Abstract
Background
Although spiritual health and social well-being can influence attitudes toward childbearing, little is known about their combined role among nurses. Therefore, this study aims to investigate the relationship between spiritual health and social well-being with attitudes toward childbearing among nurses working at Khoy University of Medical Sciences.
Methods
This cross-sectional study was conducted using stratified random sampling and involved 320 employed nurses at the university. The data collection instrument comprised a questionnaire that included demographic characteristics, measures of spiritual health, social well-being, and attitudes toward childbearing. The relationships among the variables were analyzed using statistical tests, including correlation coefficients, one-way analysis of variance (ANOVA), and multiple linear regression.
Results
The mean scores for spiritual health, social well-being, and attitude toward childbearing were 79.89 ± 15.93, 61.69 ± 9.74, and 57.00 ± 11.14, respectively. Spiritual health was significantly associated with attitude toward childbearing (β = 0.11, p = 0.007), and social well-being was also significantly associated with attitude toward childbearing (β = 0.10, p = 0.006). Among demographic variables, age (p = 0.004), education level (p = 0.006), economic status (p = 0.002), and number of children (p < 0.002) showed significant associations with attitude toward childbearing. The existential dimension of spiritual health (β = 0.22, p = 0.007) and the integration (β = 0.79, p < 0.001) and acceptance (β = 0.37, p = 0.046) dimensions of social well-being were the most influential factors.
Conclusions
This study highlights the significance of spiritual health and social well-being in shaping nurses’ attitudes toward childbearing. Therefore, it is recommended that suitable educational and supportive programs be developed to enhance the spiritual and social health of nurses, which may aid in improving their decision-making regarding childbearing. By fostering these aspects, healthcare organizations can contribute to more positive attitudes and informed choices among nurses relating to parenting and family planning.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12884-026-09451-0.
Keywords: Spiritual health, Social well-being, Attitude, Childbearing, Nurses
Background
Fertility rates and associated behaviors are critical components of population growth, attracting considerable attention from many social science researchers [1]. Total fertility rates are declining globally, with fertility levels in most developed countries falling below the replacement level [2]. Iran has also experienced a marked decline in fertility rates over the past decades, with the total fertility rate decreasing from 2.09 in 2017 to 1.65 in 2021 [3]. Childbearing plays a vital role in couples’ lives, as one of the factors that influence fertility is the desire to have children, which reflects an individual’s interest in parenthood. A strong desire for childbearing often corresponds to increased fertility intentions.
In Islam, childbearing is encouraged, and pregnancy and breastfeeding are viewed as acts of worship [3]. Spiritual health, a fundamental aspect of overall well-being, integrates various dimensions of health [4]. It is defined as an inner and satisfying feeling related to constructive relationships with oneself, others, and a transcendent existence within each society’s cultural framework [5]. Studies show that religious inclination strongly affects fertility preferences, with the shift from religious dependence to materialism identified as a reason for declining fertility rates [6, 7]. Given the close relationship between religion and spiritual health, it seems that spiritual health and the desire for childbearing are interrelated.
However, despite this conceptual linkage, the direct relationship between childbearing attitudes and spiritual health has not been sufficiently explored, and existing studies provide limited and sometimes inconsistent evidence.
Moreover, social determinants of health the conditions in which people are born, grow, live, and work are critical to shaping fertility intentions and family planning choices [8]. The concept of social well-being, another vital dimension of health, has drawn increasing attention in recent years. It encompasses how individuals form relationships, interact with their environment, and engage with societal norms and institutions [9]. Empirical evidence suggests that social support, particularly in the workplace or within families, helps individuals balance work family roles, reduces conflict, and positively influences attitudes toward childbearing [10]. Nevertheless, prior studies examining these factors have reported varying findings, possibly due to differences in cultural contexts, study populations, and measurement tools, highlighting the need for further research to clarify these relationships.
Attitudes toward childbearing include both positive and negative motivations. Positive motivations involve the joy of pregnancy, childbirth, and parenthood, satisfaction from child-rearing, and a sense of continuity [11]. Negative motivations, on the other hand, include fear of parenthood, stress, and concerns about childcare challenges. Childbearing within a family carries profound implications it can strengthen family foundations, promote psychological and spiritual growth, and enhance happiness and coping abilities [9]. Research shows that factors such as location of residence, socioeconomic status, and attitudes toward modernity also affect fertility preferences. Emotional and social influences may encourage individuals to have children, whereas financial pressures and rising costs can discourage them [12, 13].
A clearer understanding of how spiritual health and social well-being jointly influence childbearing attitudes can contribute to designing more effective educational, counseling, and policy interventions aimed at supporting fertility decisions.
