The Relationship of Family Communication Pattern with Adolescents’ Assertiveness

article information

Modern Care Journal: Vol.14, issue 4; e66696
published online: October 28, 2017
article type: Research Article
received: August 28, 2017
revised: September 15, 2017
accepted: September 28, 2017
DOI: https://doi.org/10.5812/modernc.66696
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The Relationship of Family Communication Pattern with Adolescents’ Assertiveness

authors:

avatar Samaneh Nakhaee ORCID 1 , avatar Seyyed Abolfazl Vagharseyyedin 2 , avatar Ehsan Afkar 3 , avatar Maryam Salmani Mood 2 , *

Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
Faculty of Nursing and Midwifery, Birjand University of Medical Sciences, Birjand, Iran
Deputy of Research & Technology, Birjand University of Medical sciences, Birjand, Iran

how to cite: Nakhaee S, Vagharseyyedin S A, Afkar E, Salmani Mood M. The Relationship of Family Communication Pattern with Adolescents’ Assertiveness. Mod Care J. 2017;14(4):e66696. https://doi.org/10.5812/modernc.66696.

Abstract

Background:

Adolescence is among the most critical stages of life, during which assertiveness starts to develop. Parents and their communication patterns have significant roles in adolescents’ successful transition to adulthood. The present study aimed to examine the relationship of family communication patterns with adolescents’ assertiveness.

Methods:

This descriptive - analytical study was conducted on 400 high - school students in Birjand, Iran. Students were selected via multistage random sampling. A demographic questionnaire, the 26 - item Revised Family Communication Patterns, and the 30 - item Rathus Assertiveness Schedule were employed for data collection. The SPSS software (v. 16) was used to analyze the data by conducting the one - way analysis of variance, the Chi - square test, and the stepwise multivariate regression at a significance level of less than 0.05.

Results:

The most and the least common family communication patterns among participants were pluralistic (73 students, 28.1%) and protective (58 students, 22.3%) patterns, respectively. Students with pluralistic family communication patterns obtained significantly higher assertiveness scores than those with laissez - faire (P < 0.001) and protective (P = 0.004) patterns. The conversation orientation dimension of family communication pattern explained 9% of the total variance of students’ assertiveness.

Conclusions:

The conversation orientation dimension of family communication pattern is a significant predictor of adolescents’ assertiveness. Parents can increase their adolescents’ assertiveness through creating a more hospitable and open atmosphere in their families and encouraging adolescents to express and discuss their ideas and feelings.

1. Background

Adolescence is among the most critical stages of life. The most striking characteristics of adolescence are independence seeking and peer relations (1, 2). Peers have considerable effects on adolescents’ behaviors and hence, adolescents are at great risk for unhealthy lifestyle habits, high - risk behaviors, social deviance, identity crisis, emotional disorders, and familial and occupational problems (3, 4).

Assertiveness can protect adolescents against peer pressure and health threats (5). It is the ability to fight for personal rights and express thoughts, feelings, and beliefs appropriately, directly, and honestly, without infringing others’ rights (6-8). Assertive adolescents respect themselves and others, are not passive, do not allow others to misuse their abilities, and have stronger social support. Conversely, unassertive adolescents may be passive or aggressive (4). Assertiveness is closely correlated with unhealthy behaviors (such as cigarette smoking and drug abuse), self - esteem, self - confidence, academic failure, and anxiety, particularly academic anxiety (6, 9). Parents usually recommend their adolescents to use social assertiveness in order to moderate the negative effects of peers (10, 11). Assertiveness can also improve the self - efficacy of the adolescent (12) and thereby, positively affects their self - esteem and self-confidence (10, 12), interpersonal relationships, personality, and internal control (10).

Assertiveness is affected by genetic, personality, and environment. In other words, it is both a personality characteristic and an acquired social ability, which can be improved over time. Family is the most basic factor behind assertiveness development. It is the most accessible source of information, which helps individuals learn social interactions (13). It can facilitate socialization and physical and mental development. Moreover, family communications have significant roles in the development of adolescents’ personality characteristics and behaviors (14). Therefore, family studies can help obtain a better understanding about its members (15).

