A quasi-experimental study to assess the effect of Benson's relaxation on anxiety and depression among patients with heart failure in Jordan.

BACKGROUND: Despite advancements in treatment, heart failure (HF) remains a leading cause of death. Anxiety and depression (A&D) are highly prevalent among patients with HF, negatively impacting their mortality, and morbidity. The Benson relaxation technique (BRT) is a non-pharmacological approach that is easy to learn, use, and apply for reducing A&D. This study aimed to investigate the effectiveness of the BRT in reducing A&D among patients with HF in Jordan. METHODS: This quasi-experimental pre and post-design study involved a consecutive sample of 204 participants with a confirmed diagnosis of HF. Data were collected from four hospitals in Jordan. RESULTS: A total of 204 patients participated in this study, with 138 males and 66 females. The mean A&D scores for the sample at baseline were 11.09±2.60 and 10.80±2.30, respectively. In the intervention group, there was a statistically significant difference between pre-intervention anxiety and post-intervention anxiety levels (P<0.001), as well as between pre-intervention depression and post-intervention depression levels (P<0.001). In contrast, the control group showed no statistically significant differences between pre-intervention and post-intervention A&D levels (P=0.83 and P=0.34) respectively. CONCLUSIONS: BRT can be used as an adjunctive intervention for patients with HF to reduce A&D. Healthcare professionals should consider incorporating BRT into treatment plans, while nursing departments can lead its implementation.

Nurses' Knowledge and Practice of Appropriate Techniques of Body Mechanics and Non-specific Back Pain.

Background Nursing is a compassionate profession that carries occupational hazards, including work-related injuries. Back pain is a common concern due to the physically demanding tasks performed by nurses. Utilizing proper techniques of body mechanics is vital to prevent work-related back pain and enhance overall well-being. Aim To assess the knowledge and practice of the nurses working in Jordanian hospitals about the appropriate techniques of body mechanics and their relation to non-specific back pain. Methods A cross-sectional design with a convenience sample of 280 participants was randomly selected from hospitals. The tool included the use of a paper questionnaire or scanning the barcode at nursing stations; a reliable, adopted tool was used in this study. Results Out of 280 participants, six (2.1%) had poor knowledge, 96 (34.3%) had average knowledge, and 178 (63.6%) had good knowledge, with a mean score of 3.72±0.58. For practice, seven (2.5%) had poor, 225 (80.4%) had average, and 48 (17.1%) had good practice, with a mean score of 3.30±0.49. Both knowledge and practice scores were negatively correlated with non-specific back pain (rpb = -.393 and rpb = -.306, p < .001), respectively. Furthermore, sociodemographic characteristics did not significantly affect body mechanics knowledge and practice scores (p > 0.05) for all variables. Conclusion Nurses working in Jordanian hospitals had good knowledge of body mechanics but average practice. Higher knowledge and practice levels were correlated with less experience of non-specific back pain. Additionally, there was no significant difference in sociodemographic data between nurses with knowledge and practice scores.

Factors Associated With Foot Self-Care in Patients With Diabetes-Related High-Risk Feet: A Cross-Sectional Design.

Foot self-care has been commonly studied among people with diabetes. Previous research on foot self-care among those with diabetes-related high-risk feet is almost unavailable or very limited. The current study aims to fill this gap and provide a contemporary unprecedented analysis of this area of specialization. To assess the levels of, and factors associated with foot self-care among people with diabetes-related high-risk feet. A multi-center cross-sectional study from Jordan assessed the foot self-care of 107 participants with diabetes-related high-risk feet. Multiple socio-demographic, physiological, and psychosocial factors were collected, and the Arabic version of the diabetes foot self-care behavior scale was used to estimate the foot self-care of the study population. A multiple linear regression model was employed to identify factors associated with foot self-care. The mean score of foot self-care was 25.4 ± 7.1 (35 is the highest) indicating ~73% of adherence to foot self-care. Factors associated with higher foot self-care were being treated at the King Abdullah University Hospital (ß = .30, P < .01) and reporting higher scores of patients' interpretations about neuropathy physical causes of foot ulcers (ß = ".22," P = .02). People with diabetes-related high-risk feet reported a relatively adequate foot self-care practice. However, clinicians are still required to enhance foot self-care among this population. Health promotion programs may benefit from engaging people in understanding the pathophysiology of diabetes-related foot ulcers to improve foot self-care practices.

Knowledge and Compliance With Standard Precautions Among Nurses.

