Perception of family sense of coherence during parental transition: A qualitative study

Abstract

This study described the perspectives and interplay of factors affecting the family sense of coherence of Chinese couples during the perinatal period. We adopted a grounded theory approach and conducted semi-structured interviews with 36 Chinese couples during pregnancy and at 2–3 months postpartum. Four major themes emerged involving meaningfulness, comprehensibility, and manageability of new parenthood and factors affecting the family sense of coherence. The strong sense of family unity and harmony embedded in the Confucian philosophy and the collective coping, in particular the strong social support network, seemed to contribute to couple’s experience of new parenthood as meaningful, comprehensible, and manageable.

Keywords

Chinese couples family sense of coherence parental transition qualitative

Introduction

The transition to parenthood is a major developmental task in couples’ life, which involves deep changes in personal identity, responsibilities, lifestyles, roles, and relationships of individuals (Ngai and Ngu, 2014). Although many couples enjoy a sense of fulfillment and satisfaction during the parental transition, some feel overburdened by the demands of parenthood and become depressed in the perinatal period (Cameron et al., 2016; Woody et al., 2017), which can have detrimental effects on the psychosocial development of the infants (Murray et al., 2011; Netsi et al., 2018). Several studies have revealed the impact of childbirth on the couples’ lives and the difficulties when taking on the tasks and responsibilities of new parenthood (Martins, 2019; Rania, 2019). In a qualitative study of five couples in Portugal with repeated semi-structured interviews, the couples described transition to parenthood as living on the edge of one’s capacities, in which they felt exhausted and overwhelmed with emotions, such as anxiety, disappointment, feeling incapable of dealing with parenthood, stress, and depression (Martins, 2019). Systematic reviews have reported that both women (11.9%) (Woody et al., 2017) and men (8.4%) (Cameron et al., 2016) may suffer from depression in the perinatal period. In a longitudinal study of 200 Chinese pregnant women in Hong Kong, postpartum depression was reported to affect 11.5 percent of mothers and 10.5 percent of fathers at 6 months postpartum, and partner’s depression was found to be a major predictor of depression for both mothers and fathers (Ngai and Ngu, 2015). These findings highlight the need for understanding postnatal depression in the family as a social system in which the couples experience stressors and engage in coping during the critical time of parental transition.

Recent studies have attempted to elucidate both the risk factors for postnatal depression and the protective factors that prevent negative experiences during the transition to parenthood (Lu et al., 2012). One of the identified protective factors that contribute significantly to the couples’ well-being during parental transition is the family sense of coherence (Antonovsky and Sourani, 1988; Ngai and Ngu, 2014). The family sense of coherence is rooted in the salutogenic theory, which offers an explanation for how people maintain a good health status during stressful life events (Antonovsky, 1987). According to Antonovsky (1987), people respond to stressors by mobilizing generalized resistance resources, and the ability to use these resources is dependent on one’s sense of coherence, which can exist at the individual and family level. The family sense of coherence is the family’s global belief that the environment is comprehensible (structured, predictable, and explicable), manageable (resources are available to meet demands), and meaningful (demands are challenges and worthy of investment) (Antonovsky and Sourani, 1988). During parenthood transition, the family sense of coherence represents the extent to which the couples see their family worldview as coherent (Sagy, 1998). A strong sense of family coherence provides the motivational, perceptual, and behavioral basis for couples to cope with the physical and emotional demands posed by parental stressors, thus promoting a good quality of life and minimizing the risk of depression (Antonovsky and Sourani, 1988). A previous survey of 116 American families with mentally retarded children reported that these families’ sense of coherence predicted positive family adaptation significantly (Lustig and Akey, 1999). In another study of 78 American families with a sick family member, the family sense of coherence was found to be a strong predictor of quality of life and a mediator in reducing the impact of stress on the quality of family life (Anderson, 1998). In a survey of 224 Chinese childbearing couples, a stronger sense of family coherence was correlated with a lower level of depressive symptoms and a better family functioning (Ngai and Ngu, 2014). Taken together, these findings suggest that the family sense of coherence can promote positive adaptation and well-being during the transition to parenthood.

