Predictors of filial responsibility toward older parents: A cross-sectional study of Iranian adults

doi:10.21203/rs.3.rs-8223986/v1

Filial responsibility toward older parents impacts the quality of family relationships, the quality of elder care, the reluctance to send older adults in nursing facilities, and the health and care costs imposed on governments. This study aimed to examine this phenomenon and its predictors in a group of Iranian adults. In this cross-sectional study, 500 adults were selected through multistage random sampling in 2025 in Kashan, Iran. Data were collected using the Persian version of the Filial Responsibility Scale (P-FRS) and a questionnaire on potential predictors. Data were analyzed using SPSS-22 with One-Way ANOVA, Independent t-test, Pearson and Spearman–Brown correlation coefficients, and multiple linear regression. The mean filial responsibility score was 51.69 ± 6.35 (95% CI: 51.13–52.25). The simultaneous presence of three variables—degree of opposition to institutionalization of older parents, psychological well-being, and age—was significant (R² = 0.088, F = 15.982, p < 0.0001). Greater opposition to institutionalization of older parents (Beta = 0.228) and better psychological well-being (Beta = 0.120) were associated with higher filial responsibility; while older age (Beta = − 0.148) was associated with lower filial responsibility. The filial responsibility score toward older parents was relatively high. Health policy planners in the field of geriatric care should consider age, psychological well-being, and attitudes toward nursing facilities when designing effective interventions to enhance filial responsibility in adults. It is recommended that future investigations of this phenomenon not rely solely on attitude assessments and self-report methods, but also incorporate objective measurement tools.

Filial Responsibility

Older Parent

Adult

Iran

Declining functional capacity, increasing incidence of chronic diseases, and greater care needs in the elderly heighten their dependence on others, particularly their children(Dziechciaż & Filip, 2014). Adult children are identified as the primary source of care for aging parents(Aghajani et al., 2018). It is estimated that more than half of individuals aged 50 and older undertake the responsibility of caring for their older parents(hosseinabbasi & Aghaamiri, 2023), and such unpaid services annually result in billions of dollars in government cost savings(Kaufman et al., 2024).

The relationship between adult children and older parents is considered one of the most important and complex forms of reciprocal family relationships(Aggarwal et al., 2017). With increasing life expectancy, the duration of reciprocal interaction between adult children and aging parents is rising substantially(Bao et al., 2022). Moreover, alongside the growth in the elderly population and declining birth rates, the number of caregiving children is decreasing(Wongkongdech et al., 2024). Therefore, maintaining and improving this reciprocal relationship is of great importance. Among the factors that can help preserve and enhance the relationship between adult children and elderly parents, and greatly prevent the institutionalization of older adults, is the commitment of adult children to the concept of filial responsibility toward their aging parents(Aires, Mocellin, et al., 2019).

Filial responsibility reflects the obligations that define the social role of adult children in caring for their parents throughout the aging process(Gans & Silverstein, 2006). Filial responsibility has been introduced as a norm across various societies and cultures(Phillips et al., 2010) and, regardless of the benefits it brings to older parents and society(Aires, Dal Pizzol, et al., 2019), existing evidence indicates that it often yields positive outcomes for adult children, such as a sense of pride(Wang et al., 2023) and psychological well-being(Liu et al., 2020).

Filial responsibility is dynamic and influenced by certain social factors(Liu et al., 2024). In Asian countries, cultural expectations dictate that elderly individuals should be cared for by their family members(Aghajani et al., 2018). Iran, as an Asian country, is culturally influenced by Islamic perspectives. In Islam, numerous recommendations emphasize kindness and devotion to one’s parents(Aghajani et al., 2018). Consequently, for Iranian families, providing in-home care for aging parents has long been considered an undeniable duty(Abdollahpour et al., 2012). However, in recent years, social changes—such as increasing individualism, migration of children to large cities, economic challenges, smaller housing spaces, declining birth rates, and the growing tendency of women to work outside the home—may have altered perceptions, attitudes, and behaviors related to filial responsibility in various societies, including Iran(Aghajani et al., 2018; Aires, Pizzol, et al., 2017). It is evident that over time, a shift in attitudes toward filial responsibility may lead to an increase in the institutionalization of elderly parents, resulting in dissatisfaction and lower quality of life among older adults(Aires, Mocellin, et al., 2019), as well as creating challenges for families and societies, including imposing substantial financial burdens on both families and governments(Kaufman et al., 2024).

