Developing a Health-Promoting Lifestyle Model for Parents of Slow-Learner Children Based on Biological Health, Marital Satisfaction, and Spiritual Vitality
Keywords:
Health-Promoting Lifestyle; Biological Health; Marital Satisfaction; Spiritual Vitality; Slow-Learner Children; Parents; Structural Equation ModelingAbstract
Purpose: This study aimed to develop and test a structural model of health-promoting lifestyle among parents of slow-learner children based on biological health and marital satisfaction, with spiritual vitality as a mediating variable.
Methods and Materials: This applied, quantitative, descriptive-correlational, cross-sectional study was conducted among parents of slow-learner children aged 6–14 years in Shiraz, Iran. Using a multistage sampling procedure, 400 parents, including 200 fathers and 200 mothers, were recruited. Data were collected using a demographic information form, the Afrouz Marital Satisfaction Questionnaire, the Afrouz Spiritual Vitality Questionnaire, the 52-item Health-Promoting Lifestyle Profile, and the Family Health Status Inventory. Data were analyzed using descriptive statistics, Pearson correlations, confirmatory factor analysis, and structural equation modeling in SPSS 21 and LISREL 8.80. Indirect effects were examined using the Sobel test and bootstrap resampling with 5,000 samples.
Findings: All structural paths were statistically significant (p < .001). Biological health negatively predicted spiritual vitality (β = -.38) and health-promoting lifestyle (β = -.42), reflecting the reverse scoring of poorer health status. Marital satisfaction positively predicted spiritual vitality (β = .56) and health-promoting lifestyle (β = .38), while spiritual vitality positively predicted health-promoting lifestyle (β = .52). Spiritual vitality significantly mediated the relationship between biological health and health-promoting lifestyle (indirect effect = -.36, Sobel Z = 5.23, p < .001) and between marital satisfaction and health-promoting lifestyle (indirect effect = .25, Sobel Z = 6.52, p < .001). Bootstrap confidence intervals excluded zero. The final model demonstrated acceptable fit: χ²/df = 2.84, RMSEA = .068, SRMR = .052, CFI = .94, NFI = .91, IFI = .94, and GFI = .91.
Conclusion: Health-promoting lifestyle among parents of slow-learner children is jointly associated with biological health, marital satisfaction, and spiritual vitality, with spiritual vitality functioning as a significant partial mediator, highlighting the value of integrated family-centered interventions addressing physical, relational, and spiritual resources.
Downloads
References
Al-Saliti, R. A. M. N., Al-Karamneh, M. S., Tarawneh, H., Elmorsy, G. N., Badran, A. H. A., & Ismail, A. F. (2025). Spiritual Intelligence and Its Relationship to Marital Satisfaction Among Mothers of Children with Disabilities.
Alghamdi, S. A., Assiri, M. I., Fallatah, R. A., Albeladi, F. M., Alabdulaziz, H., & Alsaggaf, F. (2025). Health-Promoting Activities Among Saudi Arabian Parents of Children with Disabilities: A Cross-Sectional Study. Belitung Nursing Journal. https://doi.org/10.33546/bnj.3624
Amani, M., Afrooz, G., & Mousavi, F. (2025). The Relationship Between Reading Skills in Slow-Paced Adolescents with Down Syndrome and Their Interpersonal Interactions and Social Adjustment.
Amanollahi, Z., GhasemiNiaei, F., Davarani, F. F., & Esfahan, M. M. (2025). Development of an Integrated Developmental Model for Adaptation with Autistic Children in Family System. Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s10803-025-06917-6
Azimi, S., Afrooz, G., Arjmandnia, A., & Bonab, B. G. (2025). Effectiveness Family Based Mental Empowerment Program on Working Memory and Attention of Slow Learners' Students. Journal of New Approach to Children's Education (JNACE), 7(2).
Azimi, S., Afrooz, G., Arjmandnia, A. A., & Ghobari Bonab, B. (2025). Effectiveness of a Family-Centered Mental Empowerment Program on Working Memory and Attention in Slow Learners.
Azizi, M., & Afrooz, G. (2025). Comparison of Lifestyle and Spiritual Vitality Between Adults Over 80 with and without Alzheimer's Disorder. Journal of Psychological Science.
