Volume 29, Issue 4 (Winter 2024)                   IJPCP 2024, 29(4): 460-477 | Back to browse issues page


XML Persian Abstract Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Kheirkhah M, Kiani Z, Kianimoghadam A S, Amanollahi Z, Farshad F, Esfahan M M. Effect of Supportive Counseling Based on Swanson's Caring Theory on the Quality of Life of Pregnant Women With A History of Abortion: A Randomized Controlled Trial Study. IJPCP 2024; 29 (4) :460-477
URL: http://ijpcp.iums.ac.ir/article-1-3898-en.html
1- Department of Reproductive Health and Midwifery, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
2- Department of Consultation on Midwifery, School of Nursing & Midwifery, Iran University of Medical Sciences, Tehran, Iran. , zohre.kiani81@gmail.com
3- Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
4- Department of Counseling, Faculty of Education and Psychology, Alzahra University, Tehran, Iran.
5- Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
Full-Text [PDF 7500 kb]   (316 Downloads)     |   Abstract (HTML)  (1081 Views)
Full-Text:   (168 Views)
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.
 


References
  1. Salmela-Aro K, Read S, Rouhe H, Halmesmäki E, Toivanen RM, Tokola MI, et al. Promoting positive motherhood among nulliparous pregnant women with an intense fear of childbirth: RCT intervention. Journal of Health Psychology. 2012; 17(4):520-34. [PMID]
  2. Sharifi- Shaki S, Aakhte M, Alipor A, Fahimi-Far A, Taghadosi M, Karimi R et al.[The effectiveness of mindfulness-based cognitive therapy in reducing anxiety and meta-worry in women with recurrent miscarriages (Persian)]. Feyz. 2015; 19(4):334-40. [Link]
  3. Bicking Kinsey C, Baptiste-Roberts K, Zhu J, Kjerulff KH. Effect of previous miscarriage on the maternal birth experience in the First Baby Study. Journal of Obstetric, Gynecologic, and Neonatal nursing. 2013; 42(4):442-50. [PMID]
  4. Gong X, Hao J, Tao F, Zhang J, Wang H, Xu R. Pregnancy loss and anxiety and depression during subsequent pregnancies: Data from the C-ABC study. European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2013; 166(1):30-6. [DOI:10.1016/j.ejogrb.2012.09.024] [PMID]
  5. Bellieni CV, Buonocore G. Abortion and subsequent mental health: Review of the literature. Psychiatry and Clinical Neurosciences. 2013; 67(5):301-10. [DOI:10.1111/pcn.12067] [PMID]
  6. Curley M. An explanatory model to guide assessment, risk and diagnosis of psychological distress after abortion. Open Journal of Obstetrics and Gynecology. 2014; 4(15):944-53. [DOI:10.4236/ojog.2014.415133]
  7. Wijesooriya L, Palihawadana T, Rajapaksha RNG. A study of psychological impact on women undergoing miscarriage at a Sri Lankan hospital setting. Sri Lanka Journal of Obstetrics and Gynaecology. 2015, 37(2):10-13. [DOI:10.4038/sljog.v37i2.7747]
  8. Woods-Giscombé CL, Lobel M, Crandell JL.The impact of miscarriage and parity on patterns of maternal distress in pregnancy. Research in Nursing & Health. 2010; 33(4):316-28. [DOI:10.1002/nur.20389] [PMID]   
  9. Feizollahi N, Nahidi F, Sereshti M, Nasiri M, Motlagh AA. Evaluation of quality of life in women with abortion experience in Tehran 2015-2016. Advances in Nursing & Midwifery. 2020; 29(1):8-15. [Link]
  10. Pesavento F, Marconcini E, Drago D. [Quality of life and depression in normal and in high-risk pregnancy. Analysis of a sample of 100 women (Italian)]. Minerva Ginecologica. 2005; 57(4):451-60. [PMID]
  11. Bahrami M. Iranian nurses perceptions of cancer patients quality of life. Iranian Journal of Cancer Prevention. 2016; 9(3):e4076. [DOI:10.17795/ijcp-4076] [PMID]   