Introduction: The spread of microorganisms is caused by direct or indirect contact, respiratory droplets, and airborne transmission. Knowledge and compliance with standard precautions are crucial in preventing infection in the hospital. Objectives: To assess the level of knowledge and compliance with standard precautions among registered nurses who work in military hospitals and the factors affecting compliance with standard precautions. Methods: A descriptive cross-sectional study was conducted. Four hundred and eight registered nurses at three Jordanian Royal Medical Services hospitals completed an online self-report questionnaire using a convenience sampling technique. The statistical package for social sciences (SPSS) version 25 was used to analyze the data. Results: The level of knowledge of standard precautions among nurses was excellent, with an overall mean score of 15.59 ± 2.22 out of 20; around half (54%) of them had an excellent level. Nurses' compliance with standard precautions was intermediate, with an overall mean score of 59.65 ± 14.57 out of 80. Forty-seven percent of nurses had a high degree of compliance. Compliance with standard precautions was correlated positively with age, working experience in years, total knowledge score, training in standard precautions, and availability of personal protective equipment, and negatively with exposure to sharp injuries. Conclusion: Nurses play a key role in preventing and managing hospital infections through their responsibility for a large proportion of patient treatment and care. Therefore, efforts should be made to improve nurses' perceptions of the basic elements of standard precautions. Even so, results showed that compliance with standard precautions was intermediate. This highlights the need to take the necessary measures to raise the level of compliance. Even so, results showed that compliance with standard precautions was intermediate. This highlights the need to take the necessary measures to raise the level of compliance.

Open visitation policy in intensive care units in Jordan: cross-sectional study of nurses' perceptions.

INTRODUCTION: Intensive care unit patients and families experience significant stress. It creates frustrations, nervousness, irritability, social isolation for patients, anxiety, and depression for families. An open visitation policy with no time or duration limits may assist in reducing these negative experiences. However, most Jordanian and regional hospitals within the Middle-East and Northern Africa (MENA) have not implemented this strategy. PURPOSE: To evaluate nurse managers' and nurses' perspectives on the effects of an open visitation policy at intensive care units (ICUs) on patients, families, and nurses' care. METHOD: A cross-sectional, descriptive, and comparative survey design was used. RESULTS: A total of 234 nurses participated in the study; 59.4% were males, and 40.6% were females. The mean of their age was 28.6 years, with a mean of 4.1 years of experience. Nurses generally had negative perceptions and attitudes toward the open visitation policy and its consequences on the patient, family, and nursing care. CONCLUSIONS: ICU managers and staff nurses did not favor implementing an open visitation in their units despite its known benefits, international recommendations, and relevance and compatibility with the local religious and cultural context. A serious discussion regarding this hesitation from the side of the healthcare professionals should be started to find a suitable solutions that consider the benefits of the open visitation policy and the challenges that prevent its implementation in the Jordanian and Arabic cultures.

Determinants of husbands' violence against women in Jordan.

BACKGROUND: Intimate partner violence (IPV) is the most common form of abuse against women. It comes in the form of physical, sexual, emotional, and controlling behaviors abuse, and affects women's physical and psychological well-being. Perceived social support decreases IPV risk. PURPOSE: This study explores the determinants of IPV in J society. METHOD: One hundred and eighty-seven women exposed to IPV were recruited from J Women Unions to take part in this cross-sectional prospective quantitative design, administering the Arabic version of the Multidimensional Scale of Perceived Social Support (AVMSPSS) to 187, who also answered the demographic characteristics data sheet. RESULTS: Almost 83% of participants perceived that they received lower to moderate PSS. Based on multiple regression, determinants of IPV were PSS, followed by participant education, husband education, participant age, and financial income (p < .001). The number of children and parental level of education showed no statistical significance. CONCLUSION: The findings highlight the importance of social support systems among IPV women. Alongside socioeconomic development continuing to increase education among both men and women, there is a need to increase societal awareness and foster social support systems to prevent violence against women and offer resources to affected women, targeted at the most at-risk age groups.

Assessment of Perceived Compliance and Barriers to Personal Protective Equipment Use Among Healthcare Workers During the COVID-19 Pandemic's Second Wave Surge: "Walk to Talk" Cross-Sectional Correlational Study.

