Effect of Childbirth Education Program on Maternal Anxiety: A Randomized Controlled Trial Using Roy's Adaptation Model

Authors

  • Endang Koni Suryaningsih Universitas 'Aisyiyah Yogyakarta, Indonesia
  • Meei-Ling Gau Women Health Department, National Taipei University of Nursing and Health Sciences, Taiwan, Taiwan, Province of China https://orcid.org/0000-0001-9685-2598
  • Chien-Huei Kao Women Health Department, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, Province of China https://orcid.org/0000-0002-6642-5349
  • Chieh-Yu Liu Speech Language Pathology and Audiology Department, National Taipei University of Nursing and Health, Taipei, Taiwan, Taiwan, Province of China
  • Su-Yu Kuo Nursing Department, Taipei Medical University, Taiwan, Province of China https://orcid.org/0000-0003-4221-7673
  • Jen-Jiuan Liaw School of Nursing, National Defense Medical Center, Taiwan, Taiwan, Province of China https://orcid.org/0000-0001-7810-3104

DOI:

https://doi.org/10.31101/jhtam.2862

Keywords:

Anxiety, Nursing theory, Childbirth education, Clinical trial,

Abstract

Background: Globally, 5.1 - 37.5 % of mothers suffer from anxiety during pregnancy due to adaptation problems. Childbirth education could enhance knowledge and skills to help mothers prepares to cope with adaptation. However, in Indonesia, the manner program provided following nursing theory as a framework has been absent. Objective: To test the effectiveness of childbirth education program based on Roy's Adaptation Model on maternal anxiety Methods: A randomized controlled trial using a computer random allocation block to allocate participants from five health centers in Yogyakarta has been performed. Pregnant women in the experimental group received a modified childbirth education program in four consecutive weeks comprised of lecturing, counseling, brainstorming, and practicing some essential skills for cope adaptation. A self-developed questionnaire was used to assess the demographic data set, Pregnancy-Related Anxiety Questionnaire-Revised was completed to measure the maternal anxiety during pregnancy. An independent t-test and ANCOVA were used to analyze the data.  Results: A total of 87 pregnant women were analyzed (experimental, n= 52, control, n=35), with a mean age of 23. 92 (SD = 1.89), and 29.14 (SD = 2.10), respectively. After the intervention, the score of maternal anxiety had significantly lower in the experimental group compared with the control group (p < .001). In the T-test analysis, the demographic variables were not related to maternal anxiety. Conclusion: Based on the findings, a modified childbirth education program focus on adaptation change based on nursing theory was effective to decrease maternal anxiety during pregnancy. However, what  the participant perceived in the prenatal education program is one of the salient limitations in this study.

Author Biographies

Endang Koni Suryaningsih, Universitas 'Aisyiyah Yogyakarta

Google Scholar

Chien-Huei Kao, Women Health Department, National Taipei University of Nursing and Health Sciences, Taipei

Women Health Department, National Taipei University of Nursing and Health Sciences, Taiwan

References

Abasi, E., Tahmasebi, H., Zafari, M., Gholamreza, & Takami, N. (2012). Assessment on effective factors of maternal-fetal attachment in pregnant women. Life Science Journal, 9(1 Supplemen.), 68–75. https://doi.org/10.7537/marslsj0901s12.12

Amanak, K., Sevil, U., & Karacam, Z. (2019). The impact of prenatal education based on the roy adaptation model on gestational hypertension, adaptation to pregnancy and pregnancy outcomes. The Journal of the Pakistan Medical Association., 69(1), 11–17.

Andersson, I., Nilsson, S., & Candidate, R. N. (2012). How women who have experienced one or more miscarriages manage their feelings and emotions when they become pregnant again – a qualitative interview study. Scandinavian Journal of Caring Sciences, 4. https://doi.org/10.1111/j.1471-6712.2011.00927.x

Asa, Premberg, & Lundgren. (2016). Fathers’ Experiences of Childbirth Education. The Journal of Perinatal Education, 15(2), 21–28. https://doi.org/10.1624/105812406X107780

Bastani, F., Hidarnja, A., MOntgomery, K., Aguilar-Vafaei, M., & Kazemnejad, A. (2006). Does Relaxation Education in Anxious Primigravid Iranian Women Influence Adverse Pregnancy Outcomes? Journal Perinatal and Neonatal Nursing, 20(2), 138–146.