To prevent or at least mitigate the secondary problems arising from these attitudinal and behavioral changes toward filial responsibility for older parents, it is essential to plan and provide the necessary infrastructure for appropriate elder care by adult children and to strengthen their sense of responsibility. The first step in this regard is to assess the current status of filial responsibility and the factors in the adult population. Some studies have examined the status of filial responsibility and certain related factors, such as life satisfaction, psychological well-being, opposition to institutionalization of the older adults, gender, and number of children(Aires, Mocellin, et al., 2017; Leung & Shek, 2024; Miyawaki, 2017; Mocellin et al., 2019; Van der Pas et al., 2005). Some of these studies have even reported contradictory findings(Funk et al., 2013; Pan et al., 2022). To the best knowledge, no study has yet addressed this topic specifically in Iran; however, some investigations have explored related issues, such as family social support for older parents or parental expectations of their children(Nouri & Farsi, 2018; Shamsikhani et al., 2021). Overall, although some findings have suggested that the status of filial responsibility toward older parents, or characteristics associated with it, is at a moderate or relatively desirable level in certain societies(Miyawaki, 2017), the influence of time and ongoing changes in social structure make it an undeniable necessity to examine this phenomenon. Therefore, given the limited number of related studies in recent years, negligence of this subject by researchers in the field of geriatric health in Iran, and the presence of contradictory findings in related research, the present study was conducted to investigate the status of filial responsibility toward older parents and its predictors in a group of Iranian adults.

Study design and sampling

This cross-sectional study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement(von Elm et al., 2007). The study population comprised adults aged 18 years and older who were covered by urban comprehensive health centers affiliated with Kashan University of Medical Sciences in 2025.

The sample size was calculated using Cochran’s formula, based on a standard deviation of 2.7(Aires, Mocellin, et al., 2017) and a margin of error of 0.27 (10% of the standard deviation), yielding an estimated 384 participants. To account for a 9% nonresponse rate and a design effect of 1.2, the final sample size was set at 500 participants. Considering the importance of the age variable (Older adults vs. non- older adults), 250 participants were allocated to each of two age groups: under 60 years and 60 years and older.

Inclusion criteria were age 18 years or older, Iranian nationality, ability to communicate in Persian, no severe psychiatric disorders and cognitive impairment as documented in the individual’s health center records, having at least one living elderly parent for participants under 60 years, and having at least one living adult child for participants aged 60 years or older. Exclusion criteria included non-cooperation, withdrawal during questionnaire completion, and incomplete completion of the Filial Responsibility Scale.

A multistage random sampling method was employed. The city of Kashan was stratified into five socioeconomic levels: poor, lower-middle, upper-middle, good, and very good. From each stratum, three urban comprehensive health centers were randomly selected as clusters. Within each cluster, quota sampling was performed according to age group (under 60 years and 60 years or older). Within each age group, participants were randomly selected in proportion to the eligible population covered by each center and the required sample size. In cases of non-cooperation, another individual from the same center and age group was randomly selected.

Data collection

After obtaining permission from the Department of Research at Tehran University of Social Welfare and Rehabilitation Sciences and Kashan University of Medical Sciences, sampling was conducted over a two-month period from early January 2025 to early March 2025 at the selected urban comprehensive health centers. The first author (T. L.) made arrangements with the managers of each selected center, compiled a list of eligible individuals for each of the two age groups (under 60 years and 60 years or older), and contacted the selected participants by telephone. After explaining the study objectives, confirming eligibility, and obtaining verbal consent, arrangements were made for an in-person meeting at a location of the participant’s choice (home, health center, park, etc.). During the in-person meeting, written informed consent was obtained, and both the questionnaire on potential predictors and the Persian version of the Filial Responsibility Scale were completed. A unique identification code was assigned to each participant. For individuals who were illiterate, semi-literate, or visually impaired, the questionnaires were administered through face-to-face interviews conducted by the first author.

Measurement instruments

Questionnaire on potential predictors of filial responsibility: The questionnaire comprised 21 variables, including: gender, education level, education in religious sciences, employment status, spouse’s employment status, marital status, having children, basic and supplementary health insurance coverage, economic status, housing status, living arrangements, known underlying disease, opinion regarding placement of older parents in long-term care facilities, age, number of children (daughters and sons), ability to perform activities of daily living, level of religious beliefs, and psychological well-being. Content validity was confirmed by a panel of 10 faculty members specializing in gerontology, geriatric nursing, psychology, and sociology. Reliability was assessed using a test–retest method (20 adults, two-week interval). Agreement for quantitative variables was calculated using the intraclass correlation coefficient (ICC), and for categorical variables using Cohen’s kappa. For personal variables, all responses were identical in both tests; the ICC for other quantitative variables was at least 0.89, and the kappa for categorical variables was at least 0.92. Psychological well-being, as a potential related factor, was measured using the five-item World Health Organization Well-Being Index (WHO-5), which includes five statements scored from 0 to 5. This tool assesses mental well-being on a scale of 0 to 25, with higher scores indicating better well-being. The content validity of the Persian version of this instrument has been confirmed, and its reliability has been reported as 0.89(Dehshiri & Mousavi, 2016). In the present study, its reliability was calculated with a Cronbach’s alpha coefficient of 0.915.

