Factors Related To Parenting Stress Among Mothers With Preschool Aged Children

Introduction: Raising preschool aged children often causes stress to mothers because at this period children are still very dependent on their parents and often has behavioral problems and difficulty in managing their intense emotions.. Objective: This study aimed to determine factors associated with parenting stress among mothers with preschool aged children. Methods: A cross-sectional study design was used in this study. Sample size of this study was 118 mothers who lived in Desa Jatisari, Kecamatan Jenggawah, Kabupaten Jember, selected using convenience sampling. Data was collected using a demographic questionnaire, Parenting Stress Index-Short Form (PSI-SF), and a social support questionnaire which was developed based on Taylor's theory of social support. Statistical analysis used univariate analysis (frequency distribution) and ordinal logistic regression with statistical significance at an alpha level of 0.05. Results: There were 90 respondents who experienced moderate parenting stress. As many as 12 mothers had low parenting stress, while 16 mothers had high parenting stress. Factors related to parenting stress were mother's education (p=0.015) and social support (p=0.000). The higher the mother's education and social support received by the mother, the lower the level of parenting stress is, and vice versa. Conclusion: In this study, level of education and social support were associated to parenting stress among mothers. Cooperation between nurses, families, and local health workers is needed to provide adequate social support to mothers with preschool children. Husbands and families are expected to provide support such as direct assistance in caring for children, appreciation, and love for mothers. Nurses can also work with local health workers in providing information to mothers related to


Introduction:
Every parent hopes to be able to provide the best care to ensure the welfare of their children. However, the implementation, many parents experience difficulties and feel burdened when carrying out their parenting practices. According to Oates in Kumalasari and Fourianalistyawati (2020), the responsibilities and demands of care at preschool age are at the widest and most intensive level. In this phase, parents are not only required to be able to provide good physical care so that children's growth can be optimal, but are also required to be the right role model for children because preschoolers are easy to imitate the actions of others around them (Hurlock, 2012). In this phase, children often experience temper loss (Wakschlag et al., 2012) as well as several behavioral problems (Solem, Christophersen, & Martinussen, 2011). Parents are expected to provide opportunities for children to try new things because at this phase, children like to explore and demand freedom (Hurlock, 2012). On the other hand, parents must also be aware of the safety of their children. The magnitude of the responsibility and the high demands of parenting cause parents with preschool children to be more susceptible to stress, if the parents are not able to find the right way of this care.
Parenting stress has many negative effects on both parents and children. Several previous studies have found that parenting stress causes mental health problems in children (Lohaus et al., 2017) and reduced emotional well-being in fathers and mothers (Skreden, 2012). Liu and Wang (2015) proved that parenting stress has an influence on the emergence of internalizing behavior in children which is characterized by depression, anxiety, and withdrawal and externalizing behavior in children characterized by aggressive behavior and delinquency. Parenting stress causes the quality of parenting behavior to be bad. Parents who experience parenting stress tend to apply authoritarian parenting, discipline children using violence, and behave violently which in turn leads to the emergence of problematic behavior in children (Jackson & Choi, 2018;Liu & Wang, 2015). Parenting stress can also have an impact on other problems that are more extreme and dangerous for the child. In their research, Nur Aini, Susanto, and Rasni (2020) and Wu and Xu (2020) show that parents who experience parenting stress have the potential to commit physical violence or abuse on children.
Cases of violence against children in Indonesia have increased in the last 3 years. According to data from the Ministry of Women's Empowerment and Child Protection (2020), from January 1 to June 19, 2020 there have been 3,087 cases of violence against children, including 852 physical violence, 768 psychological, and 1,848 cases of sexual violence. Most of the perpetrators of violence against children are the closest people, including fathers and mothers (Huraerah, 2012). From the results of a preliminary study of 10 mothers with preschool-aged children in Desa Jatisari, Kecamatan Jenggawah, Kabupaten Jember using the interview method, it was found that 5 mothers stated that their children were difficult to manage and often got angry if their wishes were not obeyed. Two mothers said that every day they shouted and threatened their children to discipline their children if necessary. Meanwhile, three other mothers admitted that they sometimes pinched and hit them when they were annoyed with their children.
Several studies state that parenting stress is caused by several factors that influence each other, such as child factors, parental factors, and environmental factors. Children with problematic behavior can cause stress to the mother (Yeo & Teo, 2013). Social support is closely related to parenting stress. Hong and Liu (2019) found that parents who received social support had lower levels of parenting stress, whereas parents who did not receive social support showed higher levels of parenting stress. Increased parenting stress is also associated Jurnal Kesehatan dr. Soebandi Vol. 10, No.1 http://journal.Universitasdrsoebandi.ac.id/ Publisher : LP3M Universitas dr. Soebandi Jember with low parental education (Parkes, Sweeting, & Wight, 2015), number of children in the family (Hong & Liu, 2019), and low socioeconomic status (Nagy et al., 2020). However, Chairani (2013) found that maternal education was not related to parenting stress. Park and Chang (2013) found that maternal employment status was related to parenting stress where working mothers had higher parenting stress than mothers who did not work. Different results were expressed by Yeo and Teo (2013) which proved that working and non-working mothers had relatively the same parenting stress.
From all of the background above and the varying results from several previous studies, researchers are interested in conducting research related to factors related to parenting stress in mothers with preschool-aged children in Desa Jatisari.