The strength of family sense of coherence is determined by the family’s general resistant resources (Antonovsky, 1987). These resources involve physical (e.g. a strong physique, strong immune system, genetic strengths), artefactual (e.g. money, clothing, food, power), cognitive (e.g. intelligence, education, adaptive strategies for coping), emotional (e.g. emotional intelligence), social (e.g. support from friends and/or family), or macrosocial aspects (e.g. culture and shared belief systems) (Antonovsky, 1987). Thus, an individual’s family sense of coherence is constructed within his or her social, cultural, and ethnic background, as well as through the idiosyncratic events in his or her own family context. However, most of the previous studies of the family sense of coherence adopted a quantitative methodological approach and were predominantly conducted in Caucasian populations (Ahlborg et al., 2013; Ferguson et al., 2014). Moreover, qualitative studies that investigate couples’ own accounts of the family sense of coherence and factors affecting their sense of family coherence during the parental transition within Chinese societies have been lacking. We therefore aimed to examine the concept of the family sense of coherence and the factors that influence its development during the parental transition in Chinese couples from Hong Kong. The results of this study will facilitate the development of appropriate interventions to strengthen couples’ family sense of coherence and potentially improve perinatal health. The aims of this study were (1) to describe the family sense of coherence from the perspective of Chinese parents and (2) to examine the nature and interplay of factors that affect the sense of family coherence during the perinatal period.

Methods

Design

A grounded theory approach was adopted to explore the views and influencing factors on the family sense of coherence during the parental transition of Chinese couples. Grounded theory is rooted in symbolic interactionism, which seeks to understand the basic social processes of human behavior in the social context (Corbin and Strauss, 2015).

Participants

Stratified purposive participants of Chinese childbearing couples were recruited according to gestation and parity. These criteria ensured that there were variations in gestation and parity, and thus a broad range of the couples’ experiences was explored. The inclusion criteria were childbearing couples who were aged 18 years or above, at the second or third trimester of pregnancy, and able to communicate in Cantonese. Couples who were mentally ill or unable to fully articulate their experiences were excluded.

Data collection

Ethics approval was obtained from the hospital and university ethics committees. The eligibility of the couples was determined according to the sample inclusion criteria by a research nurse. Potential eligible participants were approached during their obstetric visit at the antenatal clinics of a regional public hospital between June 2017 and September 2018. Couples were informed on the nature of the study and invited to participate in the study. Verbal and written explanations of the purpose and the procedure of the study were provided by the research nurse and written consent was obtained from couples who agreed to participate in the study.

Data were collected using repeated face-to-face in-depth semi-structured interviews during the pregnancy and at 2–3 months after birth. The repeated interviews allowed an in-depth understanding of the couples’ transitions to parenthood in relation to the family sense of coherence. The interview was conducted with both members of the couples together during their obstetric visit at the antenatal clinics and again at 2–3 months after birth at each couple’s home. A semi-structured interview guide was developed to facilitate the interview, which consisted of three open-ended questions related to couples’ views about the family sense of coherence, the factors affecting family sense of coherence during pregnancy and after birth, and their views on what could be done to help strengthen their family sense of coherence during the parental transition. The semi-structured interview guide enabled the researcher to collect important information about the meaning of the family sense of coherence and the wider context that affect the Chinese couples’ sense of family coherence during the parental transition. It also allowed the couples to report on their own thoughts and feelings. The interview guide consisted of an opening question—“How do you conceive your family world?”—and probing questions responding to the couples’ own ordering of ideas and phrasing to follow up on specific issues related to the three components of the family sense of coherence (comprehensible, meaningful, and manageable) in the perinatal period, such as “How do you make sense of the pregnancy/childbirth?” “In what ways are the pregnancy/childbirth important in your family life?” “What challenges have you experienced during pregnancy/childbirth?” and “What resources are being used?” The couples were next asked to identify the factors that affected their family sense of coherence during the parental transition with probing questions such as “How do the challenges that you have experienced during pregnancy/childbirth affect your sense of family coherence?” The interview was ended by inviting couples to suggest ways to improve their family sense of coherence during the perinatal period, such as “How do you maintain a family sense of coherence during pregnancy/after birth?”

The interviews were conducted by a trained research assistant using the semi-structured interview guide. Field notes were taken to contextualize the data and to record the non-verbal interactions or emotions that might be relevant for the data interpretation. The interviews, which were all tape-recorded, lasted for 45–60 minutes. Interviews were conducted until the theoretical saturation of data was reached.