Interpersonal communication between parents and children, called family communication, is the basis for children’s emotional development. Family communication helps children learn how to communicate with others, interpret their behaviors, and experience different feelings. The 2 key dimensions of family communication patterns (FCPs) are conversation orientation and conformity orientation (16). Conversation orientation means that family members have constant and self - motivated interactions with each other, while conformity orientation refers to the homogeneity of family members’ attitudes, values, and beliefs as well as children obedience to their parents and older family members (17). The different interactions of conversation orientation and conformity orientation create the following 4 types of FCPs or 4 types of families:

  1. Consensual families: These families have high conversation orientation and high conformity orientation. Parents in these families are deeply interested in their children and their opinions, but are the ultimate decision makers.

  2. Pluralistic families: These families have high conversation orientation and low conformity orientation. Parents in these families tend to accept their children’s attitudes and opinions and allow them equally participate in decision making.

  3. Protective families: These families are characterized by low conversation orientation and high conformity orientation. Parents in protective families believe that they should make all decisions for their families and children.

  4. Laissez - faire families: These families have both low conversation orientation and low conformity orientation. In these families, parents have little, if any, communications with their children and allow them to make their own decisions (17, 18).

In protective and laissez - faire families, conversation orientation is very low and therefore, children are at risk for different threats (18). Moreover, in laissez - faire families, there is no investment on children’s decision - making and therefore, they are in a state of emotional divorce. On the other hand, pluralistic families encourage children to engage in decision-making and therefore, conformity orientation in these families is low (19).

FCP significantly affects the different aspects of family members’ personality characteristics (20). For instance, it may indirectly contribute to the formation of assertiveness among adolescents, so that adolescents in pluralistic and consensual families are more assertive than their counterparts in laissez - faire and protective families (13, 20). Some studies also showed a significant correlation between childrearing styles and students’ assertiveness (21, 22).

Despite the importance of assertiveness in adolescence, our literature search (in online databases such as PubMed, Sciencedirect, Magiran, SID, and EMBASE) showed that there is limited information about the roles of FCP in Iranian adolescents’ assertiveness. Therefore, the present study aimed to examine the relationship of FCP with adolescents’ assertiveness.

2. Methods

This was a descriptive - analytical study. The study population included all high - school students in Birjand, Iran. A random sample of 400 students was selected via multistage random sampling in the following steps. First, a list of all high schools in Birjand city was created and the city was divided into the 4 regions of north, east, west, and south. After that, the lists of all high schools in each region were created and 1 boys’ and 1 girls’ school were randomly selected from each region. Finally, one class was selected from each educational grade in each school (3 classes in total) and 17 students were selected from each class through simple random sampling. The sample size was calculated using the results of a study by Seyyed - Fatemi et al. (2008), which reported a standard deviation of 20.75 (23). Therefore, with a type I error of 0.05 and a d of 1/10 of standard deviation, 396 students were estimated to be necessary. The selection criteria included agreement to participate in the study, living with both parents, and no history of mental disorders or drug abuse among parents. Recruited students were informed about the aim of the study and were ensured of the confidential handling of their information. Then, informed consent was obtained from them and they were asked to complete the study questionnaires.

A total of 3 instruments were used for data collection. The 1st instrument was a demographic questionnaire with items such as age, gender, educational grade, and place of residence, as well as parents’ employment and educational status. The 2nd instrument was the Revised Family Communication Patterns (RFCP). As a self-administered questionnaire, RFCP was developed in 2002 by Koerner and Fitzpatrick. It assesses FCP and contains 26 items on conversation orientation (15 items) and conformity orientation (11 items). Each item is scored from 1 (“Completely disagree”) to 5 (“Completely agree”). In order to determine the most common FCPs among students, conversation and conformity orientation scores, which fell between the 41 and the 60 percentiles were excluded and the scores between the 1st and the 40 percentiles were considered as the low conversation or conformity group, while the scores between the 61 to the last percentile were considered as the high conversation or conformity group. After that, FCPs were determined through the interaction of the groups of the dimensions (18). Students with high conversation and conformity orientation, high conversation orientation and low conformity orientation, low conversation orientation and high conformity orientation, and low conversation and conformity orientation were respectively classified into consensual, pluralistic, protective, and laissez - faire families. The Cronbach’s alpha values of the conversation orientation and the conformity orientation of the original RFCP were 0.89 and 0.79, respectively (19). These values for the Persian RFCP were 0.87 and 0.81 (24), respectively. Moreover, these values in the present study were 0.93 and 0.78, respectively. The 3rd instrument used in this study was the 30 - item Rathus Assertiveness Schedule (RAS). The possible responses to RAS items include “Very much like me” (scored 3), “Rather like me” (scored 2), “Slightly like me” (1), “Slightly unlike me” (scored -1), “Rather unlike me” (scored -2), and “Very much unlike me” (scored -3). Therefore, the total score of RAS can range from 90 to -90. Higher positive scores stand for higher assertiveness. The inter - item correlation coefficient of the original RAS was 0.78 (25) and the 2 - week test - retest correlation coefficient of the Persian RAS was 0.83 (12). Moreover, the Cronbach’s alpha of RAS in the present study was 0.83.