Persian version of the filial responsibility scale (P-FRS):

The original instrument was developed in 1990 by Hamon and Blieszner in Pennsylvania in English, consisting of 16 items to assess filial responsibility toward aging parents(Hamon & Blieszner, 1990). The Persian version (P-FRS) was translated and culturally adapted by Tagharrobi et al. (2025). The P-FRS contains 15 items across two subscales: “socio-emotional responsibilities” (9 items) and “physical responsibilities” (6 items). Each item is rated on a 4-point Likert scale from 1 (strongly disagree) to 4 (strongly agree). The tool measures filial responsibility toward older parents within a range of 15 to 60, with higher scores indicating higher levels of filial responsibility. The Persian version’s validity was verified through factor analysis and known-group comparison, and its internal consistency was confirmed using Cronbach’s alpha and McDonald’s omega coefficients, reported as 0.912(Tagharrobi et al., 2025).

Data analysis

The collected data were analyzed using SPSS v.22. The filial responsibility score was determined on a 15–60 scale and its range was estimated in the target population with 95% confidence. To assess data normality, skewness and kurtosis were used (a range of ± 2 was considered indicative of normality). Stepwise multiple linear regression analysis was employed to prioritize the questionnaire components—that is, to examine the contribution of each dimension of “socio-emotional responsibilities” and “physical responsibilities” to filial responsibility.

To identify predictors, the factors were analyzed in two stages. First, univariate analysis was performed for each variable separately; to examine the relationship of filial responsibility or its dimensions with categorical variables, the independent t-test or one-way ANOVA was used, and to assess the relationship of filial responsibility or its dimensions with quantitative variables, Pearson or Spearman correlation coefficients were applied. For a more precise evaluation of relationships and to determine the contribution of each factor in explaining the filial responsibility score or each of its dimensions, stepwise multiple linear regression analysis was performed; in this stage, variables with a p-value < 0.2 in the univariate analysis were entered into the model as independent variables, and the filial responsibility score or its dimensions were entered as dependent variables. To address the multicollinearity problem, among the three variables of number of children, number of daughters, and number of sons, the number of sons was not included in the model (p < 0.05).

Out of a total of 500 individuals, two questionnaires were excluded due to incomplete responses, and the data of 498 adults (249 individuals in each of the age groups under 60 and 60 years and older) were analyzed. The participants’ ages ranged from 18 to 99 years, with a mean of 54.47 ± 16.20 years. Of these, 38.2% were male and 12.2% were without children [Table 1].

Table 1

Background characteristics of the samples, Kashan, 2025
Categorized Variables		(n = 498) n (%)
Gender	Male	190 (38.2)
Gender	Female	308 (61.8)
Education	No Formal Education	48 (9.6)
	Basic Literacy (able to read and write)	46 (9.2)
	Primary School	99 (19.9)
	Middle School	54 (10.8)
	High School	92 (18.5)
	Associate or Bachelor's degree	119 (23.9)
	Master’s degree or higher	40 (8)
Economic Status	Low	44 (8.8)
	Lower-middle	117 (23.5)
	Average	268 (53.8)
	Upper-middle	64 (12.9)
	High	5 (1)
Housing Situation	Owned	409 (82.1)
	Rented	38 (7.6)
	Organizational	2 (0.4)
	Relative’s Home	49 (9.8)
Employment Status	Full-Time Employee (Government or Private Sector)	68 (13.7)
	Part-Time Employee (Government or Private Sector)	34 (6.8)
	Retired	109 (21.9)
	Unemployed (Seeking Work)	5 (1)
	Disabled / Unable to Work	5 (1)
	Self-Employed	57 (11.4)
	Homemaker	220 (44.2)
Known Underlying Health Conditions	Yes	238 (47.8)
Known Underlying Health Conditions	No	260 (52.2)
Living Arrangements	Alone	35 (7)
	with Spouse	135 (27.1)
	with Children	39 (7.8)
	with At least One Parent	38 (7.6)
	with Spouse and at least One Parent	3 (0.6)
	With Spouse and Child and at least One Parent	3 (0.6)
	with Spouse and Child and at least One Parent of Spouse	3 (0.6)
	with Child and at least One Parent	2 (0.4)
	with Spouse and Children	239 (48)
	with other Relatives	1 (0.2)
Marital Status	Married	386 (77.5)
	Never Married	36 (7.2)
	Divorced	15 (3)
	Widowed	61 (12.2)
Having Children	Yes	437 (87.8)
Having Children	No	61 (12.2)
Employment Status of Spouse (N = 386)	Full-Time Employee (Government or Private Sector)	52 (10.4)
	Part-Time Employee (Government or Private Sector)	30 (6)
	Retired	92 (18.5)
	Unemployed (Seeking Work)	0
	Disabled / Unable to Work	4 (0.8)
	Self-Employed	78 (15.7)
	Homemaker	130 (26.1)
Basic Health Insurance Status	Yes	472 (94.8)
Basic Health Insurance Status	No	26 (65.3)
Supplementary Health Insurance Status	Yes	325 (65.3)
Supplementary Health Insurance Status	No	173 (34.7)
Decision to Place Older Parents in a Nursing Home	Strongly Agree	8 (1.6)
	Agree	14 (2.8)
	Neutral	39 (7.8)
	Disagree	82 (16.5)
	Strongly Disagree	355 (71.3)
Quantitative Variables		Mean ± SD
Age (years)		54.16 ± 47.20
Number of Children (n)		2.2 ± 98.24
Number of Daughters (n)		1.1 ± 56.44
Number of Sons (n)		1.1 ± 43.39
Ability To Perform ADLs (1 to 5)		4.0 ± 81.64
Religious Beliefs (1 to 5)		4.1 ± 16.08
Mental Well-Being (1 to 5)		14.5 ± 18.93

