{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T06:01:55Z","timestamp":1785132115311,"version":"3.55.0"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Admission to the neonatal intensive care unit (NICU) places families in complex medical environments where parental agency, the perceived capacity to understand treatment, communicate effectively, participate in decisions, and maintain emotional well-being, is crucial for family-centered care. This study aimed to develop and psychometrically validate the NICU Parental Agency Scale (NICU-PAS), a brief instrument measuring this multidimensional construct.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The 15-item NICU-PAS was developed through literature review, expert panel evaluation, and parent focus groups. A multicenter cross-sectional study was conducted across eight NICUs in Suzhou, China, recruiting 350 primary caregivers. Psychometric validation included exploratory and confirmatory factor analysis, internal consistency reliability, and assessment of convergent validity (with parental stress) and discriminant validity (with general health and coping). Subgroup analyses compared first-time and experienced parents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Confirmatory factor analysis supported the four-domain structure of Treatment Understanding, Communication, Decision Making Participation, and Emotional Well-being (\u03c7\n                      <jats:sup>2<\/jats:sup>\n                      \/df\u2009=\u20091.69, CFI\u2009=\u20090.972, RMSEA\u2009=\u20090.045). Internal consistency was good (Cronbach's \u03b1\u2009=\u20090.783\u20130.860 for domains; 0.839 for total scale). Convergent validity was demonstrated by a significant negative correlation with parental stress (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u2009\u22120.189,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), while discriminant validity was supported by negligible associations with general health and coping (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05). Experienced parents reported higher agency than first-time parents in Communication (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.013), Emotional Well-being (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005), and total scores (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The NICU-PAS demonstrates robust psychometric properties and provides a practical, domain-specific measure of parental agency suitable for research and clinical quality improvement in NICU settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2026.1842011","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T05:41:23Z","timestamp":1785130883000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and psychometric validation of the NICU parental agency scale: a multicenter cross-sectional study"],"prefix":"10.3389","volume":"14","author":[{"given":"Li","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Neonatology, Children's Hospital of Soochow University","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lili","family":"Li","sequence":"additional","affiliation":[{"name":"Neonatology Department, Suzhou Municipal Hospital","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenying","family":"Zhu","sequence":"additional","affiliation":[{"name":"Neonatology Department, The First People's Hospital of Kunshan","place":["Kunshan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Zhang","sequence":"additional","affiliation":[{"name":"Neonatology Department, The Ninth Affiliated Hospital of Soochow University","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhen","family":"Wang","sequence":"additional","affiliation":[{"name":"Neonatology Department, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingwen","family":"Zhu","sequence":"additional","affiliation":[{"name":"Neonatology Department, Changshu NO.1 People's Hospital","place":["Changshu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, The First People's Hospital of Taicang City","place":["Taichang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shenzhen","family":"Zhang","sequence":"additional","affiliation":[{"name":"Neonatology Department, Suzhou Municipal Hospital","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Children's Hospital of Soochow University","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Children's Hospital of Soochow University","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"532","DOI":"10.1111\/jocn.15972","article-title":"Support needs of parents in neonatal intensive care unit: an integrative review","volume":"31","author":"Adama","year":"2021","journal-title":"J Clin Nurs"},{"key":"B2","doi-asserted-by":"publisher","first-page":"820","DOI":"10.1186\/s12912-024-02458-y","article-title":"Parental stress and nurse-parent support in the neonatal intensive care unit: a cross-sectional study","volume":"23","author":"Konukbay","year":"2024","journal-title":"BMC Nurs"},{"key":"B3","doi-asserted-by":"publisher","first-page":"572","DOI":"10.1186\/s12912-024-02258-4","article-title":"Family-centred care as a mediator in the relationship between parental nurse support and parental stress in neonatal intensive care units","volume":"23","author":"Loutfy","year":"2024","journal-title":"BMC Nurs"},{"key":"B4","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1016\/j.iccn.2018.08.008","article-title":"The impact of family centred care interventions in a neonatal or paediatric intensive care unit on parents' Satisfaction and length of stay: a systematic review","volume":"50","author":"Segers","year":"2019","journal-title":"Intensive Crit Care Nurs"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e0252074","DOI":"10.1371\/journal.pone.0252074","article-title":"Development and psychometric evaluation of the CO-PARTNER tool for collaboration and