Considering that nurses face spiritual challenges and social well-being issues in their work environment, this topic assumes particular significance. Social awareness, high levels of literacy, distinct lifestyle patterns, as well as stress and psychological pressures, are among the social well-being challenges experienced by nurses, which can have substantial impacts on their attitudes toward parenthood. The reduced time spent in child-rearing processes and the increasing costs and responsibilities associated with it are factors that led us to select the nursing group as the subject of our study. Nurses were specifically selected because they play a key role in healthcare systems, have direct and continuous interaction with patients and families, and are often exposed to unique occupational stressors that may influence both their spiritual health and social well-being, thereby affecting their attitudes toward childbearing. Despite their critical role, limited research has focused specifically on this professional group in this context.
Furthermore, a study that simultaneously examines these three concepts among nurses has not been identified, and no such research has been conducted among the nurses at the Khoy School of Medical Sciences to date. Therefore, addressing this research gap can provide valuable insights for healthcare managers and policymakers to develop supportive strategies for nurses’ well-being and family-related decisions. this study aims to investigate spiritual health and social well-being and their relationship with attitudes toward parenthood among nurses working at the Khoy School of Medical Sciences in 2023.
Methods
This cross-sectional study was conducted among nurses employed in public hospitals affiliated with Khoy University of Medical Sciences, Iran, in 2023. Due to the lack of prior data on the attitude toward childbearing among nurses in Iran, a prevalence of 50% (P = 0.5) was assumed to calculate the maximum required sample size. With a 95% confidence level (Z = 1.96) and a margin of error of 0.05 (d = 0.05), the initial sample size was calculated as 384 using the standard formula.
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Considering the finite population size of 1050 nurses (N = 1050) based on the statistics of the Nursing Management Office of Khoy University of Medical Sciences, the sample size was adjusted using Cochran’s correction formula, yielding a minimum required sample of 282 participants. To account for a potential 10% attrition rate, the final target sample size was set at 310 nurses. A stratified random sampling method with proportional allocation (Neyman allocation) was employed to ensure representativeness. The sampling frames were the four public hospitals affiliated with the university: Imam Khomeini Hospital, Ayatollah Khoyi Hospital, Qamar Bani Hashem Hospital, and Ayatollah Madani Hospital. Each hospital was considered a distinct stratum because hospitals differ in management structure, work environment, and organizational culture, which may influence the main study variables. The required sample from each stratum (hospital) was determined proportionally to the number of active nurses in that hospital relative to the total nurse population. The allocation of the sample across shifts (morning, evening, and night) and different wards was performed randomly to ensure that all working conditions were represented. Nurses with rotating shifts were excluded from the study to avoid within-subject variability in work conditions. Only nurses with fixed morning, evening, or night shifts were included. After selecting the proportional quota for each hospital, the final participants were selected using a simple random sampling method from the list of eligible nurses provided by each hospital’s nursing office. This method ensured that every nurse had an equal chance of being selected within each stratum.
Inclusion criteria for the study included being an employed nurse in one of the hospitals in Khoy, being married, and expressing willingness to participate in the study. Additionally, specific physiological and reproductive conditions such as menopause, primary infertility, secondary infertility, and other relevant conditions were clearly defined and considered where applicable Exclusion criteria comprised incomplete questionnaires and withdrawal from completing the questionnaires.
Measurement tools
Spiritual health (SWB)
The spiritual heath questionnaire developed by Paloutzian was utilized to assess the spiritual heath of the participants. This 20-item questionnaire is designed to measure two main dimensions: religious health and existential health. Each item is rated on a Likert scale, ranging from 1 (strongly disagree) to 6 (strongly agree), allowing for a comprehensive evaluation of the individual’s spiritual health. The spiritual heath questionnaire has been widely used in various studies and has demonstrated high reliability and validity. It provides valuable insights into the participants’ sense of purpose, life satisfaction, and connection to a higher power or spiritual beliefs. The scores from the questionnaire can range from 20 to 120, with higher scores indicating greater spiritual heath. The Persian version of the spiritual heath questionnaire has been extensively validated through various methods, including content validity, construct validity, and concurrent validity. The reliability of the Persian version has been assessed using methods such as test-retest reliability and internal consistency (Cronbach’s alpha). These characteristics make the Persian version of the spiritual heath questionnaire a reliable and valid tool for assessing spiritual health in various populations, including hospital staffs [14] This questionnaire was used in Iran in the studies of the Farahaninia (2015) and Jadidi (2011) studies.The validity of the Spiritual Health Questionnaire was confirmed through content validity analysis. Additionally, its internal consistency was assessed using Cronbach’s alpha coefficient, which was calculated as 0.82 [15, 16].