OBJECTIVE: This study aimed at investigating HCWs' perceptions of PPE compliance and barriers, as well as influencing factors, in order to develop methods to combat the rise in their infection rates. METHODS: During the 'second wave' surge, a cross-sectional correlational analysis was conducted over a 1-month period. It consists of HCWs from various hospital sectors that admit COVID-19 patients using an online self-administered predesigned tool. RESULTS: Out of the 285 recruited participants, 36.1% had previously been diagnosed with COVID-19. Around 71% received training on PPE use. The perceived compliance was good for (PPE) usage (mean 2.60 ± 1.10). A significant higher compliance level was correlated with previous diagnosis with COVID-19, working with patients diagnosed with COVID-19, and having a direct contact with a family member older than 45 years old (P < 0.01). The main perceived barriers to the use of PPEs were unavailability of full PPEs (35%), interference with their ability to provide patient care (29%), not enough time to comply with the rigors of PPEs (23.2%) and working in emergency situations (22.5%). With regards to perceived barriers, those working with patients diagnosed with COVID-19 and those who reported having a direct contact with a family member older than 45 years old showed significantly higher level of barriers. CONCLUSION: A series of measures, including prioritization of PPE acquisition, training, and monitoring to guarantee appropriate resources for IPC, are necessary to reduce transmission.

Effect of Aggression Management Training on Perceived Stress Levels of Nurses Working in Mental Health Care Settings in Jordan.

The current study investigated the effect of an aggression management training course on reducing perceived stress levels of nurses working in mental health care settings in Jordan. This quasi-experimental pre/post study included 83 nurses (44 male, 39 female; mean age = 33 years) who completed a sociodemographic characteristics questionnaire and the Arabic Version of the Perceived Stress Scale 10-Items Questionnaire. Participants attended 32 hours of an aggression management training course and then answered the questionnaires for a second time. Female nurses reported significantly higher stress levels than male nurses before and after the training course. Paired-samples t test showed a significant decrease in the mean total score of perceived stress of all nurses after attending the training course. The results of this study highlight the need to design and implement aggression management courses, as such training can improve nurses' mental health and perceived stress levels. [Journal of Psychosocial Nursing and Mental Health Services, 58(10), 32-38.].

Correlation of selected stress associated factors with vitamin D deficiency in Jordanian men and women.

Background: To identify stress associated factors for vitamin D deficiency (VDD) in healthy Jordanian people based on serum 25(OH)D levels. Design: Prospective cohort study. Methods: Three hundred and seventy-one Jordanian men and women aged 17-52 years, who were identified as VD deficient 25(OH)D <30 ng/mL, were eligible to participate in the study. Serum vitamin 25(OH) D was measured using chemiluminescent immunoassay. Cortisol, parathyroid hormone, calcium, phosphate, fasting lipid profile, and blood glucose were also analyzed. Questionnaires were used to collect lifestyles parameters. Anthropometric parameters including: body mass index (BMI), waist (W) and hip (H) circumferences, W/H ratio (WHR) were also calculated. Results: The vast majority (91%) of the participants had vitamin D deficiency (25- (OH) D <30 ng/mL). Positive correlations were observed between vitamin D deficiency and the following anthropometric parameters in all study sample; gender (P=0.010), height (P=0.22), height/hip ratio (P=0.015) and waist/hip ratio (P=0.013). Lifestyle parameters that indicated very weak positive correlations with VDD were number of family members (P=0.011) and insufficient exposure to sunlight (P=0.023). The following clinical parameters showed weak or very weak correlations with VDD; serum cortisol (r=0.318), low density lipoprotein (r=0.246) and total cholesterol (r=0.133). Skin color and water pipe tobacco smoking were added to the multivariable stepwise regression analyses as they have been weakly correlated with VDD. These predictors together explained only 12.2% of the variance in serum cortisol levels in the VDD study sample. Conclusion: A weak positive association between VDD and elevated serum cortisol was observed in this study. Subcutaneous changes may be involved in that association but further studies are needed to clarify a potential role for adrenocorticotropic hormone (ACTH).

Evaluation of public awareness, knowledge and attitudes towards basic life support: a cross-sectional study.

