Satisfaction and Experiences of Saudi Parents in Neonatal Intensive Care Units: Mixed Methods Study

Abstract

The Neonatal Intensive Care Unit (NICU) is an inherently stressful environment for parents, where their satisfaction is a critical indicator of the quality of care provided. However, limited research has explored the satisfaction levels of Saudi fathers and mothers in the NICU, which are influenced by Islamic cultural values, family dynamics, and societal norms. A convergent parallel mixed-methods design was employed to explore the differences between Saudi fathers and mothers by integrating quantitative data on satisfaction with qualitative insights from NICU parental experiences of satisfaction through the lens of Leininger’s Culture Care Theory (CCT). Quantitative data were collected through a cross-sectional descriptive correlation design using the Critical Care Family Satisfaction Survey (CCFSS), adapted for the Saudi context. Qualitative data were gathered through an ethnonursing design involving participant observations and semi-structured individual interviews. The study included 75 parents (34 fathers and 41 mothers) from King Fahad Medical City in Riyadh, Saudi Arabia. Quantitative data were analyzed using independent t-tests, while qualitative data (25 observations and 22 interviews) were analyzed according to Leininger’s four phases of the Data Analysis Enabler. The mixed-methods analysis employed a side-by-side comparison to present both findings in a parallel format. The quantitative findings revealed that both Saudi fathers and mothers reported high satisfaction levels with the care their infants received in the NICUs. However, Saudi fathers reported slightly higher satisfaction than mothers across the total score and all five subscales of the CCFSS, which include assurance, proximity, information, and support. A significant difference was observed only in the comfort subscale (p = 0.002), where fathers reported higher satisfaction. From the qualitative data, six major themes were identified: (a) emphasizing parental active engagement in NICU care, (b) addressing parental cultural considerations in NICUs, (c) integrating Islamic practices into NICU care, (d) cultivating collaborative partnerships between parents and NICU staff, (e) facing unexpected challenges during their infant's NICU stay, and (f) applying coping mechanisms to overcome NICU parental challenges. The mixed-methods findings showed that the roles of Saudi fathers and mothers in the NICU, shaped by social, cultural, and religious norms, significantly impacted their satisfaction. Convergence was found in total satisfaction, assurance, and comfort, while divergence occurred in proximity, information, and support. The findings of this study have important implications for NICU care in Saudi Arabia, highlighting the need for culturally sensitive, family-centered practices that integrate Islamic values, actively involve both parents in their infant’s care, and address the emotional and practical needs of fathers and mothers to enhance their overall satisfaction and well-being during their NICU experience.