Data analysis

The interview data were transcribed verbatim and analyzed by constant comparative analysis (Corbin and Strauss, 2015). Using a software program NVivo 12, meaningful entities related to the understanding about the family sense of coherence and the wider context that affected a sense of family coherence during parental transition were identified. Data were reviewed and coded independently by the authors. Each term, sentence, and phrase that represented an idea were identified through open coding to generate substantive codes. Codes were compared for similarities and differences, and grouped into categories through axial coding. The categories were then related to each other and selectively coded for analysis of the emerging core theme. Analysis was constantly compared between the couples and different time points, and the effects of time and evidence of change in couples’ perceptions of the family sense of coherence during the parental transition were identified. After independent coding, the authors then compared the categories in each interview, looked for commonalities and differences, developed a theoretical understanding, and identified the emerging theory that best described the couples’ perceptions of the family sense of coherence during the parental transition.

Trustworthiness

The data were reviewed and coded independently by two authors. Categories and themes were identified and compared with ongoing and regular communication to ensure consensus and accurate interpretation of the data, thus enhancing both the credibility and dependability of the findings. Reflexivity was employed to avoid any bias in the interpretation of the data. Feedbacks about the categories developed during data analysis were collected from the couples to ensure the validity of the findings. All interviews were conducted by the research assistant using the semi-structured interview guide to ensure consistency during data collection. All interviews were tape-recorded and transcribed by the same research assistant to ensure dependability of the findings. To facilitate data analysis and interpretation, field notes were taken to document the additional observations and the interviewer’s personal experience with a particular encounter.

Results

A total of 36 couples participated in the study. The mean ages of the childbearing women and their partners were 34.1 years (standard deviation (SD) = 3.7) and 36.4 years (SD = 5.5), respectively. Twenty-two couples (60.1%) were first-time parents. The mean ages of first-time and second-time mothers were 32.8 years (SD = 4.0) and 34.9 years (SD = 3.3), respectively. Most of the couples had completed postsecondary education. Over 70 percent of the childbearing women were employed and 100 percent of their partners were employed. The median family income was HK$38,920 (US$4,990) per month. The demographic and obstetric characteristics of the participants are detailed in Table 1.

Table 1.

Characteristics of participants (N = 72).

Characteristics	Mothers (n = 36)n (%)	Fathers (n = 36)n (%)
Age, mean (SD)	34.1 (3.7)	36.4 (5.5)
Education
Secondary	8 (22.2)	8 (22.2)
Tertiary	7 (19.4)	3 (8.3)
University or above	21 (58.3)	25 (69.4)
Employment status
Unemployed	10 (27.8)	0
Employed	26 (72.2)	36 (100)
Monthly household income
<HKD$20,000	3 (8.3)
HKD$20,000–HKD$30,000	3 (8.3)
HKD$30,001–HKD$40,000	4 (11.1)
HKD$40,001–HKD$50,000	9 (25.0)
>HKD$50,000	17 (47.2)
Religion
Buddhism	2 (5.6)	1 (2.8)
Catholic	1 (2.8)	1 (2.8)
Christian	5 (13.9)	4 (11.1)
None	28 (77.8)	30 (83.3)
Parity
Primipara	22 (61.1)
Multipara	14 (38.9)
Gestation
Second trimester	15 (41.7)
Third trimester	21 (58.3)
Mode of delivery
Normal vaginal delivery	11 (30.6)
Assisted vaginal delivery	8 (22.2)
Cesarean section	17 (47.2)
Gestation at delivery
Term	34 (94.4)
Preterm	2 (5.6)
Gender of newborn
Male	18 (50.0)
Female	18 (50.0)
Newborn body weight (kg)
⩾2.5	32 (88.9)
<2.5	4 (11.1)

SD: standard deviation.

Four major themes emerged from the data that reflected a salutogenic model of the family sense of coherence during parental transition: meaningfulness of the pregnancy and childbirth, comprehensibility of new parenthood, manageability of parental role, and factors affecting the family sense of coherence during the parental transition (Figure 1). The findings revealed that the first-time and second-time parents described a similar perspective of the family sense of coherence in the context of Chinese parenthood.

Figure 1.

A salutogenic model of family sense of coherence during parental transition.

Theme 1: meaningfulness of pregnancy and childbirth

Most couples perceived the pregnancy and childbirth with a new sense of meaning and purpose in their lives, which provided the motivational basis for their efforts in managing the demands of parental role. The findings revealed three subthemes of meaningfulness: new hope for the family, a common goal in raising the child, and family unity.