BACKGROUND: Out-of-hospital cardiac arrest is a major cause of mortality worldwide. When basic life support techniques are implemented quickly, the chance of survival is doubled. Therefore, this study evaluated public awareness, knowledge and attitudes towards basic life support in Jordan. METHODS: A descriptive, cross-sectional design with a convenience sample of 300 Jordanian adults aged over 18 years, recruited from three metropolitan areas in the northern, middle and southern regions. RESULTS: A total of 87 participants (29%) stated that they have received training about cardiopulmonary resuscitation (CPR). Among them, 20 participants (23%) received their training through the media. The highest response rate for cardiac arrest signs was chest pain (n = 129, 43%). Participants who received training had greater knowledge of the three signs of consciousness evaluation. The numbers of participants who received training and performed chest compression, mouth-to-mouth ventilation, and both compression and ventilation were higher than those who did not receive training. Overall, 256 participants (88.3%) reported that they would perform CPR on someone from their family without hesitation. The most important concern about performing CPR was making a mistake. CONCLUSIONS: Improving knowledge about cardiopulmonary resuscitation is an important topic, which can be achieved by training the general population. Media can play an important role in this issue.

Persistent (Anxiety and Depression) Affected Academic Achievement and Absenteeism in Nursing Students.

BACKGROUND: Anxiety and depression are common among nursing students due to different factors. When they are minimal and not persistent, they work as stimuli for good achievement. However, when they are high or persistent they have negative consequences (i.e. low academic achievement and higher absenteeism rates). OBJECTIVE: The purpose of this study was to check the effect of persistent anxiety and depression on nursing student academic achievement and absenteeism rate. METHODS: A prospective observational correlational design with a convenience sample of 170 students enrolled in the undergraduate and graduate programs-college of nursing at a private university in Amman, Jordan. Anxiety and depression were measured twice at the beginning of the semester and then two months later by Hospital Anxiety and Depression Scale. Data regarding grade point average, number of absenteeism and the gender of the students; were collected from the electronic system of the university. RESULTS: Persistently anxious group has lower grade point average than persistently non-anxious group (mean [SD], 64.1 [13.8] vs. 73.1 [12.3], P< .001). Moreover, they have higher absenteeism rate than persistently non-anxious group (7.62 [5.7] vs. 4.0 [3.4], P< .001) and higher than transiently anxious group (7.62 [5.7] vs. 4.7 [4.6], P< .05). Persistently depressed group has lower grade point average than persistently non-depressed group (64.0 [13.8] vs. 73.2 [13.0], P< .001) and lower than transiently depressed (64.0 [13.8] vs. 71.7 [10.6], P< .01). CONCLUSION: Nursing administrators should search for the underlying causes for these negative emotions. Furthermore, setting strategies to control these negative emotions is highly recommended.

The effectiveness of age-appropriate pre-operative information session on the anxiety level of school-age children undergoing elective surgery in Jordan.

BACKGROUND: Undergoing surgery is an anxious experience for children. Applying anxiety reduction age-appropriate programs by nurses would be beneficial in reducing anxiety to children. AIM: To test the effectiveness of age-appropriate preoperative information session in reducing anxiety levels of school-age children undergoing elective surgery in Jordan. DESIGN: The study used a quasi-experimental design. METHODS: One hundred and twenty-six children were recruited from an educational hospital in Amman from January to June 2012 and were randomly assigned to intervention and control groups. The anxiety levels of children were assessed using the State Anxiety Scale for children, and children's levels of cooperation after surgery were assessed using Children Emotional Manifestation Scale. The heart rate and blood pressure of children were also measured 1 hour before going to operation room. RESULTS: The study results revealed that children in the intervention group reported lower anxiety levels and more cooperation than children in the control group. Also, they displayed lower heart rate and blood pressure than children in the control group. CONCLUSION: The application of age-appropriate preoperative intervention for children could be beneficial in decreasing anxiety levels and increasing their cooperation post surgery.

Jordanian adolescents' health behaviour and school climate.

AIM: This study was conducted to assess the occurrence of physical activity, nutritional habits, tooth brushing and seat belt use behaviour among adolescent school students in Jordan, and to examine the effect of psychosocial aspects of school on these behaviours. METHOD: A cross-sectional descriptive correlational design was used to draw a sample of in-school adolescents aged between 11 and 15 years. The final sample included 1166 adolescents from five public and two private schools. Study participants filled in a translated version of the health behaviour in school aged children questionnaire. Descriptive statistics, correlational (point biserial), and bivariate analyses (chi-square tests) were used to analyse the data. RESULTS: Among the study sample 34.5% of the adolescents practised exercise outside school hours once a week or less frequently, and only 53.1% of them brushed their teeth more than once a day. Regarding seat belt use, 44.7% of the adolescents used them rarely or never. Concerning carbonated sugary drinks and sweets consumption, about 64% and 83.3% of the adolescents, respectively, consumed them once a day or more often. The percentages of adolescents who never drank low fat or whole fat milk were 43.1% and 38.2%, respectively. CONCLUSIONS: The study concluded that school adolescents do engage in unhealthy behaviour. Psychosocial aspect of schools were associated with students' physical activity, nutritional habits, tooth brushing and seat belt use behaviours.

