Development of Parental Confidence among Parents of Infants with Medical Complexity

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Parental confidence is an important factor in gaining expertise in the parental role. The process of becoming a confident parent requires a personal belief in one’s own capacity but also the ability to engage in mastery experiences (e.g. repeated exposure to specific behaviors). Yet, this repeated exposure and ability to gain confidence in parenting may be limited when an infant requires complex care and hospitalization. The separation and limited interaction between an infant and parent alter the parenting trajectory and can halt confidence and ability to acquire parenting skills that are needed to meet the complex caregiving needs of an infant with medical complexity.

This dissertation aimed to develop knowledge related to parental confidence among parents of infants with medical complexity by clearly delineating the concept, understanding parent engagement within intensive care, exploring relevant contextual factors, and examining the development of confidence and factors contributing to change in parental confidence. The primary study conducted for this dissertation was an exploratory longitudinal multi-method study to examine the development of parental confidence, relationship between contextual factors and confidence, and the extent to which confidence, contextual factors, and parent/infant demographic characteristics predicted parent and infant outcomes. Findings demonstrated a significant increase in parental confidence over time and significant association between better family functioning and higher confidence. The higher confidence was also predictive of higher maternal psychological well-being three months after discharge. Furthermore, findings from a second mixed-methods study revealed that parents described confidence as either an emotional state of being or their ability to engage in specific behaviors. Using multiple methods to examine the development of confidence, essential knowledge was generated about how parents of infants with medical complexity gain confidence in their parental role. Recommendations for clinical practice and future research are provided to advance our understanding of parental confidence in order to positively impact parent and infant health.






Vance, Ashlee (2019). Development of Parental Confidence among Parents of Infants with Medical Complexity. Dissertation, Duke University. Retrieved from


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