Transforming Suffering Through Faith: The Lived Experience of Spiritual Hope in Parents of Children with Disabilities 

Transforming Suffering Through Faith: The Lived Experience of Spiritual Hope in Parents of Children with Disabilities | 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 Transforming Suffering Through Faith: The Lived Experience of Spiritual Hope in Parents of Children with Disabilities Seyde zeinab modarresy mosalla, Leila Ghanbari-afra, Batool-sadat Hashemi, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8734968/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background Caring for a child with disability challenges parents’ emotional, existential, and spiritual worlds. Yet, within this struggle, many parents draw on faith-based resources that transform suffering into meaning and sustain hope. This study explored how spirituality and trust in God shape parents’ experiences and decisions regarding family life and future childbearing. Methods A qualitative hermeneutic phenomenological design guided by Van Manen’s approach was used. Fourteen parents of children with chronic disabilities were purposively sampled from a pediatric referral center. Semi-structured, in-depth interviews explored participants’ perceptions of faith, hope, and divine trust in relation to their parenting experiences. Data were analyzed using Van Manen’s six-step interpretive framework with MAXQDA v21. Trustworthiness was ensured through member checking, peer debriefing, and audit trails. Results Five interrelated themes captured the spiritual dimensions of parental coping and meaning-making: (1) Reinterpreting suffering as a divine test or blessing ; (2) Embodied spiritual practices—prayer, pilgrimage, scripture reading—as sources of hope and regulation ; (3) Spiritual transformation and renewed purpose enabling forward-oriented decisions ; (4) Communal and pastoral supports that institutionalize spiritual resilience ; and (5) Tensions between faith-based trust and pragmatic fear . Spirituality was not acquiescence but a constant active process of reframing, emotional regulation, and ethical strength. Hope and faith were blended together to create psychological resilience and future orientation in life, sometimes guiding decision-making for future childbearing under adversity. Conclusions Spiritual faith and hope in God are dynamic psychosocial resources that allow parents to transform suffering into meaning, sustain caregiving, and manage difficult life choices. Incorporating spiritual evaluation and pastoral collaboration within pediatric and family care can cement supportive care for families of disabled children. Spirituality Parents Children with Disabilities Hermeneutics Coping Skills Introduction Parents of children with intellectual disabilities have long fulfilled a central and irreplaceable role in providing daily care and emotional support to their children within the home environment (1). In many developing countries, these responsibilities are intensified due to limited access to essential services, insurance coverage, specialized equipment, employment opportunities, and broader social and cultural support system (2). Consequently, families often face greater pressure, and the presence of a child with a disability can significantly influence their overall quality of life (1) and multiple dimensions of parental well-being, including spiritual health (3). Researchers, disability advocates, and religious scholars have increasingly recognized spirituality as a fundamental human need (4). Defining spirituality and religion remains a topic of interest across disciplines, particularly in discussions exploring whether these concepts are separate, overlapping, or inseparable in practice (5). Existing definitions highlight themes such as connection with a higher power, meaning-making, hope, resilience, and interpersonal relationships. They also encompass a broad range of thoughts, behaviors, and practices that shape individuals’ responses to life’s challenges (6). A wide range of definitions have been proposed for spirituality. It is commonly described as a search for meaning and purpose in life, involving inner awareness and a sense of connection to something greater than oneself (7). Boukart defines spirituality as a multi-dimensional human quest to discover deeper meaning in life. This quest fosters connection not only with all living beings but also with “God” or an “ultimate truth” (8). Beyond this, spirituality is sometimes depicted as an intangible, sensory, abstract, and immaterial aspect of human existence. Metaphorically, it is often referred to as the “power of the heart” or “the spirit” (9). Within the nursing literature, spirituality is commonly understood as an individual effort to cultivate inner peace and find meaning and purpose amid life’s challenges and experiences (10). A decrease in spirituality among parents of children with disabilities can have significant psychological, social, and familial impacts. Serving as an internal coping resource, spirituality helps parents make sense of suffering, accept challenging circumstances, and sustain hope. When this resource is weakened, parents may experience heightened helplessness, emptiness, and a sense of purposelessness, which can contribute to increased anxiety and depression and reduced resilience (11, 12). A lack of sufficient spiritual connection may also strain family relationships, reducing intimacy between partners and intensifying conflicts among family members. Moreover, a decline in spirituality can foster feelings of disconnection from the wider community and lower perceived social support, leaving parents feeling uncertain or hopeless about their child’s future (12, 13). Various studies have explored the spirituality among parents of children with disabilities. For instance, Parker found that parents of healthy children scored higher on measures of spirituality and religiosity than parents of children with disabilities (14). Similarly, Dey (2019) found that spirituality indirectly influenced parents’ life satisfaction, their experience of positive and negative emotions toward their children, with resilience serving as a key mediator (3). Almodar’s research also highlighted that mothers who engaged in high levels of spiritual coping were better able to manage stress and demonstrated greater resilience (13). In contrast, a study reported challenges in spiritual well-being, particularly in the early stages of a child’s disability. Parents in these studies often questioned God’s role and experienced spiritual distress (15). Moreover, negative religious coping—such as spiritual struggle, conflict with religious communities, feelings of abandonment by God, anger toward Him, or guilt—was linked to increased depressive symptoms, anxiety, hopelessness, loneliness, greater caregiver burden, and lower quality of life (16). When a phenomenon is inherently subjective, complex, multidimensional, and shaped by individuals’ lived experiences and interpretations, qualitative research offers the most appropriate methodological approach. Additionally, if the researcher aims to gain a deep understanding of the phenomenon through participants’ experiences and perceptions, a phenomenological approach is appropriate. Given that this study seeks to describe the subjective and in-depth experiences of parents of children with disabilities regarding spirituality, a qualitative phenomenological approach was employed. Moreover, qualitative studies are particularly valuable for examining phenomena that quantitative approaches may not fully capture, especially in areas where prior quantitative findings have been inconsistent (17). In light of these inconsistencies, the present study sought to explore the lived experiences of parents of children with disabilities regarding spirituality. It should also be noted that this research represents a subset of a larger project investigating parents’ intentions regarding future childbearing after having a child with a disability. Methods Design and epistemology This study used a hermeneutic phenomenological approach (Van Manen) to explore the ways that parents' experiences and decisions are affected by hope, spirituality, and beliefs in God upon the birth of a child with a disability. Hermeneutic phenomenology promotes interpretive description of lived experience and is particularly appropriate for exploring the existential and meaning-making dimensions of parenting and religion. Setting and participants Fourteen parents (mothers and fathers) were purposively sampled from a Qom, Iran, pediatric referral clinic. Inclusion criteria were: primary caregiver or parent of a child with chronic disability, ability to participate in a detailed interview in Persian, and agreement to discuss spiritual and reproductive life. Maximum variation sampling (education, gender, age, urban versus rural residence) was used and persisted until thematic saturation was achieved. Data collection Data were collected with individual, semi-structured, open-ended interviews by the primary researcher between [dates removed for anonymization]. An interview guide prompted participants to explain their experience of raising a disabled child and to comment specifically on spiritual resources, hope, trust in God, and how these shaped decisions about future childbearing. Interviews were initiated with an open-ended question (e.g., "Could you tell me about your experience of parenting your child and how faith or spirituality has touched you") and utilized follow-up questions (e.g., "Could you tell me more about that?", "How did prayer/pilgrimage influence your emotions?"). The English version of the interview guide is provided as Supplementary File 1. Interviews were tape-recorded with written informed consent and transcribed verbatim in Persian. Data analysis Transcripts were exported into MAXQDA v21 for data management. Analysis followed Van Manen's six-step hermeneutic phenomenological process: immersion in the text, bracketing significant sentences, thematic description, writing