Baxter, R., Hastings, N., Law, A., & Glass, E. J. . (2008). Postpartum depression and sleep loss in first time mothers (Vol. 39, Issue 5). University of California, San Fransisco.

Bayrampour, H., Ali, E., McNeil, D. A., Benzies, K., MacQueen, G., & Tough, S. (2016). Pregnancy-related anxiety: A concept analysis. International Journal of Nursing Studies, 55, 115–130. https://doi.org/10.1016/j.ijnurstu.2015.10.023

Berthelot, N., Lemieux, R., Garon-Bissonnette, J., Drouin-Maziade, C., Martel, É., & Maziade, M. (2020). Uptrend in distress and psychiatric symptomatology in pregnant women during the coronavirus disease 2019 pandemic. Acta Obstetricia et Gynecologica Scandinavica, 99(7), 848–855. https://doi.org/10.1111/aogs.13925

Buss, Davis, Hobel, & Sandman. (2011). Maternal pregnancy-specific anxiety is associated with child executive function at 6–9 years age. Scholar Research Library, 14(6), 665–676.

Chang, Yu, & Chen. (2015). The effects of music listening on psychosocial stress and maternal-fetal attachment during pregnancy. Complement Ther Med, 23(4), 509–515.

Clemens, S. W., & Virginia, W. (2014). Exploring the Components of Prenatal Anxiety Exploring the Components of Prenatal Anxiety Department of Psychology. West Virginia University.

Comaskey, B., Roos, N. P., Brownell, M., Enns, M. W., Chateau, D., Ruth, C. A., & Ekuma, O. (2017). Maternal depression and anxiety disorders (MDAD) and child development: A Manitoba population-based study. 12(5). https://doi.org/10.1371/journal.pone.0177065

Deklava, L., Lubina, K., Circenis, K., Sudraba, V., & Millere, I. (2015). Causes of anxiety during pregnancy. Procedia - Social and Behavioral Sciences, 205(May), 623–626. https://doi.org/10.1016/j.sbspro.2015.09.097

Eugenie, & Napitupulu. (2014). The Positive Effect of Prenatal Education Class on Childbirth-Self Efficacy Anxiety among Primigravida. J Ilmu Dan Teknol Kesehat., 1(2), 149–155.

Fawcet, J. (2006). The roy adaptation model and content analysis. Revista Aquichan, 6(6), 34–37.

Fishell, A. (2010). Depression and anxiety in pregnancy. Journal of Population Therapeutics and Clinical Pharmacology = Journal de La Therapeutique Des Populations et de La Pharamcologie Clinique, 17(3), e363-9.

Funder, & Ozer. (2020). Corrigendum: Evaluating Effect Size in Psychological Research: Sense and Nonsense Evaluating Effect Size in Psychological Research: Sense and Nonsense. Adv Methods Pract Psychol Sci., 2(1), 156–168.

Furber, C. M., Garrod, D., Maloney, E., Lovell, K., & Mcgowan, L. (2009). A qualitative study of mild to moderate psychological distress during pregnancy. International Journal of Nursing Studies, 46, 669–677. https://doi.org/10.1016/j.ijnurstu.2008.12.003

Ghaedrahmati, M., Kazemi, A., Kheirabadi, G., Bahrami, M., & Ebrahimi, A. (2018). Examining the relationship between mothers’ prenatal mental health and demographic factors with postpartum depression. Journal of Education & Health Promotion, 7, 146.

Goodman, Guarino, Chenausky, Klein, Prager, & Petersen. (2014). CALM Pregnancy: results of a pilot study of mindfulness-based cognitive therapy for perinatal anxiety. Arch Womens Ment Health., 17(5), 373–387.