Social well-being
The Social Well-Being (SWB) questionnaire, originally developed by Corey L. Keyes, is a 20-item instrument designed to assess various dimensions of social well-being, including actualization, cohesion, integration, acceptance, and participation [17]. Each item is rated on a Likert scale ranging from 1 (strongly disagree) to 6 (strongly agree), providing a detailed evaluation of an individual’s social health. The SWB questionnaire has been widely used in numerous studies and has demonstrated high reliability and validity. It offers valuable insights into participants’ social functioning, sense of community, and interpersonal relationships. Scores from the questionnaire can range from 20 to 120, with higher scores indicating greater social well-being. The Persian version of the SWB questionnaire has undergone extensive validation through various methods, including content validity, construct validity, and concurrent validity. The reliability of the Persian version has been assessed using methods such as test-retest reliability and internal consistency (Cronbach’s alpha). This questionnaire was used in Iran in the Shayeghian study (2019). The validity of the social wellness Questionnaire was confirmed through content validity analysis. Additionally, its internal consistency was assessed using Cronbach’s alpha coefficient, which was calculated as 0.72 [17].
Attitude to childbearing
The Attitude toward Childbearing questionnaire, developed by Kaveh Firouz in 2016, is a 21-item tool designed to evaluate individuals’ attitudes toward having children. Each item is rated on a five-point Likert scale from 1 (strongly disagree) to 5 (strongly agree), capturing a comprehensive view of participants’ perspectives on childbearing. This questionnaire considers the attitudes of both partners (husband and wife). Scores range from 21 to 105, with higher scores indicating a more positive attitude toward childbearing. This questionnaire has been validated in various studies, demonstrating high reliability and validity. Firouz et al. reported a Cronbach’s alpha of 0.77, confirming its internal consistency [18].
After describing the study objectives and providing the necessary explanations about the process of completing the questionnaire, the researchers assured the nurses that the information obtained was completely confidential and that the identity of the units studied would remain anonymous. All nurses in this study were on fixed shifts (morning, evening, or night), and rotating shift nurses were not included. Nurses were then asked to pay close attention to questions and set aside about 30 min to answer them. The method of answering questions was self-reported, so that they did not interfere with the nurses’ response process. However, it was essential that while completing the questionnaire, they monitored and corrected problems.
Validity and reliability of scales
Table 1 presents the mean and standard deviation of the main study variables, along with their reliability and validity indices, including Cronbach’s alpha, composite reliability (CR), and average variance extracted (AVE). Cronbach’s alpha measures internal consistency, with values above 0.70 considered acceptable. The CR is a more conservative measure, also requiring values above 0.70. The AVE indicates the amount of variance captured by the construct, with a threshold of 0.50. The results show that all scales have acceptable internal consistency, with Cronbach’s alpha and CR values above 0.70. Except for the attitude to childbearing scale, all AVE values meet the acceptable threshold.
Table 1.
The Mean and standard deviation of the study variables, and their validity and reliability evaluations
| Variables | No of items | Mean ± SD | Cronbach’s alpha | CR | AVE |
|---|---|---|---|---|---|
| Spiritual health | 20 | 79.89 ± 15.93 | 0.87 | 0.89 | 0.52 |
| religious | 10 | 41.68 ± 10.19 | 0.87 | 0.90 | 0.53 |
| existential | 10 | 38.21 ± 7.91 | 0.75 | 0.81 | 0.51 |
| Social well-being | 20 | 61.69 ± 9.74 | 0.79 | 0.83 | 0.48 |
| actualization | 4 | 13.56 ± 3.28 | 0.67 | 0.78 | 0.50 |
| cohesion | 3 | 8.71 ± 2.75 | 0.70 | 0.83 | 0.62 |
| integration | 3 | 10.97 ± 2.64 | 0.78 | 0.82 | 0.70 |
| acceptance | 5 | 10.95 ± 2.87 | 0.65 | 0.77 | 0.53 |
| participation | 5 | 17.50 ± 4.32 | 0.83 | 0.88 | 0.75 |
| Attitude toward childbearing | 21 | 57.00 ± 11.14 | 0.79 | 0.84 | 0.44 |
Ethical considerations
This research was conducted in full compliance with ethical principles for human research and with the ethics code IR.KHOY.REC.1402.034 from the Ethics Committee of Khoy University of Medical Sciences. Before data collection began, written informed consent was obtained from all participants, clearly explaining the study’s objectives, participation procedures, data confidentiality, and the right to withdraw at any stage. The collected data were used solely for the purposes of this research and were stored in a coded and anonymized manner to protect the privacy of the participants.