and rewriting to cast a light on the phenomenon, having an intimate relationship with the lived experience, and finding a balance between parts and whole. Coding iteratively and interpretively: meaningful units that were relevant to spirituality, hope, trust, and decision-making were determined, clustered into subthemes, and abstracted still further into higher-order themes. Data collection and analysis were concurrent; initial analytic findings were used to guide subsequent interviews to explore emergent dimensions of spiritual experience. Trustworthiness and reflexivity Credibility was established through member checking (participants reviewed summaries of their interviews), prolonged engagement with the dataset, and peer debriefing within the research team. Dependability and confirmability were assured through audit trail (decision logs, coding memos) and reflexive journaling on the investigators' part to surface assumptions about religion and parenting. Transferability is guaranteed by richly contextualized quotations and clear description of participant setting and demographics. Ethical approval was obtained from the appropriate institutional review board and all participants provided written informed consent; quotations are pseudonymised to protect confidentiality. Results Demographic Data of participants is shown in Table 1 . Analysis identified a primary, fruitful theme: Spiritual trust and hope in God as a purposive and sustaining resource. Table 1 Demographic Characteristics of Participants Participant Age Gender Education Number of Children Number of Children with Disability Subsequent Childbearing after a Child with Disability P1 (Follow-up interview) 33 Female High School Diploma 4 1 3 P2 (Follow-up interview) 40 Male Middle School 4 1 3 P3 37 Female Bachelor’s Degree 3 1 0 P4 31 Female High School Diploma 1 1 0 P5 39 Male High School Diploma 3 1 0 P6 32 Female Associate Degree 2 1 10 P7 26 Female Bachelor’s Degree 1 1 0 P8 37 Male Middle School 2 1 1 P9 (Follow-up interview) 29 Female High School Diploma 3 1 2 P10 33 Female Master’s Degree 2 1 1 P11 35 Male High School Diploma 2 1 0 P12 38 Female High School Diploma 3 1 0 P13 42 Male Middle School 4 2 1 P14 41 Female Master’s Degree 3 1 1 P15 40 Female Master’s Degree 2 1 1 P16 46 Male Associate Degree 3 1 2 P17 42 Female Bachelor’s Degree 3 3 0 P18 26 Female Some High School (Incomplete high school) 2 1 1 The overall theme was represented by five interconnected subthemes: (1) reinterpreting suffering as divine test or blessing; (2) embodied spiritual practices (prayer, ritual, pilgrimage) that concretize hope; (3) spiritual transformation and renewed life-orientation that enabled risk-taking (e.g., subsequent childbearing); (4) communal and pastoral supports that institutionalize spiritual resilience; and (5) persistent tensions between faith-based trust and pragmatic fears (Table 2 ). Table 2 Themes and Subthemes on Hope, Spirituality, and Trust in God among Parents of Children with Disabilities Main Theme Subthemes Description (Interpretive Summary) Illustrative Quotation 1. Reinterpreting Suffering: From Calamity to Divine Test or Blessing a) Spiritual reframing of adversity b) Faith-based acceptance and patience c) Seeing the child as “a gift, not a punishment.” Parents moved from despair to meaning-making by viewing their child’s condition as part of God’s will, fostering acceptance, resilience, and moral endurance. “After a while, I understood maybe God placed this on us for a reason; that thought calmed me and restored my energy.” — Maryam 2. Embodied Spiritual Practices as Sources of Hope and Emotional Regulation a) Prayer and supplication as daily coping b) Pilgrimage and sacred rituals c) Reading scripture and sacred stories for comfort Faith-based practices served as concrete mechanisms for reducing anxiety, sustaining hope, and strengthening connection to divine purpose. “After prayer and pilgrimage, I felt this was a test and decided to try again.” — Maryam 3. Spiritual Transformation and Forward Orientation a) Renewed life purpose through faith b) Trust in divine wisdom guiding future steps c) Hope as moral courage to act Spiritual growth reoriented parents from fear to constructive hope, enabling some to envision a future that included new possibilities, such as having another child. “I was always worried the next child would be like the first, but after spiritual work and counseling, I felt ready.” — Reyhaneh 4. Communal and Pastoral Supports Institutionalizing Hope a) Religious community validation b) Clergy and pastoral guidance c) Peer faith-based support networks Spiritual communities, mosques, and faith groups reinforced positive interpretations and connected parents to social and emotional resources. “The community prayers and conversations gave me strength and practical tips that helped reduce my fear.” — Nadia 5. Tensions Between Faith-Based Trust and Pragmatic Fear a) Balancing divine trust with realistic caution b) Negotiating belief and medical information c) Coexistence of hope and anxiety Faith often mitigated distress but did not eliminate fears related to recurrence or financial constraints; parents integrated trust in God with pragmatic risk assessment. “Faith helped me, but I still worried about cost and whether I could cope.” — Sara 1. Reinterpreting suffering: from calamity to meaningful test or blessing Many parents moved from an initial framing of the child’s condition as catastrophic toward a spiritual reframing: the disability was understood as a test, purification, or a source of grace. This reappraisal reduced existential distress and reframed parental identity in sacred terms. One mother described: “After a while I understood maybe God placed this on us for a reason; that thought calmed me and restored my energy.” “Maryam” . Another parent described how her husband’s religious interpretations provided moral meaning: “My husband used to recite hadiths… he said illness washes sins… that gave me patience.” “Fatemeh” . 2. Embodied spiritual practices as sources of hope and regulation Prayer, ritual observance, pilgrimage and reading sacred texts were repeatedly reported as concrete practices that generated hope, regulated anxiety, and enabled coping in moments of crisis. Participants linked specific practices with measurable shifts in affect and decision readiness: “After prayer and pilgrimage, I felt this was a test and decided to try again.” “Maryam” . Such rituals functioned in tandem as brief-term emotion-regulators and indicators of commitment that increased determination when faced with ambiguity 3. Spiritual transformation enabling forward-oriented decisions For most, religious reframing brought a wider change in life direction — from defensive withdrawal to forward-looking hope — that in turn impacted concrete reproductive decisions. Several parents said that belief in God allowed them to live with lingering risk and to react (e.g., pursuing subsequent childbearing): “I was always worried the next child would be like the first… but after spiritual work and counseling I felt ready.” “Reyhaneh” . This transformation often unfolded over time and involved iterative meaning-making rather than a single revelatory event. 4. Communal and pastoral supports: institutionalizing spiritual resilience Religious support was not only individual; mosques, pilgrim networks, clergy, and parent-to-parent religious organizations provided validation, practical advice and emotional support. These networks promoted positive testimonials and connected families to material support (e.g., information about genetic counseling or charitable assistance). One participant noted: “The community prayers and conversations gave me strength and practical tips that helped reduce my fear.” “Nadia” . 5. Tensions: faith-based trust versus pragmatic fear Though faith tended to undergird hope, it was in tension with realistic fear of reoccurrence, caregiving capacity, and economic stress. Participants resolved faith in God with medical information and material constraints; faith tempered but did not eliminate pragmatic fear. In the words of one parent: “Faith helped me, but I still worried about cost and whether I could cope.” — “Sara” . This tension produced nuanced decision-making in which spiritual conviction and practical planning were enacted together. Discussion This study explored parents’ experiences of spiritual hope in raising children with disabilities. Five interrelated themes emerged, highlighting how spirituality informs coping, meaning-making, and future decisions. These findings demonstrate that parents gradually shifted from initial distress to a spiritually grounded reinterpretation of their circumstances. This movement from emotional disruption to meaning-making mirrors a central pathway highlighted in Hillman’s study (2017), in which caregivers used gratitude, unconditional love, and faith to reinterpret the challenges of disability (18). However, the present study extends Hillman’s observations by illustrating how parents perform this cognitive–spiritual shift: not only by cultivating gratitude, but also by reframing hardship as a purposeful divine test and reshaping their parental identity around patience and moral responsibility. Similarly, previous research has emphasized the role of religion in helping parents construct meaning and reinterpret distressing experiences (19). Yet, the current findings indicate that meaning-making is neither automatic nor uniform. National (20) and international studies (21, 22)show that many parents experience significant hopelessness, particularly when they anticipate a negative future trajectory for their child. Based on this study, participants experienced early despair and emotional withdrawal. Consistent with these findings, Markoudimitraki (23) noted that such pessimistic expectations may reduce parents’ motivation and engagement. This study offers further insight into the literature by demonstrating that although hopelessness is common, many parents ultimately adopt a spiritually positive interpretation of their child and the disability. According to a study, perceiving a child as a divine blessing reduces emotional distress and fosters gratitude (24). This study's participants also described a shift toward viewing their child as a source of spiritual growth rather than a form of punishment. This reframing appeared to buffer stress, lessen regret, and enhance coping capacity. Taken together, these findings suggest that spiritual reinterpretation may function as a protective psychological mechanism in contexts where structural and social support are limited. 