New hope for the family

Most couples considered the birth of a child as bringing new hope to the family. They perceived the pregnancy and childbirth as meaningful and worthwhile:

We are happy because of the new life . . . We look forward to the birth of our child. (P16, wife, second-time parent, pregnancy)

Having a child is beneficial to the family . . . it brings new hope to the family . . . our lives are quite boring . . . just shopping or finding activities to do on our own . . . Now, we have a common goal to share. (P17, husband, first-time parent, pregnancy)

A common goal in raising the child

Having a common goal in raising the child was most frequently mentioned by the couples, which provided the motivational basis for couples’ efforts in managing the demands of new parenthood:

It is important that we have the same goal . . . Now our focus is on the child . . . we both hope to take good care of our child so that he is healthy and grows up quickly. (P14, husband, first-time parent, postpartum)

All our focus is on the newborn child . . . it is a motivation . . . our daily lives and our communications all shifted towards the newborn child. (P35, husband, first-time parent, postpartum)

The wife echoed: Because we have a common goal . . . our first child. (P35, wife, first-time parent, postpartum)

After birth, our focus is now on the child . . . when facing problems, what we are concerned the most is whether the solution would be good or bad for the child . . . We would not give too much thought if it is just for the sake of ourselves . . . Having a child gives us a great motivation to solve problems. (P5, husband, first-time parent, postpartum)

We are very busy, we use all 24 hours, except going to work, to serve the family . . . in particular with the birth of second child in the family . . . We have reduced our personal and social activities because the child is our priority. (P34, wife, second-time parent, postpartum)

Family unity is important . . . we cooperate . . . work together . . . e.g., participate in childcare . . . we solve problems together . . . all family members need to cooperate on different areas, such as family expenses . . . we are prepared to make sacrifice for our child. (P20, wife, first-time parent, pregnancy)

Family unity

The couples regarded the pregnancy and childbirth as important in terms of family unity, which brought families together and unified family members. The understanding that each of them was working toward a common goal and the willingness to place the child’s needs above their own established a strong sense of family unity and joint activity toward enhancing the well-being of their child:

Family unity is important . . . we need to align our goals because of the child . . . we both put efforts and work together for the sake of our child. (P1, wife, first-time parent, pregnancy)

Family unity is important . . . we work together as a team . . . if the child keeps crying, my parents will come out to help . . . When we are busy in taking care of the newborn child . . . my parents will take care of the elder child . . . we help each other because of the unity within the family. (P33, husband, second-time parent, postpartum)

Theme 2: comprehensibility of new parenthood

Comprehensibility refers to the extent to which couples can make sense of the stimuli from their internal and external environments during the parental transition. The couples, in particular the first-time parents, articulated how their personal lives were disrupted by the pregnancy and childbirth, which involved profound physical and emotional changes, as well as changes in their roles, responsibilities, and relation-ships. Three subthemes were identified: change in physical and emotional health, change in roles and responsibilities, and change in relationships.

Change in physical and emotional health

Most couples, the mother in particular, experienced profound physical and emotional changes during the pregnancy and following childbirth:

I am happy but concerned about my child’s health . . . I eat very little because of the severe vomiting during pregnancy . . . so I worry about inadequate nutrition for my child. (P16, wife, second-time parent, pregnancy)

There have been profound changes after birth . . . Physically, I feel tired and exhausted . . . Psychologically, I worry about my child . . . I do not know how to take care of my child . . . maybe it is due to the influence of hormone, I cry more often and more easily lose my temper. (P4, wife, first-time parent, postpartum)

Some couples expressed that they had less time for other leisure and social activities because of the childcare demands:

Having the child is a constraint to me . . . I could not go out . . . I have not gone out for 2 months after birth . . . I can go off duty when I am working . . . Now I am working 24 hours straight, there is no time off . . . I want to go out but cannot . . . I cannot do anything I want . . . I can only stay at home. (P17, wife, first-time parent, postpartum)

Our personal and social activities have been reduced because the child is now our priority. (P34, husband, second-time parent, postpartum)

Change in roles and responsibilities

Some couples expressed their frustration due to their self-perceived lack of knowledge and skills in childcare:

I am not sure if I have enough milk for my child . . . I am confused whether I should give supplement to my child or not . . . things are in chaos . . . I am frustrated . . . I am emotional . . . I am feeling very busy . . . my child keeps crying because there is not enough milk . . . it is a vicious cycle. (P31, wife, first-time parent, postpartum)

Most couples demonstrated an increased sense of responsibilities of being a parent:

