Iran Journal of Nursing

Introduction
The role of the family in the health of the child is very vital because a major part of a child’s development depends on the mothers’ knowledge of how to prevent diseases and treat them on time and on their practice regarding the compliance with health behaviors. It is particularly important to prevent, diagnose, and treat diseases in childhood. In addition, one of the most important aspects of disease prevention in children is their mothers’ behavior regarding observance of health behaviors in their child. Mothers and children are important groups in any society, because they are not only the primary consumers of healthcare services but also a large group of vulnerable individuals. Mothers play a significant role in maintaining and improving the health of children. The present study aims to investigate the health behaviors and related factors in mothers of hospitalized children in Kashan, Iran.
Materials and Methods
This is a cross-sectional study that was conducted on 216 mothers of children hospitalized in children’s wards of two teaching hospitals affiliated to Kashan University of Medical Sciences from November 2019 to March 2021. The sample size was determined based on the mean score of the questionnaire in a preliminary study (20.3±4.75) and by considering the first type error of 5% and the estimation error of 0.5 using the formula. Sampling was done by a continuous method. After obtaining permission from the hospital and department managers, the second author visited the children’s wards of two hospitals. Then, among the hospitalized children, those whose mothers were at the hospital as their primary caregiver were selected. Their mothers were then given explanations about the study objectives and that their health behaviors would be observed. Afterward, they were asked to sign a written consent for participation in the study. In the next stage, the first author (who was a nurse in the children’s wards) indirectly observed the mothers’ health-related behaviors toward their children and then immediately recorded them using a checklist. Each mother’s behaviors were observed for about 8 hours. In most cases, observance was done during the morning and evening shifts when the mothers were at the children’s bedside. 
A questionnaire with two parts of demographic and clinical information was used in this study as well as a checklist to assess the mothers’ health-related behaviors towards children. It had 33 items that were recorded by the first author as “done” with 1 point and “not done” with 0 points. Data were then analyzed in SPSS v. 16 software (SPSS Inc., Chicago, IL, USA) using descriptive statistics, Pearson correlation test, one-way ANOVA, independent t-test, and linear regression analysis.
Results
Of 216 mothers, 11 were excluded since more than one-third of the items related to the health-related behaviors in the questionnaire (more than 11 items) were not applicable to them. As a result, the analyses were conducted on 205 mothers. The mean ages of mothers and fathers of hospitalized children was 29.27±5.60 and 33.61±6.03 years, respectively. Most of mothers had a bachelor’s degrees (31.7%), while the most of fathers had a diploma (37.6%). About 91% of mothers were housewives, and 43% of fathers are workers. The mean age of children was 12.16±6.43 months, and more than 80% of them were the first- and second-born children. Fever and gastroenteritis were the most common causes of hospitalization (30.7%) in children who were hospitalized. The mean score of compliance with health-related behaviors in mothers was 16.73±5.55. The items “use of fresh and safe drinking water for the child” (97.5%), “washing hands with soap and water in case of clear hand contamination” (95.6%), “Changing the child’s clothes and bedding as soon as they become contaminated with diarrhea, vomit, blood, and other contaminants” (90.7%), and “Washing hands after changing the child’s diaper” (87.3%) had the highest compliance scores. The items “washing hands before changing the child’s diaper” (8%), “covering the mobile phone with a plastic to avoid contamination” (8.8%), “washing hands with soap and water after touching the surrounding surfaces” (15.8%) and “ washing hands before breastfeeding “ (16.7%) had the lowest compliance scores. Moreover, the results of the multiple linear regression analysis showed a positive and significant correlation between the mean score of compliance with health-related behavior and age (r=0.157, P=0.000).
Discussion
The results indicated that mothers failed to comply with behaviors such as washing their children’s hands regularly and washing their own hands before breastfeeding. It is necessary to teach and inform them regarding the observation of behaviors related to the child’s health upon entering the hospital to ensure their child’s safety. In hospitals, it is, therefore, necessary for the supervisors to develop and implement special programs for informing mothers about the importance of protecting their children during hospitalization by complying to health-related behaviors. 

Ethical Considerations
Compliance with ethical guidelines
This study obtained its ethical approval from the Research Ethics Committee of Kashan University of Medical Sciences (Code: IR.KAUMS.NUHEPM.REC.1399.071). All participants received clear explanations about of the study methods. In addition, they were assured of the confidentiality of their information and were also free to leave the study at any time. They signed a written informed consent. The procedures were in accordance with the Declaration of Helsinki 2002 and the ethical principles for medical research involving human subjects.

Funding
The present study is the result of the thesis project (code: 99185) of Zahra Kachoee Bidgoli, Department of Internal Surgery, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, which was carried out with the financial support of Kashan University of Medical Sciences.

Authors' contributions
Conceptualization, design, literature search, and initial draft preparation: Ismail Azizi-Fini and Zahra Kachoee-Bidgoli; Definition of intellectual content: Ismail Azizi-Fini, Zahra Kachoee-Bidgoli and Ali Hajibagheri; Data collection: Zahra Kachoee-Bidgoli; Data analysis: Fateme Atoof; Editing & review: Ismail Azizi-Fini, Ali Hajibagheri, and Fateme Atoof.

Conflict of interest
The authors declare no conflict of interest.

Acknowledgments
The authors would like to thank the Deputy for Research of Kashan University of Medical Sciences for their support and all mothers who participated in this study. 
 

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