parent participation in neonatal care","volume":"16","author":"Van Veenendaal","year":"2021","journal-title":"PLoS One"},{"key":"B6","doi-asserted-by":"publisher","first-page":"3117","DOI":"10.1111\/jocn.14920","article-title":"Parents' And nurses' Experiences of partnership in neonatal intensive care units: a qualitative review and meta-synthesis","volume":"28","author":"Br\u00f8dsgaard","year":"2019","journal-title":"J Clin Nurs"},{"key":"B7","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1016\/j.ijnurstu.2019.03.018","article-title":"The effectiveness of a parent participation improvement program for parents on partnership, attachment infant growth in a neonatal intensive care unit: a randomized controlled trial","volume":"95","author":"Heo","year":"2019","journal-title":"Int J Nurs Stud"},{"key":"B8","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1111\/jocn.15929","article-title":"A clinical-academic partnership to develop a family management intervention for parents of preterm infants","volume":"31","author":"Weber","year":"2021","journal-title":"J Clin Nurs"},{"key":"B9","doi-asserted-by":"publisher","first-page":"875","DOI":"10.1002\/nur.22178","article-title":"Healthcare professionals' sense of coherence of parental involvement in neonatal intensive care units: a framework synthesis","volume":"44","author":"Chan","year":"2021","journal-title":"Res Nurs Health"},{"key":"B10","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1016\/j.iccn.2018.05.001","article-title":"The health care system is making \u2018too much noise' to provide family-centred care in neonatal intensive care units: perspectives of health care providers and hospital administrators","volume":"50","author":"Benzies","year":"2019","journal-title":"Intensive Crit Care Nurs"},{"key":"B11","doi-asserted-by":"publisher","first-page":"100388","DOI":"10.1016\/j.eclinm.2020.100388","article-title":"Hospitalising preterm infants in single family rooms versus open bay units: a systematic review and meta-analysis of impact on parents","volume":"23","author":"Van Veenendaal","year":"2020","journal-title":"EClinicalMed"},{"key":"B12","doi-asserted-by":"publisher","first-page":"5871","DOI":"10.3390\/jcm10245871","article-title":"Effectiveness of Alberta family-integrated care on neonatal outcomes: a cluster randomized controlled trial","volume":"10","author":"Murphy","year":"2021","journal-title":"J Clin Med"},{"key":"B13","doi-asserted-by":"publisher","first-page":"103964","DOI":"10.1016\/j.iccn.2025.103964","article-title":"Family involvement in the intensive care unit, moving to decision-making and family participation","volume":"87","author":"Dijkstra","year":"2025","journal-title":"Intensive Crit Care Nurs"},{"key":"B14","doi-asserted-by":"publisher","first-page":"e085881","DOI":"10.1136\/bmjopen-2024-085881","article-title":"Facilitators and barriers to parental involvement in neonatal pain management in the NICU: a scoping review","volume":"15","author":"Feng","year":"2025","journal-title":"BMJ Open"},{"key":"B15","doi-asserted-by":"publisher","first-page":"290","DOI":"10.3390\/children12030290","article-title":"Infant and family outcomes and experiences related to family-centered care interventions in the NICU: a systematic review","volume":"12","author":"Hodgson","year":"2025","journal-title":"Children (Basel)"},{"key":"B16","doi-asserted-by":"publisher","first-page":"2750","DOI":"10.3390\/healthcare13212750","article-title":"Psychometric validation of the parental stressor scale: neonatal intensive care unit (PSS:nICU) in a Greek cohort of parents of hospitalized neonates","volume":"13","author":"Tzeli","year":"2025","journal-title":"Healthcare"},{"key":"B17","doi-asserted-by":"publisher","first-page":"e3301","DOI":"10.1002\/smi.3301","article-title":"Stress and stressors experienced by the parents of high-risk neonates admitted in neonatal intensive care unit: systematic review and meta-analysis evidence available from India","volume":"40","author":"Siva","year":"2024","journal-title":"Stress Health"},{"key":"B18","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1186\/s12887-025-05620-w","article-title":"Family-centered care in neonatal and pediatric critical care units: a scoping review of interventions, barriers, and facilitators","volume":"25","author":"Aljawad","year":"2025","journal-title":"BMC Pediatr"},{"key":"B19","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1038\/s41390-024-03293-2","article-title":"Identifying outcomes and outcome measures in neonatal family-centered care trials: a systematic review","volume":"97","author":"Kocakabak","year":"2025","journal-title":"Pediatr Res"},{"key":"B20","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1007\/s44155-025-00209-1","article-title":"Preferences trust interaction of nurses and parents as mediating variables between knowledge and shared decision-making in the care of newborns in hospitals","volume":"5","author":"Rohmah","year":"2025","journal-title":"Discov Soc Sci Health"},{"key":"B21","doi-asserted-by":"publisher","first-page":"e002539","DOI":"10.1136\/bmjpo-2024-002539","article-title":"Parental stress, depression, anxiety and participation to care in neonatal intensive care units: results of a prospective study in Italy, Brazil and Tanzania","volume":"8","author":"Lazzerini","year":"2024","journal-title":"BMJ Paediatr Open"},{"key":"B22","doi-asserted-by":"publisher","first-page":"e2454099","DOI":"10.1001\/jamanetworkopen.2024.54099","article-title":"Outcomes following close collaboration with parents intervention in neonatal intensive care units: a nonrandomized clinical trial","volume":"8","author":"Itoshima","year":"2025","journal-title":"JAMA Netw Open"},{"key":"B23","doi-asserted-by":"publisher","first-page":"114300","DOI":"10.1016\/j.jpeds.2024.114300","article-title":"Parental self-efficacy and