Statistical methods
In the current study, descriptive statistics such as mean ± standard deviation and frequency (percentage) were used to summarize the data. The Pearson correlation coefficient was utilized to assess the linear relationships between the research variables. For mean comparisons, statistical tests including the independent T-test and one-way ANOVA were used. To examine the adjusted associations among variables, linear regression modeling and stepwise regression modeling were applied. Critical assumptions of linear models, such as residual normality, error independence, and homoscedasticity (variance consistency), were evaluated to ensure the validity of the models. To assess the validity of the scales, composite reliability (CR) and average variance extracted (AVE) were calculated using SPSS Amos version 24. Cronbach’s alpha was used to assess internal consistency and was calculated using SPSS version 24. A significance level of P < 0.05 was considered for all statistical tests. All other statisticsl analyses were conducted using SPSS version 24.
Results
Study population
The study included 320 nurses from educational hospitals in Khoy. The mean age was 33.64 ± 7.92 years. Most participants were female (67.8%). In terms of education, 81.9% had a bachelor’s degree, while 18.1% held a master’s or doctoral degree. Regarding work shifts, 45.6% worked mornings, 35.9% evenings, and 18.4% nights. Economically, 67.8% were classified as low. Additionally, 39.4% of the nurses had no children. The median marriage duration was 8 years (IQR: 3–15 years, min-max: 2–32 years) (Table 2).
Table 2.
The characteristics of study population
| Variables | n (%), mean ± SD |
|---|---|
| Age | 33.64 ± 7.92 |
| Gender | |
| male | 103 (32.2) |
| female | 217 (67.8) |
| Education level | |
| bachelor | 262 (81.9) |
| MSc, PhD | 58 (18.1) |
| Shift | |
| morning | 146 (45.6) |
| evening | 115 (35.9) |
| night | 59 (18.4) |
| Economic status | |
| low | 217 (67.8) |
| medium | 96 (30.0) |
| high | 7 (2.2) |
| Child Number | |
| 0 | 126 (39.4) |
| 1 | 99 (30.9) |
| 2 | 87 (27.2) |
| ≥ 3 | 8 (2.5) |
| Marriage duration | 8 (3 – 15)* |
MSc master science, PhD Philosophy Degree
* Median (Q1 – Q3)
Pearson correlation matrix of the study variables
Table 3 displays the Pearson correlation coefficients among spiritual health, social well-being, and attitude toward childbearing. Social well-being was positively correlated with spiritual health (r = 0.26, p < 0.01), existential health (r = 0.35, p < 0.01), and religious health (r = 0.19, p < 0.01). Actualization (r = 0.25, p < 0.01), cohesion (r = 0.13, p < 0.05), integration (r = 0.12, p < 0.05), acceptance (r = 0.16, p < 0.01), and participation (r = 0.12, p < 0.05) showed positive correlations with overall spiritual health. Attitude toward childbearing was positively correlated with spiritual health (r = 0.23, p < 0.01) and social well-being (r = 0.22, p < 0.01). Among their dimensions, existential (r = 0.26, p < 0.01), integration (r = 0.27, p < 0.01), and acceptance (r = 0.28, p < 0.01) showed significant positive correlations with attitude toward childbearing.
Table 3.
Pearson correlation test among spiritual health, social well-being, and attitude to childbearing
| Variables | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
|---|---|---|---|---|---|---|---|---|---|---|
| 1. Spiritual health | ||||||||||
| 2. religious | 0.56** | |||||||||
| 3. existential | 0.64** | 0.54** | ||||||||
| 4. Social well-being | 0.26** | 0.19** | 0.35** | |||||||
| 5. actualization | 0.25** | 0.16** | 0.18** | 0.61** | ||||||
| 6. cohesion | 0.13* | 0.08 | 0.24** | 0.52** | 0.11* | |||||
| 7. integration | 0.12* | 0.05 | 0.18** | 0.67** | 0.31** | 0.19** | ||||
| 8. acceptance | 0.16** | 0.04 | 0.29** | 0.49** | 0.13* | 0.14* | 0.22** | |||
| 9. participation | 0.12* | 0.19** | 0.17** | 0.70** | 0.28** | 0.25** | 0.40** | -0.01 | ||
| 10. Attitude to childbearing | 0.23** | 0.10 | 0.26** | 0.22** | 0.05 | 0.10 | 0.27** | 0.28** | 0.01 | |
* P<0.05
** P<0.01
Association between demographic variables and attitude to childbearing
Table 4 presents associations between demographic variables and the main study outcomes. Independent t-test was used for two-group comparisons (gender, education), and one-way ANOVA for ≥ 3 groups (age, shift, child number, income, marriage duration), with post hoc Tukey’s HSD for significant results. Significant differences were observed in attitude toward childbearing by age (p = 0.004), education (p = 0.006), number of children (p = 0.002), and income (p < 0.001). Post hoc showed: age 30–40 > 20–30 years; medium income > low income; 2 children > 0 children. Social well-being differed by number of children (p = 0.001): nurses with ≥ 3 children had lower scores than those with 0–2 children. Spiritual health differed by work shift (p = 0.03), but post hoc showed no pairwise differences. No other significant differences were found.