It is our responsibilities to take care of the child . . . we cannot just abandon the child after giving birth to it . . . We should be responsible people, responsible parents that take care of the child. (P16, husband, second-time parent, pregnancy)

We need to take care of the child 24 hours a day, the child is very fragile, and I cannot let anything happen to him. It is a huge responsibility . . . I need to use all my time and energy in taking care of the child, myself and my partner too. (P21, husband, first-time parent, postpartum)

The fathers were particularly concerned about the financial status of the family and whether it was adequate for the extra costs associated with raising a child:

The expense for the family has been increased even before the birth of the child, we needed a bigger house, to employ a domestic helper and doing-the-month maid (i.e. a maid to help during a month-long postpartum self-confinement by the new mother), and to buy many things for the child. (P14, husband, first-time parent, pregnancy)

Having a child poses increased financial pressure to the family . . . I am more concerned about my job security . . . I am afraid of losing my job. (P2, husband, first-time parent, postpartum)

I have taken one more part-time job . . . I want to improve the living standard and quality of my children’s lives. (P33, husband, second-time parent, postpartum)

Change in relationships

Some couples were concerned about how the pregnancy and childbirth would affect their relationships and the relationships with other family members:

Sometimes we have conflicts because of our different opinions in child care . . . such as the way of changing nappy . . . bringing up the wind . . . the schedule and amount of feeding . . . We are too concerned about our child that sometimes it leads to conflicts . . . but they are just minor issues. (P32, husband, second-time parent, postpartum)

My relationship with my family is not as good as it was before the childbirth . . . there are conflicts . . . there are different voices . . . sometimes their advice on childcare works, but sometimes not . . . I feel frustrated. (P21, wife, first-time parent, postpartum)

Theme 3: manageability of parental role

Manageability refers to the availability of resources to meet the demands posed by the parental transition. Most couples mobilized both internal and external resources to help them cope with the demands of new parenthood. Two subthemes were identified: internal resources (coping behaviors) and external resources (social support networks).

Internal resources: coping behaviors

Many couples drew on their internal resources by adopting a variety of coping behaviors, such as having an optimistic attitude, reframing, making compromises, maintaining effective communication, and actively solving the problems encountered during the parental transition:

I will not worry too much . . . the problem will be solved when the time comes . . . You cannot be too serious if you have a child. The child will grow by himself . . . it is a natural process . . . Just let the nature take its course. (P25, wife, second-time parent, pregnancy)

I was stressed during the pregnancy, maybe due to the hormones, I had negative thoughts . . . I tried to replace them with positive ones . . . e.g. the difficult time will only last for a while, just for the first year, the child will grow and will walk soon, I will not need to use the carrying belt anymore, it will be much better. The difficult time will soon be over . . . there is always a way out. (P34, wife, second-time parent, pregnancy)

I will not think about or exaggerate everything . . . I will try to focus on the current problem . . . I have become more practical, I do not waste the time, actually I have no time to worry about things that are too far ahead in the future. (P30, husband, first-time parent, postpartum)

Some couples emphasized the importance of making compromise after the birth of child:

I used to dislike it when people interrupted my plan once I had made one. However, I realized that this does not work after birth . . . I have to make compromises . . . I need to be open-minded and listen to others’ opinions . . . e.g. people have shared with me many different ideas . . . sometimes I have to admit that I may be wrong. (P21, husband, first-time parent, postpartum)

Effective communication with an open dialogue and mutual understanding between the mothers and fathers were considered important for the management of the demands of new parenthood:

It is important to solve the problem together . . . to talk about it whenever we need help . . . to not remain silent because it [the problem] will get worse . . . It is important that we understand each other . . . to talk about it and solve it when we feel unhappy or uncomfortable . . . The most important thing is communication. (P16, husband, second-time parent, postpartum)

Mutual support is important. We would help each other . . . I have taken time off to accompany my wife during the follow-up. (P15, husband, second-time parent, pregnancy)

The wife echoed,

Mutual understanding . . . My husband has taken one month of annual leave to share with me the workload on childcare . . . It is important to communicate and share with each other. (P15, wife, second-time parent, pregnancy)

Some couples emphasized the importance of good planning and distribution of labor to help them cope with the demands of childcare:

During the night time, I wake up and prepare the milk and my wife feeds the child, I then go back to sleep because I need to work on the next day . . . Sometimes if I cannot bring up the baby’s wind, my wife will take over . . . When I get off from work, I will ask my wife to take a nap . . . it is important to have a good time management and take turns in the child care. (P32, husband, first-time parent, postpartum)