The filial responsibility score among the studied adults, on a 15–60 scale, was 51.69 ± 6.35, which, with 95% confidence, was between 51.13 and 52.25 in the target population. The subscale score for “socio-emotional responsibilities” (on a 9–36 scale) was 32.14 ± 3.64, and the subscale score for “physical responsibilities” (on a 6–24 scale) was 19.55 ± 3.36. Regarding prioritization of the domains of the filial responsibility questionnaire, stepwise linear regression showed that the two domains of “socio-emotional responsibilities” and “physical responsibilities” explained 83.5% and 16.5% of the variance in the filial responsibility score, respectively. The item “Children who live away from their older parents should be in contact with them at least once a week” received the highest score, while the item “When older parents are unable to care for themselves, they should be able to live with one of their children” received the lowest score [Table 2].

Table 2

Descriptive indices of the statements of filial responsibility scale in adults visiting comprehensive health centers- Kashan 2025 (n = 498)
Subscale	Statement	Alternatives n (%)				Mean ± SD
Subscale	Statement	Completely disagree	Disagree	Agree	Completely agree	Mean ± SD
Socio-emotional responsibilities	Adult children who live away from their parents (more than 40 kilometers/40 minutes) should be in contact with their parents at least once a week (by telephone call/video call).	4 (8)	10 (2)	139 (27.5)	345 (69.3)	3.66 ± 0.56
	If adult children live near their parents after growing up, they should visit their parents at least once a week.	5 (1)	9 (1.8)	144 (28.9)	340 (68.3)	3.64 ± 0.57
	Adult children should feel responsible towards their elderly parents (they should provide any help when parents need it)	1 (0.2)	9 (1.8)	157 (31.5)	331 (66.5)	3.64 ± 0.53
	Adult children should support their parents emotionally	0	6 (1.2)	164 (32.9)	328 (65.9)	3.65 ± 0.5
	Elderly parents and adult children should be together during holidays and special occasions (birthdays and anniversaries).	2 (0.4)	14 (2.8)	188 (37.8)	294 (59)	3.55 ± 0.657
	Adult children should help their parents to learn about and use the services they are entitled to (such as health insurance and health care services) if needed.	0	5 (1)	205 (41.2)	288 (57.8)	3.57 ± 0.52
	When parents are sick, adult children should take care of them by any means necessary	1 (0.2)	25 (5)	206 (41.4)	266 (53.4)	3.48 ± 0.60
	Elderly parents should be able to talk with their adult children about important personal issues that affect their lives significantly.	0	24 (41.6)	207 (41.6)	267 (53.6)	3.49 ± 0.59
	Adult children should give advice to their elderly parents if needed.	1 (0.2)	14 (2.8)	239 (49)	244 (49)	3.46 ± 0.56
Physical responsibilities	When elderly parents are not able to take care of themselves, they should be able to live with one of their adult children.	14 (2.8)	93 (18.7)	195 (39.4)	196 (39.4)	3.15 ± 0.82
	In case of emergency, adult children should provide a place (a room) for elderly parents in their home.	15 (3)	79 (15.9)	209 (42)	195 (39.2)	3.17 ± 0.80
	Adult children should organize their work schedule to help their elderly parents if needed	3 (0.6)	48 (9.6)	218 (43.8)	229 (46)	3.35 ± 0.68
	Adult children should arrange their family plans to be able to help their elderly parents if needed	3 (0.6)	26 (5.2)	236 (47.4)	233 (46.8)	3.4 ± 0.62
	Adult children should be ready to sacrifice some of their personal freedoms to take care of their elderly parents if needed.	8 (1.6)	56 (11.2)	235 (47.2)	199 (40)	3.26 ± 0.72
	Adult children should help their parents financially	6 (1.2)	78 (15.7)	216 (43.4)	198 (39.8)	3.22 ± 0.75
Total score (15–60)						51.69 ± 6.35
Socio-emotional responsibilities score (9–36)						32.14 ± 3.64
Physical responsibilities score (6–24)						19.55 ± 3.36

The filial responsibility score in the two age groups, under 60 years and 60 years and older, was 52.64 ± 5.97 and 50.74 ± 6.59, respectively, which were significantly different (p = 0.001). The socio-emotional responsibilities score was significantly higher in the group under 60 years (32.46 ± 3.43) compared to the elderly group (31.82 ± 3.82) (p = 0.047). A similar difference was observed for the physical responsibility’s subscale (20.18 ± 3.00 versus 18.92 ± 3.59; p < 0.0001).

Univariate analysis showed a significant relationship between filial responsibility and the variables of education, occupation, spouse’s occupation, marital status, having children, having basic insurance, having supplementary health insurance, economic status, opinion regarding institutionalization of older parents, age, number of children, and psychological well-being status [Table 3].