Data analysis was carried out through the SPSS software (v. 16) and by conducting the one - way analysis of variance, the Chi - square test, and the stepwise multivariate regression at a significance level of less than 0.05. Data were described using the measures of descriptive statistics such as absolute and relative frequencies, mean, and standard deviation.

3. Results

A total of 400 students participated in this study. Their age was 16.03 ± 0.8, on average. They were mostly the first child of their families (34%) and lived in urban areas (69.25%). Most of their fathers and mothers held a high - school diploma (40.25% and 41.75%, respectively). Moreover, 35.25% of fathers were self - employed and 77% of mothers were housewives (Table 1).

The mean scores of conversation and conformity orientation were 46.7 ± 14.03 and 31.02 ± 8.5, respectively. The most to least common FCPs in students’ families were respectively pluralistic (73 students, 28.1%), consensual (69 students, 26.5%), laissez - faire (60 students, 23.1%), and protective (58 students, 22.3%).

FCP was significantly correlated with students’ gender, educational grade, and age as well as with their fathers’ and mothers’ educational and employment status (P < 0.05). Accordingly, the most common FCPs in the families of female and male students were pluralistic and consensual patterns, respectively (P = 0.007). Moreover, the most common FCPs reported by 1st -, 2nd -, and 3rd - year students were laissez - faire, pluralistic, and consensual patterns, respectively (P = 0.007). On the other hand, the most common FCPs among 15 -, 16 -, and 17 - year - old students were protective, pluralistic, and consensual patterns, respectively (P = 0.031). Besides, the laissez - faire pattern was the most common FCP in the families of students whose mothers or fathers were illiterate (P < 0.05). Finally, students whose fathers were laborers reported that the most common FCP in their families was the laissez-faire pattern (P < 0.001), while the most common FCP in the families of students whose mothers were laborers was the protective pattern (P = 0.014). Table 1 shows the frequency distributions of FCPs based on students’ and their parents’ characteristics.

Table 1.

FCPs Based on Participants’ and Their Parents’ Demographic Characteristics

CharacteristicsFCPs
PluralisticConsensualProtectiveLaissez - faireP Value
N%N%N%N%
GenderP = 0.007
Female48353022.123163525
Male2520393135282520
Educational gradeP = 0.007
First - year1818181828293132
Second - year3034252817191517
Third - year2532.1263313161417
Age (Years)P = 0.031
151720.216192833.32327.4
162934.52428.61315.51821.4
172729.32931.51718.51920.7
Place of residenceP = 0.548
Urban areas5429.25228.14021.63921.1
Rural areas1925.31722.718242128
Type of residenceP = 0.760
With parents6229.55526.24621.94722.4
In dormitory1122142812241326
Father’s educational statusP = 0.000
Illiterate102112256121940
Diploma3128282525232422
Associate825929825619
Bachelor’s142817341122816
Master’s and higher1041312833312
Mothers’ educational statusP = 0.008
Illiterate1823.11823.114172835
Diploma3026322825222623
Associate94041883614
Bachelor’s10271540821410
Master’s and higher66000330110
Father’s employment statusP = 0.000
Self - employed2626242420202727
Laborer4164166241144
Employee2532222820251012
Farmer731836313418
Military staff525840210525
Other63731863716
Mother’s employment statusP = 0.014
Laborer110220440330
Employee1227.91637.21227.937
Housewife5528.15025.53718.95427.6
Other545.519.1545.500

The mean score of assertiveness was 1.5 ± 16.2. Students’ assertiveness was not significantly correlated with their and their parents’ demographic characteristics (P > 0.05). The results of the one-way analysis of variance illustrated that students with different FCPs differed significantly from each other respecting their assertiveness mean scores (P = 0.002; Table 2). The Least Significant Difference post hoc test showed that students with pluralistic FCP obtained significantly higher assertiveness scores than those with laissez - faire FCP (P < 0.001) and protective FCP (P = 0.004).

Table 2.

