-time employment (public or private sector) (A) 52.01 ± 6.56 d-18.38 < 0.0001 Pairwise comparison e A,E < 0.001 Part-time employment (public or private sector) (B) 52.03 ± 6.03 B,E < 0.001 C,E < 0.001 Retired (C) 50.75 ± 6.59 A,E < 0.001 Unemployed (seeking job) (D) 48.60 ± 8.35 Unable to work (E) 59.00 ± 1.41 E,F < 0.001 Self-employed (F) 53.61 ± 5.60 E,G < 0.001 Housewife (G) 51.40 ± 6.26 Spouse’s employment status Full-time employment (public or private sector) (A) 53.27 ± 5.73 b-3.02 0.011 Pairwise comparison f A,E 0.001 B,E 0.011 Part-time employment (public or private sector) (B) 52.43 ± 5.01 E,C 0.017 E,G 0.002 Retired (C) 50.92 ± 6.32 F,E 0.010 Unable to work (E) 42.25 ± 7.80 Self-employed (F) 51.44 ± 6.18 Housewife (G) 52.04 ± 6.44 Marital status Married (A) 51.75 ± 6.26 b-2.70 0.045 Pairwise comparison c Never married (B) 53.36 ± 6.63 A,D 0.040 Divorced (C) 53.27 ± 7.01 B,D 0.011 Widowed (D) 49.95 ± 6.32 Having children Positive 51.51 ± 6.30 a-1.638 0.102 Negative 52.93 ± 6.61 Basic insurance coverage Positive 51.60 ± 6.38 a-1.368 0.172 Negative 53.35 ± 5.65 Supplementary insurance Positive 51.11 ± 6.63 a-2.917 0.004 Negative 52.77 ± 5.65 Financial status Low(A) 53.55 ± 0.88 x-3.929 0.012 Pairwise comparison e Average and below (B) 50.68 ± 6.04 B,D 0.021 Average (C) 51.34 ± 6.62 Average and higher (D) 53.45 ± 5.64 High (E) 55.00 ± 5.00 Residence House owner 5.158 ± 6.36 b-0.457 0.712 Rental 52.42 ± 5.76 Employees’ housing 48.50 ± 9.19 Living in a relative’s house 52.14 ± 6.71 Living with Alone 50.40 ± 6.74 b-1.537 0.132 Spouse 51.11 ± 6.88 Children 49.95 ± 6.14 Parent(s) 53.84 ± 6.61 Spouse and children 53.67 ± 1.53 Spouse, children, and parent(s) 54.33 ± 8.14 Spouse, children, and spouse’s parent(s) 51.67 ± 5.51 Children and parent(s) 47.00 ± 7.07 spouse and children 52.13 ± 5.91 Other relatives 56.00 Diagnosed background diseases Positive 51.26 ± 6.58 a-1.455 0.146 Negative 52.08 ± 6.12 Opinion about institutionalization of older parents Completely agree (A) 51.13 ± 7.99 d-11.164 < 0.0001 Pairwise comparison e Agree (B) 47.50 ± 8.54 C,E 0.002 No idea (C) 48.87 ± 5.82 Disagree (D) 48.84 ± 5.43 D,E 0.001 Completely disagree 52.83 ± 6.13 D,C 0.225 Note: a : independent t -test b : F ANOVA c : post hoc (LSD) post hoc (Gabriel) f post hoc (Games-Howell) e d : welch statistic/ANOVA * Only significant figures in pairwise comparison are listed B: Correlation of filial responsibility score with quantitative variables Variable r values p-value Age (year) a-0.144 0.001 Number of children a-0.096 0.032 Number of children (daughters) a-0.080 0.073 Number of children (boys) a-0.073 0.1 Ability to do everyday activities (1–5 scale) b-0.041 0.361 Religious beliefs level (1–5 scale) a-0.085 0.057 psychological well-being status based on wellbeing scale (0–25 scale) a-0.116 0.010 Note: a: Pearson coefficient b: Spearman Stepwise multiple linear regression analysis showed that the simultaneous presence of three variables—degree of opposition to institutionalization of older parents, psychological well-being status, and age—was significant in the model (F = 15.982, p < 0.001) and explained 8.8% of the variance observed in the filial responsibility score. The greatest contribution belonged to the degree of opposition to institutionalization of older parents, which alone accounted for 5.5% of the variance. The model indicated that for each standard deviation increase in the degree of opposition to institutionalization of older parents, the filial responsibility score would increase by 0.23 standard deviations; for each standard deviation increase in psychological well-being score, the filial responsibility score would increase by 0.12 standard deviations; and for each standard deviation increase in age, the filial responsibility score would decrease by 0.15 standard deviations [Table 4 ]. Table 4 Multiple linear regression analysis to determine predictors of filial responsibility in adults Model R 2 B 95% CI B SE Beta t value P-value Lower limit Upper limit Fixed coefficient Opposition to institutionalization of older parents Age (year) Psychological wellbeing status - 0.055 0.019 0.014 4.562 5 1.649 0.058 - 0.128 4.014 2 10.37 0.091 - 0.37 4.109 9 2.261 0.025 - 0.219 1.805 0.311 0.017 0.046 - 0.228 0.148 0.120 25.235 5.297 -3.437 2.778 < 0.001 < 0.001 0.001 0.006 Note: R 2 = 0.088, F = 15.982, p < 0.0001 Univariate analysis showed a significant relationship between the socio-emotional responsibility subscale and the variables of education level (p = 0.006), spouse’s occupation (p = 0.017), economic status (p = 0.025), opinion regarding institutionalization of older parents (p < 0.001), and psychological well-being (p = 0.003, r = 0.132). Multiple linear regression analysis reported that the simultaneous presence of two variables—degree of opposition to institutionalization of older parents and psychological well-being status—was significant in the model of predictors for socio-emotional responsibility (F = 11.285, p < 0.001) and explained 8.5% of the observed variance in the socio-emotional responsibility score. The greatest contribution belonged to the degree of opposition to institutionalization of older parents, which alone accounted for 4% of the variance. The model indicated that a higher degree of opposition to institutionalization of older parents (B = 0.811, SE = 0.206, p < 0.001, Beta = 0.195) and better psychological well-being (B = 0.078, SE = 0.030, p = 0.011, Beta = 0.127) were associated with higher levels of socio-emotional responsibility. Univariate analysis showed a significant relationship between the physical responsibility subscale and the variables of education level (p = 0.006), occupation (p < 0.001), spouse’s occupation (p = 0.017), supplementary insurance (p < 0.001), economic status (p = 0.025), underlying disease (p = 0.008), opinion regarding institutionalization of older parents (p < 0.001), age (r = − 0.189, p < 0.001), number of children (r = − 0.117, p = 0.009), number of sons (r = − 0.117, p = 0.009), and level of religious beliefs (r = 0.104, p = 0.020). Multiple linear regression analysis reported that the simultaneous presence of four variables—degree of opposition to institutionalization of older parents, age, level of religious beliefs, and supplementary insurance—was significant in the model of predictors for physical responsibility (F = 11.808, p < 0.001) and explained 11% of the observed variance in the physical responsibility score. The greatest contribution belonged to the degree of opposition to institutionalization of older parents, which alone accounted for 5.1% of the variance; the contributions of age, level of religious beliefs, and supplementary health insurance in the variance in physical responsibility scores were 4.3%, 1.4%, and 1.1%, respectively. The model indicated that a higher degree of opposition to institutionalization of older parents (B = 0.784, SE = 0.187, p < 0.001, Beta = 0.204) and a higher level of religious beliefs (B = 0.374, SE = 0.155, p = 0.016, Beta = 0.120) were associated with higher levels of physical responsibility, whereas increased age (B = − 0.036, SE = 0.011, p = 0.001, Beta = − 0.172) was associated with lower levels of physical responsibility. In addition, the physical responsibility score was higher in the absence of supplementary insurance (B = 0.805, SE = 0.360, p = 0.026, Beta = 0.114). Discussion The filial responsibility score in adults in Kashan ranged from 15 to 60, with a mean of 51.69 ± 6.35. There was a relatively high level of filial responsibility in this group. Iran is an Islamic country, and Islamic culture emphasizes benevolence toward parents; this is repeatedly highlighted in religious texts, including the Sahifeh Sajjadiyeh , Nahj al-Balagha , and the Holy Quran(Aghajani et al., 2018 ). Consequently, children in Iranian families tend to assume the caregiver role within their own homes to uphold the sacred duty toward older parents(Rejeh et al., 2011). All of the above may contribute to the formation of a positive attitude toward filial responsibility. However, the influence of various social factors on the phenomenon of filial responsibility over time should not be overlooked. In a qualitative study conducted by Niazi et al. ( 2023 ) to identify challenges faced by elderly individuals in Kashan, one of the reported challenges was “lack of support from children”(Niazi et al., 2023 ), which partially contrasts with the findings of the present study. It should be noted that the high filial responsibility score in this study, and its apparent discrepancy with Niazi et al.’s findings, can be explained by the nature of the instrument used. The tool measures attitudes or expectations rather than actual behaviors; therefore, the findings reflect high levels of filial responsibility attitudes but do not necessarily indicate appropriate or effective caregiving performance. Moreover, the determinants of filial responsibility are strongly influenced by cultural and social factors(Aires, Pizzol, et al., 2017 ). Although the instrument used was originally developed in the United States and culturally adapted for use in Iran, certain dimensions of filial responsibility—such as social or spiritual aspects, which are prominent in Iranian society(Tagharrobi et al., 2025 )—were not captured. The present study showed that filial responsibility scores were higher in the under-60 age group compared to older adults. In other words, increasing age predicted lower scores in overall filial responsibility as well as in the physical responsibility subscale. Based on the observations, one reason for the differences in filial responsibility attitudes between these two age groups may be the distinct roles of parents and children within the Iranian cultural context. Individuals over 60 years, as elderly parents, occupy the recipient role and tend to lower their expectations from their children, attributing fewer responsibilities to them to reduce their burden. Conversely, individuals under 60, as children, occupy the caregiver role and perceive greater obligations toward older parents who have cared for them over the years. It is plausible that when children eventually assume the role of elderly parents, they may have lower expectations and, consequently, perceive less responsibility from their own children. Consistent with our findings, Miyawaki (2017) reported that filial responsibility scores among third-generation caregivers remained strong and high compared to previous generations(Miyawaki, 2017). Contact with older parents by children who live apart held the greatest importance among the filial responsibility items in the present study. Cicirelli ( 1991 ) noted that upon reaching adolescence, communication plays a crucial role in parent–child relationships, and simple communicative behaviors such as phone calls, letter writing, or email can account for the typical interactions between children and older parents(Cicirelli, 1991 ). Contrary to the present study, a study conducted in the United States indicated that contact with parents was of lesser importance among other filial responsibility items(Hamon & Blieszner, 1990). "Living with older parents during times of incapacity" ranked lowest in importance in the present study, which aligns with Salmon (2010), who reported that elderly individuals, particularly the very old, prefer to live in their own homes(Salomon, 2010 ); increased place attachment with advancing age(Lebrusán & Gómez, 2022 ) may support this finding. The largest contribution to explaining variations in filial responsibility scores was attributed to the “socio-emotional responsibility” dimension. Socio-emotional responsibilities include regular and frequent contact, spending time with older parents, and providing necessary information to them. Evidence indicates that emotional support constitutes the most valued form of support for elderly individuals in Iran(Nazari et al., 2017 ). Consistently, multiple studies have highlighted that educating and providing informational support to older parents represents a key aspect of filial responsibility(Cheung et al., 2020 ; Collins, 2014 ; Hamon & Blieszner, 1990; Park & Kim, 2016). In the present study, “degree of opposition to institutionalization of older parents,” “psychological well-being,” and “age” were influential factors on filial responsibility scores. Among these, the greatest contribution in the predictive model of filial responsibility was related to the “degree of