Table 3

Filial responsibility score based on potential predictors in adults, Kashan, 2025 (n = 498)
A: Filial responsibility score based on categorized variables
Variable	Categories	Filial responsibility score SD ± mean	F or t-value		p-value
Gender	Female	51.44 ± 6.25	a-1.121		0.263
Gender	Male	52.09 ± 6.50	a-1.121		0.263
Education	Illiterate (A)	51.04 ± 6.51	b-3.096		0.006				Pairwise comparison ^c
	Reading writing literacy (B)	50.07 ± 7.23							A,D	0.008
	Reading writing literacy (B)	50.07 ± 7.23							B,E	0.019
	Elementary school (C)	50.30 ± 6.49							B,G	0.011
	Junior high school (D)	53.41 ± 6.25							C,D	0.004
	High school (E)	52.74 ± 5.54							C,E	0.008
	Associate and bachelors’ degree (F)	51.52 ± 6.28
	Masters’ degree and higher (G)	53.53 ± 5.83
Religious education	Positive	51.31 ± 6.55	a-0.241		0.81
Religious education	Negative	51.70 ± 6.35	a-0.241		0.81
Occupation	Full-time employment (public or private sector) (A)	52.01 ± 6.56	d-18.38		< 0.0001				Pairwise comparison ^e
	Full-time employment (public or private sector) (A)	52.01 ± 6.56							A,E		< 0.001
	Part-time employment (public or private sector) (B)	52.03 ± 6.03							B,E		< 0.001
	Part-time employment (public or private sector) (B)	52.03 ± 6.03							C,E		< 0.001
	Retired (C)	50.75 ± 6.59							A,E		< 0.001
	Unemployed (seeking job) (D)	48.60 ± 8.35							A,E		< 0.001
	Unable to work (E)	59.00 ± 1.41							E,F		< 0.001
	Self-employed (F)	53.61 ± 5.60							E,F		< 0.001
	Self-employed (F)	53.61 ± 5.60							E,G		< 0.001
	Housewife (G)	51.40 ± 6.26							E,G		< 0.001
Spouse’s employment status	Full-time employment (public or private sector) (A)	53.27 ± 5.73	b-3.02		0.011			Pairwise comparison ^f
								A,E			0.001
								B,E			0.011
	Part-time employment (public or private sector) (B)	52.43 ± 5.01						E,C			0.017
	Part-time employment (public or private sector) (B)	52.43 ± 5.01						E,G			0.002
	Retired (C)	50.92 ± 6.32						E,G			0.002
	Retired (C)	50.92 ± 6.32						F,E			0.010
	Unable to work (E)	42.25 ± 7.80
	Self-employed (F)	51.44 ± 6.18
	Housewife (G)	52.04 ± 6.44
Marital status	Married (A)	51.75 ± 6.26	b-2.70		0.045		Pairwise comparison ^c
	Never married (B)	53.36 ± 6.63					A,D				0.040
	Divorced (C)	53.27 ± 7.01					A,D				0.040
	Divorced (C)	53.27 ± 7.01					B,D				0.011
	Widowed (D)	49.95 ± 6.32					B,D				0.011
Having children	Positive	51.51 ± 6.30	a-1.638		0.102
Having children	Negative	52.93 ± 6.61	a-1.638		0.102
Basic insurance coverage	Positive	51.60 ± 6.38	a-1.368		0.172
Basic insurance coverage	Negative	53.35 ± 5.65	a-1.368		0.172
Supplementary insurance	Positive	51.11 ± 6.63	a-2.917		0.004
Supplementary insurance	Negative	52.77 ± 5.65	a-2.917		0.004
Financial status	Low(A)	53.55 ± 0.88	x-3.929		0.012	Pairwise comparison ^e
	Average and below (B)	50.68 ± 6.04				Pairwise comparison ^e
	Average and below (B)	50.68 ± 6.04				B,D					0.021
	Average (C)	51.34 ± 6.62
	Average and higher (D)	53.45 ± 5.64
	High (E)	55.00 ± 5.00
Residence	House owner	5.158 ± 6.36	b-0.457		0.712
	Rental	52.42 ± 5.76
	Employees’ housing	48.50 ± 9.19
	Living in a relative’s house	52.14 ± 6.71
Living with	Alone	50.40 ± 6.74	b-1.537		0.132
	Spouse	51.11 ± 6.88
	Children	49.95 ± 6.14
	Parent(s)	53.84 ± 6.61
	Spouse and children	53.67 ± 1.53
	Spouse, children, and parent(s)	54.33 ± 8.14
	Spouse, children, and spouse’s parent(s)	51.67 ± 5.51
	Children and parent(s)	47.00 ± 7.07
	spouse and children	52.13 ± 5.91
	Other relatives	56.00
Diagnosed background diseases	Positive	51.26 ± 6.58	a-1.455		0.146
Diagnosed background diseases	Negative	52.08 ± 6.12	a-1.455		0.146
Opinion about institutionalization of older parents	Completely agree (A)	51.13 ± 7.99	d-11.164		< 0.0001				Pairwise comparison ^e
	Agree (B)	47.50 ± 8.54							Pairwise comparison ^e
	Agree (B)	47.50 ± 8.54							C,E		0.002
	No idea (C)	48.87 ± 5.82							C,E		0.002
	Disagree (D)	48.84 ± 5.43							D,E		0.001
	Completely disagree	52.83 ± 6.13							D,E		0.001
									D,C			0.225
Note: ^a: independent t -test ^b: F ANOVA ^c: post hoc (LSD) post hoc (Gabriel) ^f post hoc (Games-Howell) ^{e d}: welch statistic/ANOVA * Only significant figures in pairwise comparison are listed
B: Correlation of filial responsibility score with quantitative variables
Variable		r values		p-value
Age (year)		a-0.144		0.001
Number of children		a-0.096		0.032
Number of children (daughters)		a-0.080		0.073
Number of children (boys)		a-0.073		0.1
Ability to do everyday activities (1–5 scale)		b-0.041		0.361
Religious beliefs level (1–5 scale)		a-0.085		0.057
psychological well-being status based on wellbeing scale (0–25 scale)		a-0.116		0.010
Note: a: Pearson coefficient b: Spearman