Comparing Adolescents’ Assertiveness Based on Their FCPs

FCPsAssertiveness
N%Mean ± SDP Value
Laissez - faire6023.1%-3.17 ± 14.7P = 0.002
Pluralistic7328.1%6.8 ± 14.2
Protective5822.3%-1.2 ± 20.3
Consensual6926.5%2.04 ± 13.9

Correlation analysis indicated that students’ assertiveness was significantly correlated only with the conversation orientation dimension of FCP (r = 0.291; P < 0.001). Stepwise regression analysis also revealed that the conversation orientation dimension of FCP explained 9% of the total variance of students’ assertiveness (P < 0.001; Table 3).

Table 3.

Prediction of Assertiveness Based on the Dimensions of FCP

PredictorsB StatisticBetatP ValueRAdjusted R SquareFP Value
Constant- 14.21-- 4.24> 0.0010.290.08523.93>.0.001
Conversation orientation0.3360.2914.89> 0.001

4. Discussion

This study aimed to examine the relationship of FCP with adolescents’ assertiveness. The most and the least common FCPs among participants were pluralistic and protective patterns, respectively. In other words, conversation orientation was high in most families of our participants. In line with our findings, 3 previous studies on adolescents reported pluralistic patterns as the most common FCP in their families (18, 24, 26).

Study findings also showed that adolescents with pluralistic FCP had significantly higher assertiveness scores than those with laissez - faire and protective FCPs. Moreover, the conversation orientation dimension of FCP was significantly correlated with assertiveness. Similarly, an earlier study reported that students with pluralistic FCP were more assertive than those with laissez - faire FCP (20). Another study showed that the democratic childrearing style was associated with greater assertiveness, while the autocratic style was associated with lower assertiveness among students (21). Children in families with high control and low kindness usually have low assertiveness and vice versa (22). Conversation orientation was also reported to be positively correlated with self-esteem and the source of internal control among adolescents (16), while high self - esteem and self - concept, in turn, can improve assertiveness (27). Therefore, conversation orientation can improve adolescents’ assertiveness due to the fact that families with high conversation orientation involve adolescents in decision - making and thereby, provide them with self - expression opportunity. Unlike our findings, a study reported that autocratic childrearing style among African Americans was associated with higher assertiveness and independence among female adolescents (28).

Our findings also indicated that the most common FCPs among male and female students were consensual and pluralistic patterns, respectively. In other words, conformity orientation among the families of male students was higher than the families of female students. Similarly, an earlier study showed stronger emotional relationships between parents and female children (29). However, in contradiction with our findings, a study showed the higher prevalence of conversation orientation among male adolescents (18). Such a contradiction can be due to the fact that different factors such as culture, self - esteem, depression, and gender can affect assertiveness (30).

Study findings also indicated that most participants whose fathers or mothers were illiterate reported laissez - faire FCP in their families, while most participants whose fathers or mothers were laborers reported, respectively, laissez - faire or protective FCPs in their families. These findings highlight the effects of culture and social class on FCP. We also found that the most common FCPs in the families of 1st -, 2nd -, and 3rd - year students were laissez - faire, pluralistic, and consensual patterns, respectively. In other words, conversation orientation was less prevalent in the families of 1st - year students. It seems that when adolescents enter a new educational level (for example from primary school to guidance school), their families move towards higher conformity orientation in order to protect them against potential problems and threats.

Another finding of the study was the insignificant difference between male and female participants respecting their assertiveness, denoting the insignificant effect of gender on adolescents’ assertiveness. Two earlier studies also reported the same finding (23, 31). However, some studies showed higher assertiveness among male adolescents (30, 32) while another study reported higher assertiveness among female adolescents (8). These contradictions may be due to the differences among the studies respecting their samples, sampling methods, sample sizes, assertiveness measurement tools, and cultural contexts.

Study findings also revealed an insignificant relationship between adolescents’ assertiveness and their parents’ educational status. This finding was in agreement with the findings of a previous study (31). However, another study reported the significant relationship of adolescents’ assertiveness with parents’ educational status (12). This contradiction may be due to differences in the educational grades or other characteristics of participants in these studies. We also found that adolescents’ assertiveness was not significantly correlated with their age. An earlier study reported the same finding (12). Conversely, 2 other studies reported significantly higher assertiveness among older adolescents probably because of their greater ability to establish interpersonal and social relationships and greater self - confidence (33, 34).

Finally, study findings indicated that only 9% of the total variance of adolescents’ assertiveness was explained by the conversation orientation dimension of FCP. Apparently, different overt and covert factors can affect adolescents’ assertiveness. Assessment of these factors and determination of their contributions to the variance of assertiveness can be areas of investigation in future studies.