opposition to institutionalization of older parents.” In other words, a higher degree of opposition was associated with higher filial responsibility scores; this pattern was also observed across the two subscales of the instrument. Individuals who believe in caring for parents at home naturally exhibit more positive attitudes toward aspects of filial responsibility and strive to fulfill their obligations toward their older parents(Mehta & Leng, 2017 ). The relationship between home-based parental care and individuals’ attitudes toward filial responsibility is also emphasized in intergenerational attachment theory throughout the life course(Cicirelli, 1991 ). The findings indicated that higher psychological well-being scores predicted higher levels of filial responsibility. This association was also observed with the socio-emotional responsibility subscale. It may be argued that, in Asian countries, fulfilling filial responsibilities fosters pride and self-esteem in children(Wang et al., 2023 ), which in turn promotes psychological well-being(Cheung et al., 2022 ; Liu et al., 2020). However, since filial responsibility is a dynamic phenomenon heavily influenced by regional cultural factors(Aires, Pizzol, et al., 2017 ), this positive correlation may not be observed universally. Funk et al. ( 2013 ) reported that feelings of responsibility toward family members can be accompanied by guilt(Funk et al., 2013 ), and a study in the United States generally found a negative association between filial responsibility expectations and well-being in older parents(Seelbach & Sauer, 1977). Higher levels of religious beliefs and convictions predicted higher levels of the physical responsibility dimension. Religions such as Christianity and Islam explicitly emphasize the child’s duty not only to support older parents but also to love and respect them(Ehsani & Masoomi, 2013 ). Interestingly, these religious teachings also highlight benefits for the child in adhering to this duty, such as longevity(Ehsani & Masoomi, 2013 ). Religious recommendations and the advantages of fulfilling filial responsibilities may explain the higher physical responsibility scores observed among individuals with stronger religious beliefs. Some adult children may focus primarily on instrumental and financial support, even to meet the emotional needs of their older parents(Wang et al., 2020 ). Supplementary health insurance emerged as a predictor of physical responsibilities; specifically, it was observed that physical responsibility scores were higher among individuals whose parents lacked supplementary health insurance. Supplementary health insurance covers the high costs of medical treatments, paying either all or the majority of these expenses( https://bimeh.com/mag/what-is-supplementary-health-insurance/ ). It appears that, in the presence of such insurance, older parents may require less financial or physical support from their children, which aligns with the findings of this study. Moreover, Brody et al. (1984) demonstrated that in countries where governmental support for the elderly is substantial, elderly individuals expect less financial support from their children and prefer to receive such support from formal sources(Brody et al., 1984). It should be noted that, since filial responsibility is a dynamic phenomenon heavily influenced by cultural, socio-economic, and temporal factors(Aires, Pizzol, et al., 2017 ), some differences between the findings of the present study and other related research—beyond variations in time, location, and statistical methods—may arise from differences in the study population. Specifically, studies targeting adult children may yield results that differ from studies focusing on older parents or on both parents and children. The sufficient sample size, quota sampling from two age groups—under 60 years and older adults—diversity in participant characteristics, and the use of multiple analyses are among the strengths of the present study, contributing to the generalizability of the findings. The large regression coefficients in the model of predictors of filial responsibility indicated that multiple factors influenced the phenomenon, many of which were not addressed in the current study. Additionally, some questionnaires were completed via interviews due to illiteracy, low literacy, or visual impairments in certain participants; given the potential impact of this method on responses, the internal and external validity of the study may have been affected. Another limitation is that the questionnaire items focused on measuring attitudes and did not capture prominent aspects of filial responsibility within the Iranian cultural and social context. It is recommended that a native instrument, developed using qualitative approaches and with a focus on performance, be designed to assess filial responsibility toward older parents in different societies. In designing questionnaires for potential predictors, changes in culturally and socially relevant factors over time should also be considered. Moreover, by addressing the limitations of the present study as much as possible and with an adequate sample size, the study should be replicated separately in the two groups of older adults and adult children. Conclusion Filial responsibility among Iranian adults is relatively high. Furthermore, the variables “degree of opposition to institutionalization of older parents,” “psychological well-being,” and age were significant predictors of filial responsibility scores. The findings provide valuable insights into filial responsibility and its factors among community-dwelling older adults in Iran and serve as a prompt for international researchers in the field of aging health to address this topic. Based on the current study, planners and policymakers in the field of elderly health should prioritize the design of effective interventions to strengthen positive attitudes toward filial responsibility, particularly among individuals indifferent or favorable to institutionalization of older parents, those with lower psychological well-being, as well as younger older adults with living parents and middle-aged adults. Abbreviations P-FRS the Persian version of the Filial Responsibility Scale STROBE the Strengthening the Reporting of Observational Studies in Epidemiology Declarations Funding: This study was part of the first author’s Ph.D. dissertation in the Department of Aging at the University of Social Welfare and Rehabilitation Sciences (Thesis Number 4265, dated January 29, 2024). The research was not funded by any government, private, or non-profit organizations. Ethics approval and consent to participate Ethical considerations This study was conducted with the approval of the Ethics Committee of the University of Social Welfare and Rehabilitation Sciences (Ethical Code IR.USWR.REC.1403.027, dated April 24, 2024). The study objectives, benefits, potential harms, and data confidentiality were explained to the participants. 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15:53:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1449005,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8223986/v1/52f0867c-6abc-4ee8-bb01-57ae03569dfb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Predictors of filial responsibility toward older parents: A cross-sectional study of Iranian adults","fulltext":[{"header":"Background","content":"\u003cp\u003eDeclining functional capacity, increasing incidence of chronic diseases, and greater care needs in the elderly heighten their dependence on others, particularly their children(Dziechciaż \u0026amp; Filip, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). Adult children are identified as the primary source of care for aging parents(Aghajani et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). It is estimated that more than half of individuals aged 50 and older undertake the responsibility of caring for their older parents(hosseinabbasi \u0026amp; Aghaamiri, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), and such unpaid services annually result in billions of dollars in government cost savings(Kaufman et al., 2024).\u003c/p\u003e\u003cp\u003eThe relationship between adult children and older parents is considered one of the most important and complex forms of reciprocal family relationships(Aggarwal et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). With increasing life expectancy, the duration of reciprocal interaction between adult children and aging parents is rising substantially(Bao et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Moreover, alongside the growth in the elderly population and declining birth rates, the number of caregiving children is decreasing(Wongkongdech et al., 2024). Therefore, maintaining and improving this reciprocal relationship is of great importance. Among the factors that can help preserve and enhance the relationship between adult children and elderly parents, and greatly prevent the institutionalization of older adults, is the commitment of adult children to the concept of filial responsibility toward their aging parents(Aires, Mocellin, et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFilial responsibility reflects the obligations that define the social role of adult children in caring for their parents throughout the aging process(Gans \u0026amp; Silverstein, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). Filial responsibility has been introduced as a norm across various societies and cultures(Phillips et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2010\u003c/span\u003e) and, regardless of the benefits it brings to older parents and society(Aires, Dal Pizzol, et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), existing evidence indicates that it often yields positive outcomes for adult children, such as a sense of pride(Wang et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) and psychological well-being(Liu et al., 2020).\u003c/p\u003e\u003cp\u003eFilial responsibility is dynamic and influenced by certain social factors(Liu et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). In Asian countries, cultural expectations dictate that elderly individuals should be cared for by their family members(Aghajani et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Iran, as an Asian country, is culturally influenced by Islamic perspectives. In Islam, numerous recommendations emphasize kindness and devotion to one\u0026rsquo;s parents(Aghajani et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Consequently, for Iranian families, providing in-home care for aging parents has long been considered an undeniable duty(Abdollahpour et al., 2012). However, in recent years, social changes\u0026mdash;such as increasing individualism, migration of children to large cities, economic challenges, smaller housing spaces, declining birth rates, and the growing tendency of women to work outside the home\u0026mdash;may have altered perceptions, attitudes, and behaviors related to filial responsibility in various societies, including Iran(Aghajani et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Aires, Pizzol, et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). It is evident that over time, a shift in attitudes toward filial responsibility may lead to an increase in the institutionalization of elderly parents, resulting in dissatisfaction and lower quality of life among older adults(Aires, Mocellin, et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), as well as creating challenges for families and societies, including imposing substantial financial burdens on both families and governments(Kaufman et al., 2024).