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Using the PEN-3 Model to describe factors influencing parental practices

in Cross River State, Nigeria

1, 2

Antor O. Ndep,

Emmanuel E. Ugobo,

Lilian E. Eyam,

Fidelis T. Otu,

Unwana A. Essien,

Sylvia A.

Agba,

Ekene M. Ani,

Bernadine N. Ekpenyong

Department of Public Health, Faculty of Allied Medical Sciences, University of Calabar, Nigeria

Department of Public Health, Faculty of Health Sciences, Havilla University Nde, Ikom, Cross River

State, Nigeria

*Corresponding Author

DOI: https://dx.doi.org/10.51244/IJRSI.2025.1215PH000180

Received: 12 October 2024; Accepted: 20 October 2024; Published: 14 November 2025

Introduction: Parenting is a potentially modifiable factor influencing positive outcomes for children.

Objectives: This study explores cultural factors that influence positive parenting practices among mothers in

Obubra Local Government Area of Cross River State.

Methodology: Using a mixed methods design, the research explored the role of the three dimensions of the

PEN-3 Model; cultural identity, relationships and expectations, and cultural empowerment on positive

parenting.

Results: For cultural identity, the women in this study were predominantly farmers, 232(54.7%) are 25-34

years old, 237(55.9%) are married, 133(31.4%) are single mothers, and 324(76.7%) had attained secondary

education. Those within the extended family system faced resistance to positive parenting interventions and

education, from their mothers-in-law, mothers, husbands, and male intimate partners. Patriarchy and cultural

beliefs informed the resistance. Many mothers were reluctant to seek formal assistance for emotional and

psychosocial problems, with fear of stigma being the key theme. For relationships and expectations; Mothers’

Perceptions mold the situational factors that promote positive parenting. Family systems, social groups, and

religious and spiritual networks could be positive agents of change yet, may also impede change. The

“nurturers” (inter-personal relationships) may or may not be supportive of positive parenting practices. For

cultural Empowerment, Positive behaviours by respondents included not missing antenatal care and delivery at

the health center, Existential behaviors included fasting and Prayers while Negative behaviors refer to

behaviours that may likely negate parenting such as low childhood immunization uptake.

Conclusion: study participants engaged in some aspects of positive parenting and interpersonal relationships

rooted in patriarchy and traditional gender roles may be positive or negative factors influencing practice. Fear

of stigma hindered participants' ability to seek help for psychological issues. How this fear translates to

parenting practice needs further study. Community health education targeting interpersonal relationships may

improve positive parenting practices.

Keywords:c, Children, patriarchy, stigma, cultural beliefs

INTRODUCTION

Parenting is a fundamental aspect of child development, involving behaviors and practices aimed at nurturing,

guiding, and supporting children throughout their developmental journey.

It is a dynamic interaction between

caregivers and children, profoundly impacting their physical, cognitive, emotional, and social well-being.

also involves providing a risk-free physical setting, closely monitoring a child's activities, guiding practices,

nurturing social, emotional, and cognitive development, and offering direction and support in everyday life.

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This role is vital throughout different developmental stages, from birth to adulthood.

While most parents

develop sufficient skills to facilitate healthy child development, some encounter difficulties such as lack of

persistence, inadequate parenting skills, feeling burdened by the child, or finding little joy in the parenting

role.

The quality of parenting is influenced by internal and external factors. Socio-economic disparities

significantly shape parental practices, with economic challenges like poverty and limited access to services as

additional stressors. Environmental conditions such as social support networks, also impact parenting

practices, particularly in rural areas.

Cultural dynamics play a crucial role in shaping parenting behaviors, with deeply ingrained beliefs, values,

traditions, and norms varying across ethnic groups. Understanding and respecting these cultural nuances are

essential for designing effective interventions to support positive parenting practices.

In Nigeria, the diversity

in culture and religion significantly influences attitudes towards parenting. With over 250 ethnic groups and

various religious affiliations, Nigeria represents a mosaic of cultural practices and belief systems.

Despite

acknowledging influential factors, there is a gap in utilizing comprehensive frameworks to understand parental

practices in Nigeria. The PEN-3 Model emerges as a promising approach, offering a culturally relevant

framework to analyze health-related behaviors within diverse populations.

