Nurturing the Future: Understanding maternal knowledge of child development in Oman

TL;DR

This study explores the knowledge of Omani women of childbearing age regarding infant development and finds significant gaps, especially among those with lower education.

Contribution

The study provides new insights into maternal knowledge of child development in Oman and highlights the role of education and employment in shaping this knowledge.

Findings

Omani women answered 63% of infant development questions correctly on average.

Higher education and employment were strongly linked to better knowledge scores.

Common misconceptions exist about infant sensory abilities and developmental milestones.

Abstract

This study aimed to examine the knowledge of Omani women of childbearing age concerning infant developmental care.

This cross-sectional study included 1,006 Omani women of childbearing age, recruited from outpatient clinics at Sultan Qaboos University Hospital (response rate = 71%). Their knowledge was evaluated using the Knowledge of Infant Development Inventory (KIDI), a validated self-report questionnaire. The KIDI scores were analysed to identify associations with demographic variables such as women's age, education level, employment status and number of children. Data were collected from June 2023 to October 2023.

The mean age of the participating women was 31.6 ± 8.4 years. The majority were from Muscat (49.6%), with over half holding bachelor's degrees (57.1%) and 39% being employed. The mean correct response rate for KIDI was 0.63 ± 0.11, suggesting that, on average, the women answered 63% of the questions accurately. Higher education levels and employment status were significantly associated with better knowledge scores (P < 0.001). Misconceptions were prevalent in areas such as infant sensory capabilities and developmental milestones.

The findings reveal significant gaps in knowledge regarding child development among Omani women, particularly those with lower levels of educational attainment. Targeted educational interventions are needed to enhance maternal knowledge and support child development in Oman.

Tables

Table 1.. Distribution of sociodemographic characteristics (N = 1,006).

Variables	n (%)
Mean women's age in years ± SD	31.6 ± 8.4
Region
Ad Dakhiliyah Governorate	107 (10.6)
Ad Dhahirah Governorate	38 (3.8)
Al Batinah North Governorate	131 (13.0)
Al Batinah South Governorate	126 (12.5)
Al Buraymi Governorate	9 (0.9)
Ash Sharqiyah North Governorate	61 (6.1)
Ash Sharqiyah South Governorate	22 (2.2)
Dhofar Governorate	13 (1.3)
Muscat Governorate	499 (49.6)
Women's education level
No formal education	3 (0.3)
Elementary	10 (1.0)
Secondary	15 (1.5)
High school	159 (15.8)
Diploma	173 (17.2)
Bachelor's degree	574 (57.1)
Master's degree	57 (5.7)
Doctorate	15 (1.5)
Employment status
Employed	393 (39.1)
Housewife	613 (60.9)
Do you have children?
Yes	486 (48.3)
No	520 (51.7)
Number of children
1	100 (20.6)
2	115 (23.7)
3	98 (20.2)
4	77 (15.8)
5	48 (9.9)
>5	48 (9.9)
Is this your first pregnancy?
Yes	79 (16.6)
No	395 (83.4)
Is the boy/girl diagnosed with a specific type of disability?
Yes	8 (1.6)
No	478 (98.4)
Mean father's age in years ± SD	38.9 ± 7.8
Father's education level
Elementary	10 (2.1)
Secondary	37 (7.6)
High school	176 (36.2)
Diploma	66 (13.6)
Bachelor's degree	136 (28.0)
Master's degree	44 (9.1)
Doctorate	17 (3.5)
How many hours does your child spend with the housekeeper or the other care provider in a day? – Median (IQR)	4.0 (0–7)
Did the mother enrol in childcare courses before having this child?
Yes	55 (11.3)
No	431 (88.7)
Have you heard about the well-baby clinic?
Yes	28 (5.8)
No	458 (94.2)

Table 2.. Knowledge about parenting practices and normative child behaviour (N = 1,006).