Goodman, J. H., Guarino, A., Chenausky, K., Klein, L., Prager, J., Petersen, R., Forget, A., & Freeman, M. (2014). CALM Pregnancy: results of a pilot study of mindfulness-based cognitive therapy for perinatal anxiety. Archives of Women’s Mental Health, 17(5), 373–387. https://doi.org/10.1007/s00737-013-0402-7

Gourounti, K., Anagnostopoulos, F., & Lykeridou, K. (2013). Coping strategies as psychological risk factor for antenatal anxiety , worries , and depression among Greek women. Archives of Women’s Mental Health, 16, 353–361. https://doi.org/10.1007/s00737-013-0338-y

Harpel, T. S. (2008). Fear of the unknown: ultrasound and anxiety about fetal health. An Interdiciplinary Journal for the Social Study of Health, Illness and Medicine, 12(3), 295–312. https://doi.org/10.1177/1363459308090050

Holden, S. C., Manor, B., Zhou, J., Zera, C., Davis, R. B., & Yeh, G. Y. (2019). Prenatal Yoga for Back Pain, Balance, and Maternal Wellness: A Randomized, Controlled Pilot Study. Global Advances in Health and Medicine, 8, 216495611987098. https://doi.org/10.1177/2164956119870984

Huizink, A. C., Mulder, E. J., Robles de Medina, P. G., Visser, G. H., & Buitelaar, J. K. (2004). Is pregnancy anxiety a distinctive syndrome? Early Human Development, 79, 81–91. https://doi.org/https://doi.org/https://doi.org/10.1016/j.earlhumdev.2004.04.014

Isbir, G. G., & Mete, S. (2010). Nursing care of nausea and vomiting in pregnancy: Roy adaptation model. Nursing Science Quarterly, 23(2), 148–155. https://doi.org/doi:http://dx.doi.org/10.1177/0894318410362489

Jamalzehi, A., Omeidi, K., Javadi, M., & Dashipour, A. (2017). Evaluation of Sleep Quality in Third Trimester of Pregnancy and Its Relation to Birth Characteristics in Women Referred to Gynecology Clinic of Tamin Ejtemaee Hospital of Zahedan. In Scholar Research Library (Vol. 9, Issue 2).

Jiang, Li, Wang, & Wang. (2016). The Relationship between Constitution of Traditional Chinese Medicine in the First Trimester and Pregnancy Symptoms: A Longitudinal Observational Study. In Evidence-Based Complement Altern Med.

Kahyaoglu Sut, H., & Kucukkaya, B. (2020). Anxiety, depression, and related factors in pregnant women during the COVID-19 pandemic in Turkey: A web-based cross-sectional study. Perspectives in Psychiatric Care, September. https://doi.org/10.1111/ppc.12627

Kristianingsih, & Suryanti. (2019). Relationship between Prenatal Education Participation and Labor-related. J Kesehat Masy Mulawarman., 1(2), 64–72.

Larsen, R., & Plog, M. (2012). The Effectiveness of Childbirth Classes for Increasing Self-Efficacy in Women and Support Persons. International Journal of Childbirth, 2(2), 107–115. https://doi.org/https://doi.org/10.1891/2156-5287.2.2.107

Lestari, Putri, & Listyaningsih. (2019). Effect of Prenatal Yoga and Pregnancy Exercise on the Anxiety Level and First Stage of Labor Duration among Primigravida . Indones J Midwifery., 7(2), 72–78.

Lewis, S., Lee, A., & Simkhada, P. (2015). The role of husbands in maternal health and safe childbirth in rural Nepal: A qualitative study. BMC Pregnancy and Childbirth, 15(1). https://doi.org/10.1186/s12884-015-0599-8

Lorenc, T., Petticrew, M., Whitehead, M., Neary, D., Clayton, S., Wright, K., Thomson, H., Cummins, S., Sowden, A., & Renton, A. (2014). Crime, fear of crime and mental health: synthesis of theory and systematic reviews of interventions and qualitative evidence. Public Health Research, 2(2), 1–398. https://doi.org/10.3310/phr02020

Madhavanprabhakaran, G. K., D’Souza, M. S., & Nairy, K. S. (2015). Prevalence of pregnancy anxiety and associated factors. International Journal of Africa Nursing Sciences, 3, 1–7. https://doi.org/10.1016/j.ijans.2015.06.002

Maxson, Edwards, Valentiner, & Miranda. (2016). A Multidimensional Approach to Characterizing Psychosocial Health During Pregnancy. Matern Child Health J. 2016;20(6):, 20(6), 1103–1113.