Post Traumatic Stress Disorder in Parents of Children With Cancer in Jordan.

AIM: To investigate levels of post traumatic stress disorder (PTSD) of those parenting children with cancer and make a comparison between mothers and fathers. BACKGROUND: Parenting a child with cancer is traumatic. Maternal and paternal roles and responsibilities change after the cancer diagnosis of their child, adding more stress to the lives of all concerned. The gender of the parent may have an effect on their PTSD. However, there is a lack of studies in Arabic countries on the differences between parents in their PTSD levels. METHODS: A sample of 416 biological parents (comprising 207 mothers and 209 fathers) of children with cancer in Jordan completed a demographic checklist and the PTSD Checklist Civilian (PCLC). RESULTS: There was a significant difference in PTSD levels between mothers and fathers, with mothers having significantly higher PTSD levels than fathers. The mean PTSD levels for mothers was (M=59.68, SD=4.86) compared to (M=52.76, SD=5.81) for fathers. The magnitude of the differences in the means was very large (eta squared=0.29). Additionally, results indicated that there was a significant negative correlation between parental PTSD levels with their age and the time since their child was diagnosed with cancer (r=-0.68, r=-0.62 respectively and p<0.001). An increase in parental PTSD levels was associated with a decrease in parental age and short time duration since the cancer diagnosis of the child. CONCLUSION: The study concluded that parenting children with cancer is traumatic and mothers were at higher risk of PTSD than fathers. Risk of PTSD was found to decrease with time. IMPLICATIONS FOR NURSING EBP: Investigating differences in PTSD between mothers and fathers in Jordan may be helpful when designing interventions to reduce the risk of PTSD. An individual parental support program is important, taking into consideration that mothers are at higher risk of PTSD, and both parents need thorough attention and care.

Eating Habits and Associated Factors Among Adolescent Students in Jordan.

The study aimed to assess adolescent patterns of eating habits, determine factors influencing these patterns, and identify male and female differences related to eating habits. Using a cross-sectional study approach, a sample of adolescents ( N = 423) in randomly selected clusters chosen from government and private schools in the south of Jordan completed self-administered questionnaires relating to socio-demographic data and personal eating habits. Results showed that parents, peers, and mass media are contributing factors, with peer pressure likely outweighing parental guidance. Males were more likely to be influenced by peers than females, whereas females were more likely to be influenced by media-based advertising. Lower body mass indices correlate with eating breakfast, which a majority of adolescents reported they do not do. Interventions targeted toward improving eating and active behaviors should involve peers as well as parents.

Attitudes and practices of school-aged girls towards menstruation.

The purpose of this study was to (i) investigate attitude and menstruation-related practices in Jordanian school-aged girls; (ii) identify the influence of premenstrual preparation on girls' attitude and menstruation-related practices. A descriptive cross-sectional design was used. Data was collected from a convenience sample of 490 school-age girls (12-18 years) from different districts in Jordan. Self-report instruments [Menstrual Attitude Questionnaire (MAQ), and Menstrual Practices Questionnaires (MPQ)] were used to assess the study variables. Descriptive statistics, correlation and chi-square tests were used to analyze the data. It was found that menstrual attitude and practices were positively correlated. Poor attitude toward menstruation and low menstrual practices were significantly associated with inadequate premenstrual preparation. There is a need to prepare girls for menstruation before menarche. The role of the schools and teachers should be reinforced through formal and well planned reproductive health educators for girls and their mothers.

Smoking patterns among Jordanian health professionals: a study about the impediments to tobacco control in Jordan.