Items	n (%)
1. When toddlers (2–3 yrs.) are strongly attached or bonded to their parents, they are clingier and tend to stick close to mom or dad.	101 (10.0)
2. A two-year-old who is two or three months behind other two-year-olds is developmentally delayed.	710 (70.6)
3. Children often will keep using the wrong word for a while, even when they are told the right way to say it (like ‘feet not footses’).	678 (67.4)
4. Babies should not be held when they cry because this will make them want to be held all the time.	437 (43.4)
5. If a baby (less than a year) wants a snack, give it nuts, popcorn or raisins.	830 (82.5)
6. Babies do some things just to make trouble for their parents, like crying for a long time or pooping in their diapers.	703 (69.9)
7. If you punish children for doing something naughty, it is okay to give them a piece of candy to stop the crying.	746 (74.2)
8. You must stay in the bathroom when your infant is in the tub.	899 (89.4)
9. Babies cannot see and hear at birth.	391 (38.9)
10. Infants understand only words they can say.	652 (64.8)
11. If children are shy or fussy in new situations, it means they have an emotional problem.	532 (52.9)
12. Talking to a child about things he (or she) is doing helps his mental development.	957 (95.1)
13. A two-year-old who says ‘no’ to everything and bosses you around is trying to get you upset.	544 (54.1)
14. The way a child is brought up has little effect on how smart he (or she) will be.	531 (52.8)
15. Babies may cry for 20–30 minutes at a time, no matter how much you try to comfort them.	394 (39.2)
16. Once kids turn three or so, they become less defiant and negativistic—‘No, I do not want to!’	366 (36.4)
17. A toddler who is energetic—always on the go—needs a low-sugar diet or Ritalin.	342 (34.0)
18. Babies have little effect on how parents care for them, at least until they get older.	480 (47.7)
19. When putting babies in the crib for sleep, place them on their backs, not stomachs.	675 (67.1)
20. A 328452845-year-old boy who wets the bed has a problem that should be seen by a doctor.	419 (41.7)
21. A brother or sister may start wetting the bed or thumb-sucking when a new baby arrives in the family.	271 (26.9)
22. New foods should be given to the infant one at a time, with 4–5 days between each one.	572 (56.9)
23. The two-year-old's sense of time is different from an adult's.	799 (79.4)
24. Most premature babies end up being abused, neglected or mentally retarded.	594 (59.0)
25. If babies are fed cow's milk, they need extra vitamins and iron.	260 (25.8)
26. Some healthy babies spit out almost every new food until they get used to it.	666 (66.2)
27. The baby's personality or temperament is set by six months of age; it does not change much after that.	671 (66.7)
28. Some parents do not bond until their baby starts to smile and look at them.	356 (35.4)
29. The way the parent treats a baby in the first months of life determines whether the child will grow up to be well-adjusted or a moody misfit.	350 (34.8)
30. Children learn all of their language by copying what they have heard adults say.	44 (4.4)
31. When a baby less than 12 months gets diarrhoea, you should stop feeding solid foods and give it a flat ginger ale or Pedialyte.	196 (19.5)
32. Infants may stop paying attention to what is going on around them if there is too much noise or too many things to look at.	547 (54.4)
33. Some normal kids do not enjoy being cuddled.	278 (27.6)
34. If a baby has trouble pooping, give it warm milk.	229 (22.8)
35. The more you soothe a crying baby by holding and talking to it, the more you spoil it.	555 (55.2)
36. A common cause of accidents for toddlers is pulling something like a frying pan, a tablecloth or a lamp down on top of them.	626 (62.2)
37. Newborn babies recognise stories and music they heard before they were born.	516 (51.3)
38. A good way to teach your child not to bite is to bite back.	653 (64.9)
39. Some days, you need to discipline your child; other days, you can ignore the same thing. It all depends on the mood you are in that day.	428 (42.5)
Item Summary	Mean ± SD
Attempted	0.78 ± 0.16
Accuracy (n = 1,005)	0.66 ± 0.12
Total	0.51 ± 0.13

Table 3.. Knowledge about child developmental milestones (N = 1,006).

Items	n (%)
40. Most babies can sit on the floor without falling over by seven months.	469 (46.6)
41. Six-month-olds will respond to someone differently if the person is happy or upset.	475 (47.2)
42. Most two-year-olds know the difference between make-believe and true stories on TV.	580 (57.7)
43. Infants usually are walking by about 12 months of age.	577 (57.4)
44. Eight-month-olds act differently with familiar people than with someone not seen before.	770 (76.5)
45. Babies are about seven months old before they can reach for and grab things.	207 (20.6)
46. Two-year-olds are able to reason logically, much like an adult would.	588 (58.4)
47. One-year-olds know right from wrong.	592 (58.8)
48. Three-month-olds often will smile when they see an adult's face.	531 (52.8)
49. Most children are ready to be toilet trained by one year of age.	642 (63.8)
50. Infants begin to respond to their name at 10 months.	287 (28.5)
51. Babies begin to laugh at things around four months.	518 (51.5)
52. Six-month-olds know what ‘no’ means.	456 (45.3)
53. Four-month-olds lying on their stomach start to lift their heads.	70 (7.0)
54. Babbling (‘a-bah-bah’ or ‘bup-bup’) begins around five months.	462 (45.9)
55. Eighteen-month-olds often cooperate and share when they play together.	385 (38.3)
56. Infants of 12 months can remember toys they have watched being hidden.	473 (47.0)
57. Babies usually say their first real word at six months.	367 (36.5)
58. Infants will avoid high places, like stairs, by six months of age.	361 (35.9)
Item Summary	Mean ± SD
Attempted	0.78 ± 0.24
Accuracy (n = 986)	0.59 ± 0.17
Total	0.46 ± 0.19