Methods:
This study used a quantitative approach with a cross-sectional research design. The study was conducted in Desa Jatisari Kecamatan Jenggawah Kabupaten Jember started from July until August 2021. The sampling technique used was a convenience sampling. There were 118 mothers with preschool children included in this study. Data were collected using a demographic questionnaire which included maternal age, number of children, sex of children, mother's education, mother's occupation, and family income. Maternal parenting stress was measured using the Parenting Stress Index-Short Form (PSI-SF), developed by Abidin (1995). Social support was measured using a social support questionnaire which was developed based on Taylor's social support theories (Taylor, Peplau, & Sears, 2009).
The validity of two research instruments was conducted by Chairani (2013) involving 30 mothers through testing the contents of the instruments with rational analysis or an assessment from a competent person. Followed by the selection of quality items using Pearson correlation test. The results of Parenting Stress Index-Short Form (PSI-SF) validity test showed that the correlation coefficient of each item was in the range of 0.364-0.762. The reliability test of the instruments used Cronbach's alpha coefficient. The Cronbach's alpha coefficient of the PSI-SF was in the range of 0.81-1.00. Meanwhile, the Cronbach's alpha coefficient of the social support questionnaire was in the range of 0. The table above shows that the majority of respondents in this study, as many as 90 (76.3%) respondents had a moderate level of parenting stress.  The table above shows that most of respondents in this study, as many as 55 respondents (46.7%) were in the range of 31-40 years. The table above shows that most of respondents, as many as 63 (53.4%) respondents had two children. The table above shows that there are more respondents who have male preschool aged children, namely 63 (53.4%) respondents. The table above shows that most of respondents, as many as 105 (88.9%) respondents do not work or are housewives. The table above shows that most of respondents, as many as 62 (52.6%) respondents finished elementary school.

Multivariate Analysis
The multivariate analysis in this study used ordinal logistic regression to determine factors associated with parenting stress among mothers. To determine whether ordinal logistic regression fits to this study or not, we evaluated goodness of fit, model fitting information, and coefficient of determination.  The fitting information model explained that without including the independent variable, the intercept only had a value of 112.847. Meanwhile, by entering the independent variable into the final model, there was a decreasing value of -2 Log likelihood into 46.848. The chi-square value of 65.998 with a significance value of p=0.000 means that the regression is the fit model.  The estimation results of the ordinal logit regression model are presented in table 12. From the estimation results, it was found that the variables that were significantly related to parenting stress were mother's education (p=0.015) and social support (p=0.000). The constants of both variables had negative values. The constant of mother's education was -2.126 and the constant of social support was -4.791. It means that the higher the social support and mother's education is, the lower the parenting stress of mother.