BACKGROUND: Little is known about Arab health professionals' smoking practices. AIM: This is the first study to examine smoking practices among Arab health professionals. METHODS: Background: Little is known about Arab nurses and physicians' smoking patterns. AIM: This study aims to examine smoking patterns among Arab nurses and physicians. METHODS: A total of 918 nurses and physicians participated in this study. Data were collected using the Global Professional Health Survey. RESULTS: About 38.8% are current smokers. The smoking percentages for male nurses and male physicians were high (83.8%, 94.6% respectively) compared to female nurses and female physicians (16.2%, 5.4% respectively). Approximately 53.8% wanted to quit and 60.6% had made previous quit attempts that lasted for more than two days. About 64.1% believed that nurses and physicians who smoke were less likely to advise patients to stop smoking. The predictors of smoking were: age when tried first cigarettes OR=6.36, 95% CI=4.48, 9.04; father smokes OR=1.95, 95% CI=1.40, 2.72; mother smokes OR=1.99, 95% CI=1.18, 3.39; shift work OR=1.45, 95% CI=1.04, 2.03; and the interaction (gender and profession) OR=1.82, 95% CI=1.55, 2.14. DISCUSSION: Effective interventions often begin with and/or depend on nurses and physicians being committed to smoking cessation. Given the very high smoking rates among nurses and physicians a key priority must be to provide quit smoking programs and to enable them to become effective champions of smoking cessation nationwide.

Association of parental history of type 2 diabetes mellitus with leptin levels in Jordanian male youths.

OBJECTIVE: To investigate the association between high level serum leptin in male youths in relation to parental history of type 2 diabetes mellitus (T2DM) and body mass index (BMI). METHODS: This cross-sectional study was carried out at the Department of Medical Technology, Applied Science University, Amman, Jordan during the period from January to April 2009. One hundred and sixteen Jordanian male nursing students aged 18-24 years were divided into 4 groups according to parental history of T2DM and BMI. Fasting blood samples were measured for blood glucose, lipid profile, and serum leptin. RESULTS: Serum leptin levels in overweight and obese male youth diabetic patients with parental history of T2DM were significantly higher than in those overweight and obese without parental history (p<0.001). Of the 116 subjects, 83 (71.6%) had a positive parental history of T2DM. Compared with other groups, significant (p<0.001) elevation was observed in the mean cholesterol and triglyceride levels of obese T2DM. No significant differences were detected in high-density lipoprotein, low-density lipoprotein, and blood glucose levels among all study groups. CONCLUSION: High levels of leptin in overweight and obese Jordanian male youths were more likely associated with a positive parental family history of T2DM than BMI factor.

Jordanian nursing students' knowledge of osteoporosis.

The aim of this study was to explore baccalaureate nursing students' knowledge of osteoporosis for beginning practice in the community. A cross-sectional study design was used. Students were selected by convenience sampling (n = 85) from one University in Jordan in the final of 4 years. Students were asked to complete a 23-item-knowledge questionnaire based on two earlier published studies of osteoporosis. Results indicated poor level of knowledge of osteoporosis on all dimensions: prevention (11 items) 62.6%; SD 14.2; general (5 items) 59.5%; SD 20.6; and the pathophysiology (7 items) 39.6%; SD 15.6, and an overall mean grade of 54.9%; SD 10.3. This result provides information that graduating nursing students have limited knowledge to undertake the role of health promotion and disease prevention in the community.

The impact on mothers of bringing up a child with intellectual disabilities: a cross-cultural study.

BACKGROUND: Most research into the impact on mothers of having a child with an intellectual disability has been done in Western cultures. These mothers are at increased risk of stress, along with poorer health and weakened family relationships. Nurses are well placed to support these mothers. OBJECTIVES: (1) To describe across three different cultures-Irish, Taiwanese and Jordanian-the inter-relationships among three indicators of maternal well-being. (2) To identify the coping strategies of mothers and the professional and informal supports available to them. (3) To identify the variables that have a negative impact on maternal well-being and possible moderating influences on them. DESIGN: A survey approach with three groups of self-selected mothers. PARTICIPANTS: The characteristics of the child determined the inclusion criteria; namely aged 5-18 years with a diagnosis of intellectual disability of such severity that the children attended special schools or centres. In each country, the special services within particular geographical areas were approached and all families known to them were given the opportunity to participate. In all 206 mothers agreed to participate. METHODS: Mothers were interviewed individually at home or in the day centre attended by their child. They completed various rating scales of known reliability and validity. In addition they described in their own words, the impact the child had on their lives and how they coped. RESULTS: In all three countries, mothers experienced poor mental health, increased levels of child-related stress and poorer family functioning which the qualitative data further illuminated. Their child's behaviour problems were a major factor in this. The impacts on mothers' well-being were not alleviated by access to professional supports or use of coping strategies. CONCLUSIONS: Health professionals need to adopt family-centred approaches that embrace the support needs of mothers. Similar strategies would apply across all cultures although they must be responsive to individual need.