Impact of Low Anorectal Malformation on Parenting Stress: A Mixed-Method Study

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The purpose of this study was to investigate parenting stress among parents of children with low ARM. Study aims: 1) Compare parenting stress among parents of children with low ARM, with parents of healthy children using questionnaires. 2) Identify subscales within the questionnaire which needed to be further explored. 3) Use semi-structured interviews with parents of children with low ARM, to explore parenting stress and to explain, expand and or support the quantitative findings.

Design and Methods:

An explanatory sequential mixed methods design was used in this follow up study. The parents completed the Swedish Parenthood Stress Questionnaire (SPSQ), semi-structured interviews were conducted.


Fifteen mothers and 13 fathers of children with low ARM age 8–18, returned completed questionnaires. A control group of 17 mothers and 6 fathers of healthy children age 8–18 that had visited the hospital for a minor procedure was recruited for comparison purposes. There were no significant differences found between index group and controls except in the subscale Incompetence, where parents of children with low ARM reported lower levels of stress compared to controls. Nine semi-structured interviews were conducted with parents of children with low ARM. Qualitative content analysis was used and revealed three themes – Communication between parents, Expectations of parenthood, and Challenges concerning parenthood.


Parents of children with low ARM did not report high levels of stress. When interviewed, they told about earlier experiences of emotional stress, feelings of guilt, and chaos at the time the child was born and during infancy.

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