Table 4.. Knowledge of infant developmental inventory tool summary and subscale scores (N = 1,006).

	Attempted		Accuracy		Total
Items	n	Mean ± SD	n	Mean ± SD	n	Mean ± SD
Total Summary Score	1,006	0.78 ± 0.17	1,005	0.63 ± 0.11	1,006	0.49 ± 0.13
Subscales
Milestones	1,006	0.82 ± 0.19	1,006	0.58 ± 0.15	1,006	0.49 ± 0.17
Principles	1,006	0.76 ± 0.19	1,005	0.62 ± 0.16	1,006	0.48 ± 0.17
Parenting	1,006	0.86 ± 0.16	1,004	0.61 ± 0.19	1,006	0.53 ± 0.20
Health and Safety	1,006	0.71 ± 0.21	1,006	0.73 0.18	1,006	0.51 ± 0.17

Table 5.. Association between demographics and knowledge of infant developmental inventory tool subscales (N = 1,006).

		Milestones		Principles		Parenting		Health and safety
			P		P		P		P
Variables	n (%)	Mean ± SD	value	Mean ± SD	value	Mean ± SD	value	Mean ± SD	value
Women's age in years (n = 943)			<0.001		<0.001		<0.001		<0.001
<25	281 (29.8)	0.45 ± 0.16		0.43 ± 0.16		0.49 ± 0.20		0.48 ± 0.17
26–30	240 (25.5)	0.48 ± 0.17		0.48 ± 0.17		0.53 ± 0.19		0.50 ± 0.17
31–35	181 (19.2)	0.54 ± 0.18		0.52 ± 0.16		0.59 ± 0.19		0.53 ± 0.16
36–40	93 (9.9)	0.48 ± 0.16		0.47 ± 0.17		0.54 ± 0.19		0.48 ± 0.17
>40	148 (15.7)	0.52 ± 0.16		0.51 ± 0.17		0.54 ± 0.19		0.54 ± 0.16
Women's education (n = 1,003)			0.130		<0.001		<0.001		<0.001
School education	184 (18.3)	0.47 ± 0.15		0.43 ± 0.16		0.48 ± 0.19		0.52 ± 0.18
Diploma	173 (17.2)	0.49 ± 0.16		0.45 ± 0.17		0.52 ± 0.20		0.52 ± 0.18
Bachelors	574 (57.2)	0.49 ± 0.17		0.48 ± 0.17		0.53 ± 0.20		0.53 ± 0.17
Master's and above	72 (7.2)	0.52 ± 0.18		0.57 ± 016		0.63 ± 0.16		0.17 ± 0.01
Women's employment status (n = 1,006)			<0.001		<0.001		<0.001		0.369
Yes	393 (39.1)	0.51 ± 0.18		0.51 ± 0.17		0.56 ± 0.20		0.51 ± 0.18
No	613 (60.9)	0.47 ± 0.16		0.45 ± 0.17		0.51 ± 0.19		0.50 ± 0.17
Do you have children (n = 1,006)			<0.001		<0.001		<0.001		<0.001
Yes	486 (48.3)	0.53 ± 0.15		0.51 ± 0.16		0.58 ± 0.19		0.54 ± 0.15
No	520 (51.7)	0.44 ± 0.17		0.44 ± 0.17		0.48 ± 0.19		0.48 ± 0.18
Father's age in years (n = 481)			0.088		0.130		0.034		0.904
≤30	66 (13.7)	0.51 ± 0.14		0.47 ± 0.15		0.59 ± 0.19		0.52 ± 0.13
31–35	129 (26.8)	0.56 ± 0.16		0.52 ± 0.17		0.62 ± 0.20		0.54 ± 0.14
36–40	106 (22.0)	0.54 ± 0.15		0.52 ± 0.14		0.58 ± 0.19		0.54 ± 0.16
>40	180 (37.4)	0.52 ± 0.15		0.51 ± 0.16		0.55 ± 0.19		0.54 ± 0.16
Father's education (n = 486)			0.001		0.004		0.002		0.583
School education	223 (45.9)	0.50 ± 0.14		0.48 ± 0.16		0.54 ± 0.19		0.54 ± 0.15
Diploma	66 (13.6)	0.57 ± 0.16		0.53 ± 0.15		0.59 ± 0.19		0.52 ± 0.15
Bachelors	136 (28.0)	0.56 ± 0.18		0.53 ± 0.15		0.62 ± 0.19		0.53 ± 0.16
Master's and above	61 (12.6)	0.55 ± 0.18		0.55 ± 0.17		0.60 ± 0.20		055 ± 0.16
First pregnancy (n = 475)			0.625		0.563		0.030		0.481
Yes	79 (16.6)	0.54 ± 0.15		0.50 ± 0.14		0.62 ± 0.18		0.55 ± 0.14
No	396 (83.4)	0.53 ± 0.16		0.51 ± 0.17		0.57 ± 0.19		0.53 ± 0.16
Source of assistance (n = 364)			0.083		0.041		0.067		0.035
Housekeeper	80 (22.0)	0.53 ± 0.14		0.53 ± 0.15		0.56 ± 0.20		0.56 ± 0.16