Stepwise multiple linear regression analysis showed that the simultaneous presence of three variables—degree of opposition to institutionalization of older parents, psychological well-being status, and age—was significant in the model (F = 15.982, p < 0.001) and explained 8.8% of the variance observed in the filial responsibility score. The greatest contribution belonged to the degree of opposition to institutionalization of older parents, which alone accounted for 5.5% of the variance. The model indicated that for each standard deviation increase in the degree of opposition to institutionalization of older parents, the filial responsibility score would increase by 0.23 standard deviations; for each standard deviation increase in psychological well-being score, the filial responsibility score would increase by 0.12 standard deviations; and for each standard deviation increase in age, the filial responsibility score would decrease by 0.15 standard deviations [Table 4].

Table 4

Multiple linear regression analysis to determine predictors of filial responsibility in adults
Model	R²	B	95% CI B		SE	Beta	t value	P-value
Model	R²	B	Lower limit	Upper limit	SE	Beta	t value	P-value
Fixed coefficient Opposition to institutionalization of older parents Age (year) Psychological wellbeing status	- 0.055 0.019 0.014	4.562 5 1.649 0.058 - 0.128	4.014 2 10.37 0.091 - 0.37	4.109 9 2.261 0.025 - 0.219	1.805 0.311 0.017 0.046	- 0.228 0.148 0.120	25.235 5.297 -3.437 2.778	< 0.001 < 0.001 0.001 0.006
Note: R² = 0.088, F = 15.982, p < 0.0001

Univariate analysis showed a significant relationship between the socio-emotional responsibility subscale and the variables of education level (p = 0.006), spouse’s occupation (p = 0.017), economic status (p = 0.025), opinion regarding institutionalization of older parents (p < 0.001), and psychological well-being (p = 0.003, r = 0.132). Multiple linear regression analysis reported that the simultaneous presence of two variables—degree of opposition to institutionalization of older parents and psychological well-being status—was significant in the model of predictors for socio-emotional responsibility (F = 11.285, p < 0.001) and explained 8.5% of the observed variance in the socio-emotional responsibility score. The greatest contribution belonged to the degree of opposition to institutionalization of older parents, which alone accounted for 4% of the variance. The model indicated that a higher degree of opposition to institutionalization of older parents (B = 0.811, SE = 0.206, p < 0.001, Beta = 0.195) and better psychological well-being (B = 0.078, SE = 0.030, p = 0.011, Beta = 0.127) were associated with higher levels of socio-emotional responsibility.

Univariate analysis showed a significant relationship between the physical responsibility subscale and the variables of education level (p = 0.006), occupation (p < 0.001), spouse’s occupation (p = 0.017), supplementary insurance (p < 0.001), economic status (p = 0.025), underlying disease (p = 0.008), opinion regarding institutionalization of older parents (p < 0.001), age (r = − 0.189, p < 0.001), number of children (r = − 0.117, p = 0.009), number of sons (r = − 0.117, p = 0.009), and level of religious beliefs (r = 0.104, p = 0.020). Multiple linear regression analysis reported that the simultaneous presence of four variables—degree of opposition to institutionalization of older parents, age, level of religious beliefs, and supplementary insurance—was significant in the model of predictors for physical responsibility (F = 11.808, p < 0.001) and explained 11% of the observed variance in the physical responsibility score. The greatest contribution belonged to the degree of opposition to institutionalization of older parents, which alone accounted for 5.1% of the variance; the contributions of age, level of religious beliefs, and supplementary health insurance in the variance in physical responsibility scores were 4.3%, 1.4%, and 1.1%, respectively. The model indicated that a higher degree of opposition to institutionalization of older parents (B = 0.784, SE = 0.187, p < 0.001, Beta = 0.204) and a higher level of religious beliefs (B = 0.374, SE = 0.155, p = 0.016, Beta = 0.120) were associated with higher levels of physical responsibility, whereas increased age (B = − 0.036, SE = 0.011, p = 0.001, Beta = − 0.172) was associated with lower levels of physical responsibility. In addition, the physical responsibility score was higher in the absence of supplementary insurance (B = 0.805, SE = 0.360, p = 0.026, Beta = 0.114).