Table 4.
Association among base characteristics with spiritual heath, social well-being, and attitude to childbearing
| Variables | Spiritual heath | Social well-being | Attitude toward childbearing | ||||
|---|---|---|---|---|---|---|---|
| Groups | Mean ± SD | p | Mean ± SD | p | Mean ± SD | p | |
| Gender | male | 78.32 ± 19.36 | 0.28 | 62.23 ± 10.17 | 0.49 | 58.12 ± 10.83 | 0.22 |
| female | 80.64 ± 14.00 | 61.43 ± 09.54 | 56.47 ± 11.27 | ||||
| Age | 20–30 | 79.49 ± 17.42 | 0.06 | 61.46 ± 10.26 | 0.15 | 54.80 ± 13.20 | 0.004 |
| 30–40 | 81.73 ± 14.83 | 62.62 ± 08.65 | 64.19 ± 09.99 | ||||
| 40–50 | 79.90 ± 13.52 | 59.55 ± 10.52 | 56.08 ± 10.76 | ||||
| ≥ 50 | 68.31 ± 18.50 | 64.75 ± 09.94 | 58.57 ± 08.64 | ||||
| Education | bachelor | 79.80 ± 15.89 | 0.83 | 61.37 ± 09.81 | 0.21 | 56.19 ± 11.25 | 0.006 |
| MSc/PhD | 80.31 ± 16.26 | 63.14 ± 09.39 | 60.66 ± 09.93 | ||||
| Shift | morning | 81.06 ± 14.37 | 0.03 | 61.33 ± 09.67 | 0.68 | 57.26 ± 09.42 | 0.25 |
| evening | 76.87 ± 16.44 | 61.65 ± 10.26 | 57.84 ± 12.36 | ||||
| night | 82.90 ± 17.82 | 62.66 ± 08.65 | 54.71 ± 12.41 | ||||
| Child no | 0 | 79.70 ± 16.10 | 0.21 | 62.37 ± 08.99 | 0.001 | 53.63 ± 12.69 | 0.002 |
| 1 | 81.51 ± 15.16 | 62.14 ± 09.53 | 58.59 ± 08.87 | ||||
| 2 | 78.87 ± 16.23 | 60.37 ± 10.99 | 60.03 ± 10.14 | ||||
| ≥ 3 | 74.13 ± 08.37 | 54.14 ± 05.99 | 57.38 ± 07.95 | ||||
| Economy | low | 79.91 ± 15.63 | 0.26 | 61.41 ± 09.89 | 0.72 | 55.16 ± 10.98 | < 0.001 |
| medium | 81.17 ± 14.66 | 62.07 ± 08.93 | 60.82 ± 10.61 | ||||
| high | 62.00 ± 20.03 | 65.14 ± 12.55 | 61.71 ± 09.95 | ||||
| Marriage duration | 1–5 | 78.63 ± 16.52 | 0.41 | 61.56 ± 08.21 | 0.52 | 58.16 ± 10.06 | 0.35 |
| 5–10 | 82.38 ± 13.07 | 62.90 ± 08.91 | 57.27 ± 09.23 | ||||
| 10–15 | 78.23 ± 19.78 | 60.18 ± 10.32 | 59.18 ± 10.41 | ||||
| ≥ 15 | 78.37 ± 13.57 | 61.04 ± 11.02 | 60.22 ± 09.12 | ||||
Independent t-test for gender and education; one-way ANOVA for age, shift, child number, income, and marriage duration. Post hoc comparisons using Tukey’s HSD test for significant ANOVA results showed: Age: 30–40 years > 20–30 years (p = 0.002); Income: medium > low (p < 0.001); Child number: 2 children > 0 children (p = 0.003)
Regression modeling results
Table 5 presents the linear regression modeling results examining the association between spiritual health, social well-being, and attitude toward childbearing. The regression models were estimated and fitted both without and with adjustments for identified influencing variables based on Table 4. Model 1 assessed the impact of spiritual health and social well-being on attitude toward childbearing, showing that both spiritual health (β = 0.10, p = 0.009) and social well-being (β = 0.17, p = 0.011) were significant predictors. Model 2 included adjustments for age, number of children, education, and income, with spiritual health (β = 0.11, p = 0.007) and social well-being (β = 0.10, p = 0.006) remaining significant.