Against this backdrop, this study aimed to explore cultural factors influencing parenting practices among

mothers in the Obubra Local Government Area of Cross River State. By employing the PEN-3 Model, this

research seeks to provide a comprehensive understanding of how cultural beliefs, values, and norms intersect

with parental practices in this specific context. Through this exploration, the aim is to inform culturally

sensitive interventions and policies that promote positive parenting and enhance child well-being in the region.

THEORETICAL FRAMEWORK

Airhihenbuwa developed the PEN 3 cultural model in response to the apparent omission of culture in

explaining health outcomes in existing health behavior theories and models.

The PEN-3 cultural model

centralizes culture in the study of health beliefs, behaviors, and health outcomes. The model also places culture

at the core of developing, implementing, and evaluating successful public health interventions.

The model

consists of three primary domains:

1. Cultural Identity,

2. Relationships and Expectations,

3. Cultural Empowerment.

Each domain includes three constructs that form the acronym PEN; Person, Extended Family, and

Neighbourhood (Cultural Identity domain); Perceptions, Enablers, and Nurturers (relationship and expectation

domain); Positive, Existential and Negative (Cultural Empowerment domain). The Cultural Identity domain

highlights the intervention points of entry. These may occur at the level of persons (e.g., mothers or health care

workers), extended family members (grandmothers), or neighborhoods (communities or villages).

Cultural norms about parenting practices typically influence how children are raised. These norms affect what

beliefs and values parents teach their children, what behaviors are considered appropriate, and the methods

used to teach these values and behaviors.

However, despite some differences among cultures, there are key

common parenting themes that emerge across cultures. Understanding the differences and commonalities in

parenting practices and child-rearing goals across cultural groups is a significant step in developing culturally

relevant guidelines and support for parents of all backgrounds.

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Figure 1:The PEN-3 cultural model showing the domains and their constructs

Source: (Airhihenbuwa, 1989)

Moreover, in addition to the individual perceptions, the PEN-3 Model also considers broader community and

societal factors shaping parenting behaviors. This holistic approach enables researchers to examine the

interplay between individual beliefs, community resources, and cultural norms influencing decisions about

health behaviours.

Methods

Study setting: This study was carried out in Obubra Local Government Area which is one of the oldest Local

Government Areas in Nigeria located in the Central Senatorial District of Cross River State with the

administrative headquarters in Obubra Town. It occupies an area of 1,115km

with a density of 206.8km

and

is bounded to the north by Yala Local Government Area, to the east by Ikom Local Government Area, to the

south by Akamkpa Local Government Area, to the south-west by Yakurr Local Government Area, and to the

west by Ebonyi State.

Today, it consists of a mono-cultural group of people of Mbembe descent.

The major

units of this Mbembe-speaking people include Aduni Ofumbongha, Okum, and Osopong. Traditionally, the

people are predominantly small subsistence farmers. It has an estimated population of about 172,543 people, as

of the 2006 census.

The current estimated population of Obubra using an annual growth rate of 3% was

calculated using the compound interest formula of A = P x (1+r)

, where A is the final population after n years,

P is the initial 2006 census population figure, r is the annual growth rate in decimal form and n is the number

of years between 2006 and 2023. Therefore, A = 172,543 (1+0.03)

, giving the final 2023 estimated

population of 272,673.

Study design: This qualitative study adopted a narrative design to describe the parenting practices among

respondents using the PEN-3 Cultural Model lens.

Study population: The population of the study were mothers with children under-five years old, residing in

Obubra Local Government Area of Cross River State, Nigeria.

Data collection and analysis

A total of 22 participants were recruited purposively to participate in three separate Focus Group Discussions

(10 participants in Group A, 6 in Group B, and 6 in Group C).This sampling strategy allowed the selection of

informants with experience in the context of the subject matter (information-rich participants). This method of

recruiting implies that data generated from the study can have substantial relevance to the participants.

A Focus Group discussion protocol was designed to explore the experiences of mothers on parenting. The FGD

protocol was divided into three sections. The first section consisted of greetings, introductions, ground rules

and ethical considerations. The second section covered questions on the mothers’ pregnancy, childbirth and

parenting experiences. The third section was closing remarks and appreciation of participants.

