Results
In present study, 102 parents were assessed for eligibility. 90 parents who meet the inclusion criteria were randomized as 45 individuals in each groups (Fig. 1). The socio-demographic characteristics of the parents participating in the study are presented in Table 1.
The average age of the parents is 33.51 ± 6.53, 54.5% of them are in the 30-39 age group. The majority of the parents (77.9%) were female, university graduates (51.9%), had middle income (58.4%) and the majority (90.9%) had no illness. In addition, about half of the parents (51.9%) were working during the pandemic period. There was no statistically significant difference between the intervention and control groups in terms of sociodemographic characteristics before the intervention (p> .05) (Table 1).
When the issues that cause the parents, who participated in the study, to be worried were examined; it was seen that 64.9% of the parents stated that they were afraid that their child could be sick and that their child's being away from school negatively affected his/her mental health. In addition, 58.4% of the parents stated that their child became aggressive because he/she was always at home.
It was determined that the majority of the parents, who participated in the study, had access to information about the pandemic via TV (34%) and social media (29%). It was determined that the social life of 93.5% of the parents, the family life of 66.2% of the parents, the work life of 55.8% of the parents, the economic status of 54.5% of the parents and the sexual life of 15.6% of the parents were affected. When the parents' coping behaviours during the pandemic period were examined, it was determined that 23.4% of the parents spent time with their family and were interested in activities and hobbies, 20.8% did nothing or tried not to think about the pandemic. When the parents' predictions about the pandemic were evaluated, it was seen that 33.8% of the parents stated that they would continue to take precautions even if the pandemic decreases. In addition, 33.2% of the parents stated that they believed there would be new pandemics, 19.5% believed that this pandemic would decrease over time, and 15.5% did not believe that the pandemic would decrease (Table 2).
When the effect of SFSP on parents' state anxiety scores was examined, a statistically significant difference was found between the pre-test (56.10 ± 10.14) and post-test (43.51 ± 9.22) STAI-S total scores of the intervention group to which the programme was applied (p = .000). However, there was no statistically significant difference between the pre-test and post-test STAI-S total scores of the control group (p = .616, Table 3). When the changes in the parents' trait anxiety scores were examined, STAI-T post-test mean scores in the intervention group were found to be lower than the pre-test mean scores. However, this difference is not statistically significant (p = .149). In the control group, no statistically significant difference was found between the pre-test and post-test STAI-T mean scores (p = .817).
SEM Test Results
In the SEM, it is seen that SFSP decreases parents' anxiety (p = 0.022, Fig. 2). The non-standard path coefficient of the STAI-S post-test was found to be 0.11, and the obtained coefficient was statistically significant (p <0.05). The non-standard path coefficient of the STAI-T post-test was obtained as 0.03 and the obtained coefficient was statistically significant (p <0.05). When the fit values were examined, the following values were obtained: CMIN= 7.639, DF= 2, CMIN/DF= 3.819, RMSEA= 0.28, CFI= 0.865 and GFI= 0.913. Since CFI, RMSEA, CMIN/DF were not within the required limits, the correction indices were examined.
Discussion
The burden and effects of COVID‐19 are felt all around the world, and this is likely to cause fear and anxiety.36 This study was conducted with the aim of examining the effects of online SFSP applied to parents with high levels of anxiety during the COVID-19 pandemic. As a result of the study, it was determined that online SFSP was an effective method in reducing the state anxiety levels of parents with high anxiety levels.
In studies conducted with different sample groups in the COVID-19 pandemic, it has been reported that the pandemic significantly increases the anxiety level of children and parents.10,36 In this study, the anxiety levels of the parents of children aged 3-6 who had to spend most of their time at home by leaving the nursery, school and many social environments due to the pandemic were evaluated and it was determined that the pre-test anxiety levels of the parents were quite high in the intervention and control groups. In a study conducted in China (n = 2446), it was stated that the participants had a high level of anxiety and approximately 80% of them scored above 40 in both STAI-S and STAI-T subscales.37 In the study conducted by Lee et al. (2020), it was determined that parents' anxiety levels were high and parental anxiety caused an increase in the anxiety level of children.10 In the study conducted by Saddik et al. (2020), it was determined that most of the participants experienced mild or severe anxiety due to the pandemic. In the same study, the participants stated that the measures taken by the government to prevent the pandemic increased their anxiety.24 In another study conducted with 1069 participants, it was stated that having a child is one of the reasons that increase anxiety during the COVID-19 pandemic.3 All these studies and our study findings show similarities in the sense that parental anxiety is high during the pandemic.
The COVID-19 pandemic places a wide range of stressors on young children, including its invisibility, the danger of infection, frustration and boredom, inadequate information, lack of face to face contact with family members, classmates, friends and teachers, and lack of personal space at home. Stress levels of children directly or indirectly cause stress and anxiety on their parents.38 In this study, more than half of the parents stated that their children’s being away from the nursery and being constantly isolated at home made them aggressive and worsened their mental health. Sudden changes in the routines of children, who previously attended a nursery or nursing facility, events they cannot understand in a home-oriented life environment and many other factors can play a role in increasing the stress and anxiety levels of children and parents.
It has been reported that correct information about the virus has a negative and significant correlation with individuals' anxiety levels.39 In this study, almost all of the parents stated that they had access to information about COVID-19 via television (44.2%) and social media (37.8%). In the study conducted by Malesza and Kaczmarek (2021), more than 80% of the participants stated that they had access to COVID-19 information through television while 70% of the participants acquired information via the internet. However, only 20% of the participants had access to information through health authorities. When these findings are interpreted together with the high anxiety levels of the parents, it is thought that reaching the information from the right source may also have an effect on the anxiety level.
