The hospitalization of a child represents a profound crisis that transcends the pediatric patient and challenges the entire family system (Nunes et al., 2024). Family caregivers, typically parents, are abruptly thrust into a high-stress environment where they must navigate multifaceted roles as medical decision-makers, emotional anchors, and care coordinators (Schembari et al., 2024). This transition is characterized by significant physical exhaustion and psychological distress, exacerbated by prognostic uncertainty, challenges in processing medical information, and the disruption of normal family life (Seliner et al., 2016; Shaygan et al., 2025). Consequently, elevated caregiver stress is pervasive, impacting parental well-being and potentially hindering optimal family functioning and pediatric recovery (Zhu et al., 2022).

In response to this recognized familial burden, the paradigm of Family-Centered Care (FCC) has been established as the gold standard in modern pediatrics (Heijboer et al., 2025; O'Connor et al., 2019). FCC principles advocate for the active partnership of families in care, aiming to reduce stress and improve clinical outcomes (Chen et al., 2024; Heijboer et al., 2025). However, the efficacy of FCC is ultimately mediated not by the support offered, but by the support that is subjectively perceived and internalized by caregivers (Phiri et al., 2022). This distinction is critical, as social support theory posits that an individual's perception of support is a more potent predictor of their adaptation and well-being than objectively measured support (Alqarawi & Alhalal, 2024; Delfin et al., 2024). Therefore, Family Perceived Support (FPS)—defined as the caregiver's subjective appraisal of the emotional, informational, and instrumental support received from nursing staff—emerges as the crucial metric for evaluating the true impact of FCC in clinical practice (Sveinbjarnardottir et al., 2012).

A significant gap exists between the ideals of FCC and family-reported experiences (Freudiger et al., 2024), with a notable proportion of caregivers, including over 40% in some Chinese contexts, reporting feelings of isolation and insufficient support (Liang, 2015). This gap underscores the urgent need to investigate the determinants of FPS. Existing literature indicates that FPS is not uniform but varies significantly across comparable care settings, suggesting the influence of a complex array of factors (Bruce et al., 2016; Dieperink et al., 2018). While studies have identified disparate variables—ranging from individual characteristics to cultural contexts—the evidence remains fragmented (Dieperink et al., 2018). Concurrently, a major limitation is the predominant focus on Western healthcare contexts, leaving a critical void in our understanding of how FPS is shaped within distinct cultural and systemic environments like China's (Freudiger et al., 2024). The influence of deeply embedded collectivist values, unique family structures, and the concept of ‘relational ethics’—an interpersonal ethic rooted in familial affection that extends into the public sphere (Li & Liu, 2025)—on support perception is theoretically salient yet remains empirically underexplored (Lu et al., 2024; Zhao & Jin, 2021).

To address these gaps, this study is guided by an integrative theoretical framework synthesizing Social Support Theory and Family Systems Theory (Delfin et al., 2024; Sveinbjarnardottir et al., 2012). We propose that FPS among caregivers of hospitalized children is determined by factors operating at two interconnected levels:

The Interpersonal Level: This encompasses the direct interaction between the caregiver and the healthcare system, primarily through nurse-caregiver communication quality (e.g., clarity, empathy, and involvement in decision-making), and the internal dynamics of the family unit, conceptualized as family system functioning (e.g., cohesion and adaptability) (Delfin et al., 2024; Sveinbjarnardottir et al., 2012).

The Systemic Level: This includes broader structural and contextual factors, such as the availability of external social support (from friends and the community) and controlling variables including the healthcare system, individual characteristics, and disparities in medical resource allocation (Chen & Wang, 2016).

H1:

Higher-quality nurse–caregiver communication and better family functioning are positively associated with FPS.

H2:

Stronger external social support is positively associated with FPS.

Accordingly, this study aimed to examine multi-level factors associated with FPS among caregivers of hospitalized children in China. The specific objectives were to: (1) quantify FPS levels in this cohort and compare them with findings reported in international studies; and (2) empirically test the hypothesized associations (H1 and H2) between FPS and its key interpersonal and systemic determinants.

By systematically examining these factors within China's unique context, this research seeks to generate actionable evidence for developing more effective, culturally sensitive FCC interventions that genuinely enhance the care experience for families facing illness.