Some couples, especially first-time parents, coped by trial and error:

When I gained some experience in taking care of our child, I share it with my wife. My experience may not be correct, but she can try to solve the next problem based on my experience . . . sometimes it works . . . e.g. when our child did not go to sleep after feeding, I suggested that maybe our child’s nappy was wet, and my wife changed the nappy. Afterwards, our child went to sleep . . . we are using trial and error to help us cope with childcare. (P8, husband, first-time parent, postpartum)

External resources: social support networks

Many couples described the reliance on strong social support systems including family members, friends, domestic helper, “doing-the-month” maid, healthcare professionals, religious support group, and online parenting groups.

The extended family, particularly the maternal grandmother of the child, played a significant role in supporting the couples:

I am lucky . . . my mother is retired . . . she stays with me during daytime . . . she accompanies me and assists me in childcare . . . feeding the child . . . It is much better that I have my mother to share these things with me . . . she knows my needs and can take care of me better than others . . . I share with everything with her . . . My mother keeps reassuring me to not worry too much because she is here to help me. She always says that we will cross that bridge when we come to it. (P34, wife, second-time parent, postpartum)

I get help from a “doing-the-month” maid and a domestic helper. They have childcare experiences, so they provide a lot of support to me. My husband assists in the feeding at night time . . . my family sometimes assists me in childcare, so I could take a break. (P35, wife, first-time parent, postpartum)

Some couples sought advice from their friends, colleagues, healthcare professionals, and online parenting support groups for information about pregnancy and childcare:

I have many friends who have childcare experiences . . . when somethings happen to my child . . . I will seek their advice . . . e.g., my child developed a facial rash, I asked them which cream is better . . . the rash disappeared immediately after applying the cream recommended by my friends . . . so friends are important . . . they are very experienced in childcare . . . it is really good to listen to their advice. (P1, husband, first-time parent, postpartum)

I seek advice from my friends, they have the experience and they are more reliable than the information available on the Internet . . . There is a lot of information I can search on the Internet, but I do not know whether it is right or wrong . . . it can only be used as a reference. (P8, wife, first-time parent, postpartum)

Some couples accessed online parenting support through social media:

I have some friends who are pregnant . . . I have joined several parenting groups on Facebook. (P21, wife, first-time parent, pregnancy)

The nurses at the hospital taught me how to feed the child . . . I have attended the antenatal classes that teach parenting skills, bathing etc. It would be more helpful if they can provide more information on diet because now I need to find out myself on the Internet. (P32, wife, second-time parent, pregnancy)

A few couples relied on their religious beliefs for emotional support:

Our religious belief is a support for us . . . emotional support . . . Our friends pray for us every day . . . we are thankful that we have friends to share together . . . friends who provide support and give advice. (P30, husband, first-time parent, postpartum)

Theme 4: factors affecting family sense of coherence

The couples identified two major factors that affected their sense of family coherence: harmony in the relationship and time constraint.

Harmony in relationship

Many couples emphasized the importance of harmony in the relationship, with mutual understanding and self-control required to enhance the family sense of coherence:

It is important to have a harmonious environment . . . a peaceful environment that awaits me when I come back home . . . If a family is full of conflicts and the parents are always arguing, I would not want to go back home . . . To have a harmonious environment, we need to control our emotions . . . If we are always having conflicts, how could we maintain family coherence? (P23, husband, first-time parent, pregnancy)

Caring and mutual understanding among the family members are the most important things to enhance family coherence . . . Sometimes we may have different opinions because of our different personalities . . . It is important to have mutual understanding to avoid conflicts that may worsen the situation. (P20, husband, first-time parent, postpartum)

Family harmony is important . . . we have less conflict than before . . . maybe she’s our second child . . . we have the experience . . . we know how to manage (child care). (P29, wife, second-time parent, postpartum)

Time constraint

Some couples mentioned the importance of spending time with the family and negotiating work and family to maintain family coherence:

Time is important because Hong Kong is a busy city . . . we need to allocate our time to stay with our family to maintain family coherence . . . Now I am balancing my work and family. (P6, wife, first-time parent, postpartum)

Good time management is important . . . I now try to reduce my time at work and spend more time at home to assist my wife in childcare. (P6, husband, first-time parent, postpartum)