4.1. Conclusion

The conversation orientation dimension of FCP is a significant predictor of adolescents’ assertiveness. Parents can increase their adolescents’ assertiveness through creating a more hospitable and open atmosphere in their families and encouraging adolescents to express and discuss their ideas and feelings. Adolescent affairs organizations and authorities, particularly the Department of Education, are recommended to provide parents with adequate information about the effects of FCP on adolescents’ assertiveness.

Acknowledgements

References

  • 1.

    McKay MT. Parental rules, parent and peer attachment, and adolescent drinking behaviors. Subst Use Misuse. 2015;50(2):184-8. [PubMed ID: 25295597]. https://doi.org/10.3109/10826084.2014.962053.

  • 2.

    Epstein JA, Botvin GJ. The moderating role of risk-taking tendency and refusal assertiveness on social influences in alcohol use among inner-city adolescents. J Stud Alcohol. 2002;63(4):456-9. [PubMed ID: 12160104].

  • 3.

    Richmond MJ, Mermelstein RJ, Metzger A. Heterogeneous friendship affiliation, problem behaviors, and emotional outcomes among high-risk adolescents. Prev Sci. 2012;13(3):267-77. [PubMed ID: 22207411]. https://doi.org/10.1007/s11121-011-0261-2.

  • 4.

    Eslami AA, Rabiei L, Afzali SM, Hamidizadeh S, Masoudi R. The Effectiveness of Assertiveness Training on the Levels of Stress, Anxiety, and Depression of High School Students. Iran Red Crescent Med J. 2016;18(1). e21096. [PubMed ID: 26889390]. https://doi.org/10.5812/ircmj.21096.

  • 5.

    Khademi Mofrad SH, Mehrabi T. The role of self-efficacy and assertiveness in aggression among high-school students in Isfahan. J Med Life. 2015;8(Spec Iss 4):225-31. [PubMed ID: 28316736].

  • 6.

    Olanrewaju AK. Comparative Effectiveness of Self-Management, Emotional Intelligence and Assertiveness Training Programs in Reducing the Potentials for Terrorism and Violence among Nigerian Adolescents. Int J Appl Psychol. 2014;4(6):214-22.

  • 7.

    Hojjat SK, Golmakani E, Norozi Khalili M, Shakeri Chenarani M, Hamidi M, Akaberi A, et al. The Effectiveness of Group Assertiveness Training on Happiness in Rural Adolescent Females With Substance Abusing Parents. Glob J Health Sci. 2015;8(2):156-64. [PubMed ID: 26383218]. https://doi.org/10.5539/gjhs.v8n2p156.

  • 8.

    Korem A, Horenczyk G, Tatar M. Inter-group and intra-group assertiveness: adolescents' social skills following cultural transition. J Adolesc. 2012;35(4):855-62. [PubMed ID: 22209662]. https://doi.org/10.1016/j.adolescence.2011.12.002.

  • 9.

    Goldsmith JB, McFall RM. Development and evaluation of an interpersonal skill-training program for psychiatric inpatients. J Abnorm Psychol. 1975;84(1):51-8. [PubMed ID: 1110273].

  • 10.

    Shimizu T, Kubota S, Mishima N, Nagata S. Relationship between self-esteem and assertiveness training among Japanese hospital nurses. J Occup Health. 2004;46(4):296-8. [PubMed ID: 15308829].

  • 11.

    Onuoha FN, Munakata T. Correlates of adolescent assertiveness with HIV avoidance in a four-nation sample. Adolescence. 2005;40(159):525-32. [PubMed ID: 16268131].

  • 12.

    Mohebbi S, Shahsiah M, Moshki M, Delshad A, Matlabi M. The effect of teaching courageousness based on PRECEDE model on the assertiveness of high school adolescents in Gonabad [In Persian]. J Res Health. 2011;1:45-53.

  • 13.

    Porreco A. It’s your family, I assert you: the role of family communication patterns in determining differences in assertive communication. University of Delaware; 2010.

  • 14.

    Farahati M, Fathi-Ashtiani A, Moradi A. Relationship between family communication patterns and locus of control and self-esteem in adolescents. Int J Behav Sci. 2011;5(3):279-85.

  • 15.

    Keshtkaran T. The Relationship Between Family Communication Pattern Whith Resiliency Among Students of Shiraz University. Know Res App Psychol. 2009;11(39):43-53.

  • 16.