1. Embodied Spiritual Practices as Sources of Hope and Emotional Regulation Parents in the present study identified specific spiritual practices as central strategies for fostering hope and regulating emotions, highlighting three key subthemes: Prayer and Supplication as Daily Coping : Engaging in routine prayer enabled parents to manage anxiety, sustain hope, and maintain a sense of connection to divine guidance. Pilgrimage and Participation in Sacred Rituals : Visiting holy sites and engaging in ritual activities reinforced spiritual resilience, moral courage, and a sense of purpose. Reading Scripture and Sacred Narratives for Comfort : Interaction with sacred texts provided emotional solace, facilitated meaning-making, and strengthened a sense of alignment with divine intention. These findings resonate with prior research demonstrating the protective role of spiritual practices in coping with adversity. McMahon-Panther (2025) reported that when individuals with disabilities did not experience improvement through prayer, they were sometimes labeled as lacking faith or being morally flawed, and their condition was interpreted as a manifestation of evil or divine punishment for unforgiven sins. Such framing, occasionally reinforced by clergy or religious leaders, contributed to profound self-loathing among affected individuals (25). In contrast, other studies have shown that engagement in spiritual practices can enhance parental resilience and foster adaptive coping. For instance, parents of children with disabilities who actively participated in prayer, religious activities, and spiritual reflection often experienced strengthened spiritual orientation, improved emotional regulation, and greater capacity to manage anxiety and despair (5). The present study extends these insights by illustrating that spiritual practices do not merely offer comfort but function as active coping mechanisms that buffer stress, enhance psychological endurance, and facilitate adjustment to the challenges associated with raising a child with a disability. Collectively, these findings suggest that embodied spiritual practices serve as a dynamic resource , integrating emotional, cognitive, and behavioral dimensions of coping, and highlighting the interplay between individual spirituality and broader social or religious support systems. Spiritual Transformation and Forward-Oriented Life Purpose Participants in this study also described undergoing a spiritual transformation accompanied by a renewed sense of life purpose, which facilitated future-oriented decision-making. This renewed purpose was grounded in faith, trust in divine wisdom guiding future steps, and hope as a form of moral courage. Consistent with the present findings, some families face severe mental health challenges—even suicidal ideation—yet rely on spirituality, faith, and divine guidance to make ethical and constructive decisions (26). In the study by Abanit Asa, some individuals interpreted their child’s disability as an expression of God’s will, believing that medical treatment or counseling might interfere with divine plans (27). Overall, spiritual transformation and a renewed sense of purpose appear to support a future-focused orientation. Trust in God enhances meaning and purpose in life, strengthens hope and self-efficacy, and facilitates thoughtful decision-making when facing future challenges. Anchoring decisions in spiritual and ethical values fosters psychological resilience and life satisfaction (6). Thus, the present study extends existing literature by illustrating how spiritual transformation functions as both a protective and promotive mechanism, enabling parents to navigate adversity while maintaining hope, moral agency, and a constructive orientation toward the future. Communal and Pastoral Supports The present study highlighted the pivotal role of communal and spiritual support in enhancing parents’ resilience when caring for a child with a disability. Participants reported that guidance from spiritual leaders, peer-based faith networks, and broader religious communities provided both emotional sustenance and practical strategies for coping. These findings are consistent with Pandya (28), who demonstrated that structured spiritual interventions led by religious leaders can promote acceptance and facilitate spiritual adaptation among parents of children with disabilities. While Pandya emphasized formal, leader-driven programs, the present study extends this understanding by showing that informal, community-based practices —including peer support and guidance from spiritual figures— can similarly foster resilience and a sense of hope. Carter (29)further noted that professional support systems tend to prioritize parents’ physical and psychological well-being, often overlooking spiritual dimensions. The current study reinforces and expands on this perspective, illustrating that engagement in spiritual communities not only addresses this gap but also complements parents’ personal coping strategies. Through these collective supports, parents reported enhanced adaptation, strengthened hope, and a deeper sense of meaning, underscoring the integrative function of communal and pastoral resources in spiritual resilience . Tensions Between Faith-Based Trust and Pragmatic Caution The fifth theme highlighted the inherent tension parents experience between faith-based trust and pragmatic caution. Subthemes included: a) Balancing Divine Trust with Realistic Caution b) Negotiating Belief and Medical Information c) Coexistence of Hope and Anxiety Findings from the present study align with prior research indicating that parents commonly undergo a period of spiritual disruption following their child’s diagnosis. Similar to our participants’ accounts, earlier studies report that many parents initially question God’s role in the disability, experiencing a temporary crisis of meaning before gradually reaffirming their faith (15). This convergence suggests that spiritual questioning may function as a transitional phase through which parents reorganize their beliefs in light of the new reality. However, our findings extend previous research by illustrating how parents navigate this tension in everyday decision-making. While earlier studies have emphasized the presence of spiritual struggle, they have paid less attention to the active processes parents employ to integrate religious beliefs with medical recommendations. Participants in this study described seeking medical counseling, consulting faith leaders, and engaging in reflective practices that allowed them to anchor medical decisions within a spiritual framework. This integrative approach appears to facilitate acceptance and contribute to more adaptive coping. Additionally, other scholarship has examined deeper theological conflicts surrounding human flourishing and divine intent in the context of raising a child with a disability (30). Compared to those studies—which primarily discuss philosophical or doctrinal tensions—our findings highlight the practical dimension of this conflict: how parents operationalize faith in moments of uncertainty, risk assessment, and caregiving decisions. This contrast underscores the unique contribution of our study in revealing the everyday embodiment of these abstract religious dilemmas in parents’ lived experiences. (31) Limitations This study was conducted as a secondary analysis of data from a previous research project. Consequently, had the study been originally designed specifically to explore the concept of spirituality, the interview questions could have been more focused and tailored, potentially yielding richer and more nuanced insights. Although secondary analysis offers the advantage of re-examining previously collected data and maximizing the value of qualitative datasets (32), the benefits of an initial study designed with open-ended questions, opportunities for in-depth responses, and systematic analytical follow-ups remain substantial. Conclusion The findings of this study indicate that trust in God and spiritual hope function as dynamic psychosocial resources for parents of children with disabilities. These resources: (a) help reconstruct meaning in the context of caregiving, (b) facilitate emotional regulation through embodied spiritual practices, (c) engage and mobilize community supports, and (d) enable some parents to embrace uncertainty while making life-affirming decisions. Spirituality not only moderates emotional responses to risk but also interacts with practical realities, including access to healthcare and economic circumstances, thereby shaping the trajectories and coping strategies of these parents. Declarations Ethics approval and consent to participate This study was conducted in accordance with the Declaration of Helsinki and received approval from the Ethics Committee of Qom University of Medical Sciences (Approval Code: IR.MUQ.REC.1403.015). All participants were fully informed about the study objectives, the voluntary nature of their participation, and their right to withdraw at any stage without any consequences. Written informed consent was obtained from all participants prior to data collection, including consent for the anonymous quotation of their statements in any resulting publications. Consent for publication Not applicable Declarations Not applicable Availability of data and materials The datasets generated or analyzed during the current study are not publicly available due to the sensitive nature of qualitative data and the need to protect participant confidentiality, but are available from the corresponding author on reasonable request. Competing Interests The authors declare that they have no conflicts of interest. Funding This research received funding from Deputy of Research and Technology of Qom University of Medical Sciences (Grand ID:3136). Authors' contributions S.Z.M. conceptualized the study and led the research design. L.G.A. and B.S.H. conducted data collection and contributed to data analysis. L.T. assisted with interpretation of findings and methodological refinement. L.T. and L.G.A. drafted the initial manuscript. All authors contributed to manuscript revision, read, and approved the final version of the manuscript. 