\u003c/p\u003e\u003cp\u003e To prevent or at least mitigate the secondary problems arising from these attitudinal and behavioral changes toward filial responsibility for older parents, it is essential to plan and provide the necessary infrastructure for appropriate elder care by adult children and to strengthen their sense of responsibility. The first step in this regard is to assess the current status of filial responsibility and the factors in the adult population. Some studies have examined the status of filial responsibility and certain related factors, such as life satisfaction, psychological well-being, opposition to institutionalization of the older adults, gender, and number of children(Aires, Mocellin, et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Leung \u0026amp; Shek, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Miyawaki, 2017; Mocellin et al., 2019; Van der Pas et al., 2005). Some of these studies have even reported contradictory findings(Funk et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Pan et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). To the best knowledge, no study has yet addressed this topic specifically in Iran; however, some investigations have explored related issues, such as family social support for older parents or parental expectations of their children(Nouri \u0026amp; Farsi, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Shamsikhani et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Overall, although some findings have suggested that the status of filial responsibility toward older parents, or characteristics associated with it, is at a moderate or relatively desirable level in certain societies(Miyawaki, 2017), the influence of time and ongoing changes in social structure make it an undeniable necessity to examine this phenomenon. Therefore, given the limited number of related studies in recent years, negligence of this subject by researchers in the field of geriatric health in Iran, and the presence of contradictory findings in related research, the present study was conducted to investigate the status of filial responsibility toward older parents and its predictors in a group of Iranian adults.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003eStudy design and sampling\u003c/h2\u003e\n\u003cp\u003eThis cross-sectional study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement(von Elm et al., \u003cspan class=\"CitationRef\"\u003e2007\u003c/span\u003e). The study population comprised adults aged 18 years and older who were covered by urban comprehensive health centers affiliated with Kashan University of Medical Sciences in 2025.\u003c/p\u003e\n\u003cp\u003eThe sample size was calculated using Cochran\u0026rsquo;s formula, based on a standard deviation of 2.7(Aires, Mocellin, et al., \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e) and a margin of error of 0.27 (10% of the standard deviation), yielding an estimated 384 participants. To account for a 9% nonresponse rate and a design effect of 1.2, the final sample size was set at 500 participants. Considering the importance of the age variable (Older adults vs. non- older adults), 250 participants were allocated to each of two age groups: under 60 years and 60 years and older.\u003c/p\u003e\n\u003cp\u003eInclusion criteria were age 18 years or older, Iranian nationality, ability to communicate in Persian, no severe psychiatric disorders and cognitive impairment as documented in the individual\u0026rsquo;s health center records, having at least one living elderly parent for participants under 60 years, and having at least one living adult child for participants aged 60 years or older. Exclusion criteria included non-cooperation, withdrawal during questionnaire completion, and incomplete completion of the Filial Responsibility Scale.\u003c/p\u003e\n\u003cp\u003eA multistage random sampling method was employed. The city of Kashan was stratified into five socioeconomic levels: poor, lower-middle, upper-middle, good, and very good. From each stratum, three urban comprehensive health centers were randomly selected as clusters. Within each cluster, quota sampling was performed according to age group (under 60 years and 60 years or older). Within each age group, participants were randomly selected in proportion to the eligible population covered by each center and the required sample size. In cases of non-cooperation, another individual from the same center and age group was randomly selected.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eAfter obtaining permission from the Department of Research at Tehran University of Social Welfare and Rehabilitation Sciences and Kashan University of Medical Sciences, sampling was conducted over a two-month period from early January 2025 to early March 2025 at the selected urban comprehensive health centers. The first author (T. L.) made arrangements with the managers of each selected center, compiled a list of eligible individuals for each of the two age groups (under 60 years and 60 years or older), and contacted the selected participants by telephone. After explaining the study objectives, confirming eligibility, and obtaining verbal consent, arrangements were made for an in-person meeting at a location of the participant\u0026rsquo;s choice (home, health center, park, etc.). During the in-person meeting, written informed consent was obtained, and both the questionnaire on potential predictors and the Persian version of the Filial Responsibility Scale were completed. A unique identification code was assigned to each participant. For individuals who were illiterate, semi-literate, or visually impaired, the questionnaires were administered through face-to-face interviews conducted by the first author.\u003c/p\u003e\n\u003ch3\u003eMeasurement instruments\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eQuestionnaire on potential predictors of filial responsibility\u003c/strong\u003e: The questionnaire comprised 21 variables, including: gender, education level, education in religious sciences, employment status, spouse\u0026rsquo;s employment status, marital status, having children, basic and supplementary health insurance coverage, economic status, housing status, living arrangements, known underlying disease, opinion regarding placement of older parents in long-term care facilities, age, number of children (daughters and sons), ability to perform activities of daily living, level of religious beliefs, and psychological well-being. Content validity was confirmed by a panel of 10 faculty members specializing in gerontology, geriatric nursing, psychology, and sociology. Reliability was assessed using a test\u0026ndash;retest method (20 adults, two-week interval). Agreement for quantitative variables was calculated using the intraclass correlation coefficient (ICC), and for categorical variables using Cohen\u0026rsquo;s kappa. For personal variables, all responses were identical in both tests; the ICC for other quantitative variables was at least 0.89, and the kappa for categorical variables was at least 0.92. Psychological well-being, as a potential related factor, was measured using the five-item World Health Organization Well-Being Index (WHO-5), which includes five statements scored from 0 to 5. This tool assesses mental well-being on a scale of 0 to 25, with higher scores indicating better well-being. The content validity of the Persian version of this instrument has been confirmed, and its reliability has been reported as 0.89(Dehshiri \u0026amp; Mousavi, \u003cspan class=\"CitationRef\"\u003e2016\u003c/span\u003e). In the present study, its reliability was calculated with a Cronbach\u0026rsquo;s alpha coefficient of 0.915.\u003c/p\u003e\n\u003ch3\u003ePersian version of the filial responsibility scale (P-FRS):\u003c/h3\u003e\n\u003cp\u003eThe original instrument was developed in 1990 by Hamon and Blieszner in Pennsylvania in English, consisting of 16 items to assess filial responsibility toward aging parents(Hamon \u0026amp; Blieszner, 1990). The Persian version (P-FRS) was translated and culturally adapted by Tagharrobi et al. (\u003cspan class=\"CitationRef\"\u003e2025\u003c/span\u003e). The P-FRS contains 15 items across two subscales: \u0026ldquo;socio-emotional responsibilities\u0026rdquo; (9 items) and \u0026ldquo;physical responsibilities\u0026rdquo; (6 items). Each item is rated on a 4-point Likert scale from 1 (strongly disagree) to 4 (strongly agree). The tool measures filial responsibility toward older parents within a range of 15 to 60, with higher scores indicating higher levels of filial responsibility. The Persian version\u0026rsquo;s validity was verified through factor analysis and known-group comparison, and its internal consistency was confirmed using Cronbach\u0026rsquo;s alpha and McDonald\u0026rsquo;s omega coefficients, reported as 0.912(Tagharrobi et al., \u003cspan class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n\u003ch2\u003eData analysis\u003c/h2\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003cp\u003eThe collected data were analyzed using SPSS v.22. The filial responsibility score was determined on a 15\u0026ndash;60 scale and its range was estimated in the target population with 95% confidence. To assess data normality, skewness and kurtosis were used (a range of \u0026plusmn;\u0026thinsp;2 was considered indicative of normality). Stepwise multiple linear regression analysis was employed to prioritize the questionnaire components\u0026mdash;that is, to examine the contribution of each dimension of \u0026ldquo;socio-emotional responsibilities\u0026rdquo; and \u0026ldquo;physical responsibilities\u0026rdquo; to filial responsibility.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n\u003cp\u003eTo identify predictors, the factors were analyzed in two stages. First, univariate analysis was performed for each variable separately; to examine the relationship of filial responsibility or its dimensions with categorical variables, the independent t-test or one-way ANOVA was used, and to assess the relationship of filial responsibility or its dimensions with quantitative variables, Pearson or Spearman correlation coefficients were applied. For a more precise evaluation of relationships and to determine the contribution of each factor in explaining the filial responsibility score or each of its dimensions, stepwise multiple linear regression analysis was performed; in this stage, variables with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.2 in the univariate analysis were entered into the model as independent variables, and the filial responsibility score or its dimensions were entered as dependent variables. To address the multicollinearity problem, among the three variables of number of children, number of daughters, and number of sons, the number of sons was not included in the model (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eOut of a total of 500 individuals, two questionnaires were excluded due to incomplete responses, and the data of 498 adults (249 individuals in each of the age groups under 60 and 60 years and older) were analyzed. The participants\u0026rsquo; ages ranged from 18 to 99 years, with a mean of 54.47\u0026thinsp;\u0026plusmn;\u0026thinsp;16.20 years. Of these, 38.2% were male and 12.2% were without children [Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBackground characteristics of the samples, Kashan, 2025\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eCategorized Variables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;498)\u003c/p\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e190 (38.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e308 (61.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"7\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo Formal Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBasic Literacy (able to read and write)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46 (9.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e99 (19.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMiddle School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54 (10.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e92 (18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAssociate or Bachelor\u0026apos;s degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e119 (23.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaster\u0026rsquo;s degree or higher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40 (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEconomic Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44 (8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLower-middle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e117 (23.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAverage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e268 (53.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUpper-middle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64 (12.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHousing Situation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOwned\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e409 (82.