For each of the FGDs, there was a facilitator and a note-taker/recorder. Each FGD was convened at a venue

free of interruption or excessive noise interference and convenient to participants. Each session lasted between

60-90 minutes. Participants were assured of confidentiality, and the right to withdraw from the FGD at any

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Page 2434

time without fear of penalty. The focus group discussions were recorded and later transcribed for analysis. The

tapes were locked in a filing cabinet where only the team lead has access to the tapes.

The facilitator and note-taker coded the transcripts. First, general themes related to overall perceptions of the

experience of mothers were examined. Two coders independently identified codes from the generated textual

data, and then three forms of coding (descriptive, topic, and analytical) were applied. A summary of descriptors

of each paragraph of text was developed, and then it was organized into sections by sorting text segments into

groups and providing a label from the PEN-3 domains. For analytical coding, the researcher created codes that

expressed new ideas about the data by considering the meanings in context. Next, coded data about

participants’ daily experiences as mothers were matched to the domains of the PEN-3 model: Cultural Identity

(Person, Extended family, Neighborhood); Relationships and Expectations (Perception, Enablers, Nurturers);

and Cultural Empowerment (Positive, Existential, Negative).

Ethical considerations: The full research protocol, an application for ethical approval, and a letter of

introduction from the Department of Public Health, University of Calabar were submitted to the Research

Ethics Committee, Ministry of Health, Cross-River State. After receiving an approval letter

(CRSMOH/RP/REC/2018/105) from the Ethics Committee, recruitment of research subjects and data

collection commenced. The subjects were briefed on the purpose of the study and that participation was

voluntary. Only those who provided written consent were recruited. Respondents were informed that all the

information provided would be confidential and that the results and reports from this study would not reveal

the identity of the respondents. The researchers did not use any unfair means to influence the participants to

obtain information. This study is part of a a larger mixed methods study. The questionnaire used for data

collection was without any personally identifying information and the researcher maintained an elevated level

of confidentiality when treating the information collected. All data collected using a questionnaire and the

audio tapes were domiciled in the Department of Public Health, University of Calabar, locked in a restricted

file cabinet. All data entered into the computer were protected with password accessibility and kept in the

custody of the team lead.

Results

Application of the PEN-3 model in the study

Cultural identity

The cultural identity dimension of the PEN-3 model identifies internal (intrapersonal characteristics) and

external forces such as family, extended family networks, and the community that might influence parenting

practices.

 Person (description of the participants in the study)The respondents had a mean age ± standard

deviation of 25.37±4.6. the age range was 25-34 years, and more than half of the respondents were

married while others were either single mothers or cohabiting with their sexual partners. Most of the

respondents had a secondary education. For the occupation, traditionally, the women in this study were

predominantly subsistent farmers. While all participants had at least one child below the age of five, the

least number of child/children was one and the most was six. All the respondents were Christians but

some reported leaning toward other belief systems.

 Extended family. Results from the FGDs showed that those within the extended family system might be

resistant to some aspects of positive parenting interventions and education. First, mothers-in-law,

mothers, husbands/male intimate partners may initially be willing to provide support for the young

mothers in this study however, sometimes, these same relatives may not be open to change, particularly

those who adhere to patriarchal and cultural beliefs. For instance, some mothers/mothers-in-law oppose

exclusive breastfeeding by insisting that the infant should be given water to quench their thirst. Cultural

beliefs about discarding colostrum are upheld by family members. Baby care and house chores are

culturally viewed as a woman’s job. Some respondents did not feel supported in baby care, house chores,

and/or farm work leading to sleep deprivation, stress and exhaustion.

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 Neighborhoods: There were social and institutional structures within neighborhoods or communities that

could promote or impede positive parenting practices. Respondents reported high perceived stress and

depressive mood swings due to lack of social support. Yet, many mothers were reluctant to seek formal

assistance for emotional and psychosocial problems, relying instead on themselves or close family and

friends. The stigma associated with mental health issues and the fear of being shamed for not being a

capable mother formed barriers to help-seeking behaviours.

Relationships and expectations

 Perceptions: Respondents believed that some practices such as throwing the baby up and catching them

could be dangerous. They fear that the baby could fall but most did not know that there could be other

dangers to the baby’s internal organs and blood vessels. Mothers did not have any formal training on

parenting but reported watching their parents or assisting their mothers to be parents to their younger

siblings (parentification). Parenting practices therefore were based on family traditions rather than

cognitive awareness of the pros and cons of each aspect of the practice.

