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Cultural influences on parental responses to children's pain

Kristjansdottir, Olofa,*; McGrath, Patrick J.b; Finley, G. Allenc; Kristjansdottir, Gudruna; Siripul, Pulsukd; Mackinnon, Sean P.e; Yoshida, Yokof

doi: 10.1097/j.pain.0000000000001289
Research Paper
Editor's Choice
Global Year 2018

There is a scarcity of work examining the relationship between culture and pain-related caregiver behaviors. Moreover, no pediatric pain studies have examined the relationship between caregiver cultural values and pain-related caregiver behaviors nor discern if this process is mediated by caregiver parenting styles and moderated by ecosocial context. Based on cross-cultural developmental theories, this study hypothesized that ecosocial context would moderate the relationship between cultural values, parenting styles, and pain-related caregiver behaviors; and that parenting styles mediate the effect of cultural values on pain-related caregiver behaviors. A cross-cultural survey design was employed using a convenience sample of 547 caregivers of 6 to 12 year olds living in Canada (n = 183), Iceland (n = 184), and Thailand (n = 180). Multigroup structural equation modeling showed that ecosocial context did not affect which cultural model of parenting the caregiver adopted. Parenting styles mediated the relationship between cultural values and pain-related caregiver behavior. Vertical/horizontal individualism, collectivism, and authoritative- and authoritarian-parenting styles positively predicted solicitousness. Vertical individualism and authoritarian-parenting style positively predicted discouraging behavior, whereas other predictors did not. The findings support the sociocommunication model of children's pain by showing that cultural context does affect parents' behaviors. They also corroborate with others' claims of solicitousness universality in a pediatric pain context. However, solicitousness may have different cultural meanings among individuals and may be used in conjunction with discouraging behavior. The findings from this study have implications for the theory development about culture and pediatric pain, but do not provide specific clinical recommendations.

Culture influences pain-related parental behaviors, but not always as expected. Solicitous pain-related parental behavior seems to be a universal response to children in pain.

aFaculty of Nursing, University of Iceland, Reykjavík, Iceland

bDepartments of Psychology, Pediatrics and Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada

cDepartments of Anesthesia and Psychology, Dalhousie University, Halifax, Nova Scotia, Canada

dFaculty of Nursing, Khon Kaen University, Khon Kaen, Thailand

eDepartment of Psychology, Dalhousie University, Halifax, Nova Scotia, Canada

fDepartment of Sociology and Social Anthropology, Dalhousie University, Halifax, Nova Scotia, Canada

Corresponding author. Address: Faculty of Nursing, University of Iceland, Eirbergi, Eiriksgotu 34, IS-101 Reykjavik, Iceland. E-mail: (O. Kristjansdottir).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received December 20, 2017

Received in revised form May 07, 2018

Accepted May 17, 2018

© 2018 International Association for the Study of Pain
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