Table 5.
Regression modeling results: the association among spiritual health, social well-being with attitude to childbearing
| Predictors | Model 1 | Model 2 | Model 3 | Model 4 | ||||
|---|---|---|---|---|---|---|---|---|
| β (95% CI) | P | β (95% CI) | P | β (95% CI) | P | β (95% CI) | P | |
| Spiritual health | 0.10 (0.03–0.18) | 0.009 | 0.11 (0.04–0.29) | 0.007 | ||||
| religious | -0.04 (-0.19, 0.11) | 0.61 | ||||||
| existential | 0.31 (0.12, 0.50) | < 0.001 | 0.22 (0.06, 0.37) | 0.007 | ||||
| constant | 47.1 (40.4, 53.9) | < 0.001 | ||||||
| Adjusted R-Square | 0.04a | |||||||
| Social well-being | 0.17 (0.03–0.18) | 0.011 | 0.10 (0.05–0.30) | 0.006 | ||||
| actualization | -0.15 (-0.54, 0.24) | 0.45 | ||||||
| cohesion | 0.11 (-0.35, 0.56) | 0.65 | ||||||
| integration | 1.04 (0.51, 1.58) | < 0.001 | 0.79 (0.31, 1.27) | < 0.001 | ||||
| acceptance | 0.61 (0.15, 1.06) | 0.009 | 0.37 (0.03, 0.81) | 0.046 | ||||
| participation | -0.21 (-0.54, 0.11) | 0.20 | ||||||
| constant | 38.5 (29.9–47.2) | < 0.001 | 33.3 (20.6–45.9) | < 0.001 | 44.1 (36.0, 52.1) | < 0.001 | 35.5 (27.6, 43.4) | < 0.001 |
| Adjusted R-Square | 0.05 | 0.10 | 0.08b | 0.07 | ||||
Regression assumptions were evaluated for all models. Normality of residuals was confirmed by visual inspection of Q-Q plots. Homoscedasticity (constant variance of errors) was confirmed by visual inspection of scatter plots of standardized residuals against standardized predicted values. The Durbin-Watson statistic ranged from 1.965 to 2.035, indicating no autocorrelation. Collinearity diagnostics showed VIF values below 1.40 and Tolerance values above 0.71, confirming no multi-collinearity. The complete SPSS output, including diagnostic plots, is provided as a supplementary file
Model 1: spiritual health + social well-being
Model 2: spiritual health + social well-being + age + child number + education + income
Model 3: (a): religious + existential, (b): actualization + cohesion + integration + acceptance + participation
Model 4: existential + integration + acceptance + age + child number + education + income
Model 3 evaluated the individual dimensions of spiritual health and social well-being separately. The existential dimension of spiritual health (β = 0.31, p < 0.001) and the integration (β = 1.04, p < 0.001) and acceptance (β = 0.61, p = 0.009) dimensions of social well-being were significant predictors. Model 4, which used a stepwise regression approach, assessed the impact of all dimensions of spiritual health and social well-being on attitude toward childbearing, while also adjusting for age, number of children, education, and income. In this model, the existential dimension (β = 0.22, p = 0.007), integration (β = 0.79, p < 0.001), and acceptance (β = 0.37, p = 0.046) remained significant predictors. The stepwise regression process identified the most important variables among the dimensions of spiritual health and social well-being. The final model evaluated the remaining significant variables (existential spiritual health, social integration, and social acceptance) while adjusting for the demographic variables (model 4). These results indicate that spiritual health, particularly its existential dimension, and social well-being, particularly its integration and acceptance dimensions, are important factors influencing attitudes toward childbearing. The associations remained significant even after adjusting for key demographic variables.