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRented\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38 (7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOrganizational\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRelative\u0026rsquo;s Home\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49 (9.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"7\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFull-Time Employee (Government or Private Sector)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68 (13.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePart-Time Employee (Government or Private Sector)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34 (6.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRetired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e109 (21.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnemployed (Seeking Work)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDisabled / Unable to Work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelf-Employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57 (11.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHomemaker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e220 (44.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnown Underlying Health Conditions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e238 (47.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e260 (52.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"10\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLiving Arrangements\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAlone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35 (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ewith Spouse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e135 (27.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ewith Children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39 (7.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ewith At least One Parent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38 (7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ewith Spouse and at least One Parent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWith Spouse and Child and at least One Parent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ewith Spouse and Child and at least One Parent of Spouse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ewith Child and at least One Parent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ewith Spouse and Children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e239 (48)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ewith other Relatives\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e386 (77.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNever Married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36 (7.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61 (12.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHaving Children\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e437 (87.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61 (12.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"7\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment Status of Spouse\u003c/strong\u003e (N\u0026thinsp;=\u0026thinsp;386)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFull-Time Employee (Government or Private Sector)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52 (10.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePart-Time Employee (Government or Private Sector)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRetired\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e92 (18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnemployed (Seeking Work)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDisabled / Unable to Work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelf-Employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78 (15.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHomemaker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e130 (26.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eBasic Health Insurance Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e472 (94.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26 (65.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSupplementary Health Insurance Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e325 (65.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e173 (34.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDecision to Place Older Parents in a Nursing Home\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStrongly Agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNeutral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39 (7.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82 (16.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStrongly Disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e355 (71.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuantitative Variables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54.16\u0026thinsp;\u0026plusmn;\u0026thinsp;47.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of Children\u003c/strong\u003e (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.2\u0026thinsp;\u0026plusmn;\u0026thinsp;98.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of Daughters\u003c/strong\u003e (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;56.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of Sons\u003c/strong\u003e (n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.1\u0026thinsp;\u0026plusmn;\u0026thinsp;43.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbility To Perform ADLs\u003c/strong\u003e (1 to 5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.0\u0026thinsp;\u0026plusmn;\u0026thinsp;81.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligious Beliefs\u003c/strong\u003e (1 to 5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;16.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMental Well-Being\u003c/strong\u003e (1 to 5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.5\u0026thinsp;\u0026plusmn;\u0026thinsp;18.93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe filial responsibility score among the studied adults, on a 15\u0026ndash;60 scale, was 51.69\u0026thinsp;\u0026plusmn;\u0026thinsp;6.35, which, with 95% confidence, was between 51.13 and 52.25 in the target population. The subscale score for \u0026ldquo;socio-emotional responsibilities\u0026rdquo; (on a 9\u0026ndash;36 scale) was 32.14\u0026thinsp;\u0026plusmn;\u0026thinsp;3.64, and the subscale score for \u0026ldquo;physical responsibilities\u0026rdquo; (on a 6\u0026ndash;24 scale) was 19.55\u0026thinsp;\u0026plusmn;\u0026thinsp;3.36. Regarding prioritization of the domains of the filial responsibility questionnaire, stepwise linear regression showed that the two domains of \u0026ldquo;socio-emotional responsibilities\u0026rdquo; and \u0026ldquo;physical responsibilities\u0026rdquo; explained 83.5% and 16.5% of the variance in the filial responsibility score, respectively. The item \u0026ldquo;Children who live away from their older parents should be in contact with them at least once a week\u0026rdquo; received the highest score, while the item \u0026ldquo;When older parents are unable to care for themselves, they should be able to live with one of their children\u0026rdquo; received the lowest score [Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDescriptive indices of the statements of filial responsibility scale in adults visiting comprehensive health centers- Kashan 2025 (n\u0026thinsp;=\u0026thinsp;498)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eSubscale\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eStatement\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"4\" align=\"left\"\u003e\n \u003cp\u003eAlternatives n (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCompletely disagree\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDisagree\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAgree\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCompletely agree\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"9\" align=\"left\"\u003e\n \u003cp\u003eSocio-emotional responsibilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAdult children who live away from their parents (more than 40 kilometers/40 minutes) should be in contact with their parents at least once a week (by telephone call/video call).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e139 (27.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e345 (69.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.66\u0026thinsp;\u0026plusmn;\u0026thinsp;0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIf adult children live near their parents after growing up, they should visit their parents at least once a week.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e144 (28.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e340 (68.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.64\u0026thinsp;\u0026plusmn;\u0026thinsp;0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAdult children should feel responsible towards their elderly parents (they should provide any help when parents need it)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e157 (31.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e331 (66.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.64\u0026thinsp;\u0026plusmn;\u0026thinsp;0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAdult children should support their parents emotionally\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e164 (32.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e328 (65.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.65\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eElderly parents and adult children should be together during holidays and special occasions (birthdays and anniversaries).\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e188 (37.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e294 (59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.657\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAdult children should help their parents to learn about and use the services they are entitled to (such as health insurance and health care services) if needed.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e205 (41.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e288 (57.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.57\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWhen parents are sick, adult children should take care of them by any means necessary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e206 (41.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e266 (53.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.48\u0026thinsp;\u0026plusmn;\u0026thinsp;0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eElderly parents should be able to talk with their adult children about important personal issues that affect their lives significantly.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24 (41.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e207 (41.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e267 (53.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.49\u0026thinsp;\u0026plusmn;\u0026thinsp;0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAdult children should give advice to their elderly parents if needed.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e239 (49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e244 (49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.46\u0026thinsp;\u0026plusmn;\u0026thinsp;0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" align=\"left\"\u003e\n \u003cp\u003ePhysical responsibilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWhen elderly parents are not able to take care of themselves, they should be able to live with one of their adult children.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93 (18.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e195 (39.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e196 (39.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIn case of emergency, adult children should provide a place (a room) for elderly parents in their home.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15 (3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79 (15.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e209 (42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e195 (39.