The filial responsibility score in adults in Kashan ranged from 15 to 60, with a mean of 51.69 ± 6.35. There was a relatively high level of filial responsibility in this group. Iran is an Islamic country, and Islamic culture emphasizes benevolence toward parents; this is repeatedly highlighted in religious texts, including the Sahifeh Sajjadiyeh, Nahj al-Balagha, and the Holy Quran(Aghajani et al., 2018). Consequently, children in Iranian families tend to assume the caregiver role within their own homes to uphold the sacred duty toward older parents(Rejeh et al., 2011). All of the above may contribute to the formation of a positive attitude toward filial responsibility. However, the influence of various social factors on the phenomenon of filial responsibility over time should not be overlooked. In a qualitative study conducted by Niazi et al. (2023) to identify challenges faced by elderly individuals in Kashan, one of the reported challenges was “lack of support from children”(Niazi et al., 2023), which partially contrasts with the findings of the present study. It should be noted that the high filial responsibility score in this study, and its apparent discrepancy with Niazi et al.’s findings, can be explained by the nature of the instrument used. The tool measures attitudes or expectations rather than actual behaviors; therefore, the findings reflect high levels of filial responsibility attitudes but do not necessarily indicate appropriate or effective caregiving performance. Moreover, the determinants of filial responsibility are strongly influenced by cultural and social factors(Aires, Pizzol, et al., 2017). Although the instrument used was originally developed in the United States and culturally adapted for use in Iran, certain dimensions of filial responsibility—such as social or spiritual aspects, which are prominent in Iranian society(Tagharrobi et al., 2025)—were not captured.

The present study showed that filial responsibility scores were higher in the under-60 age group compared to older adults. In other words, increasing age predicted lower scores in overall filial responsibility as well as in the physical responsibility subscale. Based on the observations, one reason for the differences in filial responsibility attitudes between these two age groups may be the distinct roles of parents and children within the Iranian cultural context. Individuals over 60 years, as elderly parents, occupy the recipient role and tend to lower their expectations from their children, attributing fewer responsibilities to them to reduce their burden. Conversely, individuals under 60, as children, occupy the caregiver role and perceive greater obligations toward older parents who have cared for them over the years. It is plausible that when children eventually assume the role of elderly parents, they may have lower expectations and, consequently, perceive less responsibility from their own children. Consistent with our findings, Miyawaki (2017) reported that filial responsibility scores among third-generation caregivers remained strong and high compared to previous generations(Miyawaki, 2017).

Contact with older parents by children who live apart held the greatest importance among the filial responsibility items in the present study. Cicirelli (1991) noted that upon reaching adolescence, communication plays a crucial role in parent–child relationships, and simple communicative behaviors such as phone calls, letter writing, or email can account for the typical interactions between children and older parents(Cicirelli, 1991). Contrary to the present study, a study conducted in the United States indicated that contact with parents was of lesser importance among other filial responsibility items(Hamon & Blieszner, 1990). "Living with older parents during times of incapacity" ranked lowest in importance in the present study, which aligns with Salmon (2010), who reported that elderly individuals, particularly the very old, prefer to live in their own homes(Salomon, 2010); increased place attachment with advancing age(Lebrusán & Gómez, 2022) may support this finding.

The largest contribution to explaining variations in filial responsibility scores was attributed to the “socio-emotional responsibility” dimension. Socio-emotional responsibilities include regular and frequent contact, spending time with older parents, and providing necessary information to them. Evidence indicates that emotional support constitutes the most valued form of support for elderly individuals in Iran(Nazari et al., 2017). Consistently, multiple studies have highlighted that educating and providing informational support to older parents represents a key aspect of filial responsibility(Cheung et al., 2020; Collins, 2014; Hamon & Blieszner, 1990; Park & Kim, 2016).

In the present study, “degree of opposition to institutionalization of older parents,” “psychological well-being,” and “age” were influential factors on filial responsibility scores. Among these, the greatest contribution in the predictive model of filial responsibility was related to the “degree of opposition to institutionalization of older parents.” In other words, a higher degree of opposition was associated with higher filial responsibility scores; this pattern was also observed across the two subscales of the instrument. Individuals who believe in caring for parents at home naturally exhibit more positive attitudes toward aspects of filial responsibility and strive to fulfill their obligations toward their older parents(Mehta & Leng, 2017). The relationship between home-based parental care and individuals’ attitudes toward filial responsibility is also emphasized in intergenerational attachment theory throughout the life course(Cicirelli, 1991).