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Supplementary Files SupplementaryFile1.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 26 Apr, 2026 Reviews received at journal 13 Apr, 2026 Reviewers agreed at journal 12 Apr, 2026 Reviewers agreed at journal 10 Apr, 2026 Reviews received at journal 09 Apr, 2026 Reviewers agreed at journal 08 Apr, 2026 Reviewers invited by journal 07 Apr, 2026 Editor assigned by journal 24 Feb, 2026 Editor invited by journal 24 Feb, 2026 Submission checks completed at journal 20 Feb, 2026 First submitted to journal 20 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8734968","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":622128815,"identity":"6dd537a5-53f8-415c-89b5-f66ee52d5c29","order_by":0,"name":"Seyde zeinab modarresy mosalla","email":"","orcid":"","institution":"Qom University of Medical Science and Health Services","correspondingAuthor":false,"prefix":"","firstName":"Seyde","middleName":"zeinab modarresy","lastName":"mosalla","suffix":""},{"id":622128816,"identity":"ddf6522d-b502-4234-aadd-8dcece7c6fbf","order_by":1,"name":"Leila Ghanbari-afra","email":"","orcid":"","institution":"Qom University of Medical Science and Health Services","correspondingAuthor":false,"prefix":"","firstName":"Leila","middleName":"","lastName":"Ghanbari-afra","suffix":""},{"id":622128817,"identity":"e786e68a-a316-41c1-b267-4ebac0a0fe1b","order_by":2,"name":"Batool-sadat Hashemi","email":"","orcid":"","institution":"Qom University of Medical Science and Health Services","correspondingAuthor":false,"prefix":"","firstName":"Batool-sadat","middleName":"","lastName":"Hashemi","suffix":""},{"id":622128818,"identity":"470cdab0-1d37-4b02-9a74-621d6fcbbace","order_by":3,"name":"Leila Taheri","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8klEQVRIiWNgGAWjYFACHiA2YJBhYGZuYPgAZLOxE9QA0cLDwMzYwDgDpIWZKC1guxgbmMFsQlrs2c8efFxRwMDDz87Y+Nm2bZs8HzMD44ePOXhs4clLNjwDdJhkM2OzdG7bbcM2ZgZmyZnb8Dksx0yyAajF4DBjA0gLI1ALGzMvPi38b8x/grTYH2Zs/m3ZdtuesBaJHDNGsC3MjG3SjG23EwlrufHGGOgwCR6Jw4xtlj3nbie3MTM24/ULe3+O4ceGPzZy/P2HD9/4UXbbdn5788EPH/FogQIJCMXIBiYbCKpHAn9IUTwKRsEoGAUjBQAA6WlCg3kODQQAAAAASUVORK5CYII=","orcid":"","institution":"Qom University of Medical Science and Health Services","correspondingAuthor":true,"prefix":"","firstName":"Leila","middleName":"","lastName":"Taheri","suffix":""}],"badges":[],"createdAt":"2026-01-29 20:23:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8734968/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8734968/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106921355,"identity":"dd595d27-a5cd-49c1-b36b-b7328b49556d","added_by":"auto","created_at":"2026-04-14 19:56:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1161824,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8734968/v1/5041ff6c-1c5a-403c-855e-7c345aec79bd.pdf"},{"id":106921354,"identity":"7cc51e28-2571-49c3-b931-879da20c7d92","added_by":"auto","created_at":"2026-04-14 19:56:04","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":16987,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8734968/v1/54f02fc471330e66f17b49df.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Transforming Suffering Through Faith: The Lived Experience of Spiritual Hope in Parents of Children with Disabilities ","fulltext":[{"header":"Introduction","content":"\u003cp\u003e Parents of children with intellectual disabilities have long fulfilled a central and irreplaceable role in providing daily care and emotional support to their children within the home environment (1). In many developing countries, these responsibilities are intensified due to limited access to essential services, insurance coverage, specialized equipment, employment opportunities, and broader social and cultural support system (2). Consequently, families often face greater pressure, and the presence of a child with a disability can significantly influence their overall quality of life (1) and multiple dimensions of parental well-being, including spiritual health (3).\u003c/p\u003e \u003cp\u003eResearchers, disability advocates, and religious scholars have increasingly recognized spirituality as a fundamental human need (4). Defining spirituality and religion remains a topic of interest across disciplines, particularly in discussions exploring whether these concepts are separate, overlapping, or inseparable in practice (5). Existing definitions highlight themes such as connection with a higher power, meaning-making, hope, resilience, and interpersonal relationships. They also encompass a broad range of thoughts, behaviors, and practices that shape individuals\u0026rsquo; responses to life\u0026rsquo;s challenges (6).\u003c/p\u003e \u003cp\u003eA wide range of definitions have been proposed for spirituality. It is commonly described as a search for meaning and purpose in life, involving inner awareness and a sense of connection to something greater than oneself (7). Boukart defines spirituality as a multi-dimensional human quest to discover deeper meaning in life. This quest fosters connection not only with all living beings but also with \u0026ldquo;God\u0026rdquo; or an \u0026ldquo;ultimate truth\u0026rdquo; (8). Beyond this, spirituality is sometimes depicted as an intangible, sensory, abstract, and immaterial aspect of human existence. Metaphorically, it is often referred to as the \u0026ldquo;power of the heart\u0026rdquo; or \u0026ldquo;the spirit\u0026rdquo; (9). Within the nursing literature, spirituality is commonly understood as an individual effort to cultivate inner peace and find meaning and purpose amid life\u0026rsquo;s challenges and experiences (10).\u003c/p\u003e \u003cp\u003eA decrease in spirituality among parents of children with disabilities can have significant psychological, social, and familial impacts. Serving as an internal coping resource, spirituality helps parents make sense of suffering, accept challenging circumstances, and sustain hope. When this resource is weakened, parents may experience heightened helplessness, emptiness, and a sense of purposelessness, which can contribute to increased anxiety and depression and reduced resilience (11, 12). A lack of sufficient spiritual connection may also strain family relationships, reducing intimacy between partners and intensifying conflicts among family members. Moreover, a decline in spirituality can foster feelings of disconnection from the wider community and lower perceived social support, leaving parents feeling uncertain or hopeless about their child\u0026rsquo;s future (12, 13).\u003c/p\u003e \u003cp\u003eVarious studies have explored the spirituality among parents of children with disabilities. For instance, Parker found that parents of healthy children scored higher on measures of spirituality and religiosity than parents of children with disabilities (14). Similarly, Dey (2019) found that spirituality indirectly influenced parents\u0026rsquo; life satisfaction, their experience of positive and negative emotions toward their children, with resilience serving as a key mediator (3). Almodar\u0026rsquo;s research also highlighted that mothers who engaged in high levels of spiritual coping were better able to manage stress and demonstrated greater resilience (13). In contrast, a study reported challenges in spiritual well-being, particularly in the early stages of a child\u0026rsquo;s disability. Parents in these studies often questioned God\u0026rsquo;s role and experienced spiritual distress (15). Moreover, negative religious coping\u0026mdash;such as spiritual struggle, conflict with religious communities, feelings of abandonment by God, anger toward Him, or guilt\u0026mdash;was linked to increased depressive symptoms, anxiety, hopelessness, loneliness, greater caregiver burden, and lower quality of life (16).\u003c/p\u003e \u003cp\u003eWhen a phenomenon is inherently subjective, complex, multidimensional, and shaped by individuals\u0026rsquo; lived experiences and interpretations, qualitative research offers the most appropriate methodological approach. Additionally, if the researcher aims to gain a deep understanding of the phenomenon through participants\u0026rsquo; experiences and perceptions, a phenomenological approach is appropriate. Given that this study seeks to describe the subjective and in-depth experiences of parents of children with disabilities regarding spirituality, a qualitative phenomenological approach was employed.\u003c/p\u003e \u003cp\u003eMoreover, qualitative studies are particularly valuable for examining phenomena that quantitative approaches may not fully capture, especially in areas where prior quantitative findings have been inconsistent (17). In light of these inconsistencies, the present study sought to explore the lived experiences of parents of children with disabilities regarding spirituality. It should also be noted that this research represents a subset of a larger project investigating parents\u0026rsquo; intentions regarding future childbearing after having a child with a disability.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign and epistemology\u003c/h2\u003e \u003cp\u003e This study used a hermeneutic phenomenological approach (Van Manen) to explore the ways that parents' experiences and decisions are affected by hope, spirituality, and beliefs in God upon the birth of a child with a disability. Hermeneutic phenomenology promotes interpretive description of lived experience and is particularly appropriate for exploring the existential and meaning-making dimensions of parenting and religion.