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAdult children should organize their work schedule to help their elderly parents if needed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e218 (43.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e229 (46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAdult children should arrange their family plans to be able to help their elderly parents if needed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26 (5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e236 (47.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e233 (46.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAdult children should be ready to sacrifice some of their personal freedoms to take care of their elderly parents if needed.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56 (11.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e235 (47.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e199 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAdult children should help their parents financially\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6 (1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78 (15.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e216 (43.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e198 (39.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.22\u0026thinsp;\u0026plusmn;\u0026thinsp;0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eTotal score (15\u0026ndash;60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.69\u0026thinsp;\u0026plusmn;\u0026thinsp;6.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eSocio-emotional responsibilities score (9\u0026ndash;36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.14\u0026thinsp;\u0026plusmn;\u0026thinsp;3.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003ePhysical responsibilities score (6\u0026ndash;24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.55\u0026thinsp;\u0026plusmn;\u0026thinsp;3.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe filial responsibility score in the two age groups, under 60 years and 60 years and older, was 52.64\u0026thinsp;\u0026plusmn;\u0026thinsp;5.97 and 50.74\u0026thinsp;\u0026plusmn;\u0026thinsp;6.59, respectively, which were significantly different (p\u0026thinsp;=\u0026thinsp;0.001). The socio-emotional responsibilities score was significantly higher in the group under 60 years (32.46\u0026thinsp;\u0026plusmn;\u0026thinsp;3.43) compared to the elderly group (31.82\u0026thinsp;\u0026plusmn;\u0026thinsp;3.82) (p\u0026thinsp;=\u0026thinsp;0.047). A similar difference was observed for the physical responsibility\u0026rsquo;s subscale (20.18\u0026thinsp;\u0026plusmn;\u0026thinsp;3.00 versus 18.92\u0026thinsp;\u0026plusmn;\u0026thinsp;3.59; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001).\u003c/p\u003e\n\u003cp\u003eUnivariate analysis showed a significant relationship between filial responsibility and the variables of education, occupation, spouse\u0026rsquo;s occupation, marital status, having children, having basic insurance, having supplementary health insurance, economic status, opinion regarding institutionalization of older parents, age, number of children, and psychological well-being status [Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eFilial responsibility score based on potential predictors in adults, Kashan, 2025 (n\u0026thinsp;=\u0026thinsp;498)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth colspan=\"13\" align=\"left\"\u003e\n \u003cp\u003eA: Filial responsibility score based on categorized variables\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\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCategories\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFilial responsibility score\u003c/p\u003e\n \u003cp\u003eSD\u0026thinsp;\u0026plusmn;\u0026thinsp;mean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eF or t-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"8\" align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.44\u0026thinsp;\u0026plusmn;\u0026thinsp;6.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003ea-1.121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"8\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.263\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52.09\u0026thinsp;\u0026plusmn;\u0026thinsp;6.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"8\" align=\"left\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIlliterate (A)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.04\u0026thinsp;\u0026plusmn;\u0026thinsp;6.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"8\" align=\"left\"\u003e\n \u003cp\u003eb-3.096\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" rowspan=\"8\" align=\"left\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" align=\"left\"\u003e\n \u003cp\u003ePairwise comparison \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eReading writing literacy (B)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e50.07\u0026thinsp;\u0026plusmn;\u0026thinsp;7.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA,D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" align=\"left\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eB,E\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" align=\"left\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eElementary school (C)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50.30\u0026thinsp;\u0026plusmn;\u0026thinsp;6.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eB,G\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" align=\"left\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJunior high school (D)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53.41\u0026thinsp;\u0026plusmn;\u0026thinsp;6.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eC,D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" align=\"left\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh school (E)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52.74\u0026thinsp;\u0026plusmn;\u0026thinsp;5.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eC,E\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" rowspan=\"3\" align=\"left\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAssociate and bachelors\u0026rsquo; degree (F)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.52\u0026thinsp;\u0026plusmn;\u0026thinsp;6.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMasters\u0026rsquo; degree and higher (G)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53.53\u0026thinsp;\u0026plusmn;\u0026thinsp;5.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eReligious education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.31\u0026thinsp;\u0026plusmn;\u0026thinsp;6.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003ea-0.241\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"8\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.70\u0026thinsp;\u0026plusmn;\u0026thinsp;6.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"10\" align=\"left\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eFull-time employment (public or private sector) (A)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e52.01\u0026thinsp;\u0026plusmn;\u0026thinsp;6.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"10\" align=\"left\"\u003e\n \u003cp\u003ed-18.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" rowspan=\"10\" align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" align=\"left\"\u003e\n \u003cp\u003ePairwise comparison \u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eA,E\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003ePart-time employment (public or private sector) (B)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e52.03\u0026thinsp;\u0026plusmn;\u0026thinsp;6.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eB,E\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eC,E\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRetired (C)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50.75\u0026thinsp;\u0026plusmn;\u0026thinsp;6.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eA,E\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnemployed (seeking job) (D)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48.60\u0026thinsp;\u0026plusmn;\u0026thinsp;8.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnable to work (E)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59.00\u0026thinsp;\u0026plusmn;\u0026thinsp;1.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eE,F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eSelf-employed (F)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e53.61\u0026thinsp;\u0026plusmn;\u0026thinsp;5.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eE,G\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHousewife (G)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.40\u0026thinsp;\u0026plusmn;\u0026thinsp;6.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"10\" align=\"left\"\u003e\n \u003cp\u003eSpouse\u0026rsquo;s employment status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eFull-time employment (public or private sector) (A)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" align=\"left\"\u003e\n \u003cp\u003e53.27\u0026thinsp;\u0026plusmn;\u0026thinsp;5.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"10\" align=\"left\"\u003e\n \u003cp\u003eb-3.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" rowspan=\"10\" align=\"left\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" align=\"left\"\u003e\n \u003cp\u003ePairwise comparison \u003csup\u003ef\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eA,E\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eB,E\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003ePart-time employment (public or private sector) (B)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e52.43\u0026thinsp;\u0026plusmn;\u0026thinsp;5.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eE,C\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eE,G\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eRetired (C)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e50.92\u0026thinsp;\u0026plusmn;\u0026thinsp;6.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" rowspan=\"4\" align=\"left\"\u003e\n \u003cp\u003eF,E\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"4\" align=\"left\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnable to work (E)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.25\u0026thinsp;\u0026plusmn;\u0026thinsp;7.80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelf-employed (F)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.44\u0026thinsp;\u0026plusmn;\u0026thinsp;6.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHousewife (G)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52.04\u0026thinsp;\u0026plusmn;\u0026thinsp;6.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" align=\"left\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried (A)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.75\u0026thinsp;\u0026plusmn;\u0026thinsp;6.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"5\" align=\"left\"\u003e\n \u003cp\u003eb-2.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"5\" align=\"left\"\u003e\n \u003cp\u003e0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" align=\"left\"\u003e\n \u003cp\u003ePairwise comparison \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNever married (B)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53.36\u0026thinsp;\u0026plusmn;\u0026thinsp;6.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eA,D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.040\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eDivorced (C)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e53.27\u0026thinsp;\u0026plusmn;\u0026thinsp;7.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eB,D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWidowed (D)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49.95\u0026thinsp;\u0026plusmn;\u0026thinsp;6.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eHaving children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.51\u0026thinsp;\u0026plusmn;\u0026thinsp;6.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003ea-1.638\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"8\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52.93\u0026thinsp;\u0026plusmn;\u0026thinsp;6.