Discussion
The findings of the present study demonstrate that spiritual health, particularly its existential dimension, has a significant impact on attitudes toward childbearing and can enhance positive perspectives regarding parenting. In this context, Zadehahmad et al. reported a positive and significant relationship between the inclination to bear children and spiritual health [11]. Moreover, Malmir et al. established a meaningful correlation between the existential aspect of spiritual health and positive parenting attitudes. These results underscore the importance of spiritual health in shaping parents’ favorable views toward child-rearing [19]. Additionally, Ojaglu et al. revealed a direct and positive relationship between religiosity and the value placed on children, indicating that an increase in religiosity can improve attitudes toward childbearing [20]. Furthermore, Heidari et al. found a positive correlation between spiritual health and breastfeeding self-efficacy, suggesting that mothers with higher spiritual well-being are more likely to engage in effective parenting behaviors [21]. The existential dimension of spiritual health is also associated with reduced stress and improved childbirth experiences, highlighting its role in enhancing maternal attitudes [22]. It appears that higher levels of spiritual health can increase feelings of satisfaction and happiness, providing nurses with a sense that childbearing adds meaning and purpose to their lives. it is important to interpret why the religious dimension of spiritual health was not related to the motivation to have children in this study, whereas the existential (spiritual) dimension was. In the context of the present study, the religious dimension may be heavily influenced by ritualistic and collective practices that do not necessarily translate into personal motivation for childbearing. In contrast, the existential dimension encompassing meaning, purpose, and inner peace has a more direct and individual connection with the decision to have children. This distinction may be further shaped by the specific cultural and religious environment of the study population, where external religious observance does not always align with internal childbearing motivations.
Additionally, religious and cultural beliefs may significantly influence family cohesion and childbearing, as nurses who adhere to these values are often more inclined to have children. These findings point to the critical role of spiritual health in supporting parents and fostering positive attitudes toward childbearing and family life. They suggest potential applications for social and cultural planning aimed at promoting family well-being and addressing the nuances of parenting in various contexts.
On the other hand, the results regarding the relationship between social well-being and attitudes toward childbearing revealed that the dimensions of integration and acceptance significantly influence perspectives on childbearing. Alijanzadeh et al. demonstrated that social integration and acceptance notably affect attitudes toward childbearing by enhancing social support and trust, which are crucial for a positive perception of fertility among Iranian women [23]. In this context, Gholipour et al. stated that social acceptance significantly impacts attitudes toward childbearing and highlights its connection with the inclination to have children among young women [24]. These studies corroborate the findings of the present study. Conversely, Moradi et al. indicated that there was no significant relationship between environmental health, social well-being, and attitudes toward childbearing; however, statistically significant relationships were found with dimensions of mental, psychological, and physical health [25]. This finding contradicts the results of the current study. From the authors’ perspective, social integration fosters a sense of belonging and support among nurses, making them more confident and committed to raising their children. Moreover, social acceptance supports the diversity and differences within society, providing parents with a sense of security and reassurance that their children will grow up in a healthy and supportive environment. Consequently, these two dimensions of social well-being can serve as positive factors in decision-making regarding childbearing and facilitate the enhancement of family quality of life.
The results of the investigation into the relationship between age and attitudes toward childbearing among nurses indicate that attitudes toward childbearing increase during the reproductive years. Malenova et al. emphasized that individuals in their reproductive years experience significant changes in their emotional and cognitive aspects, along with their attitudes toward childbearing [26]. Furthermore, Kohan demonstrated that attitudes toward fertility significantly influence reproductive decisions, and among women of childbearing age, positive perceptions are meaningfully associated with a higher likelihood of childbearing [27]. Saei et al. also reported a positive and significant relationship between attitudes toward childbearing and age [28]. These findings are consistent with those of the present study. In interpreting these results, it can be argued that during this period, many nurses achieve greater job and economic stability, leading to a stronger sense of preparedness for the responsibilities associated with childbearing. Additionally, emotional maturity and the desire to form a family during this phase impact their life experiences. On the other hand, social and cultural pressures may encourage them to pursue childbearing within these age ranges. Overall, the findings suggest that age plays a critical role in shaping attitudes toward childbearing, highlighting the importance of considering both individual and societal factors when addressing fertility decisions among this demographic.
As education levels increase, attitudes toward childbearing are significantly influenced. In the study conducted by Khadivzadeh et al., results indicated a significant relationship between education level and attitudes toward childbearing [29], which aligns with the findings of the present study. Conversely, research by Zadehahmad concluded that women’s education did not have an impact on attitudes toward childbearing [11]. This finding contradicts the results of the current study.
A positive attitude toward childbearing among individuals with higher education may be attributed to several reasons. First, educated individuals typically possess more knowledge about the benefits of childbearing, child-rearing methods, and modern parenting practices, which can lead to a more favorable perspective in this regard. Second, these individuals often achieve greater economic and job stability, enhancing their sense of preparedness for assuming parental responsibilities. Additionally, higher education is generally associated with better access to resources and social support, which can facilitate the childbearing process. Finally, educated individuals tend to pay more attention to family and social values, potentially leading to more positive attitudes toward parenting responsibilities and family roles. Overall, these insights highlight the complex interplay between education and attitudes toward childbearing, suggesting that initiatives aimed at increasing educational opportunities for women could positively influence family planning and child-rearing attitudes in society. In addition, the results of the study indicated that individuals with one or two children had higher average scores in social well-being and attitudes toward childbearing. Azmoude et al. in their study on married women aged 15 to 49, showed a positive and direct relationship between the number of children and fertility intentions [30]. Similarly, Zadehahmad’s research found a positive and direct correlation between the number of children and attitudes toward childbearing [11]. Individuals with one or two children often report higher scores in attitudes toward childbearing due to their positive parenting experiences and closer connections with their children. These individuals may enjoy greater satisfaction in their parenting roles and experience better management of their children’s needs [31]. Thus, having one or two children may create a more favorable emotional and economic environment, ultimately contributing to a more positive attitude toward childbearing.