Father	71 (19.5)	0.49 ± 0.16		0.47 ± 0.17		0.55 ± 0.19		0.51 ± 0.17
Aunt	13 (3.6)	0.53 ± 0.17		0.60 ± 0.17		0.53 ± 0.14		0.62 ± 0.15
Grandparents	140 (38.5)	0.53 ± 0.17		0.50 ± 0.17		0.58 ± 0.21		0.52 ± 0.14
Nursery/school	60 (16.5)	0.57 ± 0.16		0.51 ± 0.17		0.64 ± 0.19		0.556 ± 0.15
Enrolled in childcare course before (n = 486)			0.169		0.072		<0.001		0.034
Yes	55 (11.3)	0.56 ± 0.15		0.55 ± 0.16		0.66 ± 0.19		0.58 ± 0.16
No	431 (88.7)	0.53 ± 0.15		0.51 ± 0.16		0.57 ± 0.19		0.53 ± 0.15
Heard about the well-baby clinic? (n = 486)			0.075		0.056		0.371		0.013
Yes	28 (5.8)	0.49 ± 0.16		0.46 ± 0.13		0.57 ± 0.17		0.60 ± 0.14
No	458 (94.2)	0.53 ± 0.15		0.51 ± 0.16		0.58 ± 0.19		0.53 ± 0.16

Full text

1. Introduction

The first few years of life are crucial for brain and neural pathways development, establishing a foundation for long-term cognitive, social and educational achievements.^1^ Understanding a child's developmental milestones is vital for effective parenting and the child's overall well-being. Parental knowledge significantly influences daily decisions regarding childrearing, socialisation targets, developmental expectations, engagement in activities and overall child health.^2^

It is widely considered that understanding caregiving, developmental milestones and standards and the health and safety of children influences not just parents' actions but also their broader parenting cognitions.^4^ More explicitly, parental knowledge assists in developing more realistic expectations for children and more accurate interpretations of their actions while also improving parents' self-perceptions of competence, contentment and involvement in parenting.^3^ Several studies have demonstrated the significance of maternal knowledge regarding child development in influencing both child outcomes and parenting practices. Mothers who possess a more comprehensive understanding of child development are generally associated with more advanced parenting skills.^45^

It has been shown that parents who lack an understanding of child development often encounter anxiety and concern due to the discrepancies between their children's behaviours and their own expectations.^6^ While this knowledge may appear vital to caregivers, less is known about how parenting knowledge and its sources vary across countries.^7^

The Knowledge of Infant Development Inventory (KIDI) is an instrument specifically designed to evaluate an individual's understanding of parental practices, developmental processes and normative milestones during infancy. Its primary aim is to assess mothers' knowledge of effective parenting strategies, health and safety protocols and developmental norms and principles relevant to early childhood. The KIDI has been established as a reliable and valid tool for measuring parenting knowledge, with internal consistency (alpha reliability) ranging from 0.50 to 0.82 among parents and test-retest reliability coefficients between 0.80 and 0.92.^89^