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eBasic insurance coverage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.60\u0026thinsp;\u0026plusmn;\u0026thinsp;6.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003ea-1.368\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"8\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.172\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53.35\u0026thinsp;\u0026plusmn;\u0026thinsp;5.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eSupplementary insurance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.11\u0026thinsp;\u0026plusmn;\u0026thinsp;6.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003ea-2.917\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"8\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52.77\u0026thinsp;\u0026plusmn;\u0026thinsp;5.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" align=\"left\"\u003e\n \u003cp\u003eFinancial status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLow(A)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"6\" align=\"left\"\u003e\n \u003cp\u003ex-3.929\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" align=\"left\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"7\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003ePairwise comparison \u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eAverage and below (B)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e50.68\u0026thinsp;\u0026plusmn;\u0026thinsp;6.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" rowspan=\"4\" align=\"left\"\u003e\n \u003cp\u003eB,D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"4\" align=\"left\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAverage (C)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.34\u0026thinsp;\u0026plusmn;\u0026thinsp;6.62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAverage and higher (D)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53.45\u0026thinsp;\u0026plusmn;\u0026thinsp;5.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh (E)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55.00\u0026thinsp;\u0026plusmn;\u0026thinsp;5.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" align=\"left\"\u003e\n \u003cp\u003eResidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHouse owner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.158\u0026thinsp;\u0026plusmn;\u0026thinsp;6.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"4\" align=\"left\"\u003e\n \u003cp\u003eb-0.457\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"8\" rowspan=\"4\" align=\"left\"\u003e\n \u003cp\u003e0.712\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52.42\u0026thinsp;\u0026plusmn;\u0026thinsp;5.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmployees\u0026rsquo; housing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48.50\u0026thinsp;\u0026plusmn;\u0026thinsp;9.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLiving in a relative\u0026rsquo;s house\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52.14\u0026thinsp;\u0026plusmn;\u0026thinsp;6.71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"10\" align=\"left\"\u003e\n \u003cp\u003eLiving with\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAlone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50.40\u0026thinsp;\u0026plusmn;\u0026thinsp;6.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"10\" align=\"left\"\u003e\n \u003cp\u003eb-1.537\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"8\" rowspan=\"10\" align=\"left\"\u003e\n \u003cp\u003e0.132\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSpouse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.11\u0026thinsp;\u0026plusmn;\u0026thinsp;6.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChildren\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49.95\u0026thinsp;\u0026plusmn;\u0026thinsp;6.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eParent(s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53.84\u0026thinsp;\u0026plusmn;\u0026thinsp;6.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSpouse and children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53.67\u0026thinsp;\u0026plusmn;\u0026thinsp;1.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSpouse, children, and parent(s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54.33\u0026thinsp;\u0026plusmn;\u0026thinsp;8.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSpouse, children, and spouse\u0026rsquo;s parent(s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.67\u0026thinsp;\u0026plusmn;\u0026thinsp;5.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChildren and parent(s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47.00\u0026thinsp;\u0026plusmn;\u0026thinsp;7.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003espouse and children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52.13\u0026thinsp;\u0026plusmn;\u0026thinsp;5.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther relatives\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eDiagnosed background diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.26\u0026thinsp;\u0026plusmn;\u0026thinsp;6.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003ea-1.455\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"8\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.146\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52.08\u0026thinsp;\u0026plusmn;\u0026thinsp;6.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"7\" align=\"left\"\u003e\n \u003cp\u003eOpinion about institutionalization of older parents\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCompletely agree (A)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.13\u0026thinsp;\u0026plusmn;\u0026thinsp;7.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"7\" align=\"left\"\u003e\n \u003cp\u003ed-11.164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" rowspan=\"7\" align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003ePairwise comparison \u003csup\u003ee\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eAgree (B)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e47.50\u0026thinsp;\u0026plusmn;\u0026thinsp;8.54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eC,E\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo idea (C)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48.87\u0026thinsp;\u0026plusmn;\u0026thinsp;5.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDisagree (D)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48.84\u0026thinsp;\u0026plusmn;\u0026thinsp;5.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eD,E\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCompletely disagree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52.83\u0026thinsp;\u0026plusmn;\u0026thinsp;6.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd colspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eD,C\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.225\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"13\" align=\"left\"\u003e\n \u003cp\u003eNote: \u003csup\u003ea\u003c/sup\u003e: independent t -test \u003csup\u003eb\u003c/sup\u003e: F ANOVA \u003csup\u003ec\u003c/sup\u003e: post hoc (LSD)\u003c/p\u003e\n \u003cp\u003epost hoc (Gabriel) \u003csup\u003ef\u003c/sup\u003e post hoc (Games-Howell) \u003csup\u003ee d\u003c/sup\u003e: welch statistic/ANOVA\u003c/p\u003e\n \u003cp\u003e* Only significant figures in pairwise comparison are listed\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"13\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eB: Correlation of filial responsibility score with quantitative variables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003er values\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"9\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eAge (year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003ea-0.144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"9\" align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eNumber of children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003ea-0.096\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"9\" align=\"left\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eNumber of children (daughters)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003ea-0.080\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"9\" align=\"left\"\u003e\n \u003cp\u003e0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eNumber of children (boys)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003ea-0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"9\" align=\"left\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eAbility to do everyday activities (1\u0026ndash;5 scale)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eb-0.041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"9\" align=\"left\"\u003e\n \u003cp\u003e0.361\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eReligious beliefs level (1\u0026ndash;5 scale)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003ea-0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"9\" align=\"left\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003epsychological well-being status based on wellbeing scale (0\u0026ndash;25 scale)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003ea-0.116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"9\" align=\"left\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"13\"\u003eNote: a: Pearson coefficient b: Spearman\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eStepwise multiple linear regression analysis showed that the simultaneous presence of three variables\u0026mdash;degree of opposition to institutionalization of older parents, psychological well-being status, and age\u0026mdash;was significant in the model (F\u0026thinsp;=\u0026thinsp;15.982, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and explained 8.8% of the variance observed in the filial responsibility score. The greatest contribution belonged to the degree of opposition to institutionalization of older parents, which alone accounted for 5.5% of the variance. The model indicated that for each standard deviation increase in the degree of opposition to institutionalization of older parents, the filial responsibility score would increase by 0.23 standard deviations; for each standard deviation increase in psychological well-being score, the filial responsibility score would increase by 0.12 standard deviations; and for each standard deviation increase in age, the filial responsibility score would decrease by 0.15 standard deviations [Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e].\u0026nbsp;\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMultiple linear regression analysis to determine predictors of filial responsibility in adults\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eModel\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e95% CI B\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eBeta\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003et value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLower limit\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eUpper limit\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\"\u003e\n \u003cp\u003eFixed coefficient\u003c/p\u003e\n \u003cp\u003eOpposition to institutionalization of older parents\u003c/p\u003e\n \u003cp\u003eAge (year)\u003c/p\u003e\n \u003cp\u003ePsychological wellbeing status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003cp\u003e0.055\u003c/p\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003cp\u003e0.