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSetting and participants\u003c/h3\u003e\n\u003cp\u003e Fourteen parents (mothers and fathers) were purposively sampled from a Qom, Iran, pediatric referral clinic. Inclusion criteria were: primary caregiver or parent of a child with chronic disability, ability to participate in a detailed interview in Persian, and agreement to discuss spiritual and reproductive life. Maximum variation sampling (education, gender, age, urban versus rural residence) was used and persisted until thematic saturation was achieved.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eData were collected with individual, semi-structured, open-ended interviews by the primary researcher between [dates removed for anonymization]. An interview guide prompted participants to explain their experience of raising a disabled child and to comment specifically on spiritual resources, hope, trust in God, and how these shaped decisions about future childbearing. Interviews were initiated with an open-ended question (e.g., \"Could you tell me about your experience of parenting your child and how faith or spirituality has touched you\") and utilized follow-up questions (e.g., \"Could you tell me more about that?\", \"How did prayer/pilgrimage influence your emotions?\"). The English version of the interview guide is provided as Supplementary File 1.\u003c/p\u003e \u003cp\u003eInterviews were tape-recorded with written informed consent and transcribed verbatim in Persian.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eTranscripts were exported into MAXQDA v21 for data management. Analysis followed Van Manen's six-step hermeneutic phenomenological process: immersion in the text, bracketing significant sentences, thematic description, writing and rewriting to cast a light on the phenomenon, having an intimate relationship with the lived experience, and finding a balance between parts and whole. Coding iteratively and interpretively: meaningful units that were relevant to spirituality, hope, trust, and decision-making were determined, clustered into subthemes, and abstracted still further into higher-order themes. Data collection and analysis were concurrent; initial analytic findings were used to guide subsequent interviews to explore emergent dimensions of spiritual experience.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eTrustworthiness and reflexivity\u003c/h3\u003e\n\u003cp\u003eCredibility was established through member checking (participants reviewed summaries of their interviews), prolonged engagement with the dataset, and peer debriefing within the research team. Dependability and confirmability were assured through audit trail (decision logs, coding memos) and reflexive journaling on the investigators' part to surface assumptions about religion and parenting. Transferability is guaranteed by richly contextualized quotations and clear description of participant setting and demographics. Ethical approval was obtained from the appropriate institutional review board and all participants provided written informed consent; quotations are pseudonymised to protect confidentiality.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eDemographic Data of participants is shown in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Analysis identified a primary, fruitful theme: Spiritual trust and hope in God as a purposive and sustaining resource.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDemographic Characteristics of Participants\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eParticipant\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c5\"\u003e\n \u003cp\u003eNumber of Children\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c6\"\u003e\n \u003cp\u003eNumber of Children with Disability\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c7\"\u003e\n \u003cp\u003eSubsequent Childbearing after a Child with Disability\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\" colname=\"c1\"\u003e\n \u003cp\u003eP1 (Follow-up interview)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eHigh School Diploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eP2 (Follow-up interview)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eMiddle School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eP3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eBachelor\u0026rsquo;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eP4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eHigh School Diploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eP5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eHigh School Diploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eP6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eAssociate Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eP7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eBachelor\u0026rsquo;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eP8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eMiddle School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eP9 (Follow-up interview)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eHigh School Diploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eP10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eMaster\u0026rsquo;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eP11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eHigh School Diploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eP12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eHigh School Diploma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eP13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eMiddle School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eP14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eMaster\u0026rsquo;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eP15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eMaster\u0026rsquo;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eP16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eAssociate Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eP17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eBachelor\u0026rsquo;s Degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eP18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eSome High School\u003c/p\u003e\n \u003cp\u003e(Incomplete high school)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\n \u003cp\u003e1\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 overall theme was represented by five interconnected subthemes: (1) reinterpreting suffering as divine test or blessing; (2) embodied spiritual practices (prayer, ritual, pilgrimage) that concretize hope; (3) spiritual transformation and renewed life-orientation that enabled risk-taking (e.g., subsequent childbearing); (4) communal and pastoral supports that institutionalize spiritual resilience; and (5) persistent tensions between faith-based trust and pragmatic fears (Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eThemes and Subthemes on Hope, Spirituality, and Trust in God among Parents of Children with Disabilities\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eMain Theme\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eSubthemes\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eDescription (Interpretive Summary)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eIllustrative Quotation\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\" colname=\"c1\"\u003e\n \u003cp\u003e1. Reinterpreting Suffering: From Calamity to Divine Test or Blessing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003ea) Spiritual reframing of adversity\u003c/p\u003e\n \u003cp\u003eb) Faith-based acceptance and patience\u003c/p\u003e\n \u003cp\u003ec) Seeing the child as \u0026ldquo;a gift, not a punishment.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eParents moved from despair to meaning-making by viewing their child\u0026rsquo;s condition as part of God\u0026rsquo;s will, fostering acceptance, resilience, and moral endurance.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e\u0026ldquo;After a while, I understood maybe God placed this on us for a reason; that thought calmed me and restored my energy.\u0026rdquo; \u0026mdash; Maryam\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e2. Embodied Spiritual Practices as Sources of Hope and Emotional Regulation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003ea) Prayer and supplication as daily coping\u003c/p\u003e\n \u003cp\u003eb) Pilgrimage and sacred rituals\u003c/p\u003e\n \u003cp\u003ec) Reading scripture and sacred stories for comfort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eFaith-based practices served as concrete mechanisms for reducing anxiety, sustaining hope, and strengthening connection to divine purpose.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e\u0026ldquo;After prayer and pilgrimage, I felt this was a test and decided to try again.\u0026rdquo; \u0026mdash; Maryam\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e3. Spiritual Transformation and Forward Orientation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003ea) Renewed life purpose through faith\u003c/p\u003e\n \u003cp\u003eb) Trust in divine wisdom guiding future steps\u003c/p\u003e\n \u003cp\u003ec) Hope as moral courage to act\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eSpiritual growth reoriented parents from fear to constructive hope, enabling some to envision a future that included new possibilities, such as having another child.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e\u0026ldquo;I was always worried the next child would be like the first, but after spiritual work and counseling, I felt ready.