Public awareness of early symptoms of acute coronary syndrome and its association with anticipated prehospital delay: a cross-sectional study in Palestine.

According to WHO data (), approximately 13 million preterm infants are born globally each year, accounting for 10% of all newborns. Due to the immaturity of their organs, preterm infants face long-term complications such as growth retardation and delayed cognitive development even after discharge (, ). Parents must not only meet their basic needs but also acquire essential medical care knowledge and skills (). High-quality discharge teaching may help parents acquire the knowledge and skills required for post-discharge care. However, many parents currently exhibit deficiencies in preterm infant care (, ), which not only compromises care quality but also increases the risk of readmission (). Therefore, enhancing the caregiving competence of parents of preterm infants is crucial. Previous studies () have found that educational quality can effectively improve parental caregiving competence, but the specific mechanisms underlying this relationship remain unclear. Identifying the mediating factors involved is of significant importance. Discharge teaching quality is particularly important at the time of NICU discharge, when parents begin to assume primary responsibility for caring for a medically vulnerable infant at home. High-quality discharge teaching may help parents understand their infant's condition, master essential caregiving skills, and prepare for common post-discharge challenges. In this sense, discharge teaching is not only an educational process but also a key clinical intervention that may facilitate parents' adaptation to a new caregiving role. Tajalli et al. () demonstrated that psychological factors significantly influence the caregiving competence of preterm infant caregivers. Previous research has shown that internal locus of control is positively associated with self-care capacity (–). The concept of “locus of control” originated from Rotter's () 1966 social learning theory, representing an individual's belief regarding the attribution of health outcomes (). In the context of preterm infant care, internal locus of control reflects the extent to which parents believe that their own caregiving behaviors can positively influence their infant's health, recovery, and development. Parents with a stronger internal locus of control may be more likely to engage in active learning, problem-solving, and sustained caregiving efforts, which in turn may promote better caregiving competence. As a malleable belief, internal locus of control can be guided and reinforced through targeted health education (). Therefore, it is plausible that high-quality discharge teaching may enhance caregiving competence not only directly by providing knowledge and skills, but also indirectly by strengthening parents' internal locus of control. Transition Theory provides a useful framework for understanding this process. According to Transition Theory, individuals undergoing health-related transitions often experience changes in roles, responsibilities, behaviors, and emotional states, and their transition outcomes are influenced by personal, community, and societal conditions (). For parents of preterm infants, discharge from the NICU represents a critical transition from hospital-supported care to home-based caregiving. During this transition, parents must adapt to a new role, manage uncertainty, and develop confidence in their ability to care for their infant independently. From this perspective, discharge teaching quality may be considered a transitional support, internal locus of control a key psychological condition, and caregiving competence an important transition outcome. Although previous studies have examined the relationship between discharge education and parental caregiving outcomes, research on the mediating role of internal locus of control in this association among parents of preterm infants remains limited. In addition, the relevance of Transition Theory to this relationship has not been sufficiently clarified in existing research. Therefore, guided by Transition Theory, the present study aimed to examine the association between discharge teaching quality and caregiving competence among parents of preterm infants at NICU discharge and to test whether internal locus of control mediates this association. By clarifying both the direct and indirect pathways, this study seeks to provide evidence for developing discharge interventions that address not only parents’ practical caregiving needs but also their psychological readiness for home care.