In addition, social support and family connections play a significant role in reinforcing these attitudes. Research has shown that more favorable financial conditions are associated with higher fertility and earlier childbearing, partly by reducing opportunity costs and income fluctuations [32]. In contrast, low economic status and single parenthood are associated with greater financial and social strain, which can undermine emotional well-being and parenting resources [33]. Therefore, economic status shapes not only childbearing decisions but also the conditions available for child rearing.Therefore, economic status not only influences decision-making regarding childbearing but also impacts the quality of child-rearing and the socialization of parents. The participants were nurses employed in hospitals in Khoy, a city with a strong religious and traditional family background, where familial norms and social expectations play a prominent role in shaping attitudes. In such a context, religious adherence often has a collective and external dimension and does not necessarily translate into personal, internalized motivations for childbearing. This may explain the finding that the religious dimension of spiritual health was not associated with attitudes toward childbearing, whereas the existential (spiritual) dimension showed a significant relationship. Furthermore, the traditional family values prevalent in this region may have overshadowed the influence of variables such as economic status and education on childbearing attitudes. Thus, the present discussion, by emphasizing these contextual considerations, attempts to provide a more realistic interpretation of the observed patterns, consistent with the cultural background of the target population.
Understanding the interplay between economic factors and attitudes toward childbearing can inform interventions aimed at supporting families, particularly those facing economic challenges, and enhancing their overall parenting experiences.
Research limitations
This study was subject to limitations that should be considered when interpreting the findings. Firstly, the self-reported nature of the data collected from participants may have been influenced by recall biases or social desirability bias. Secondly, while the sample size was designed to achieve adequate statistical power, it might limit the generalizability of the results to broader populations. Furthermore, the cross-sectional nature of the study does not allow for the determination of definitive causal relationships, only indicating correlations. Additionally, the absence of a control group in certain aspects of the study necessitates a more cautious interpretation of the results.
Conclusion
The findings of the present study indicate that spiritual well-being, particularly its existential dimension, significantly influences the formation of positive attitudes towards parenthood. Additionally, the impact of social well-being, along with the dimensions of social integration and acceptance, underscores the necessity of social support in fostering and reinforcing positive attitudes toward childbearing. Furthermore, various factors such as age, educational level, number of children, and economic status have also been identified as influential components in this context. Therefore, to enhance attitudes towards parenthood and improve the quality of family life, it is recommended that supportive and educational programs be designed and implemented, focusing on increasing the spiritual well-being and social wellness of parents. Such programs could include educational workshops, group counseling sessions, and other community-oriented activities. Moreover, addressing the specific needs of diverse groups, including youth, individuals with lower educational attainment, and families facing economic hardships, is essential. These initiatives can contribute to cultivating more positive attitudes toward childbearing, ultimately leading to improved quality of life and happiness within families. In this regard, attention to spiritual and social well-being may play a crucial role in enhancing parental experiences and empowering individuals in their journey toward parenthood.
Supplementary Information
Acknowledgements
We would like to thank all the nurses who participated in the research. This survey was carried out in accordance with the guidelines of the Declaration of Helsinki. The authors acknowledge the use of ChatGPT (OpenAI) for language editing and translation. The authors carefully verified the accuracy of the content and take full responsibility for of the text.
Authors’ contributions
Research idea and study design: MZ, FM, MZ; data acquisition: FM, MZ; data analysis/ interpretation: MK; statistical analysis: MK; supervision or mentorship: MZ. the manuscript draft writing: MZ, MK. All authors revised and approved the draft of the manuscript.
Funding
Not Applicable.
Data availability
The datasets generated and/or analysed during the current study are not publicly available but are available from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
This research was approved by the Ethics Committee of Khoy University of Medical Sciences (Ethics code: IR.KHOY.REC.1402.034), and Written informed consent was given by all participants.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
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Supplementary Materials
Data Availability Statement
The datasets generated and/or analysed during the current study are not publicly available but are available from the corresponding author on reasonable request.