  12. Irani M, Khadivzadeh T, Asghari Nekah SM, Ebrahimipour H, Tara F. Emotional and cognitive experiences of pregnant women following prenatal diagnosis of fetal anomalies: A qualitative study in Iran. International Journal of Community Based Nursing and Midwifery. 2019; 7(1):22-31. [PMID]
  13. Tavoli Z, Mohammadi M, Tavoli A, Moini A, Effatpanah M, Khedmat L, et al. Quality of life and psychological distress in women with recurrent miscarriage: A comparative study. Health and Quality of Life Outcomes. 2018; 16(1):150. [DOI:10.1186/s12955-018-0982-z] [PMID]   
  14. Couto ER, Couto E, Vian B, Gregorio Z, Nomura ML, Zaccaria R, et al. Quality of life, depression and anxiety among pregnant women with previous adverse pregnancy outcomes. Sao Paulo Medical Jurnal. 2009; 127(4):185-9.  [DOI:10.1590/S1516-31802009000400002] [PMID]
  15. Fergusson M, Elisa M, Rodríguez M, Alemán Parra CM, Ávila Martín LA, Badillo Romero K, Barajas Lizarazo MA. [From nursing theory to practice: Experiences with care management projects (Spanish)]. Colombia: Universidad de la Sabana; 2016. [Link]
  16. Coverdale J, Gordon MR, Beresin EV, Guerrero APS, Louie AK, Balon R, et al. Access to abortion after Dobbs v. Jackson Women’s Health Organization: Advocacy and a call to action for the profession of psychiatry. Academic Psychiatry. 2023; 47(1):1-6. ‏ [DOI:10.1007/s40596-022-01729-7] [PMID]   
  17. Ngo A, Nguyen VT, Phan H, Pham V, Ngo C, Nguyen L, et al. Effectiveness of mHealth intervention on safe abortion knowledge and perceived barriers to safe abortion services among female sex workers in Vietnam. Mhealth. 2023; 9:3.  [DOI:10.21037/mhealth-22-41] [PMID]   
  18. Ellina AD, Adiutama NM. Evaluation of patient satisfaction and nurse caring behaviour: Based on swanson’s theory’. Indian Journal of Public Health Research and Development. 2019; 10(8):2698-702. [Link]
  19. Adolfsson A. Women’s well-being improves after missed miscarriage with more active support and application of Swanson’s Caring Theory. Psychology Research and Behavior Management. 2011; 4:1-9. [PMID]
  20. Swanson KM. Nursing as informed caring for the well-being of others. Image: The Journal of Nursing Scholarship. 1993; 25(4):352-7. [DOI:10.1111/j.1547-5069.1993.tb00271.x] [PMID]
  21. Ardekani ZB, Akhondi MM, Sadeghi MR, Sadri-Ardekani H. [The necessity of a comprehensive study on abortion in Iran (Persian)]. Journal of Reproduction & Infertility. 2005; 6(4):299-320. [Link]
  22. Beristain-García I, Álvarez-Aguirre A, Huerta-Baltazar MI, Casique-Casique L. [Kristen Swanson’s theory of care: Literature review (Spanish)]. Sanus. 2022; 7(212). [DOI:10.36789/revsanus.vi1.212]
  23. Ellina AD, Nursalam N, Yunitasari E, Adiutama NM. Evaluation of quality of nursing work-life: Based on Swanson’s Theory of Caring. Open Access Macedonian Journal of Medical Sciences. 2022; 9(T5):185-9. [DOI:10.3889/oamjms.2021.7844]
  24. Aguilera J, García M, Cáceda G. [La familia como determinante social del intento de suicidio en adultos jóvenes: Una mirada desde la complejidad (Spanish)]. Revista Ciencia y Tecnologia. 2016;12(1):161-75. [Link]
  25. Palas Karaca P, Oskay ÜY. Effect of supportive care on the psychosocial health status of women who had a miscarriage. Perspectives in Psychiatric Care. 2021; 57(1):179-88. [DOI:10.1111/ppc.12540] [PMID]
  26. Golmakani N, Ahmadi M, Asghari P, Esmaili H. [The effect of supportive care program on bereavement in women with early miscarriage (Persian)]. Iranian Journal of Obstetrics, Gynecology and Infertility. 2016; 20(8):33-41. [Link]