\u0026rdquo; \u0026mdash; Reyhaneh\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e4. Communal and Pastoral Supports Institutionalizing Hope\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003ea) Religious community validation\u003c/p\u003e\n \u003cp\u003eb) Clergy and pastoral guidance\u003c/p\u003e\n \u003cp\u003ec) Peer faith-based support networks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eSpiritual communities, mosques, and faith groups reinforced positive interpretations and connected parents to social and emotional resources.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e\u0026ldquo;The community prayers and conversations gave me strength and practical tips that helped reduce my fear.\u0026rdquo; \u0026mdash; Nadia\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e5. Tensions Between Faith-Based Trust and Pragmatic Fear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003ea) Balancing divine trust with realistic caution\u003c/p\u003e\n \u003cp\u003eb) Negotiating belief and medical information\u003c/p\u003e\n \u003cp\u003ec) Coexistence of hope and anxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eFaith often mitigated distress but did not eliminate fears related to recurrence or financial constraints; parents integrated trust in God with pragmatic risk assessment.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e\u0026ldquo;Faith helped me, but I still worried about cost and whether I could cope.\u0026rdquo; \u0026mdash; Sara\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\u003e\u003cstrong\u003e1. Reinterpreting suffering: from calamity to meaningful test or blessing\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMany parents moved from an initial framing of the child\u0026rsquo;s condition as catastrophic toward a spiritual reframing: the disability was understood as a test, purification, or a source of grace. This reappraisal reduced existential distress and reframed parental identity in sacred terms. One mother described: \u0026ldquo;After a while I understood maybe God placed this on us for a reason; that thought calmed me and restored my energy.\u0026rdquo; \u003cem\u003e\u0026ldquo;Maryam\u0026rdquo;\u003c/em\u003e. Another parent described how her husband\u0026rsquo;s religious interpretations provided moral meaning: \u0026ldquo;My husband used to recite hadiths\u0026hellip; he said illness washes sins\u0026hellip; that gave me patience.\u0026rdquo; \u003cem\u003e\u0026ldquo;Fatemeh\u0026rdquo;\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. Embodied spiritual practices as sources of hope and regulation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrayer, ritual observance, pilgrimage and reading sacred texts were repeatedly reported as concrete practices that generated hope, regulated anxiety, and enabled coping in moments of crisis. Participants linked specific practices with measurable shifts in affect and decision readiness: \u0026ldquo;After prayer and pilgrimage, I felt this was a test and decided to try again.\u0026rdquo; \u003cem\u003e\u0026ldquo;Maryam\u0026rdquo;\u003c/em\u003e. Such rituals functioned in tandem as brief-term emotion-regulators and indicators of commitment that increased determination when faced with ambiguity\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3. Spiritual transformation enabling forward-oriented decisions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor most, religious reframing brought a wider change in life direction \u0026mdash; from defensive withdrawal to forward-looking hope \u0026mdash; that in turn impacted concrete reproductive decisions. Several parents said that belief in God allowed them to live with lingering risk and to react (e.g., pursuing subsequent childbearing): \u0026ldquo;I was always worried the next child would be like the first\u0026hellip; but after spiritual work and counseling I felt ready.\u0026rdquo; \u003cem\u003e\u0026ldquo;Reyhaneh\u0026rdquo;\u003c/em\u003e. This transformation often unfolded over time and involved iterative meaning-making rather than a single revelatory event.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4. Communal and pastoral supports: institutionalizing spiritual resilience\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eReligious support was not only individual; mosques, pilgrim networks, clergy, and parent-to-parent religious organizations provided validation, practical advice and emotional support. These networks promoted positive testimonials and connected families to material support (e.g., information about genetic counseling or charitable assistance). One participant noted: \u0026ldquo;The community prayers and conversations gave me strength and practical tips that helped reduce my fear.\u0026rdquo; \u003cem\u003e\u0026ldquo;Nadia\u0026rdquo;\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5. Tensions: faith-based trust versus pragmatic fear\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThough faith tended to undergird hope, it was in tension with realistic fear of reoccurrence, caregiving capacity, and economic stress. Participants resolved faith in God with medical information and material constraints; faith tempered but did not eliminate pragmatic fear. In the words of one parent: \u0026ldquo;Faith helped me, but I still worried about cost and whether I could cope.\u0026rdquo; \u0026mdash; \u003cem\u003e\u0026ldquo;Sara\u0026rdquo;\u003c/em\u003e. This tension produced nuanced decision-making in which spiritual conviction and practical planning were enacted together.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study explored parents\u0026rsquo; experiences of spiritual hope in raising children with disabilities. Five interrelated themes emerged, highlighting how spirituality informs coping, meaning-making, and future decisions.\u003c/p\u003e \u003cp\u003e These findings demonstrate that parents gradually shifted from initial distress to a spiritually grounded reinterpretation of their circumstances. This movement from emotional disruption to meaning-making mirrors a central pathway highlighted in Hillman\u0026rsquo;s study (2017), in which caregivers used gratitude, unconditional love, and faith to reinterpret the challenges of disability (18). However, the present study extends Hillman\u0026rsquo;s observations by illustrating \u003cem\u003ehow\u003c/em\u003e parents perform this cognitive\u0026ndash;spiritual shift: not only by cultivating gratitude, but also by reframing hardship as a purposeful divine test and reshaping their parental identity around patience and moral responsibility. Similarly, previous research has emphasized the role of religion in helping parents construct meaning and reinterpret distressing experiences (19). Yet, the current findings indicate that meaning-making is neither automatic nor uniform. National (20) and international studies (21, 22)show that many parents experience significant hopelessness, particularly when they anticipate a negative future trajectory for their child. Based on this study, participants experienced early despair and emotional withdrawal. Consistent with these findings, Markoudimitraki (23) noted that such pessimistic expectations may reduce parents\u0026rsquo; motivation and engagement.\u003c/p\u003e \u003cp\u003e This study offers further insight into the literature by demonstrating that although hopelessness is common, many parents ultimately adopt a spiritually positive interpretation of their child and the disability. According to a study, perceiving a child as a divine blessing reduces emotional distress and fosters gratitude (24). This study's participants also described a shift toward viewing their child as a source of spiritual growth rather than a form of punishment. This reframing appeared to buffer stress, lessen regret, and enhance coping capacity. Taken together, these findings suggest that spiritual reinterpretation may function as a protective psychological mechanism in contexts where structural and social support are limited.\u003c/p\u003e\n\u003ch3\u003e1. Embodied Spiritual Practices as Sources of Hope and Emotional Regulation\u003c/h3\u003e\n\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003e Parents in the present study identified specific spiritual practices as central strategies for fostering hope and regulating emotions, highlighting three key subthemes:\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003ePrayer and Supplication as Daily Coping\u003c/b\u003e: Engaging in routine prayer enabled parents to manage anxiety, sustain hope, and maintain a sense of connection to divine guidance.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003ePilgrimage and Participation in Sacred Rituals\u003c/b\u003e: Visiting holy sites and engaging in ritual activities reinforced spiritual resilience, moral courage, and a sense of purpose.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eReading Scripture and Sacred Narratives for Comfort\u003c/b\u003e: Interaction with sacred texts provided emotional solace, facilitated meaning-making, and strengthened a sense of alignment with divine intention.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eThese findings resonate with prior research demonstrating the protective role of spiritual practices in coping with adversity. McMahon-Panther (2025) reported that when individuals with disabilities did not experience improvement through prayer, they were sometimes labeled as lacking faith or being morally flawed, and their condition was interpreted as a manifestation of evil or divine punishment for unforgiven sins. Such framing, occasionally reinforced by clergy or religious leaders, contributed to profound self-loathing among affected individuals (25). In contrast, other studies have shown that engagement in spiritual practices can enhance parental resilience and foster adaptive coping. For instance, parents of children with disabilities who actively participated in prayer, religious activities, and spiritual reflection often experienced strengthened spiritual orientation, improved emotional regulation, and greater capacity to manage anxiety and despair (5). The present study extends these insights by illustrating that spiritual practices do not merely offer comfort but function as \u003cb\u003eactive coping mechanisms\u003c/b\u003e that buffer stress, enhance psychological endurance, and facilitate adjustment to the challenges associated with raising a child with a disability.