Naharani, Siswati, & Fatkiyah. (2018). The Relationship between Participation Behavior and Childbirth Self-efficacy-r. J SIKLUS, 7(1), 300–306.

O’Donnell, A., McParlin, C., Robson, S. C., Beyer, F., Moloney, E., Bryant, A., Bradley, J., Muirhead, C., Nelson-Piercy, C., Newbury-Birch, D., Norman, J., Simpson, E., Swallow, B., Yates, L., & Vale, L. (2016). Treatments for hyperemesis gravidarum and nausea and vomiting in pregnancy: A systematic review and economic assessment. Health Technology Assessment, 20(74), vii–268. https://doi.org/10.3310/HTA20740

O’Donnell, K. J., Bugge, A., Freeman, L., Khalife, N., Connor, T. G. O., & Glover, V. (2012). Maternal prenatal anxiety and downregulation of placental 11 b -HSD2. Psychoneuroendocrinology, 37(6), 818–826. https://doi.org/10.1016/j.psyneuen.2011.09.014

Rasouli, Pourheidari, & . G. (2019). Effect of Self ‑ care Before and During Pregnancy to Prevention and Control Preeclampsia in High ‑ risk Women. In Int Journa Prev Med.

Roomruangwong, C., & Epperson, C. N. (2011). Perinatal depression in Asian women: prevalence , associated factors , and cultural aspects. Asian Biomedicine, 5(April), 179–193. https://doi.org/10.5372/1905-7415.0502.024

Roy. (2009). The Roy Adaptation Model (3rd ed.). NJ: Pearson Education, Inc.

Saghaei, M. (2004). Random allocation software for parallel group randomized trials. BMC Medical Research Methodology, 6(4), 1–6. https://doi.org/10.1186/1471-2288-4-26

Sercekus, P., & Mete, S. (2010). Effects of antenatal education on maternal prenatal and postpartum adaptation. Journal of Advanced Nursing, 999–1010. https://doi.org/10.1111/j.1365-2648.2009.05253.x

Skouteris, H., Wertheim, E. H., Rallis, S., Milgrom, J., & Paxton, S. J. (2009). Depression and anxiety through pregnancy and the early postpartum: An examination of prospective relationships. Journal of Affective Disorders, 113(3), 303–308. https://doi.org/10.1016/j.jad.2008.06.002

Sumiyarsi, Nugraheni, Mulyani, & Cahyanto. (2018). Factors Affecting Hemoglobin in Third Trimester Pregnant Women. Placentum: Jurnal Ilmiah Kesehatan Dan Aplikasinya, 6(2), 22. https://doi.org/10.20961/Placentum.V6i2.22836

Tragea, Chrousos, Alexopoulos, & Darviri. (2014). A randomized controlled trial of the effects of a stress management programme during pregnancy. Complement Ther Med [Internet]., 22(2), 203–211.

Wenzel, A. (2011). Anxiety in childbearing women: diagnosis and treatment. American Psychological Association. https://doi.org/http://dx.doi.org/10.1037/12302-000

Yikar, S. K. (2019). Effects of prenatal education on complaints during pregnancy and on quality of life. Patient Education and Counseling, 102, 119–125. https://doi.org/10.1016/j.pec.2018.08.023

Yuksel, F., Akin, S., & Durna, Z. (2013). Prenatal distress in Turkish pregnant women and factors associated with maternal prenatal distress. 1, 54–64. https://doi.org/10.1111/j.1365-2702.2012.04283.x

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Published

2023-05-16

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Suryaningsih, E. K., Gau, M.-L., Kao, C.-H., Liu, C.-Y., Kuo, S.-Y., & Liaw, J.-J. (2023). Effect of Childbirth Education Program on Maternal Anxiety: A Randomized Controlled Trial Using Roy’s Adaptation Model. Journal of Health Technology Assessment in Midwifery, 6(1), 36–48. https://doi.org/10.31101/jhtam.2862

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Vol. 6 No. 1 (2023): May

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Copyright (c) 2023 Endang Koni Suryaningsih, Meei-Ling Gau, Chien-Huei Kao, Chieh-Yu Liu, Su-Yu Kuo, Jen-Jiuan Liaw

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