The global COVID-19 pandemic is a stressor that originated outside of the family system but given the novelty and uncertainty concerning this disease, it is likely to be perceived as a significant stressor for many parents and children.14 Individuals use different methods in order to cope with the anxiety experienced in the pandemic. When the coping behaviours of parents are examined; it is seen that they use different methods such as spending time with the family, trying not to think about the pandemic, cleaning, spending time by watching television and using telephone and praying. However, the high anxiety score averages of the parents indicate that these coping methods are not very effective in the pandemic process, which has very devastating effects.
It has been reported that the COVID-19 pandemic negatively affects the mental health of both parents and children and significantly reduces their psychological well-being.11,40 In our study, majority of the parents stated that they will continue to take measures even if the pandemic decreases and they believe that there will be new pandemic. These findings are important in terms of suggesting that parents experience anxiety about their future lives.
The effectiveness of SFSP in literature has been evaluated in many studies.17,29,41–43 Studies have shown that SFSP is effective in individuals with social anxiety disorder,16 reduces depression and anxiety,15,18 improves quality of life17, affects mindfulness and psychological well-being44 and is effective in solving mental problems by contributing to the development of all areas of mental health.43 In the study conducted by Novella, Ng and Samuolis (2020), SFSP was applied to university students with mild and moderate anxiety simultaneously with two different methods using face-to-face and online programmes. As a result of the study, it was determined that both methods significantly reduced students' anxiety levels and there was no significant difference between the effectiveness of the two methods.23 The use of video teleconferencing platforms is important in terms of providing a suitable alternative for continuity of care in times of social, economic and health-related problems, and provides more flexibility and access opportunities than face-to-face therapy.45 In our study, SFSP was applied through the online video-conference method due to the restrictions and precautions during the pandemic and it was found to be an effective method in reducing anxiety.
In order to reduce the anxiety level of individuals in the COVID-19 pandemic, different interventions were implemented and their effectiveness was evaluated. Internet-based integrated intervention focusing on relaxation, self-care, and raising sense of security applied to individuals diagnosed with COVID-19 with psychological problems was found to have a significant pleasing effect on mild and moderate depression and anxiety symptoms.46 In a study conducted, it was determined that informing via teleconference was effective in reducing the anxiety levels of mothers with chronic diseases during the pandemic period.36 In the study conducted by Chen (2020), it was aimed to administer 2-4 sessions of online Solution Focused Brief Therapy to adolescents who showed anxiety symptoms in the COVID-19 pandemic. It was hypothesized that participants who are randomly assigned to Solution Focused Brief Therapy would have betterclinical outcomes, lower depression levels, and increased coping strategies in dealing with distress during the COVID-19 pandemic.30 In our study, SFSP was applied to parents who had high levels of anxiety and it was found that the state anxiety levels of the parents were significantly reduced. In the model established in SEM analysis, it was determined that the SFSP intervention had a significant effect on anxiety (Fig. 2). After SFSP, the state and trait anxiety mean scores of the intervention group decreased compared to the pre-intervention mean scores. While this difference between state anxiety scores was statistically significant, the difference between trait anxiety scores was not statistically significant. With these findings, our first hypothesis was confirmed, while our second hypothesis was rejected. This result can be related to the fact that the state anxiety level is a result of the individual's direct psychological reactions related to negative events while the trait anxiety is related to the tendency to exhibit personal anxiety and it is relatively stable. This finding can be considered as an expected result, since the change in the state anxiety level must gain continuity in order for the trait anxiety level to change. However, it is noteworthy that the state anxiety score in the intervention group is still high (over 40) even in the post-test. It is an expected result that the anxiety does not decrease to the desired level due to the continuation of the pandemic.
Limitations
This study has several limitations. Firstly, the study results can only be generalized to the study population; however, the results cannot be generalized to all parents in Turkey. Inclusion of only parents with internet and computer infrastructure is an important limitation of the study. The pandemic continues worldwide. Parents' anxiety levels are likely to differ at the beginning or end of the pandemic. For this reason, the results should be interpreted against the background of the situation in Turkey at the time the study was conducted. Finally, SFSP was applied as 4 sessions in this study. The effect of SFSP on the trait anxiety levels of the participants can be investigated by increasing the number of sessions in future studies which will be applied to reduce anxiety.
Conclusions
As far as we know, this is the first study which investigates the effect of SFSP applied to parents with high level of anxiety in the COVID-19 pandemic on reducing anxiety. In the study, it has been found that SFSP applied to parents with high level of anxiety is an effective method in reducing the state anxiety levels of parents. Considering the advantages of applying SFSP in a short time and its rapid effect, it is recommended that SFSP should be applied to disadvantaged groups such as vulnerable children (with chronic diseases) and their parents in order to minimize the negative effects that may occur during and after the pandemic process. It may be recommended to provide in-service training on SFSP to people who provide services to the community (such as pediatric nurses, social workers, family health nurses). In addition, it is recommended to conduct follow-up studies to examine the long-term effects of SFSP.
Acknowledgements: The authors would like to thank all the parents who contributed by participating in the study
Conflict of Interest: No conflict of interest was declared by the authors.
Financial Disclosure: The authors declared that this study has received no financial support.
Data Availability Statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.