A South African study employing the KIDI found that early childhood development practitioners achieved a mean knowledge score of 47%.^10^ In Turkey, 56.9% of mothers provided correct responses regarding child development, while a study from Mexico indicated that mothers accurately assessed their child's development 61% of the time. Similarly, in Brazil, the mean correct response rate was 62.9%.^111213^ In the United States, a study revealed significant racial and ethnic disparities in KIDI scores, with White and Hispanic mothers scoring higher than African American mothers, even after controlling for demographic factors.^5^

Oman, situated on the eastern coast of the Arabian Peninsula, has made significant progress in social and economic fields in recent years. Consequently, it has greatly improved its ranking on the Global Human Development Index.^1415^

Recent studies assessing maternal knowledge in Qatar and Saudi Arabia highlight relatively low levels of understanding regarding child development and parenting practices. In Qatar, a sample of 263 mothers showed an average correct response rate of only 51.85% on the KIDI, indicating deficiencies in areas such as developmental milestones and norms, with mothers scoring particularly low in milestone knowledge (46.25%).^16^ Similarly, in Saudi Arabia, Alqurashi et al. found that Saudi mothers had an average score of 53.3% on the KIDI, reflecting limited awareness of developmental milestones and general principles.^17^ Another study focusing on Saudi mothers' knowledge of infant developmental milestones revealed that while mothers demonstrated strong knowledge of physical safety, gaps persisted in their understanding of other developmental processes, including emotional and cognitive development.^18^ These findings emphasise the necessity of improving maternal knowledge in this region to enhance child developmental outcomes.

Interestingly, the 2014 Oman Multiple Indicator Cluster Survey found that only 68.3% of children aged 3–6 years were developing on track.^15^ Consequently, this study aims to utilise KIDI to examine the level of knowledge that women of childbearing age in Oman possess regarding infant development and identify significant variables associated with variations in parenting knowledge. Understanding this population's knowledge level is crucial, as it can directly impact parenting practices, decisions regarding childrearing and ultimately, the distribution of health and social support services.

2. Methods

This study included women of childbearing age from Oman who were recruited from various outpatient clinics at Sultan Qaboos University Hospital, including antenatal care, gynaecology, the child health department and family medicine clinics. As a tertiary care hospital, Sultan Qaboos University Hospital serves patients from across the country, enabling the inclusion of a diverse population in the study. Data were collected electronically from June 2023 to October 2023 using a convenience sampling method.

The inclusion criteria were as follows: women of reproductive age (18–45 years); women attending antenatal care, gynaecology, child health department and family medicine clinics at Sultan Qaboos University Hospital; and Omani women. Women below 18 years or above 45 years of age; women with significant cognitive impairments, including dementia or delirium; and women who are unwilling or unable to provide informed consent for participation were excluded from the study.

The study utilised various demographic variables as independent predictors to assess their potential influence on women's knowledge, as measured by the KIDI. The demographic variables included region of residence, the presence of previous children, maternal age, maternal education, employment status, paternal age, paternal education, sources of assistance available to the mother, previous enrolment in a childcare course and prior awareness of the well-baby clinic.

The instrument is well-known as the KIDI, a self-report questionnaire initially designed by MacPhee in 1981 and subsequently revised in 2002. It comprises 58 items organised along a unidimensional scale. The KIDI was developed to evaluate an individual's factual understanding of parental practices, child developmental processes and behavioural norms for children, offering a comprehensive overview of early development. The tool has been translated and validated into different languages, including an Arabic version, which was used in this study.^1719^ The test-retest reliability of the Arabic version of the KIDI, conducted two weeks apart on a sample of 58 Jordanian mothers, yielded a reliability coefficient of 0.92.^20^ In this study population, the 58-item tool achieved a high-reliability coefficient of 0.89, underscoring its robustness for application in this context.

Responses to KIDI items can be assessed using two distinct methods. For the initial 39 items about normative child behaviour, participants are requested to express their level of agreement, disagreement or uncertainty regarding the given assertions. The items are scored as correct, incorrect or unsure. In brief, two mean scores and the standard deviation (SD) of the scores are derived. The first score, attempted, reflects the frequency with which respondents check ‘not sure’ (the more often this option is endorsed, the lower the attempted score). The second score, accuracy, represents the proportion of correct answers out of those attempted (where ‘not sure’ is not checked). ‘Attempted’ indicates confidence in one's knowledge, whereas ‘accuracy’ signifies exposure to reliable, normative information about infants. In the second part (items 40–58), if respondents disagreed, they indicated whether a younger or older child would be able to achieve a particular milestone. The total score, calculated by adding the ‘attempted’ and ‘accuracy’ scores, represents the proportion of accurate responses among the entire set of KIDI items. The total scores obtained from the questionnaire are reported as a continuous outcome without a defined cut-off point for assessing knowledge levels.