  27. Chang SC, Kuo PL, Chen CH. Effectiveness of empathic caring on stress and depression for women with recurrent miscarriage: A randomized controlled trial. Complementary Therapies in Clinical Practice. 2021; 43:101367. [DOI:10.1016/j.ctcp.2021.101367] [PMID]
  28. Moghadasi M, Soltanahmadi Z, Azizzadeh Forozi M, Mahdizadeh AL, Jahani Y. [The effect of supportive counseling on reducing the anxiety of women at risk of preterm birth (Persian)]. Nursing and Midwifery Journal. 2016; 14 (2):151-8. [Link]
  29. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical care. 1992; 30(6):473-83. ‏ [DOI:10.1097/00005650-199206000-00002] [PMID]
  30. Motamed N, Ayatollahi AR, Zare N, Sadeghi Hassanabadi A. Validity and reliability of the Persian translation of the SF-36 version 2 questionnaire. EMHJ-Eastern Mediterranean Health Journal. 2005; 11 (3):349-57. [PMID]
  31. Johnson OP, Langford RW. A randomized trial of a bereavement intervention for pregnancy loss. Journal of Obstetric, Gynecologic & Neonatal Nursing. 2015; 44(4):492-9. [DOI:10.1111/1552-6909.12659] [PMID]
  32. Nynas J, Narang P, Kolikonda MK, Lippmann S. Depression and anxiety following early pregnancy loss: Recommendations for primary care providers. The Primary Care Companion for CNS Disorders. 2015; 17(1):10.4088/PCC.14r01721.  [DOI:10.4088/PCC.14r01721] [PMID]   
  33. Adolfsson A, Larsson PG. Applicability of general grief theory to Swedish women’s experience after early miscarriage, with factor analysis of Bonanno’s taxonomy, using the Perinatal Grief Scale. Upsala Journal of Medical Sciences. 2010; 115(3): 201-9. ‏ [DOI:10.3109/03009731003739851] [PMID]   
  34. Díaz-Pérez E, Haro G, Echeverria I. Psychopathology present in women after miscarriage or perinatal loss: A systematic review. Psychiatry International. 2023; 4(2):126-35. [DOI:10.3390/psychiatryint4020015]
  35. Azadi Y, Yazdanpanah M, Mahmoudi H. Understanding smallholder farmers’ adaptation behaviors through climate change beliefs, risk perception, trust, and psychological distance: Evidence from wheat growers in Iran. Journal of Environmental Management. 2019; 250:109456. [DOI:10.1016/j.jenvman.2019.109456] [PMID]
  36. Kao MH, Chen CC. The effects of support interventions on anxiety and depression in women with preterm labor during hospitalization. European Psychiatry. 2017; 41(S1):S736-7. [DOI:10.1016/j.eurpsy.2017.01.1352]
  37. Kong GW, Chung TK, Lok IH. The impact of supportive counselling on women's psychological wellbeing after miscarriage--a randomised controlled trial. BJOG: An International Journal of Obstetrics and Gynaecology 2014; 121(10):1253-62. [DOI:10.1111/1471-0528.12908] [PMID]
  38. Iwanowicz-Palus G, Mróz M, Bień A.  Quality of life, social support and self-efficacy in women after a miscarriage. Health and Quality of Life Outcomes. 2021; 19(16):16. [DOI:10.1186/s12955-020-01662-z] [PMID]   
  39. Swanson KM, Chen HT, Graham JC, Wojnar DM, Petras A. Resolution of depression and grief during the first year after miscarriage: A randomized controlled clinical trial of couples focused interventions. Journal of Women's Health (2002). 2009; 18(8):1245-57. [DOI:10.1089/jwh.2008.1202] [PMID]   
Type of Study: Original Research | Subject: Psychiatry and Psychology
Received: 2023/05/28 | Accepted: 2023/12/6 | Published: 2024/01/1

Add your comments about this article : Your username or Email:
CAPTCHA

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2024 CC BY-NC 4.0 | Iranian Journal of Psychiatry and Clinical Psychology

Designed & Developed by : Yektaweb