Balvayeh, M., Naghsh, Z., Rezaei, S., & Afrooz, G. A. (2024). Developming an Educational Program Based on Spiritual Vitality and Evaluating of Its Effectiveness on Hope, Engagement, and Parenting Stress Reduction in Parents of Children with Autism Spectrum Disorder. Razi Journal of Medical Sciences, 31(1). https://doi.org/10.47176/rjms.31.197
Curley, K., Hughes, R., & Kotera, Y. (2025). Stressful but Not Unhappy: A Review of the Positive Aspects of Parenting a Child with Autism Spectrum Disorder. Children. https://doi.org/10.3390/children12010107
Fauziah, N. (2026). Understanding the Dynamics of Family Harmony with ASD Children: A Grounded Theory Approach. Journal of Family Issues, 47(1). https://doi.org/10.1177/0192513X251362452
Fekri Shiran, M., Afrooz, G., Pourhossein, R., Aghajani, S., & Alipour, A. (2025). Development and Evaluation of the Effectiveness of a Family-Centered Psychological Intervention Program Based on Spiritual Vitality for Anxiety Management and Blood Glucose Reduction in Adults with Diabetes. Health Psychology, 14(55).
Fietzer, A. W., Wu Cen, A. Z., Frosh, A., & Ponterotto, J. G. (2025). A Review and Guide to Structural Equation Modeling in Counseling Psychology Research. The counseling psychologist, 53(6). https://doi.org/10.1177/00110000251352577
Ginanjar, A. S., Hudiyana, J., Pranawati, S. Y., & Safitri, S. (2026). Marital Satisfaction Mediates the Relationship Between Dyadic Coping and Parenting Stress Among Parents of Children with Autism Spectrum Disorder. Discover Psychology. https://doi.org/10.1007/s44202-026-00712-9
Hakimi Dezfouli, Z. S., & Ebrahimpour, G. (2025). The Role of Psychological Flexibility, Affective Empathy, and Spiritual Experiences in Predicting Marital Satisfaction of Married Women. Islam and Psychology Studies, 18(35).
Hosseini, H., Vakili, S., Mousavi, M., Afrooz, G., & Azizi, M. P. (2025). Development and Validation of a Family-Centered Art-Based Perceptual-Motor Intervention Program for Children with Behavioral Problems.
Jackson, S. Z., Pinto-Martin, J. A., Deatrick, J. A., Boyd, R., & Souders, M. C. (2024). High Depressive Symptoms, Low Family Functioning, and Low Self-Efficacy in Mothers of Children with Autism Spectrum Disorder Compared to Two Control Groups. Journal of the American Psychiatric Nurses Association, 30(2). https://doi.org/10.1177/10783903221104147
Ju, H. J. (2025). Parental Stress, Self-Compassion, and Meaning in Life Among Mothers of Children with Autism Spectrum Disorder University of Kentucky].
Kang, M. S., Kim, K. M., Jung, N. H., & Chang, M. Y. (2024). Effects of Parenting Stress and Health Promotion Behavior of Parents of Disabled Children on Quality of Life. The Journal of Korean Academy of Sensory Integration, 22(3). https://doi.org/10.18064/JKASI.2024.22.3.15
Kazemian Heydari, F., Rajabi, G., & Amanelahi, A. (2025). Predictors of Marital Happiness: Conscientiousness, Marital Satisfaction, and Gratitude Toward the Spouse. Journal of New Advances in Behavioral Sciences, 10(58).
Mahdavi, S., Kord Mirza, E., Rahmanian, M., Ghodrati Mirkoo, M., & Alibakhshi, Z. (2025). Comparison of the Effectiveness of Positive Thinking Training and Solution-Focused Therapy on Perceived Stress, Resilience, and Mother-Child Interaction Quality in Mothers of Children with Intellectual Disability. Journal of Psychological Science, 25(157).
Mahmoudnejad, A. H., Afrooz, G., & Arjmandnia, A. A. (2024). The Relationship Between Marital Satisfaction of Parents with Physical-Motor Impairments and Their Children's Mental Health and Creativity. Empowering Exceptional Children, 15(2).
Mohammad Ali, A., Pourhossein, R., Nosrati, F., & Afrooz, G. (2025). The Relationship of Parents' Marital Satisfaction and Their Popularity in the Family with Self-Worth and Spiritual Vitality of Their Child Enrolled in Gifted Schools. Journal of Psychological Science, 23(143).
Mousavi, Afrooz, G., & Ghasemzadeh, S. (2025). Effectiveness of Skill-Based Knowledge Enhancement on Improving Emotional and Communication Functioning of Parents with Adolescent Children. Quarterly Journal of New Psychological Research, 20(79).
Nasrallah, L. Y. (2025). Marital Quality and Its Relationship to Symptoms of Psychological Disorders Among Mothers of Autistic Children in Nablus Governorate An-Najah National University].