The second-time parents felt that they spent less time with their elder child because of the busy schedule of newborn care:

I could not go out during the first month because of “doing-the-month” . . . We have less of a family day . . . we stay at home even during the weekends . . . we do fewer outdoor activities together than before. (P16, wife, second-time parent, postpartum)

Because of the frequent feeding time, every hour, it uses up all our time during the day, including the toilet time (Laugh) . . . When the child grows up and starts walking, we will have more time together for the whole family . . . thus, better family coherence . . . Now the child is still very small . . . all our focus is on him . . . When he grows up, we will shift more of our attention back to the elder child . . . to improve harmony in the family. (P16, husband, second-time parent, postpartum)

Discussion

To our knowledge, this is the first study to provide an in-depth description of the family sense of coherence experienced among Chinese couples during the transition to parenthood in Hong Kong. The notion of family unity emerges as a cultural construct that is deeply embedded in the conceptual framework of the family sense of coherence about family life as comprehensible, meaningful, and manageable (Antonovsky and Sourani, 1988). The notion of family unity is a cultural ideal embodied in Confucianism within the Chinese society, which focuses on collectivism and filial piety (Qi, 2015; Wang, 2016). Confucian philosophy stresses the collective welfare of the family, where parents are obligated to take care of their children and subordinate their own interests and desires for the welfare of their family (Wang, 2016). Although the couples in this study faced profound changes in their personal lives, they demonstrated a strong sense of family unity with a common goal and commitment to make sacrifice for the family and the child, which was consistent with previous studies (Leung and Shek, 2020; Ngai et al., 2011). The strong sense of family unity seemed to create a sense of meaning and purpose in the couples’ lives, which provides the motivational basis for the couples’ commitment and devotion to the family during parental transition. Consistent with Antonovsky’s conceptualization of family sense of coherence, the meaningfulness component is an important motivational element that improves the couples’ experience during the parental transition (Antonovsky and Sourani, 1988).

The first-time parents in this study tend to experience childbirth as a greater overall life change than the second-time parents, which is in line with previous findings (Aber et al., 2013). Nevertheless, both the first-time and second-time parents expressed a strong sense of meaningfulness and unity with the family. Most of them perceived the demands of parental role as challenges and deployed various coping resources to meet the challenges during parental transition. In this study, the couples drew heavily on their own resources and worked together to solve the problems encountered in childcare. They employed a variety of coping strategies, such as the cognitive process of reframing the situation, making compromise, trial and error, and problem solving. These findings concurred with previous studies that self-reliance and active problem solving are important strategies used by Chinese mothers in coping with the demands of parenthood (Ngai et al., 2012). In this study, the couples stressed the importance of mutual support and sharing of parental responsibilities in childcare. Traditional Chinese societies exhibit strict role divisions and power imbalances between the father and mother (Yeung, 2013). While the father is primarily responsible for providing financial support and making important decisions within a family, the mother is responsible for managing the household and taking care of the children (Yeung, 2013). In recent decades, the change in gender roles and the increased participation of women in the workforce have significantly shifted in the roles of fathers and mothers in both the eastern and western societies (Featherstone, 2009; Rania et al., 2015). In contrast to past generations, fathers nowadays are also expected to be the breadwinner for their families, but also to participate in childbirth and share the responsibilities for the care and rearing of the child (Chui et al., 2016; Featherstone, 2009; Rania et al., 2015). Consistent with previous findings (Chui et al., 2016; Ho et al., 2010; Yeung, 2013), our study showed that fathers in contemporary Chinese societies are more willing to engage in everyday childcare and share the parental responsibilities with their partner.

The couples in this study also sought advice and support from the extended family, in particular their own parents or parents-in-law. The role of the extended family in childcare is an essential component of Chinese societies (Liu et al., 2015). Traditionally, Chinese women are assisted by a female family member, usually their own mother and mother-in-law, in infant care and housework for the first month after childbirth (Liu et al., 2015). Chinese culture, being collective in nature, is well known for its emphasis on family relationships and support (Wang, 2016). Families are described as close-knit units, manifested as three-generational households (Wang, 2016). Although the nuclear family is the most common family structure in Hong Kong (Census and Statistics Department, 2017), the extended family of the couples in this study paid frequent visits to the couples and assisted in childcare and household tasks. Thus, collective coping, which stems from the culture of collectivism, is still commonly practiced in Chinese societies (Wong, 2016). When the extended family members are not available, a “doing-the-month” maid or domestic helper is usually employed to assist in the traditional postpartum care, childcare, and domestic work (He and Wu, 2019).