While the item content does not include subscales, it generated a conceptually derived blueprint encompassing domains such as norms and milestones, principles, parenting and health and safety. Hence, to calculate the KIDI outcomes as comprehensively as possible, the questionnaire was subdivided into four subscales: milestones (24 items: 2, 6, 9, 23, 17, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57 and 58), principles (15 items: 3, 10, 11, 14, 16, 18, 21, 24, 26, 27, 29, 30, 32, 33 and 37), parenting (9 items: 1, 4, 7, 12, 13, 28, 35, 38 and 39) and health and safety (10 items: 5, 8, 15, 19, 20, 22, 25, 31, 34 and 36).^2021^

Women attending antenatal care, gynaecology, child health department and family medicine clinics who met the inclusion criteria and did not meet any exclusion criteria were approached by a research assistant and invited to participate in the study. While waiting in the clinic, participants were given a QR code that allowed them to access and complete the study questionnaire via their mobile devices. The questionnaires were anonymous, with no mandatory fields for names or identification numbers. To prevent duplication, participants were asked if they had previously completed the questionnaire.

The data were analysed using the Statistical Package for Social Sciences (SPSS) software, Version 29 (IBM Corporation, Armonk, New York, USA). Categorical variables were reported as percentages, while continuous computed scores closely approximated a normal distribution and were presented as means with corresponding SDs. One-way ANOVA and t-tests were employed to identify significant differences in mothers' knowledge of developmental milestones in relation to the research variables. The examined variables included parental age, education level, parity, child's age and any assistance received in childcare, along with the source of this assistance.

The first section of the questionnaire included detailed information about the study, clearly indicating that completing the questionnaire would be considered as providing consent. The benefits and risks of participation were also explained, emphasising the voluntary nature of participation and reassurance that their participation would not affect the clinical care they received.

3. Results

A total of 1,006 mothers participated in the survey (response rate = 71%). The participating women's mean age was 31.6 ± 8.4 years (median = 29.7). The Muscat Governorate accounted for almost half (49.6%) of all respondents, while the North and South Batinah regions together represented approximately 25.5%, and the Dhakiliyah Governorate accounted for 10.6%. Approximately 48.3% of the participating women had children, with 16.6% experiencing their first pregnancy and 1.6% having children diagnosed with disabilities. The mean age of fathers was 38.9 ± 7.8 years, and they had diverse educational backgrounds. Only 11.3% of mothers participated in childcare courses, and merely 5.8% were aware of well-baby clinics [Table 1].

Participants engaged with the questionnaire items, as indicated by an average attempt score of 0.78 ± 0.16 [Table 2]. However, the accuracy score was lower, with a mean of 0.66 ± 0.12, suggesting that while most participants completed the questions, their knowledge accuracy in parenting practices and child behaviour requires improvement. Notably, only 10% of participants correctly identified that strong attachment in toddlers could lead to clinginess, and just 4.4% recognised that children learn language by imitating adults. These findings underscore significant gaps in understanding the core aspects of normative child behaviour and development among the study population. Only 38.9% correctly answered questions about infants' ability to see and hear at birth. A concerning finding is that 82.5% of participants incorrectly believe that giving nuts, popcorn or raisins as snacks to babies under one year is appropriate. This misconception highlights a critical gap in knowledge regarding safe feeding practices, emphasising the need for enhanced education on infant nutrition and choking hazards.

Participants showed only moderate accuracy, as indicated by a mean accuracy score of 0.59 ± 0.17 [Table 3]. Key misconceptions include the fact that only 20.6% of respondents correctly identified the age at which babies can reach for and grasp objects, and only 7% correctly understood when infants begin to lift their heads.

The findings reveal that participants had a mixed awareness of early social development indicators. For instance, while 76.5% correctly identified that eight-month-olds interact differently with familiar people compared to strangers, only 47.2% recognised that six-month-olds can respond differently based on a person's emotional expression. This disparity highlights a partial understanding of infants' early social cues and emotional responsiveness.