Discussion:
In this study, the mother's stress varied from low, medium, to high levels. The majority of respondents have a moderate level of parenting stress with a total of 90 respondents (76.3%). There are 16 people (13.6%) with a high level of parenting stress. The distribution of the least is the low category as many about 12 people (10.1%). This shows that the majority of respondents experience parenting stress that cannot be underestimated. Deather-Deckard et al. (2013) stated that parenting stress experienced by mothers occurs because of an imbalance between the demands of parenting felt and parenting resources owned by parents. Preschoolers are considered a very troublesome age and place a lot of demands on parents. Sources of demands for parenting preschool aged children generally come from daily hassles in daily parenting (Vasilenko, Savenysheva, & Zapletina, 2021), immature cognitive development (Papalia, Olds, & Feldman, 2013), difficulties in holding emotions (Wakschlag et al., 2012) and the tendency to experience behavioral problems (Cherry, Gerstein, & Circiolla, 2019).
The preschool period is also a period that is vulnerable to health problems such as nutritional problems, speech disorders, behavior disorders, enuresis, and sleep disorders. This is a daily challenge that parents, especially mothers, must face. Cappa et al. (2011) stated that every mother has a different response in facing the challenges and demands of parenting. Some mothers are able to deal with difficult situations in effective parenting practices and maintain prosocial behavior, while others are unable to adapt to these demands and experience parenting stress.
Mash and Johnston in Chairani (2013) state that there are three main domains that cause parenting stress, namely child characteristics, parental characteristics, and environmental characteristics. In this study, the sex of the child and the number of children represent the characteristics of the child, while the factors of mother's age, mother's occupation, mother's education, and family income represent the characteristics of the parents. Social support factors represent environmental characteristics. In this study, maternal age, number of children, family income, gender of children, and mother's occupation were not related to parenting stress. This finding is in line with the research conducted by Vasilenko et al. (2021), which involved 112 mothers with children aged 4 months to 7 years, who stated that parenting stress was not related to mother's age, child's age and sex, family experience, and number of children. This is in contrast to Qian, Mei, Tian, and Dou (2021) who proved that parenting stress of a mother with two children was higher than parenting stress of a mother with one child. This is because mothers with two children are required to care for and educate two children at once and required to be able to overcome problems that arise related to sibling relationships, so that mothers need more energy and time to meet the demands of parenting. In addition, the more children who are cared for, the expenses required are also greater. This causes increased pressure felt by the mother (Chen, 2016). The parenting stress of the respondents in this study is relatively the same regardless of the number of children they have. This could be due to respondents with more than one child already having parenting experience from their first child. Such parenting experiences help mothers anticipate and better adapt to the parenting demands of their next child.
The results of this study are also not in line with the research of Jaghariah and Kumar (2021) which proves that parenting stress for working mothers is higher than parenting stress for non-working mothers. Working mothers have a dual role and responsibilities beside managing household needs and raising children, namely earning a living. This allows mothers to have more hassles and burdens than mothers who do not work. In addition, working mothers spend quite a long time outside the home so that they have to complete their domestic responsibilities in relatively less time than mothers who do not work. According to the researcher, there is no relationship between parenting stress and mother's work status because in this study the distribution of maternal employment status was not balanced, where the distribution of mothers who did not work or housewives was very dominant, namely 105 people (88.9%) while working mothers were only 13 people (11.1%).
Family income is one of the important resources for parents in carrying out parenting practices. Sufficient family income can help parents carry out parenting practices more easily and comfortably so that family income is predicted to contribute to parenting stress. However, this study did not find a significant relationship between family income and parenting stress. In contrast to several previous studies, it has been proven that family income is related to parenting stress (Nagy et al., 2020;Nurmalia, 2021). This study is in line with Raikes and Thomson (2005) which proves that family income has no relationship with parenting stress unless mediated by parental selfefficacy. This finding proves that family income does not always have an effect on parenting stress for mothers with preschoolaged children, considering that there are other factors that play a greater role. In addition, most of the respondents in this study have a monthly income of between 500,000 to 1 million, so it can be said that the income data in this study is less diverse. Future research is expected to expand the characteristics of parents with preschool children not limited to mothers who live in villages but also live in cities so that they have different income levels or socioeconomic backgrounds in order to obtain a broader picture of the effect of income on parenting stress.
Based on the results of ordinal logistic analysis, there are only two factors related to parenting stress, namely maternal education and social support. Mothers with higher education have the ability to manage their knowledge to deal with stressors, including stressors in parenting. In addition, according to Parkes et al. (2015) mothers with higher education tend to have wider networks that can assist mothers in obtaining information related to health and child care. Mothers with higher education also tend to have more references to health services and find it easier to access quality health services that their children need. This ultimately helps mothers in implementing better parenting practices and according to their expectations.
In this study, social support was the strongest factor associated with parenting stress. The results obtained are in line with Hong and Liu's research (2019) which states that social support has an effect on parenting stress for mothers with one child in China. Mothers who have preschool age children sometimes feel stress in taking care of children. When experiencing stress, parents, especially mothers, will be less effective in implementing parenting practices. In this study, the social support received by mothers came from their spouses, in-laws, and health workers. The social support includes reward support, information support, instrumental support, and emotional support (Taylor et al., 2009). (Suzuki, 2010) found that support from spouse, in-laws, and friends resulted in a lower stress level for mothers, which in turn increased mother's self-efficacy.
Lee and Ahn (2016) also prove that the emotional support provided by the husband can reduce the stress felt by the mother. The support obtained from the husband by appreciating what has been done by the mother will reduce negative feelings for the mother and can help the mother make positive decisions. Social support in the form of providing information about children's health from the nearest health worker can make mothers more confident in carrying out their parenting roles.
Munawaroh and Amalia (2019) (2019) stated that someone who has high social support will likely experience less stress and deal with stress easily. Social support provided to social mothers can maintain the mother's mental health so that mothers avoid feeling frustrated and depressed during parenting. The importance of social support for mothers is also reinforced by Al-Kandari et al. (2017) which proves that the mother's social support has an effect on the formation of mother's coping so that it helps the mother to be more adaptive to handle the stress. Based on the description above, it can be concluded that social support can help and reduce parenting stress for mothers who have preschool age children. When mothers get social support, mothers will feel more comfortable, valued, and accepting of the situation and can solve problems well.
This study has limitations such as the sample used is quite homogenous. Future research may include mothers who live in cities with varying levels of education and socio-economic backgrounds to produce more representative study results.

Conclusions
Mothers with preschool aged children in this study showed stress during parenting their children with the level of parenting stress tend to be moderate. Mother's education level and social support are the factors related the most to parenting stress.