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.562\u003c/p\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003cp\u003e1.649\u003c/p\u003e\n \u003cp\u003e0.058\u003c/p\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003cp\u003e0.128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.014\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003cp\u003e10.37\u003c/p\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.109\u003c/p\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003cp\u003e2.261\u003c/p\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003cp\u003e0.219\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.805\u003c/p\u003e\n \u003cp\u003e0.311\u003c/p\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003cp\u003e0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003cp\u003e0.228\u003c/p\u003e\n \u003cp\u003e0.148\u003c/p\u003e\n \u003cp\u003e0.120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.235\u003c/p\u003e\n \u003cp\u003e5.297\u003c/p\u003e\n \u003cp\u003e-3.437\u003c/p\u003e\n \u003cp\u003e2.778\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\"\u003eNote: R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.088, F\u0026thinsp;=\u0026thinsp;15.982, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eUnivariate analysis showed a significant relationship between the socio-emotional responsibility subscale and the variables of education level (p\u0026thinsp;=\u0026thinsp;0.006), spouse\u0026rsquo;s occupation (p\u0026thinsp;=\u0026thinsp;0.017), economic status (p\u0026thinsp;=\u0026thinsp;0.025), opinion regarding institutionalization of older parents (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and psychological well-being (p\u0026thinsp;=\u0026thinsp;0.003, r\u0026thinsp;=\u0026thinsp;0.132). Multiple linear regression analysis reported that the simultaneous presence of two variables\u0026mdash;degree of opposition to institutionalization of older parents and psychological well-being status\u0026mdash;was significant in the model of predictors for socio-emotional responsibility (F\u0026thinsp;=\u0026thinsp;11.285, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and explained 8.5% of the observed variance in the socio-emotional responsibility score. The greatest contribution belonged to the degree of opposition to institutionalization of older parents, which alone accounted for 4% of the variance. The model indicated that a higher degree of opposition to institutionalization of older parents (B\u0026thinsp;=\u0026thinsp;0.811, SE\u0026thinsp;=\u0026thinsp;0.206, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Beta\u0026thinsp;=\u0026thinsp;0.195) and better psychological well-being (B\u0026thinsp;=\u0026thinsp;0.078, SE\u0026thinsp;=\u0026thinsp;0.030, p\u0026thinsp;=\u0026thinsp;0.011, Beta\u0026thinsp;=\u0026thinsp;0.127) were associated with higher levels of socio-emotional responsibility.\u003c/p\u003e\n\u003cp\u003eUnivariate analysis showed a significant relationship between the physical responsibility subscale and the variables of education level (p\u0026thinsp;=\u0026thinsp;0.006), occupation (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), spouse\u0026rsquo;s occupation (p\u0026thinsp;=\u0026thinsp;0.017), supplementary insurance (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), economic status (p\u0026thinsp;=\u0026thinsp;0.025), underlying disease (p\u0026thinsp;=\u0026thinsp;0.008), opinion regarding institutionalization of older parents (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), age (r = \u0026minus;\u0026thinsp;0.189, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), number of children (r = \u0026minus;\u0026thinsp;0.117, p\u0026thinsp;=\u0026thinsp;0.009), number of sons (r = \u0026minus;\u0026thinsp;0.117, p\u0026thinsp;=\u0026thinsp;0.009), and level of religious beliefs (r\u0026thinsp;=\u0026thinsp;0.104, p\u0026thinsp;=\u0026thinsp;0.020). Multiple linear regression analysis reported that the simultaneous presence of four variables\u0026mdash;degree of opposition to institutionalization of older parents, age, level of religious beliefs, and supplementary insurance\u0026mdash;was significant in the model of predictors for physical responsibility (F\u0026thinsp;=\u0026thinsp;11.808, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and explained 11% of the observed variance in the physical responsibility score. The greatest contribution belonged to the degree of opposition to institutionalization of older parents, which alone accounted for 5.1% of the variance; the contributions of age, level of religious beliefs, and supplementary health insurance in the variance in physical responsibility scores were 4.3%, 1.4%, and 1.1%, respectively. The model indicated that a higher degree of opposition to institutionalization of older parents (B\u0026thinsp;=\u0026thinsp;0.784, SE\u0026thinsp;=\u0026thinsp;0.187, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Beta\u0026thinsp;=\u0026thinsp;0.204) and a higher level of religious beliefs (B\u0026thinsp;=\u0026thinsp;0.374, SE\u0026thinsp;=\u0026thinsp;0.155, p\u0026thinsp;=\u0026thinsp;0.016, Beta\u0026thinsp;=\u0026thinsp;0.120) were associated with higher levels of physical responsibility, whereas increased age (B = \u0026minus;\u0026thinsp;0.036, SE\u0026thinsp;=\u0026thinsp;0.011, p\u0026thinsp;=\u0026thinsp;0.001, Beta = \u0026minus;\u0026thinsp;0.172) was associated with lower levels of physical responsibility. In addition, the physical responsibility score was higher in the absence of supplementary insurance (B\u0026thinsp;=\u0026thinsp;0.805, SE\u0026thinsp;=\u0026thinsp;0.360, p\u0026thinsp;=\u0026thinsp;0.026, Beta\u0026thinsp;=\u0026thinsp;0.114).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe filial responsibility score in adults in Kashan ranged from 15 to 60, with a mean of 51.69\u0026thinsp;\u0026plusmn;\u0026thinsp;6.35. There was a relatively high level of filial responsibility in this group. Iran is an Islamic country, and Islamic culture emphasizes benevolence toward parents; this is repeatedly highlighted in religious texts, including the \u003cem\u003eSahifeh Sajjadiyeh\u003c/em\u003e, \u003cem\u003eNahj al-Balagha\u003c/em\u003e, and the Holy Quran(Aghajani et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Consequently, children in Iranian families tend to assume the caregiver role within their own homes to uphold the sacred duty toward older parents(Rejeh et al., 2011). All of the above may contribute to the formation of a positive attitude toward filial responsibility. However, the influence of various social factors on the phenomenon of filial responsibility over time should not be overlooked. In a qualitative study conducted by Niazi et al. (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) to identify challenges faced by elderly individuals in Kashan, one of the reported challenges was \u0026ldquo;lack of support from children\u0026rdquo;(Niazi et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), which partially contrasts with the findings of the present study. It should be noted that the high filial responsibility score in this study, and its apparent discrepancy with Niazi et al.\u0026rsquo;s findings, can be explained by the nature of the instrument used. The tool measures attitudes or expectations rather than actual behaviors; therefore, the findings reflect high levels of filial responsibility attitudes but do not necessarily indicate appropriate or effective caregiving performance. Moreover, the determinants of filial responsibility are strongly influenced by cultural and social factors(Aires, Pizzol, et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Although the instrument used was originally developed in the United States and culturally adapted for use in Iran, certain dimensions of filial responsibility\u0026mdash;such as social or spiritual aspects, which are prominent in Iranian society(Tagharrobi et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2025\u003c/span\u003e)\u0026mdash;were not captured.\u003c/p\u003e\u003cp\u003eThe present study showed that filial responsibility scores were higher in the under-60 age group compared to older adults. In other words, increasing age predicted lower scores in overall filial responsibility as well as in the physical responsibility subscale. Based on the observations, one reason for the differences in filial responsibility attitudes between these two age groups may be the distinct roles of parents and children within the Iranian cultural context. Individuals over 60 years, as elderly parents, occupy the recipient role and tend to lower their expectations from their children, attributing fewer responsibilities to them to reduce their burden. Conversely, individuals under 60, as children, occupy the caregiver role and perceive greater obligations toward older parents who have cared for them over the years. It is plausible that when children eventually assume the role of elderly parents, they may have lower expectations and, consequently, perceive less responsibility from their own children. Consistent with our findings, Miyawaki (2017) reported that filial responsibility scores among third-generation caregivers remained strong and high compared to previous generations(Miyawaki, 2017).\u003c/p\u003e\u003cp\u003eContact with older parents by children who live apart held the greatest importance among the filial responsibility items in the present study. Cicirelli (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e1991\u003c/span\u003e) noted that upon reaching adolescence, communication plays a crucial role in parent\u0026ndash;child relationships, and simple communicative behaviors such as phone calls, letter writing, or email can account for the typical interactions between children and older parents(Cicirelli, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e1991\u003c/span\u003e). Contrary to the present study, a study conducted in the United States indicated that contact with parents was of lesser importance among other filial responsibility items(Hamon \u0026amp; Blieszner, 1990). \"Living with older parents during times of incapacity\" ranked lowest in importance in the present study, which aligns with Salmon (2010), who reported that elderly individuals, particularly the very old, prefer to live in their own homes(Salomon, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2010\u003c/span\u003e); increased place attachment with advancing age(Lebrus\u0026aacute;n \u0026amp; G\u0026oacute;mez, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) may support this finding.\u003c/p\u003e\u003cp\u003eThe largest contribution to explaining variations in filial responsibility scores was attributed to the \u0026ldquo;socio-emotional responsibility\u0026rdquo; dimension. Socio-emotional responsibilities include regular and frequent contact, spending time with older parents, and providing necessary information to them. Evidence indicates that emotional support constitutes the most valued form of support for elderly individuals in Iran(Nazari et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Consistently, multiple studies have highlighted that educating and providing informational support to older parents represents a key aspect of filial responsibility(Cheung et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Collins, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Hamon \u0026amp; Blieszner, 1990; Park \u0026amp; Kim, 2016).\u003c/p\u003e\u003cp\u003eIn the present study, \u0026ldquo;degree of opposition to institutionalization of older parents,\u0026rdquo; \u0026ldquo;psychological well-being,\u0026rdquo; and \u0026ldquo;age\u0026rdquo; were influential factors on filial responsibility scores. Among these, the greatest contribution in the predictive model of filial responsibility was related to the \u0026ldquo;degree of opposition to institutionalization of older parents.\u0026rdquo; In other words, a higher degree of opposition was associated with higher filial responsibility scores; this pattern was also observed across the two subscales of the instrument. Individuals who believe in caring for parents at home naturally exhibit more positive attitudes toward aspects of filial responsibility and strive to fulfill their obligations toward their older parents(Mehta \u0026amp; Leng, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). The relationship between home-based parental care and individuals\u0026rsquo; attitudes toward filial responsibility is also emphasized in intergenerational attachment theory throughout the life course(Cicirelli, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e1991\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe findings indicated that higher psychological well-being scores predicted higher levels of filial responsibility. This association was also observed with the socio-emotional responsibility subscale. It may be argued that, in Asian countries, fulfilling filial responsibilities fosters pride and self-esteem in children(Wang et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), which in turn promotes psychological well-being(Cheung et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Liu et al., 2020). However, since filial responsibility is a dynamic phenomenon heavily influenced by regional cultural factors(Aires, Pizzol, et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), this positive correlation may not be observed universally. Funk et al. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2013\u003c/span\u003e) reported that feelings of responsibility toward family members can be accompanied by guilt(Funk et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2013\u003c/span\u003e), and a study in the United States generally found a negative association between filial responsibility expectations and well-being in older parents(Seelbach \u0026amp; Sauer, 1977).\u003c/p\u003e\u003cp\u003eHigher levels of religious beliefs and convictions predicted higher levels of the physical responsibility dimension. Religions such as Christianity and Islam explicitly emphasize the child\u0026rsquo;s duty not only to support older parents but also to love and respect them(Ehsani \u0026amp; Masoomi, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Interestingly, these religious teachings also highlight benefits for the child in adhering to this duty, such as longevity(Ehsani \u0026amp; Masoomi, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Religious recommendations and the advantages of fulfilling filial responsibilities may explain the higher physical responsibility scores observed among individuals with stronger religious beliefs. Some adult children may focus primarily on instrumental and financial support, even to meet the emotional needs of their older parents(Wang et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSupplementary health insurance emerged as a predictor of physical responsibilities; specifically, it was observed that physical responsibility scores were higher among individuals whose parents lacked supplementary health insurance. Supplementary health insurance covers the high costs of medical treatments, paying either all or the majority of these expenses(\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://bimeh.com/mag/what-is-supplementary-health-insurance/\u003c/span\u003e\u003cspan address=\"https://bimeh.com/mag/what-is-supplementary-health-insurance/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cem\u003e).\u003c/em\u003e It appears that, in the presence of such insurance, older parents may require less financial or physical support from their children, which aligns with the findings of this study. Moreover, Brody et al. (1984) demonstrated that in countries where governmental support for the elderly is substantial, elderly individuals expect less financial support from their children and prefer to receive such support from formal sources(Brody et al., 1984).\u003c/p\u003e\u003cp\u003eIt should be noted that, since filial responsibility is a dynamic phenomenon heavily influenced by cultural, socio-economic, and temporal factors(Aires, Pizzol, et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2017\u003c/span\u003e), some differences between the findings of the present study and other related research\u0026mdash;beyond variations in time, location, and statistical methods\u0026mdash;may arise from differences in the study population. Specifically, studies targeting adult children may yield results that differ from studies focusing on older parents or on both parents and children.\u003c/p\u003e\u003cp\u003e The sufficient sample size, quota sampling from two age groups\u0026mdash;under 60 years and older adults\u0026mdash;diversity in participant characteristics, and the use of multiple analyses are among the strengths of the present study, contributing to the generalizability of the findings. The large regression coefficients in the model of predictors of filial responsibility indicated that multiple factors influenced the phenomenon, many of which were not addressed in the current study. Additionally, some questionnaires were completed via interviews due to illiteracy, low literacy, or visual impairments in certain participants; given the potential impact of this method on responses, the internal and external validity of the study may have been affected. Another limitation is that the questionnaire items focused on measuring attitudes and did not capture prominent aspects of filial responsibility within the Iranian cultural and social context. It is recommended that a native instrument, developed using qualitative approaches and with a focus on performance, be designed to assess filial responsibility toward older parents in different societies. In designing questionnaires for potential predictors, changes in culturally and socially relevant factors over time should also be considered. Moreover, by addressing the limitations of the present study as much as possible and with an adequate sample size, the study should be replicated separately in the two groups of older adults and adult children.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eFilial responsibility among Iranian adults is relatively high. Furthermore, the variables \u0026ldquo;degree of opposition to institutionalization of older parents,\u0026rdquo; \u0026ldquo;psychological well-being,\u0026rdquo; and age were significant predictors of filial responsibility scores. The findings provide valuable insights into filial responsibility and its factors among community-dwelling older adults in Iran and serve as a prompt for international researchers in the field of aging health to address this topic. Based on the current study, planners and policymakers in the field of elderly health should prioritize the design of effective interventions to strengthen positive attitudes toward filial responsibility, particularly among individuals indifferent or favorable to institutionalization of older parents, those with lower psychological well-being, as well as younger older adults with living parents and middle-aged adults.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u0026nbsp;P-FRS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; the Persian version of the Filial Responsibility Scale\u003c/p\u003e\n\u003cp\u003eSTROBE \u0026nbsp; \u0026nbsp; \u0026nbsp;the Strengthening the Reporting of Observational Studies in Epidemiology\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was part of the first author\u0026rsquo;s Ph.D. dissertation in the Department of Aging at the University of Social Welfare and Rehabilitation Sciences (Thesis Number 4265, dated January 29, 2024). The research was not funded by any government, private, or non-profit organizations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted with the approval of the Ethics Committee of the University of Social Welfare and Rehabilitation Sciences (Ethical Code IR.USWR.REC.1403.027, dated April 24, 2024). The study objectives, benefits, potential harms, and data confidentiality were explained to the participants. They were informed of their right to withdraw at any stage and were assured that refusal to cooperate would not interfere with the provision of services at comprehensive health centers. Oral and written informed consents were obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\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\u003cli\u003e\u003cspan\u003eAbdollahpour, I., Noroozian, M., Nedjat, S., \u0026amp; Majdzadeh, R. (2012, Aug). Caregiver Burden and its Determinants among the Family Members of Patients with Dementia in Iran. \u003cem\u003eInternational journal of preventive medicine\u003c/em\u003e, \u003cem\u003e3\u003c/em\u003e(8), 544\u0026ndash;551.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAggarwal, M., Rawat, M. S., Singh, S., Srivastava, S., \u0026amp; Gauba, P. 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Aging Population Challenges and the Role of Thai Adolescents in Caring for the Elderly: A Cross-Sectional Study. \u003cem\u003eStud Health Technol Inform, 314\u003c/em\u003e, 32\u0026ndash;36. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3233/shti240052\u003c/span\u003e\u003cspan address=\"10.3233/shti240052\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"ageing-international","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"agin","sideBox":"Learn more about [Ageing International](http://link.springer.com/journal/12126)","snPcode":"12126","submissionUrl":"https://submission.springernature.com/new-submission/12126/3","title":"Ageing International","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Filial Responsibility, Older Parent, Adult, Iran","lastPublishedDoi":"10.21203/rs.3.rs-8223986/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8223986/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e Filial responsibility toward older parents impacts the quality of family relationships, the quality of elder care, the reluctance to send older adults in nursing facilities, and the health and care costs imposed on governments. This study aimed to examine this phenomenon and its predictors in a group of Iranian adults. In this cross-sectional study, 500 adults were selected through multistage random sampling in 2025 in Kashan, Iran. Data were collected using the Persian version of the Filial Responsibility Scale (P-FRS) and a questionnaire on potential predictors. Data were analyzed using SPSS-22 with One-Way ANOVA, Independent t-test, Pearson and Spearman\u0026ndash;Brown correlation coefficients, and multiple linear regression. The mean filial responsibility score was 51.69\u0026thinsp;\u0026plusmn;\u0026thinsp;6.35 (95% CI: 51.13\u0026ndash;52.25). The simultaneous presence of three variables\u0026mdash;degree of opposition to institutionalization of older parents, psychological well-being, and age\u0026mdash;was significant (R\u0026sup2; = 0.088, F\u0026thinsp;=\u0026thinsp;15.982, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Greater opposition to institutionalization of older parents (Beta\u0026thinsp;=\u0026thinsp;0.228) and better psychological well-being (Beta\u0026thinsp;=\u0026thinsp;0.120) were associated with higher filial responsibility; while older age (Beta = \u0026minus;\u0026thinsp;0.148) was associated with lower filial responsibility. The filial responsibility score toward older parents was relatively high. Health policy planners in the field of geriatric care should consider age, psychological well-being, and attitudes toward nursing facilities when designing effective interventions to enhance filial responsibility in adults. It is recommended that future investigations of this phenomenon not rely solely on attitude assessments and self-report methods, but also incorporate objective measurement tools.\u003c/p\u003e","manuscriptTitle":"Predictors of filial responsibility toward older parents: A cross-sectional study of Iranian adults","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-08 17:43:10","doi":"10.21203/rs.3.rs-8223986/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"327848211652771339133630992166291812416","date":"2026-02-25T04:49:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"206161450222056196406372993418452429936","date":"2026-02-09T17:41:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"122747221019317500986724045310668694419","date":"2026-01-27T08:06:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"246472503089373472758493472980081897549","date":"2026-01-06T16:16:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"212372034458475596444616619924131422782","date":"2025-12-06T06:54:48+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-04T20:42:52+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-03T06:48:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-03T06:47:24+00:00","index":"","fulltext":""},{"type":"submitted","content":"Ageing International","date":"2025-11-27T16:26:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"ageing-international","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"agin","sideBox":"Learn more about [Ageing International](http://link.springer.com/journal/12126)","snPcode":"12126","submissionUrl":"https://submission.springernature.com/new-submission/12126/3","title":"Ageing International","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"d4b949f7-fe9e-4c17-a9f1-b81a8319c8be","owner":[],"postedDate":"December 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-08T17:43:10+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-08 17:43:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8223986","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8223986","identity":"rs-8223986","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}