The total attempt score was high, with a mean of 0.78 ± 0.17, while the accuracy score averaged 0.63 ± 0.11 [Table 4]. Participants demonstrated the highest accuracy in the health and safety subscale, achieving a mean score of 0.73 ± 0.18, which indicates a strong understanding of safety practices. In contrast, the lowest accuracy was observed in the milestones subscale, with a mean score of 0.58 ± 0.15, highlighting a notable gap in knowledge regarding child developmental milestones. This discrepancy suggests that participants are relatively well-informed about safety but are less familiar with typical developmental timelines.

A positive relationship was observed between maternal age and knowledge scores across all subscales, with mothers over the age of 40 demonstrating the highest knowledge levels, including mean scores of 0.52 in milestones and 0.54 in parenting (P < 0.001) [Table 5]. Educational attainment also significantly influenced knowledge levels; mothers with advanced degrees, particularly those holding a master's degree or higher, achieved the highest scores in the parenting subscale (mean = 0.63 ± 0.16; P < 0.001), indicating a deeper understanding associated with higher educational levels. Employment status further contributed to differences in knowledge accuracy, as employed mothers scored significantly higher than their non-employed counterparts across the milestones, principles and parenting subscales (P < 0.001 each). Additionally, attendance in childcare courses was associated with higher scores in the parenting (mean = 0.66 ± 0.19; P < 0.001) and health and safety (mean = 0.58 ± 0.16; P = 0.034) subscales.

4. Discussion

This study is the first to examine early child developmental care knowledge among women of childbearing age, with participants from nine governorates in Oman. It provides valuable insights into Omani mothers' understanding of child development, highlighting significant gaps and misconceptions that must be addressed to promote better parenting practices and improve child development outcomes. The mean correct response rate for KIDI was 0.63 ± 0.11, suggesting that, on average, women answered 63% of the questions accurately. The findings reveal that while there are general gaps in knowledge, critical areas urgently require improvement, particularly regarding principles of parenting and health and safety.

This cohort demonstrated a notable disparity between response accuracy and confidence, as evidenced by high attempt rates on the KIDI. This pattern suggests that many women in this study showed substantial confidence in their perceived knowledge despite providing incorrect responses. Similar findings in studies involving Saudi and Jordanian participants also reveal prevalent knowledge overestimation.^1720^ Such gaps in overconfidence and accuracy highlight a critical issue: parents may be unaware of their knowledge limitations, which could diminish the likelihood of seeking guidance and contribute to a substantial gap in help-seeking behaviours among parents. Different studies from other areas indicate that this shortfall may stem from accessibility barriers and the absence of tailored public health policies that promote proactive support-seeking.^3722^ It has been postulated that parents often lack structured and reliable channels for accessing child development information, which limits their ability to recognise and address knowledge gaps effectively.^2324^ In the local context, the Care for Child Development (CCD) Program, developed by the World Health Organization and UNICEF and recently adapted for Oman, is well-positioned to address this knowledge gap regarding early childcare and enhance parenting practices. Oman's robust primary healthcare system provides an ideal entry point for implementing this programme, offering a comprehensive platform to effectively reach parents and integrate evidence-based child development practices into routine health services.^15^

Data from this cohort indicate that women often possess greater knowledge of parenting practices, like feeding and discipline, than they do of developmental milestones in children. This suggests that their awareness of what to expect in early development—key indicators such as smiling, babbling and social responsiveness—may be limited. This knowledge gap is concerning, as the early identification of developmental delays relies heavily on parental awareness, which is essential for timely interventions that can greatly improve long-term outcomes for children.^25^ In concordance with this study's findings, studies from Jordan and the United Arab Emirates have documented that, while mothers have better awareness of general childrearing activities, their understanding of specific developmental milestones is lacking.^2026^ This discrepancy may stem from a stronger focus on practical parenting skills in health education, while developmental milestones receive comparatively less emphasis. Additionally, cultural factors and the assumption that mothers will naturally recognise these milestones may contribute to this gap. Bornstein et al. discussed the paediatrician's role in shaping mothers' parenting practices. They noted that paediatricians tend to focus on basic care and health maintenance, often neglecting aspects of childrearing education.^22^