In addition to the support from family members, the couples in this study sought advice and information about pregnancy and childcare from a range of social networks, including their friends, colleagues, healthcare professionals, religious support groups, and online parenting groups. The Internet and online social media groups are increasingly used as sources of health information, in particular by couples during the early postpartum period when it is often difficult for them to leave the house due to the demands of childcare (Gleeson et al., 2019). However, similar to the results of previous studies (Gleeson et al., 2019; Ngai and Chan, 2019; Pilkington et al., 2017), some couples in this study were concerned about the reliability of the online information. Thus, facilitating access to high-quality online health information is important to enhance couples’ coping resources. This is especially important for Chinese mothers who practice postpartum confinement or “doing the month” (Liu et al., 2015).

This study highlighted the importance of a harmonious relationship in enhancing the sense of family coherence during the parental transition. Chinese families perceive a sense of harmony as an important aspect of family strengths (Chan et al., 2011; Xu et al., 2007). In this study, avoiding conflicts and making compromises were considered by the couples to be essential for maintaining a good and harmonious family relationship and enhancing the family sense of coherence. Furthermore, the couples in this study emphasized that spending time with the family and maintaining work–family balance were also important in enhancing their family sense of coherence. However, most couples in this study were engaged in full-time employment and had limited time to meet the demands imposed by their dual roles as working parents, in particular for the second-time parents. In accord with previous findings (Cook and Dong, 2011; Law, 2011), time scarcity and the experience of work and family conflicts represented a pervasive experience of contemporary Chinese families, which seemed to threaten the couples’ family sense of coherence. In recent years, the Hong Kong Government has recommended the development of family-friendly workplaces and good people management measures that allow employees to balance the responsibilities of their work and families (Yip and Chun, 2009). Thus, the implementation of family-friendly workplace policies, such as adopting flexible work arrangements and providing family leave and nursery services, should be reinforced to assist couples to have a better work–family balance, so that they could spend more time with their family, thus promoting their sense of family coherence.

Strengths and limitations

A limitation of this study is that all participants were recruited from a single hospital in Hong Kong. Thus, generalization of the current findings should be done with caution. Nevertheless, we sampled couples with parity and gestation variations using repeated in-depth interviews to maximize the trustworthiness and theoretical validity of our findings.

The present findings suggest that the Confucianism seems to be one of the most influent factors in shaping the development of family sense of coherence in the context of Chinese parenthood. Future studies should examine the beliefs and practices of Confucianism among the Chinese parents. Furthermore, future research could explore the cross-cultural transferability of the findings in western contexts where family value is high under the influence of Christianity (Madajczak, 2011).

Conclusion

The present findings provide a good qualitative empirical basis on which to draw out the components of family sense of coherence and to make sense of the family coherence as an experiential construct that can be contextualized in the lived world during parental transition. New parenthood is a life-changing experience that may spur couples to examine their belief systems. Although the couples in this study encountered profound changes in their family lives, they came to gain a sense of family coherence through changes in their world views and priorities, which involved different ways of thinking about their parenting role and the role of the family. These findings demonstrated the importance of the family sense of coherence in enabling couples to create a sense of meaning and purpose in life during the parental transition. Chinese families have long been described as a corporate kin group that cared for the welfare of all family members and who are bound by common goals and interests (Wang, 2016). The strong sense of family unity embedded in the Confucian philosophy seems to assist couples to pursue their goals, comprehend childbirth as worthwhile, and draw on their resources to meet the challenges during the parental transition. Moreover, collective coping, especially strong social support from the extended families and a harmonious family relationship, contribute to the couple’s experience of new parenthood as being comprehensible, manageable, and meaningful. The results of this study contribute to both the theoretical development and clinical application of the salutogenic model of the family sense of coherence in promoting perinatal health. Accordingly, healthcare professionals can foster a sense of family coherence by developing interventions that are grounded in the life experiences of the new parents, that strengthen family unity and harmony, and that support existing coping resources and social networks needed to promote positive adaptation during the parental transition.

Footnotes

Acknowledgements

The authors would like to thank the research team in data collection and management.

Data accessibility statement

The data that support the findings of this study are available on request from the corresponding author (F.W.N.).

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by the Block Grant except CRG of the Hong Kong Polytechnic University.

ORCID iD

Fei Wan Ngai

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