@2024 Afarand., IRAN

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ISSN: 2252-0805    The Horizon of Medical Sciences 2018;24(1):41-46

Background
Although the maternal process is a pleasurable and evolutionary process of women`s life, it can also be with anxiety as a result of physical and mental changes [1, 2], so that some researchers consider pregnancy as a kind of women`s life crisis and state that pregnancy may be anxious for some women [3, 4].
Previous Studies
… [5-7]. Lee et al. reported that anxiety gradually increases over the entire length of pregnancy, especially with the advent of late pregnancy in women [4]. Counseling and education by nursing staff is one of the interventions that have been suggested as anxiety prevention in pregnancy and postpartum [8]. One component of patient-centered and community-based nursing patterns is self-care. … [9, 10]. One of the important patterns that can help the patient to take care of herself and build on their individual abilities and their needs for self-care is Orem`s self-care model, which deals with self-care issues [11]. … [12. 13]. Scottef et al. examined the effect of pregnancy training on women`s anxiety levels and reported that education has been able to reduce the amount of anxiety, so that trained women experienced less anxiety compared with the control group [14].
Aim(s)
Regarding the importance and side effects of anxiety in pregnancy and childbirth and with emphasis on the use of non-prescriptive methods to reduce these complications, this study aimed to investigate the effect of educational-support intervention based on Orem self-care model on anxiety in primiparous women.
Research type
The present study is a single-blind, double-blind clinical trial study.
Research society, place and time
The statistical population of the study consisted of primiparous women aged 18-35 with normal pregnancy and gestational age of 28-32 weeks. They were referred to health centers in Mashhad for pregnancy care in 2017.
Sampling method and number
To determine the sample size, the results of Akbarzadeh et al. [8] and comparison of two mean with 95% of confidence interval and 80% test power were used. In this way, the sample size was estimated to be 34 in each group (68 in total). To select the research units, firstly, among the health centers of Mashhad, two health centers, namely, “Student Health Center” and “Motahari Health Center” were randomly selected, and then from each health center, pregnant women who were eligible to enter the study were randomly selected. During the study, 8 subjects were excluded from the study. Therefore, 60 people were selected through cluster sampling and randomly assigned to two groups of experimental and control (each group was 30).
Used devices&materials
The instrument was a questionnaire for personal and fertility characteristics and Spielberger`s anxiety scale. Individuality and fertility profile questionnaire consisted of a number of individual variables such as age, education, occupation, socioeconomic status, spouse`s age, spouse`s occupation, as well as fertility variables such as gestational age and number of previous pregnancies. Spielberger`s Anxeity Scale has 40 items that in two scales of overt and covert anxiety, measures situational and personality anxiety in two ways “state” and “adjective”; Thus, 20 items measure overt anxiety “state” and 20 items measure hidden anxiety “attribute”. The options for this test are “very little”, “little”, “moderate”, and “highly” and each of the statements that are set to be positive or negative are scored between one and 4 based on the response. The score 4 indicates the highest level of anxiety. Items one to 20 are used to measure overt anxiety, and items 21 to 40 are used to measure covert anxiety. Some items are scores in reverse order. The scores of each of the two scales can range from 20 to 80. Persian version of Spielberger`s anxiety scale has been normalized by Mehram et al. in Mashhad and its reliability has been confirmed [8]. In order to collect the information, the researcher referred to the selected health centers after obtaining permission from the authorities and, after introducing and presenting the permit, identified the pregnant women eligible for entry. After presenting the necessary explanation regarding the goals and method of the study, they were invited to participate in the study, and if they were willing to participate in the study, they written and informed consent was obtained from them. There was no specific intervention in the control group and they only received routine care from the health centers. In the experimental group, the educational program was implemented based on the self-care model of Orem. The intervention was carried out in three steps: Stage one: the Orem questionnaire was used to determine the needs of general self-care, developmental and deviation of health and self-care needs in the field of anxiety and their control. Stage one: The Orem questionnaire was used to determine the general self-care, developmental and deviation of health needs and self-care needs in the field of anxiety and their control. Stage two: Based on the findings of the previous stage, based on the Orem conceptual framework in the form of a nursing system, the educational-support program was designed and developed. The program included familiarity with the nature of anxiety (cases, stages, symptoms, anxiety control, and relaxation techniques, and respiratory exercises). Stage three: A designed educational-support program was held in form of a 4 60-minute sessions theoretically and practically, in 4 consecutive weeks (weekly one session) by the researcher through group discussion, question and answer, lecture and broadcasting slides and films for a group of 10-15 participants in the training center of the selected health center. The researcher units in both the experimental and control groups completed the Spielberger Anxiety Scale at the beginning of the study and one week after the intervention. In order to observe ethics in research, at the end of the study, the participants in the control group were given a booklet which included the important points of the educational-support program implemented in the experimental group. Data were analyzed by SPSS18 using descriptive and inferential statistics. Chi-square and Mann-Whitney test were used to examine the demographic variables in both groups. T-test and paired t-test were used for assessing the effect of educational program in comparison between the two groups and before and after the intervention in each group. In the tests, the confidence coefficient was 95%.
Findings by Text
There were no statistically significant differences between two groups in terms of demographic characteristics (p>0.05; Table 1).In the pre-intervention stage, there was no significant difference between the mean of anxiety scores in the experimental and control groups. However, there was a significant difference between the two groups at the post-intervention stage. There was also a significant difference between the mean of anxiety score before and after the intervention in the experimental group, but the difference was not significant in the control group (Table 2).
Main comparison to the similar studies
Although there was no similar study in the literature in relation to Orem self-care model and anxiety level in pregnancy, the results of using Orem self-care model in some diseases suggest that self-care model has the potential for positive effect in different conditions such as hemodialysis [15], stress in patients with diabetes [16], multiple sclerosis [17], blood pressure [18], and the importance of life quality of the elderly [16]. These results are consistent with the findings of this study. … [19-21]. Findings of the research by Delaram and Soltanpour showed that providing information to mothers regarding their unawareness and how to support and take care of themselves during the third trimester of pregnancy can help reduce their anxiety during delivery [22]. Ticksira et al. also found that pregnancy education could be effective in reducing anxiety during pregnancy which was confirmed by Davis [8, 19]. … [23-28].
Suggestions
Given the limited number of studies regarding self-care behaviors based on the Orem model during pregnancy, it is suggested that future studies be conducted with more samples. The health care providers responsible for taking care of mothers are suggested to use anti-anxiety educational-support program based on Orem self-care model to control the anxiety of pregnant mother.
Limitations
One of the limitations of the present study was the lack of a similar study, which made some limitations in the comparison and discussion of the findings although it was tried to reduce this limitation by using studies in other areas.
Conclusions
The educational-support intervention based on Orem`s self-care model is effective in reducing the anxiety of primiparous women in third trimester of pregnancy.
Acknowledgments
In this regard, the authors declare their gratitude to Mashhad University of Medical Sciences for financial support.
Conflict of interest
Non-declared
Ethical Permissions
Informed and written constant was obtained from the participants. Also, in order to observe ethics in the research, at the end of the study, the participants in the control group were given a booklet which included the important points of the educational-support program implemented in the test group. This study was conducted at Iranian Clinical Trial Site with code IRCT2015112225182N1.
Funding Sources
This article is part of a master`s thesis titled “The impact of anti-anxiety educational program based on Orem`s Self-Care Model on anxiety in Primiparous women” and sponsored by the Vice-Chancellor of Research in Mashhad University of Medical Sciences.

TABLES and CHARTS

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