Nemati, S., Bardel, M., Mohammadi, N., Jabali Adeh, M., & Hosseinpour, N. (2024). The Effect of Positive Parenting Training on Mental Health and Marital Satisfaction of Mothers of Children with Specific Learning Disorder. Positive Psychology Research, 9(4).
Piland, N. (2026). Spirituality, Health, and Well-Being Among Families and Persons Living with Intellectual and Developmental Disabilities. In Handbook of Spirituality, Health, and Well-Being. Routledge. https://doi.org/10.4324/9781003440048-48
Piro-Gambetti, B., Greenlee, J., Bolt, D., Litzelman, K., & Hartley, S. L. (2025). Longitudinal Pathways Between Parent Depression and Child Mental Health in Families of Autistic Children. Development and Psychopathology, 37(4). https://doi.org/10.1017/S0954579424001378
Piro-Gambetti, B., Greenlee, J., Bolt, D., Papp, L. M., & Hartley, S. L. (2024). Parent-Couple Satisfaction, Parent Depression, and Child Mental Health in Families with Autistic Children. Frontiers in Psychiatry. https://doi.org/10.3389/fpsyt.2023.1306456
Pourrazi, F., Naghsh, Z., Hemmati Alamdarloo, G., & Bardideh, M. (2025). Predicting Attitudes Toward Marriage in University Students Based on Parents' Marital Satisfaction and Spiritual Vitality. Rooyesh-e-Ravanshenasi Journal, 14(6).
Sakhtemani, F., Afrooz, G. A., Arjmandnia, A. A., & GholamAli Lavasani, M. (2026). Developing a Family-Centered Art Therapy Program and Evaluating Its Effectiveness on the Communication Skills and Social Adjustment of Students with Autism Spectrum Disorder. Quarterly Journal Of Family and Research.
Sullivan, W. C. (2025). Associations Between Marital Quality and Depressive Symptoms in Parents of Autistic Adolescents: A Dyadic Model Texas Christian University].
Sun, C., Zhu, Z., Zhang, P., Wang, L., Zhang, Q., Guo, Y., & Qin, Y. (2024). Exploring the Interconnections of Anxiety, Depression, Sleep Problems and Health-Promoting Lifestyles Among Chinese University Students: A Comprehensive Network Approach. Frontiers in Psychiatry. https://doi.org/10.3389/fpsyt.2024.1402680
Talebi, M., & Ghazanfari, A. (2025). Parental Self-Efficacy and Spiritual Intelligence Impact Mothers' Psychological Well-Being, Mediated by Alexithymia, in Families of Children with Intellectual Disabilities. Health, Spirituality and Medical Ethics. https://doi.org/10.32598/hsmej.12.3.1005.1
Tamannaeifar, M., Mazhabdar, A., & Hadizadeh, F. (2025). Structural Equation Modeling of Marital Satisfaction Based on Spiritual Well-Being and Psychological Hardiness: The Mediating Role of Marital Adjustment. Women and Family Studies, 13(3).
Vrankić Pavon, M., Wagner Jakab, A., & Löw, A. (2024). Exploring Relationship Satisfaction in Mothers of Children with Disabilities: The Predictive Role of Interparental Conflicts and Moderating Role of Dyadic Coping. Frontiers in Psychiatry. https://doi.org/10.3389/fpsyt.2023.1307827
Zabeti Arani, M., Hasanzadeh, S., Afrooz, G., & Salehi, K. (2025). Creating a Development-Oriented Social, Movement and Language Skills Program: Investigating Its Effectiveness on Improving the Developmental Indicators of Children with Global Developmental Delay. Journal of Applied Psychological Research.
Zeinalizadeh, B., Afrooz, G., & Gholamali Loo, M. (2025). Factor Structure of the Second Edition of the Reynolds Cognitive Assessment Scales in Children in Tehran. Journal of Psychological Science, 24(148).
Zeinoddini, Z., Afrooz, G., Hashemian, K., & Nikkhoo, F. (2025). Effectiveness of Emotion-Focused Couple Therapy Training on Marital Satisfaction and Spiritual Vitality in Women with Breast Cancer. Psychological Dynamics in Mood Disorders, 3(5).
Downloads
Publication Timeline
- Submitted
- Revised
- Accepted
Issue
Section
License
Copyright (c) 2025 Diba Zare (Author); Gholamali Afrooz; Ghorban Hemmati Alamdarloo (Author)

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.