Transforming Parental Distress through a Concurrent Mixed-Method, Nurse-Led Educational Intervention for Families of Children with Autism Spectrum Disorder in Iran

Abstract Background: Autism Spectrum Disorder (ASD) imposes substantial psychological burdens on parents, including chronic stress, anxiety, and depressive symptoms. Despite the central role of parents in caregiving, few structured interventions directly address their emotional well-being in low-resource contexts such as Iran. Aim: This study aimed to evaluate the immediate psychological effects of a nurse-led educational group intervention on stress, anxiety, and depression among parents of children with ASD, using a concurrent mixed-method design. Methods: A quasi-experimental single-group pretest-posttest design was employed, with a qualitative component integrated simultaneously. Thirty parents participated in four weekly group sessions focused on ASD-related education, stress management, and emotional processing. Quantitative outcomes were assessed using the Depression Anxiety Stress Scales (DASS-21), while qualitative data were collected via observational notes and parent narratives, analyzed using thematic content analysis. Results: Statistically significant reductions were observed in stress, anxiety, and depression scores following the intervention (p < 0.05). Post-intervention, the intervention group exhibited significant reductions in depression (P < 0.001, η²=0.898), anxiety (P < 0.001, η²=0.856), and stress (P < 0.001, η²=0.885) compared to the control group. Qualitative analysis revealed eight experiential themes, including: invisible suffering, social blame, resistance-to-participation shift, emotional neglect, maladaptive coping, emerging emotional awareness, peer support formation, and acknowledgment of self-care importance. Conclusion: The short-term nurse-led intervention was effective in reducing psychological distress and increasing emotional awareness among participating parents. While effects were immediate, further research is required to explore long-term impacts and optimize integration of such interventions into comprehensive ASD care systems.