personal time help explain impact of parent-staff interactions on parental distress and bonding in the neonatal intensive care unit","volume":"276","author":"Grunberg","year":"2025","journal-title":"J Pediatr"},{"key":"B24","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1016\/j.anr.2024.04.001","article-title":"Development and psychometric testing of the Fathers' self-efficacy scale for newborn care","volume":"18","author":"Erg\u00fcn Arslanl\u0131","year":"2024","journal-title":"Asian Nurs Res (Korean Soc Nurs Sci)"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1213","DOI":"10.1007\/s00125-021-05382-x","article-title":"The suitability of patient-reported outcome measures used to assess the impact of hypoglycaemia on quality of life in people with diabetes: a systematic review using COSMIN methods","volume":"64","author":"Carlton","year":"2021","journal-title":"Diabetologia"},{"key":"B26","doi-asserted-by":"publisher","first-page":"e002429","DOI":"10.1136\/bmjpo-2023-002429","article-title":"Parental stress, depression, anxiety and participation in care in neonatal intensive care unit: a cross-sectional study in Italy comparing mothers versus fathers","volume":"8","author":"Bua","year":"2024","journal-title":"BMJ Paediatr Open"},{"key":"B27","doi-asserted-by":"crossref","first-page":"151926","DOI":"10.1016\/j.semperi.2024.151926","article-title":"Parental impact during and after neonatal intensive care admission","volume":"48","author":"Guez-Barber","year":"2024","journal-title":"Semin Perinatol"},{"key":"B28","doi-asserted-by":"publisher","first-page":"911","DOI":"10.1111\/jocn.16920","article-title":"Psychometric properties of parental stress scales used in paediatric health care settings: a systematic review","volume":"33","author":"Montoro-P\u00e9rez","year":"2024","journal-title":"J Clin Nurs"},{"key":"B29","doi-asserted-by":"publisher","first-page":"101233","DOI":"10.1016\/j.eclinm.2021.101233","article-title":"Prevalence of anxiety and post-traumatic stress (PTS) among the parents of babies admitted to neonatal units: a systematic review and meta-analysis","volume":"43","author":"Malouf","year":"2021","journal-title":"EClinicalMed"},{"key":"B30","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1097\/ANC.0000000000001249","article-title":"Culture of family-centered care in the NICU","volume":"25","author":"Strine","year":"2025","journal-title":"Adv Neonatal Care"},{"key":"B31","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1038\/s41372-025-02439-2","article-title":"Parents' Perspectives on the use of statistics to convey uncertainty in the NICU: a qualitative analysis","volume":"46","author":"Krick","year":"2026","journal-title":"J Perinatol"},{"key":"B32","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1097\/ANC.0000000000001282","article-title":"Parents' Experiences with an early behavioral intervention, H-HOPE, in the NICU and at home: a qualitative study","volume":"25","author":"Schmitt","year":"2025","journal-title":"Adv Neonatal Care"},{"key":"B33","doi-asserted-by":"publisher","first-page":"2025","DOI":"10.3389\/fpubh.2025.1667721","article-title":"Needs for discharge planning among parents of preterm infants in the NICU: a systematic review and meta-synthesis","volume":"13","author":"Wu","year":"2025","journal-title":"Front Public Health"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1623","DOI":"10.1080\/10410236.2020.1785373","article-title":"Organizational sensegiving in family-centered care: how NICU nurses help families make sense of the NICU experience","volume":"36","author":"Gilstrap","year":"2021","journal-title":"Health Commun"},{"key":"B35","doi-asserted-by":"publisher","first-page":"878","DOI":"10.1177\/01939459241285697","article-title":"The mediating effect of perceived social support and health literacy on the relationship between decisional dilemma and participation in shared decision-making among Chinese parents of premature infants","volume":"46","author":"Ma","year":"2024","journal-title":"West J Nurs Res"},{"key":"B36","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1186\/s12887-024-04758-3","article-title":"Parents' And neonatal healthcare professionals' Views on barriers and facilitators to parental presence in the neonatal unit: a qualitative study","volume":"24","author":"Schmid","year":"2024","journal-title":"BMC Pediatr"},{"key":"B37","doi-asserted-by":"publisher","first-page":"2024","DOI":"10.3389\/fpubh.2024.1332720","article-title":"Interventions to promote health literacy among working-age populations experiencing socioeconomic disadvantage: systematic review","volume":"12","author":"Singh","year":"2024","journal-title":"Front Public Health"},{"key":"B38","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1186\/s12939-025-02677-y","article-title":"Socioeconomic gradients and mechanisms of chronic disease health literacy: the mediating role of preventive healthcare utilization in rural Shangdong, China","volume":"24","author":"Wang","year":"2025","journal-title":"Int J Equity Health"},{"key":"B39","doi-asserted-by":"publisher","first-page":"32320","DOI":"10.1038\/s41598-025-07094-3","article-title":"Health literacy model integrating health education, health behaviors, self-rated health, and socioeconomic status in the Chinese population","volume":"15","author":"Zhang","year":"2025","journal-title":"Sci Rep"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1842011\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T05:41:24Z","timestamp":1785130884000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1842011\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,27]]},"references-count":39,"alternative-id":["10.3389\/fped.2026.1842011"],"URL":"https:\/\/doi.org\/10.3389\/fped.2026.1842011","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,27]]},"article-number":"1842011"}}