Notably, findings from this cohort revealed that, although attendance in childcare courses is rare, it is associated with higher scores in the parenting and health and safety subscales. This underscores the critical need for structured preconception education and the integration of child development knowledge into primary healthcare services. Such interventions could ensure that accurate information about child development is effectively disseminated even before pregnancy, thereby enhancing early parenting practices and potentially leading to improved developmental outcomes. The demonstrated value of formal childcare education highlights how early, structured educational programmes can positively impact parenting knowledge, particularly regarding essential safety practices and the understanding of developmental milestones.^27^ Expanding the CCD Program within the Omani context through the primary healthcare system presents a valuable opportunity to effectively reach a wide range of parents, thereby enhancing their knowledge of early child development. This initiative, in conjunction with various public health and community interventions that adopt a multisectoral approach, aims to provide early-stage support. It also aligns harmoniously with broader health objectives, striving to enhance developmental outcomes for the population.^252829^

Interestingly, the study findings indicate that older mothers tend to have a greater understanding of developmental principles and parenting practices, likely due to their accumulated experience and increased exposure over time. Furthermore, the analysis suggests that higher levels of academic exposure may enhance both the comprehension and practical application of parenting practices, underscoring the role of education in fostering informed parenting knowledge [Table 5]. This aligns with previous research indicating that educated mothers are more likely to access and comprehend information about child development.^3719^ However, it was found that higher levels of academic exposure had a non-significant impact on knowledge of developmental milestones, as well as health and safety, in a neighbouring Arab community.^17^

The other noteworthy finding is the positive association between employment and mothers' knowledge of early developmental care. Generally, employed mothers may have better access to information and resources, possibly through a broader social network that facilitates the exchange of knowledge and experiences related to child development or specific workplace-related programmes.^3031^ Although these findings may be confounded by the mother's education level, which influences their employment status, these observations underscore the need for parental support in the workplace.

This study has several limitations, including the use of convenience sampling, which may not accurately represent the broader Omani population and the potential for self-report bias stemming from socially desirable responses. The cross-sectional design limits causal inference, and the KIDI tool may not fully capture culturally relevant parental knowledge. Additionally, a significant limitation of this study is that a greater proportion of respondents had higher educational levels compared to those with less than a high school education. This imbalance may have influenced the results and could limit the generalisability of the findings. Future research should use representative sampling, longitudinal designs and qualitative methods to better understand cultural influences and the roles of fathers and extended family members in child development.

5. Conclusion

This study emphasises significant gaps in the knowledge of child development among Omani mothers and underscores the need for targeted educational interventions. Maternal education and employment are key factors linked to better knowledge, indicating that improving educational opportunities and workplace support for mothers could enhance child development outcomes. To promote optimal child development in Oman, it is essential to address cultural misconceptions and provide accessible resources for all mothers. By tailoring interventions to address these gaps and rectify misconceptions, healthcare providers, educators and policymakers can support parents in their crucial role of fostering the healthy development of their children. This, in turn, can contribute to the well-being and future success of the next generation.

Authors' Contribution

Watfa Al-Mamari: Conceptualization, Methodology, Formal Analysis. Ahmed B. Idris: Conceptualization, Methodology, Investigation, Data Curation, Formal Analysis, Writing – Original Draft. Saquib Jalees: Writing – Original Draft. Muna Al-Jabri: Investigation, Data Curation. Mohammed A. Mirghani: Investigation, Data Curation. Dina Al Khalili: Formal Analysis. Asila Al Yarubi: Investigation, Data Curation. Jamana Al Zadjali: Investigation, Data Curation. Zahra Al Lawati: Investigation, Data Curation. Ayat Al Lawati: Investigation, Data Curation. Ahmed Al Saidi: Writing – Original Draft. Kamila Al Alawi: Formal Analysis. Sathiya Murthi: Formal Analysis. Wafa S. Al-Maamari: Formal Analysis, Writing – Original Draft.

Acknowledgement

The authors gratefully acknowledge Dr. Khaled Alkherainej from Kuwait University for providing the Arabic version of the Knowledge of Infant Development Inventory (KIDI). This work would not have been possible without the financial and logistical support of the Al Jisr Foundation.

Ethics Statement

Ethical approval for this study was obtained from the Medical Research Ethics Committee at the College of Medicine and Health Sciences, Sultan Qaboos University, Oman (MREC #2959). Informed consent was obtained from those who agreed to participate.

Conflict of Interest

The authors declare that there are no conflicts of interest.

Funding

This research received generous funding from AL Jisr Foundation, which is a non-profit organisation registered under the Ministry of Social Development in Oman and has its registered office at PO Box 332, Postal Code 118 Al Harthy Complex Muscat, Oman, website: www.aljisrfoundation.org.

Data Availability Statement

Data are available upon reasonable request from the corresponding author.