\u003c/p\u003e \u003cp\u003eCollectively, these findings suggest that embodied spiritual practices serve as a \u003cb\u003edynamic resource\u003c/b\u003e, integrating emotional, cognitive, and behavioral dimensions of coping, and highlighting the interplay between individual spirituality and broader social or religious support systems.\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eSpiritual Transformation and Forward-Oriented Life Purpose\u003c/b\u003e \u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eParticipants in this study also described undergoing a spiritual transformation accompanied by a renewed sense of life purpose, which facilitated future-oriented decision-making. This renewed purpose was grounded in faith, trust in divine wisdom guiding future steps, and hope as a form of moral courage. Consistent with the present findings, some families face severe mental health challenges\u0026mdash;even suicidal ideation\u0026mdash;yet rely on spirituality, faith, and divine guidance to make ethical and constructive decisions (26). In the study by Abanit Asa, some individuals interpreted their child\u0026rsquo;s disability as an expression of God\u0026rsquo;s will, believing that medical treatment or counseling might interfere with divine plans (27). Overall, spiritual transformation and a renewed sense of purpose appear to support a future-focused orientation. Trust in God enhances meaning and purpose in life, strengthens hope and self-efficacy, and facilitates thoughtful decision-making when facing future challenges. Anchoring decisions in spiritual and ethical values fosters psychological resilience and life satisfaction (6).\u003c/p\u003e \u003cp\u003e Thus, the present study extends existing literature by illustrating how spiritual transformation functions as both a protective and promotive mechanism, enabling parents to navigate adversity while maintaining hope, moral agency, and a constructive orientation toward the future.\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eCommunal and Pastoral Supports\u003c/b\u003e \u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003e The present study highlighted the pivotal role of communal and spiritual support in enhancing parents\u0026rsquo; resilience when caring for a child with a disability. Participants reported that guidance from spiritual leaders, peer-based faith networks, and broader religious communities provided both emotional sustenance and practical strategies for coping. These findings are consistent with Pandya (28), who demonstrated that structured spiritual interventions led by religious leaders can promote acceptance and facilitate spiritual adaptation among parents of children with disabilities. While Pandya emphasized formal, leader-driven programs, the present study extends this understanding by showing that \u003cb\u003einformal, community-based practices\u003c/b\u003e\u0026mdash;including peer support and guidance from spiritual figures\u0026mdash; can similarly foster resilience and a sense of hope. Carter (29)further noted that professional support systems tend to prioritize parents\u0026rsquo; physical and psychological well-being, often overlooking spiritual dimensions. The current study reinforces and expands on this perspective, illustrating that engagement in spiritual communities not only addresses this gap but also complements parents\u0026rsquo; personal coping strategies. Through these collective supports, parents reported enhanced adaptation, strengthened hope, and a deeper sense of meaning, underscoring the \u003cb\u003eintegrative function of communal and pastoral resources in spiritual resilience\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eTensions Between Faith-Based Trust and Pragmatic Caution\u003c/b\u003e \u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003e The fifth theme highlighted the inherent tension parents experience between faith-based trust and pragmatic caution. Subthemes included:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ea) Balancing Divine Trust with Realistic Caution\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eb) Negotiating Belief and Medical Information\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ec) Coexistence of Hope and Anxiety\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003e Findings from the present study align with prior research indicating that parents commonly undergo a period of spiritual disruption following their child\u0026rsquo;s diagnosis. Similar to our participants\u0026rsquo; accounts, earlier studies report that many parents initially question God\u0026rsquo;s role in the disability, experiencing a temporary crisis of meaning before gradually reaffirming their faith (15). This convergence suggests that spiritual questioning may function as a transitional phase through which parents reorganize their beliefs in light of the new reality.\u003c/p\u003e \u003cp\u003eHowever, our findings extend previous research by illustrating \u003cem\u003ehow\u003c/em\u003e parents navigate this tension in everyday decision-making. While earlier studies have emphasized the presence of spiritual struggle, they have paid less attention to the active processes parents employ to integrate religious beliefs with medical recommendations. Participants in this study described seeking medical counseling, consulting faith leaders, and engaging in reflective practices that allowed them to anchor medical decisions within a spiritual framework. This integrative approach appears to facilitate acceptance and contribute to more adaptive coping.\u003c/p\u003e \u003cp\u003eAdditionally, other scholarship has examined deeper theological conflicts surrounding human flourishing and divine intent in the context of raising a child with a disability (30). Compared to those studies\u0026mdash;which primarily discuss philosophical or doctrinal tensions\u0026mdash;our findings highlight the \u003cem\u003epractical\u003c/em\u003e dimension of this conflict: how parents operationalize faith in moments of uncertainty, risk assessment, and caregiving decisions. This contrast underscores the unique contribution of our study in revealing the everyday embodiment of these abstract religious dilemmas in parents\u0026rsquo; lived experiences. (31)\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study was conducted as a secondary analysis of data from a previous research project. Consequently, had the study been originally designed specifically to explore the concept of spirituality, the interview questions could have been more focused and tailored, potentially yielding richer and more nuanced insights. Although secondary analysis offers the advantage of re-examining previously collected data and maximizing the value of qualitative datasets (32), the benefits of an initial study designed with open-ended questions, opportunities for in-depth responses, and systematic analytical follow-ups remain substantial.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings of this study indicate that trust in God and spiritual hope function as dynamic psychosocial resources for parents of children with disabilities. These resources: \u003cb\u003e(a)\u003c/b\u003e help reconstruct meaning in the context of caregiving, \u003cb\u003e(b)\u003c/b\u003e facilitate emotional regulation through embodied spiritual practices, \u003cb\u003e(c)\u003c/b\u003e engage and mobilize community supports, and \u003cb\u003e(d)\u003c/b\u003e enable some parents to embrace uncertainty while making life-affirming decisions. Spirituality not only moderates emotional responses to risk but also interacts with practical realities, including access to healthcare and economic circumstances, thereby shaping the trajectories and coping strategies of these parents.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki and received approval from the Ethics Committee of Qom University of Medical Sciences (Approval Code: IR.MUQ.REC.1403.015). All participants were fully informed about the study objectives, the voluntary nature of their participation, and their right to withdraw at any stage without any consequences. Written informed consent was obtained from all participants prior to data collection, including consent for the anonymous quotation of their statements in any resulting publications.\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\u003eDeclarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated or analyzed during the current study are not publicly available due to the sensitive nature of qualitative data and the need to protect participant confidentiality, but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;This research received funding from Deputy of Research and Technology of Qom University of Medical Sciences (Grand ID:3136). \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eS.Z.M. conceptualized the study and led the research design. L.G.A. and B.S.H. conducted data collection and contributed to data analysis. L.T. assisted with interpretation of findings and methodological refinement. L.T. and L.G.A. drafted the initial manuscript. All authors contributed to manuscript revision, read, and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all parents who generously shared their experiences and time for the purposes of this study. We also acknowledge those who provided general support during data collection and manuscript preparation.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBarratt M, Lewis P, Duckworth N, Jojo N, Malecka V, Tomsone S, et al. Parental Experiences of Quality of Life When Caring for Their Children With Intellectual Disability: A Meta-Aggregation Systematic Review. 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Florence Nightingale Journal of Nursing. 2005;13(54):27\u0026ndash;34.