Trajectory and determinants of family resilience in caregivers of preterm infants: A mixed-methods study

To investigate the dynamic trajectory, predictors, and underlying adaptation mechanisms of family resilience (FR) among Chinese families with preterm infants (PIs) from birth to six months.

Guided by Ecological Systems Theory, a convergent parallel mixed-methods study was conducted in the Neonatal Intensive Care Unit (NICU) of a tertiary hospital in Fujian Province, China, from June 2023 to June 2024. Quantitative data were collected from 202 caregivers selected by convenience sampling at four time points: at birth (T0), 42 days postpartum (T1), 3 months postpartum (T2), and 6 months postpartum (T3). Generalized Estimating Equations (GEE) was used to analyze scale score differences across time points and explore factors influencing FR. Qualitative data were collected through semi-structured interviews with 14 caregivers recruited by maximum variation purposive sampling and analyzed using Colaizzi's phenomenological approach. After conducting separate data analyses, the findings were integrated through side-by-side comparison and joint display.

Quantitative results revealed a non-linear, "V"-shaped trajectory of FR, significantly influenced by educational level, conception via assisted reproduction, farming occupation, coping style, psychological resilience, family functioning, and social support. Qualitative findings identified four themes: initial uncertainty and emotional distress, post-discharge anxiety, gradual adaptation, and eventual stabilization. Integrated mixed-methods findings revealed that the initial confusion phase demands a comprehensive response to family needs (T0); the post-discharge bottleneck requires addressing the care capability-needs gap (T1); the role adaptation phase is pivotal for enhancing internal family resources (T2); and the family-work transition necessitates enhanced work-family facilitation (T3).

This study systematically identifies the unique "V"-shaped trajectory of FR in Chinese families with PIs and its key influencing factors, and accurately analyzes their dynamic experiences and adaptation across four stages. These findings provide an empirical basis for stage-specific targeted interventions, strongly support the practical advancement of the family-centered care model, and deliver critical guidance for enhancing FR.