 Enablers: Family systems, social groups, religious and spiritual networks, and community organizations

can be positive agents of change; yet, a counterargument can also be made that these same enabling

vehicles can also impede change. A mother could be taught in the antenatal classes that colostrum is a

rich source of nutrients for the infant and may find opposition from their age mates, social networks and

religious/spiritual parents (religious leaders). The same with exclusive breastfeeding where traditional

enablers may insist on giving the infant, anointing oil, holy water, and/or other foods to babies under six

months old.

 Nurturers. The majority of the nurturers are the grandmothers of the infant (especially the respondents’

mothers-in-law). These bring their own traditional beliefs of child care and insist that their own practices

are best for the infant. With support from Enablers, these group of people may support some aspects of

positive parenting such as childhood immunization but may not be sticklers to the timelines thus leading

to delayed or missed immunization. The extent to which “nurturers” (mothers, mothers-in-law,

husbands/male partners, friends, and the community) may or may not be supportive of positive parenting

practices needs to be evaluated further.

Cultural empowerment

 Positive behaviors. Attending and not missing antenatal care and delivery at the health center are some

of the positive behaviours exhibited by the mothers in this study. Respondents who reported having a

helpful family member (mother, mother-in-law, and/or sister), were more likely to engage in positive

behaviours and reported better mental well-being.

 Existential behaviors: encompass neutral practices; that is, they have no adverse health consequence

and do not need to be changed. E.g soliciting for prayers from social and religious acquaintances, fasting

and Prayers, using palm-kernel oil on baby’s skin to ward off evil spirits etc. were reported practices

among the respondents.

 Negative behaviors: Negative behaviors entail beliefs and practices that are harmful or likely to negate

parenting for example

o Home births, without a trained midwife or skilled birth attendant. A few respondents in this study

reported giving birth at the home of an un-trained Traditional Birth Attendant (TBA).

o Delaying and/or low uptake of childhood immunization is another negative behaviour found among

the respondents. Having an unfriendly mother-in-law visit after childbirth who does not help the new

mother in caring for the baby and/or help with some house chores seemed to be a major theme

contributing to the delayed or missed childhood immunizations as well as the perceived poor mental

health status of the new mothers.

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Table 2. Cross-tabulation of Cultural Empowerment and Relationships and Expectations domains of the PEN-3

Model describing parental experiences, relationships and parenting decisions among Mothers in Obubra Local

Government Area of Cross River State, Nigeria

Cultural Empowerment

Domains

Positive

Existential

Negative

Relationships/Expectations

Perceptions

Knowing that her

husband/partner is willing to

provide support.

Mothers’ knowledge about

pregnancy, childbirth and

positive parenting (engaging in

exclusive breastfeeding,

uptake of immunization, child

development milestones, age

appropriate feeding, physical

and emotional needs of the

child etc.).

Knowing and believing that

delivery at the health centre is

safe.

The birth of a new child

added joy to the family

Mothers knowledge and

use of cultural and

religious relics such as

palm kernel oil, Holy water

and anointing oil on the

baby

Believing in and implementing cultural

practices such as taboo foods during

pregnancy.

Not attending ante-natal clinic

Mothers behavioural change during

pregnancy isolation, information support,

depression, religious practice and cultural

practices.

Discarding colostrum

Introducing other liquids and foods to a

baby before six months of age.

Belief or prefer not to start talking to baby

at early age

Enablers

Information on positive

parenting are available and

accessible at the health center,

community-based

organizations etc.

Mothers received support and

love throughout pre- and

postpartum period.

Acquire parenting skills from

mothers and also learn during

parenting

Mother belong to age grade

association

Dressing baby in culturally

sensitive ways

Culture plays strong role

on how child is raised

Patronizes traditional birth attendants or

Religious organization-based birth homes.

Poor or delayed childhood immunization

uptake,

Disciplined with corporal punishment,

withholding food, withholding playtime,

and assigning extra chores.

Nurturers

Grandparents, aunties, and

siblings help mothers in

everyday caregiving

responsibilities

Prayers from the pastor,

and friends

Delaying and/or low uptake of childhood

immunization.