The findings indicated that higher psychological well-being scores predicted higher levels of filial responsibility. This association was also observed with the socio-emotional responsibility subscale. It may be argued that, in Asian countries, fulfilling filial responsibilities fosters pride and self-esteem in children(Wang et al., 2023), which in turn promotes psychological well-being(Cheung et al., 2022; Liu et al., 2020). However, since filial responsibility is a dynamic phenomenon heavily influenced by regional cultural factors(Aires, Pizzol, et al., 2017), this positive correlation may not be observed universally. Funk et al. (2013) reported that feelings of responsibility toward family members can be accompanied by guilt(Funk et al., 2013), and a study in the United States generally found a negative association between filial responsibility expectations and well-being in older parents(Seelbach & Sauer, 1977).

Higher levels of religious beliefs and convictions predicted higher levels of the physical responsibility dimension. Religions such as Christianity and Islam explicitly emphasize the child’s duty not only to support older parents but also to love and respect them(Ehsani & Masoomi, 2013). Interestingly, these religious teachings also highlight benefits for the child in adhering to this duty, such as longevity(Ehsani & Masoomi, 2013). Religious recommendations and the advantages of fulfilling filial responsibilities may explain the higher physical responsibility scores observed among individuals with stronger religious beliefs. Some adult children may focus primarily on instrumental and financial support, even to meet the emotional needs of their older parents(Wang et al., 2020).

Supplementary health insurance emerged as a predictor of physical responsibilities; specifically, it was observed that physical responsibility scores were higher among individuals whose parents lacked supplementary health insurance. Supplementary health insurance covers the high costs of medical treatments, paying either all or the majority of these expenses(https://bimeh.com/mag/what-is-supplementary-health-insurance/). It appears that, in the presence of such insurance, older parents may require less financial or physical support from their children, which aligns with the findings of this study. Moreover, Brody et al. (1984) demonstrated that in countries where governmental support for the elderly is substantial, elderly individuals expect less financial support from their children and prefer to receive such support from formal sources(Brody et al., 1984).

It should be noted that, since filial responsibility is a dynamic phenomenon heavily influenced by cultural, socio-economic, and temporal factors(Aires, Pizzol, et al., 2017), some differences between the findings of the present study and other related research—beyond variations in time, location, and statistical methods—may arise from differences in the study population. Specifically, studies targeting adult children may yield results that differ from studies focusing on older parents or on both parents and children.

The sufficient sample size, quota sampling from two age groups—under 60 years and older adults—diversity in participant characteristics, and the use of multiple analyses are among the strengths of the present study, contributing to the generalizability of the findings. The large regression coefficients in the model of predictors of filial responsibility indicated that multiple factors influenced the phenomenon, many of which were not addressed in the current study. Additionally, some questionnaires were completed via interviews due to illiteracy, low literacy, or visual impairments in certain participants; given the potential impact of this method on responses, the internal and external validity of the study may have been affected. Another limitation is that the questionnaire items focused on measuring attitudes and did not capture prominent aspects of filial responsibility within the Iranian cultural and social context. It is recommended that a native instrument, developed using qualitative approaches and with a focus on performance, be designed to assess filial responsibility toward older parents in different societies. In designing questionnaires for potential predictors, changes in culturally and socially relevant factors over time should also be considered. Moreover, by addressing the limitations of the present study as much as possible and with an adequate sample size, the study should be replicated separately in the two groups of older adults and adult children.

Filial responsibility among Iranian adults is relatively high. Furthermore, the variables “degree of opposition to institutionalization of older parents,” “psychological well-being,” and age were significant predictors of filial responsibility scores. The findings provide valuable insights into filial responsibility and its factors among community-dwelling older adults in Iran and serve as a prompt for international researchers in the field of aging health to address this topic. Based on the current study, planners and policymakers in the field of elderly health should prioritize the design of effective interventions to strengthen positive attitudes toward filial responsibility, particularly among individuals indifferent or favorable to institutionalization of older parents, those with lower psychological well-being, as well as younger older adults with living parents and middle-aged adults.

P-FRS the Persian version of the Filial Responsibility Scale

STROBE the Strengthening the Reporting of Observational Studies in Epidemiology

Funding:

This study was part of the first author’s Ph.D. dissertation in the Department of Aging at the University of Social Welfare and Rehabilitation Sciences (Thesis Number 4265, dated January 29, 2024). The research was not funded by any government, private, or non-profit organizations.

Ethics approval and consent to participate

Ethical considerations

This study was conducted with the approval of the Ethics Committee of the University of Social Welfare and Rehabilitation Sciences (Ethical Code IR.USWR.REC.1403.027, dated April 24, 2024). The study objectives, benefits, potential harms, and data confidentiality were explained to the participants. They were informed of their right to withdraw at any stage and were assured that refusal to cooperate would not interfere with the provision of services at comprehensive health centers. Oral and written informed consents were obtained from all participants.

Consent for publication

Not applicable

Clinical trial number

not applicable.

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No competing interests reported.

Predictors of filial responsibility toward older parents: A cross-sectional study of Iranian adults

Status:

Version 1

Abstract

Background

Methods

Study design and sampling

Data collection

Measurement instruments

Persian version of the filial responsibility scale (P-FRS):

Data analysis

Results

Discussion

Conclusion

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1