    Dehghani Zadeh MH, Hosein-chari M. The academic Vitality and perception of family communication patterns: the mediating role of self-efficacy. J Teach Learn Stud. 2010;4(2):21-48.

  • 17.

    Wittenberg-Lyles E, Goldsmith J, Demiris G, Oliver DP, Stone J. The Impact of Family Communication Patterns on Hospice Family Caregivers: A New Typology. J Hosp Palliat Nurs. 2012;14(1):25-33. [PubMed ID: 22308097]. https://doi.org/10.1097/NJH.0b013e318233114b.

  • 18.

    Yang J, Campo S, Ramirez M, Krapfl JR, Cheng G, Peek-Asa C. Family communication patterns and teen drivers' attitudes toward driving safety. J Pediatr Health Care. 2013;27(5):334-41. [PubMed ID: 22361241]. https://doi.org/10.1016/j.pedhc.2012.01.002.

  • 19.

    Koerner AF, Fitzpatrick MA. Toward a theory of family communication. Comm Theor. 2002;12(1):70-91.

  • 20.

    Huang LN. Family communication patterns and personality characteristics. Comm Q. 1999;47(2):230-43. https://doi.org/10.1080/01463379909370136.

  • 21.

    Seyrdowleh G, Barmas H, Asadzadeh H. Comparison of pupils’ social skills and assertiveness with parenting styles. ‏Int J Educ Appl Sci. 2014;1(3):147-52.

  • 22.

    alayi Z, Babaei Zad Khamen A, AhmadiGatab T. Parenting style and Self-Assertiveness: Effects of a Training Program on Self-Assertiveness of Iranian High School Girls. Procedia - Social Behav Sci. 2011;30:1945-50. https://doi.org/10.1016/j.sbspro.2011.10.378.

  • 23.

    Seyyed Fatemi N, Khoshnavaye Foomani F, Behbahani N, Hosseini F. ‏Assertiveness skill and use of Ecstasy among Iranian adolescents. Q J Fundam Mental Health. 1387;10(40):265-72.

  • 24.

    Kouroshnia M, Latifian M. ‏Relationship between dimensions of family communication patterns and children's level of anxiety and depression. J Family Res. 2007;3(10):587-600.

  • 25.

    Rathus SA. A 30-item schedule for assessing assertive behavior. Behav Ther. 1973;4(3):398-406. https://doi.org/10.1016/s0005-7894(73)80120-0.

  • 26.

    Shahraki SF, Navidian A, Ansary MA, Farajy SM. The relationship of family communication patterns on life quality in adolescents. J Family Counseling Psychother. 2011;1(1):101-14.

  • 27.

    Demirbilek M, Otrar M. The Examination of The Assertiveness Levels and Self-Respect of Adolescents with Single Parent and Whole Family. Int Online J Educ Sci. 2014;6(1):1-7. https://doi.org/10.15345/iojes.2014.01.001.

  • 28.

    Zare F, Bakhshipour B, Hassanzadeh R. ‏Parenting style and mental health in Iranian adolescents. J Novel Appl Sci. ‏2014;3(3):274-7.

  • 29.

    Mayseless O, Wiseman H, Hai I. Adolescents' Relationships with Father, Mother, and Same-Gender Friend. J Adolesc Res. 1998;13(1):101-23.

  • 30.

    Sarkova M, Bacikova-Sleskova M, Orosova O, Madarasova Geckova A, Katreniakova Z, Klein D, et al. Associations between assertiveness, psychological well-being, and self-esteem in adolescents. J Appl Soc Psychol. 2013;43(1):147-54. https://doi.org/10.1111/j.1559-1816.2012.00988.x.

  • 31.

    Taghavi Larijani T, Rezayat F, Seyedfatemi N, Mehran A. The effect of the assertiveness training program on nursing students’assertiveness skills. J Nurs Educ. 2013;1(2):42-52.

  • 32.

    Dibaie M. The impact of assertiveness teaching on the job-burn out of nurses in Razi psychiatric teaching center [in Persian]. Tehran: Tehran University of Medical Sciences; 2006.

  • 33.

    Baghani R, Keyghobadi F, Tabaraei Y. Factors affecting nursing and midwifery students' decisiveness in 2013. J Sabzevar Univ Med Sci. 2014;20(5):674-80.

  • 34.

    Parto M. Problem solving, self- efficacy, and mental health in adolescents: Assessing the mediating role of assertiveness. Procedia - Social Behav Sci. 2011;30:644-8. https://doi.org/10.1016/j.sbspro.2011.10.125.