Relying on self-diagnoses and traditional

remedies for the management of childhood

disease.

Unfriendly/unhelpful mothers/mothers-in-

law during the immediate post-partum

period.

DISUSSION

Parenting has become one of the most challenging tasks in recent times considering the emergence of the

different family structures and varied needs of children.

Understanding the knowledge gaps and practices on

parenting among mothers is a prerequisite to the development of interventions that are context-specific and

culturally sensitive. Understanding perceptions of mothers towards parenting and their meanings can help

identify situational factors that promote positive parenting. While mothers could list some of the expected

developmental milestones, but could not link them as part of the outcome of their parenting. This is in line with

a study conducted by Bornsteain et al,

where they demonstrated fair but less than adequate basic parenting

knowledge among mothers in Europe. Mothers’ knowledge of child development has been shown to have a

significant influence on the way mothers interact with their children and the learning opportunities they

provide.

Parents need a basic understanding of their children’s physical and emotional needs. This will

inform the types of parenting practices that promote children's achievement of the developmental milestones.

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All the participants indicated that they never had any formal parenting training but rather learned by observing

their mothers and becoming ‘parents’ to their younger siblings (parentification). Parentification is a common

practice in Obubra and environs. The application of parenting behavior can be influenced by culture and

participants in this study acknowledged the role of culture in how children are raised. Parenting practices

therefore were based on family traditions rather than cognitive awareness of the pros and cons of each aspect

of the practice. According to Ulfa, Husniah, and Wijaya,

culture helps parental development and culture

influences parental cognition which then translates to parenting practices. Culture shapes how parents care for

children

Ndep et al, found that culture plays a central role in parenting (Figure 1).

The transition to parenthood is believed to be one of the most challenging normative developmental life stages

which usually start from conception to the post-conception period with significant others playing a key role in

the parenting process.

19,21

Mothers who participated in the FGDs narrated their experiences in the pre- and

post-conception period. The excitement of birth overwhelms their parenting role. Most of the participants

experience support and love throughout the postpartum period. Despite the fact that participants in the FGD

reported experience of a social support system, only 22% of the surveyed population had poor knowledge of

child support services and systems in the community. Tossing or throwing up a child to stop him/her from

crying is a common practice in the study area. Although tossing an infant into the air may likely not generate

enough force to cause harm to an infant, however forcefully shaking an infant can cause tearing of the small

blood vessels on the surface of the brain, which can interrupt blood flow, leading to brain damage and also the

baby is at risk of being accidentally dropped down.

Mothers and mothers-in-law often insist on introducing

water to infants below six months old. Good breastfeeding practices especially EBF could prevent about 11.6%

of under-five deaths in developing countries.

Figure 2: Culture as a central theme influencing all aspects of parenting among women in Obubra Local

Government Area of Cross River State, Nigeria.

Source: (Ndep et al., 2022)

Although some respondents reported missing immunization appointments, they also reported that the age of

the child’s first appointment was less than two weeks. Similarly, a study conducted in Abakaliki, Nigeria,

reported 4.1% and 6.9% missed vaccination at 6

and 10

week respectively among mothers

.23

Immunization

against childhood diseases has been recognized as one of the most important means of preventing morbidity

and mortality among children.

Poor knowledge of parenting could lead to unnecessary clinic visits, increased vaccine preventable disease

including childhood illness, unintended injuries thereby increasing maternal anxiety and depression.

25,26

Giallo,

Rose and Vittorino

found that Mothers reported moderate levels of fatigue, which was associated with high

levels of depression, anxiety and stress. Fatigue was also significantly associated with low parental self-

efficacy, parenting warmth and involvement, and high parenting hostility. Limited health and self-care

behaviours, unrealistic expectations about sleep, and high need for social support were significant predictors of

fatigue.

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CONCLUSION

Mothers in Obubra engaged in some aspects of positive parenting and interpersonal relationships rooted in

patriarchy and cultural gender roles may be positive or negative factors influencing practice. Fear of stigma

hindered the mothers' ability to seek help for psychological issues. How this fear translates to parenting

practices need further study. Community health education targeting interpersonal relationships may improve

positive parenting practices.

LIMITATIONS

Information on participants’ mental health was based on self-report. Future research using standardized mental

health assessment tools is recommended.

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