Iran Journal of Nursing

Introduction
Approximately 300,000 children are annually diagnosed with cancer worldwide.  The complications caused by childhood cancer and its treatment not only affect the children, but also their parents. Studies have shown that the parents of most children with cancer experienced the care burden. The care burden reduces the quality of life of parents and children. One of the most appropriate ways to cope with the diseases is resilience. Caregivers with low resilience carry a high care burden, even in case of low care demand. Resilience helps people find different coping strategies and skills. Increasing family resilience can reduce the care burden by improving physical and mental functioning. Parenting styles have a significant impact on the condition of children with cancer. Promoting opportunities to care for children with cancer, face-to-face or virtual support groups, and discussions between nurses and parents can improve the parents’ ability to care for a child with cancer by improving their competence and empowering them. 
Internet-based health-related interventions are emerging as a means of providing affordable and accessible health care education to promote self-management and engagement. Such interventions can make positive changes and improve knowledge and understanding of health-related conditions in parents of children with cancer; therefore, this study aims to determine the effectiveness of an online educational  intervention on resilience and care burden of the parents of children with cancer.
Materials and Methods
This is a single-group study with pre-test/post-test design which was conducted in 2020-2021. The research environment was Hazrate Ali-Asghar hospital and pediatric medical center in Tehran, Iran.  Participants were 50 parents of children with cancer referred to these centers for chemotherapy or other care services, who were selected by a continuous sampling method From July 2020 to February 2021. 
Data collection tools were  (a) a demographic form assessing demographic information of parents ( gender, age, economic status, employment status, number of children, educational level) and their children (age, gender, duration of disease, and type of disease), (b) Connor-Davidson resilience scale  which has 25 items rated on a 5-point Likert scale, and its total score ranges from 0 to 100, where a score of 60 and above indicates a high resilience level, and (c) the Caregiver Burden Inventory developed by Novak and Guest (1989) which has 24 items rated on a 5-point Likert scale and 5 subscales; its total score ranges from 0 to 96, where a score of 36 and above indicates a high care burden. 
First, pre-test assessments were carried out. Then, educational intervention was presented for 4 weeks through an online social media which was designed based on the studies regarding the methods of increasing resilience and reducing care burden, and converted into an educational booklet; it was approved by the faculty members of the department of pediatric nursing. The post-test assessments were conducted one month after the end of the intervention. Data analysis was performed using descriptive and inferential (paired t-test) statistics in SPSS software, version 26.
Results 
Most of parents were mothers (84%), aged 30-35 years (40%). Most of them had moderate economic status (66%), were housekeeper (62%), had two children (54%), and diploma (44%). Most of children had age 3-6 years (21%), were girls 27 (n=27, 54%), had a disease duration of <6 months and 6 months to 1 year (38%), and had blood cancer (42%). The results of paired t-test showed that the mean score of resilience before intervention was 50.32±21.84 and increased to 78.24±9.16 after the intervention, which was statistically significant (P<0.001). The total score of care burden before intervention was 57.18±18.17 and reduced to 24.02±7.45 after the intervention, which was statistically significant (P<0.001).
Discussion
Resilience as a factor rooted in individual and social psychology, is strongly influenced and promoted by psychological interventions. According to the findings of this study, the online educational program increased the resilience of parents of children with cancer. Considering that parents are more likely to be at risk of mental health than other family members because of their close relationship with the child, the use of educational programs using online social media that can increase the resilience of parents of children with cancer and reduce their care burden, should be considered by nursing staff.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the ethics committee of Iran University of Medical Sciences (IR.IUMS.REC.1398.1249)

Funding
This article is taken from the master's thesis of Hajer Behzadi, Department of Pediatric and Neonatal Nursing, Faculty of Nursing, Iran University of Medical Sciences.

Authors' contributions
All authors contributed equally to the preparation of this article.

Conflict of interest
The authors declare no conflict of interest.

Acknowledgments
The authors would like to thank all parents participated in this study.

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