\u003c/li\u003e\n\u003cli\u003eMcSherry W. Education issues surrounding the teaching of spirituality. Nursing Standard (through 2013). 2000;14(42):40.\u003c/li\u003e\n\u003cli\u003eKaraca A, Konuk Şener D. Spirituality as a coping method for mothers of children with developmental disabilities. International Journal of Developmental Disabilities. 2021;67(2):112\u0026thinsp;\u0026minus;\u0026thinsp;20.\u003c/li\u003e\n\u003cli\u003eGur A, Reich A. Spirituality-based interventions for parents of children with disabilities: A systematic review. Spirituality in Clinical Practice. 2025;12(3):319\u0026thinsp;\u0026minus;\u0026thinsp;35.\u003c/li\u003e\n\u003cli\u003eAlemdar DK, Yilmaz G, G\u0026uuml;naydin N. The Spiritual and Religious Coping of Mothers with Disabled Children in Turkey: Correlation Between Stress Coping Styles and Self-Efficacy. J Relig Health. 2023;62(2):888\u0026ndash;905.\u003c/li\u003e\n\u003cli\u003eParker JA, Mandleco B, Olsen Roper S, Freeborn D, Dyches TT. Religiosity, spirituality, and marital relationships of parents raising a typically developing child or a child with a disability. J Fam Nurs. 2011;17(1):82\u0026ndash;104.\u003c/li\u003e\n\u003cli\u003eBaines S, Hatton C. The Impact of the Birth of a Child with Intellectual Disabilities on Pre-Existing Parental Christian Faith from the Perspective of Parents Who Have Parented Their Child to Adulthood. Journal of Applied Research in Intellectual Disabilities. 2015;28(6):524\u0026thinsp;\u0026minus;\u0026thinsp;35.\u003c/li\u003e\n\u003cli\u003eLeidl BF, Fox-Davis D, Walker FO, Gabbard J, Marterre B. Layers of loss: A scoping review and taxonomy of HD caregivers\u0026rsquo; spiritual suffering, grief/loss and coping Strategies. Journal of pain and symptom management. 2023;65(1):e29-e50.\u003c/li\u003e\n\u003cli\u003eCreswell JW, Poth CN. Qualitative inquiry and research design: Choosing among five approaches: Sage publications; 2016.\u003c/li\u003e\n\u003cli\u003eHillman JL, Wentzel MC, Anderson CM. Grandparents\u0026apos; Experience of Autism Spectrum Disorder: Identifying Primary Themes and Needs. J Autism Dev Disord. 2017;47(10):2957-68.\u003c/li\u003e\n\u003cli\u003eDomaradzki J, Walkowiak D. \u0026ldquo;In God We Trust\u0026rdquo;: An Exploratory Study of the Associations Between Religiosity and the Caregiving Experiences of Parents of Children with Rare Diseases in Poland. Journal of Religion and Health. 2024;63(6):4079\u0026thinsp;\u0026minus;\u0026thinsp;109.\u003c/li\u003e\n\u003cli\u003eHemati Alamdarloo G, Majidi F. Feelings of hopelessness in mothers of children with neurodevelopmental disorders. International Journal of Developmental Disabilities. 2022;68(4):485\u0026thinsp;\u0026minus;\u0026thinsp;94.\u003c/li\u003e\n\u003cli\u003eKaytez N, Deleş B, Aral N. An examination of the hopelessness levels and self-esteem of parents with special needs children. BMC Psychol. 2025;13(1):832.\u003c/li\u003e\n\u003cli\u003eKarayagiz Muslu G, Coskun Cenk S. The Family Burdens and Hopelessness of Turkish Parents of Adolescents With Intellectual Disabilities. Rehabil Nurs. 2018;43(6):351\u0026thinsp;\u0026minus;\u0026thinsp;62.\u003c/li\u003e\n\u003cli\u003eMarkodimitraki M, Charitaki G, Kypriotaki M, Fragogianni ME, Kypriotakis G. The role of marital satisfaction and social activities on parents\u0026apos; self-perception: evidence from Greek families of children with and without disabilities. Int J Dev Disabil. 2024;70(3):444\u0026thinsp;\u0026minus;\u0026thinsp;57.\u003c/li\u003e\n\u003cli\u003eHamedanchi A SR, Fadaye Vatan R, Khankeh H R. The Lived Experience of Spirituality by the Elderly Parents of Children with Intellectual Disability: A Phenomenological Study. Salmand: Iranian Journal of Ageing. 2013;8(2):70\u0026thinsp;\u0026minus;\u0026thinsp;8.\u003c/li\u003e\n\u003cli\u003eMcMahon-Panther G, Bornman J. Persons with Disabilities in the Christian Church: A Scoping Review on the Impact of Expressions of Compassion and Justice on their Inclusion and Participation. Journal of Disability \u0026amp; Religion. 2025;29(1):81\u0026ndash;108.\u003c/li\u003e\n\u003cli\u003eMasulani-Mwale C, Mathanga D, Silungwe D, Kauye F, Gladstone M. Parenting children with intellectual disabilities in Malawi: the impact that reaches beyond coping? Child Care Health Dev. 2016;42(6):871\u0026thinsp;\u0026minus;\u0026thinsp;80.\u003c/li\u003e\n\u003cli\u003eAsa GA, Fauk NK, Mwanri L, Ward PR. Understanding Barriers to the Access to Healthcare and Rehabilitation Services: A Qualitative Study with Mothers or Female Caregivers of Children with a Disability in Indonesia. Int J Environ Res Public Health. 2021;18(21).\u003c/li\u003e\n\u003cli\u003ePandya SP. Spirituality and Parents of Children With Disability: Views of Practitioners. Journal of Disability \u0026amp; Religion. 2017;21(1):64\u0026ndash;83.\u003c/li\u003e\n\u003cli\u003eCarter EW, Boehm TL, Annandale NH, Taylor CE. Supporting Congregational Inclusion for Children and Youth With Disabilities and Their Families. Exceptional Children. 2016;82(3):372\u0026thinsp;\u0026minus;\u0026thinsp;89.\u003c/li\u003e\n\u003cli\u003eWhitt JD. In the image of God: Receiving children with special needs. Review \u0026amp; Expositor. 2016;113(2):205\u0026thinsp;\u0026minus;\u0026thinsp;16.\u003c/li\u003e\n\u003cli\u003eHatun O, Yavuz-Birben F, İnce Z, Kalkan-Yeni G. The ticket to heaven: A spiritual resource for coping with disability. Spiritual Psychology and Counseling. 2016;1(2):209\u0026thinsp;\u0026minus;\u0026thinsp;35.\u003c/li\u003e\n\u003cli\u003eLong-Sutehall T, Sque M, Addington-Hall J. Secondary analysis of qualitative data: a valuable method for exploring sensitive issues with an elusive population? Journal of Research in Nursing. 2011;16(4):335\u0026thinsp;\u0026minus;\u0026thinsp;44.\u003c/li\u003e\n\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":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Spirituality, Parents, Children with Disabilities, Hermeneutics, Coping Skills","lastPublishedDoi":"10.21203/rs.3.rs-8734968/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8734968/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCaring for a child with disability challenges parents\u0026rsquo; emotional, existential, and spiritual worlds. Yet, within this struggle, many parents draw on faith-based resources that transform suffering into meaning and sustain hope. This study explored how spirituality and trust in God shape parents\u0026rsquo; experiences and decisions regarding family life and future childbearing.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA qualitative hermeneutic phenomenological design guided by Van Manen\u0026rsquo;s approach was used. Fourteen parents of children with chronic disabilities were purposively sampled from a pediatric referral center. Semi-structured, in-depth interviews explored participants\u0026rsquo; perceptions of faith, hope, and divine trust in relation to their parenting experiences. Data were analyzed using Van Manen\u0026rsquo;s six-step interpretive framework with MAXQDA v21. Trustworthiness was ensured through member checking, peer debriefing, and audit trails.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eFive interrelated themes captured the spiritual dimensions of parental coping and meaning-making: (1) \u003cem\u003eReinterpreting suffering as a divine test or blessing\u003c/em\u003e; (2) \u003cem\u003eEmbodied spiritual practices\u0026mdash;prayer, pilgrimage, scripture reading\u0026mdash;as sources of hope and regulation\u003c/em\u003e; (3) \u003cem\u003eSpiritual transformation and renewed purpose enabling forward-oriented decisions\u003c/em\u003e; (4) \u003cem\u003eCommunal and pastoral supports that institutionalize spiritual resilience\u003c/em\u003e; and (5) \u003cem\u003eTensions between faith-based trust and pragmatic fear\u003c/em\u003e. Spirituality was not acquiescence but a constant active process of reframing, emotional regulation, and ethical strength. Hope and faith were blended together to create psychological resilience and future orientation in life, sometimes guiding decision-making for future childbearing under adversity.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003e Spiritual faith and hope in God are dynamic psychosocial resources that allow parents to transform suffering into meaning, sustain caregiving, and manage difficult life choices. Incorporating spiritual evaluation and pastoral collaboration within pediatric and family care can cement supportive care for families of disabled children.\u003c/p\u003e","manuscriptTitle":"Transforming Suffering Through Faith: The Lived Experience of Spiritual Hope in Parents of Children with Disabilities ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-14 19:55:53","doi":"10.21203/rs.3.rs-8734968/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-27T03:09:40+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-13T09:28:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"335203937599587116180025630190266676432","date":"2026-04-13T03:20:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"152458310825388342623511999395691143818","date":"2026-04-10T11:07:48+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-09T06:44:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"175274842558165945935291356626426361001","date":"2026-04-08T08:17:31+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-07T13:37:20+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-24T19:29:29+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-24T11:10:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-20T16:29:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychology","date":"2026-02-20T16:24:42+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8cd67132-e254-49f7-8a7a-da510a157a8b","owner":[],"postedDate":"April 14th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-19T06:24:01+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-14 19:55:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8734968","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8734968","identity":"rs-8734968","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}