Introduction
Pregnancy and becoming a mother have important social and emotional consequences for women. It can help stabilize women's identities. The biological, psychological, and social health of women depend on their ability to have children. When they lack this ability, they feel incompetent, which is one of the reasons for abortion. Given the importance of fertility in most cultures, the desire to have a child is one of the most basic human motivations. The inability to become pregnant can create a destructive feeling and is a stressful event, leading to mental health disorders. Abortion can increase the risk of psychological problems such depression, anxiety, and poor quality of life (QoL). To eliminate anxiety and improve QoL, there are various methods such as cognitive behavioral therapy, psychoanalytic therapy, mindfulness therapy, and nonpharmacological methods. Swanson's caring theory is a model whose goal is the well-being of patients with caring methods, and creating a unique and compassionate relationship between the health care provider and the patient. This caring theory focuses on education and recovery during pregnancy and emphasizes adaptive methods during the recovery stages and the ways to help the individual and family. It is a counseling and care program for women with a history of abortion and includes the five caring processes: Knowing the person, being with the person (sharing the feeling), doing for (helping the person recover), enabling, and maintaining belief (preventing relapse). 
Providing supportive care based on Swanson's theory can be helpful more than other treatment methods that require longer sessions with continuous attendance. Since no study has been conducted in this regard in Iran, the present study aims to determine the effects of supportive care based on Swanson's theory on the QoL pregnant women with a history of abortion.

Methods
This is a randomized controlled clinical trial with a pre-test/post-test/follow-up design. The study population consists of pregnant women who had experienced abortion in the past year and referred to comprehensive health centers in Isfahan, Iran to receive care during the current pregnancy. Of these, 72 samples were selected. The data collection instrument were a demographic form and the 36-item short form health survey. The intervention group (n=36) received counseling based on Swanson's theory at three sessions. The first two counseling sessions took place face to face and privately in the comprehensive health centers, and the third counseling session was provided on the phone. The duration of sessions was 90 minutes. The third session was conducted with a one-week interval. During this period, the control group received no intervention. They received routine procedures. However, to observe ethical principles, the control group received the counseling online at the end of the study. It should be mentioned that for routine pregnancy care, every month, both groups were subjected to care visits such as weight measurement, blood pressure, fetal heart control, fetal growth rate, history taking and examination of physical and mental problems. Questionnaires were completed 4 and 8 weeks after the intervention in the health centers. For those who could not attend the centers, the questionnaire was completed by telephone. Data were analyzed using chi-square test, paired t-test, repeated measures analysis of variance, t-test, and two-way repeated measures analysis of variance in SPSS software, version 25.

Results
The QoL was the same in both groups before the intervention (P=0.448). Four weeks after the intervention, the score of role-emotional subscale was significantly higher in the intervention group than in the control group (P=0.046). Eight weeks after the intervention, the scores of physical functioning (P=0.009), social functioning (P=0.039), role-emotional (P=0.004), and bodily pain (P=0.004) were significantly higher in the intervention group than in the control group. The interaction effect of group and time (P<0.001), group effect (P<0.001), and time effect (P<0.001) were significant. The QoL eight weeks after the intervention was higher than that four weeks after the intervention (P=0.001). The QoL score in the control group was not significantly different at any time points (P=0.789). The interaction effect of group and time in the dimensions of physical functioning (P=0.04), role-physical (P=0.004), and bodily pain (P=0.015) and of group in the dimensions of physical performance (P=0.008), role-physical (P=0.035), and physical health (P=0.035) were significant.

Conclusion
The supportive care based on Swanson's theory can significantly improve the QoL of pregnant women with a history of abortion. It is recommended that this counseling program be used for pregnant women with a history of abortion in educational and medical centers. Supportive care allows these women to more easily cope with the loss and grief. It is recommended to screen all women after abortion in terms of QoL to identify vulnerable women and provide appropriate health advice and treatment to them. 

Ethical Considerations
Compliance with ethical guidelines
The procedures in this study were in accordance with the principles of the Declaration of Helsinki and ethical approval was obtained from the ethics committee of Iran University of Medical Sciences (Code: IR.IUMS.REC.1399.974). The study was registered by the Iranian Registry of Clinical Trials (IRCT) (Code: IRCT20210827052302N1)

Funding
This study has was funded by Iran University of Medical Sciences.

Authors contributions
The authors contributed equally to preparing this article.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
The authors would like to thank all women participated  in conducting the research.
 


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