The Effect of Music During Non-Stress Testing on Women's Comfort, Vital Signs and Anxiety: A Randomized Controlled Study
Phase: NA
Conditions: Pregnant Women
Sponsor: Karamanoğlu Mehmetbey University

29.03.2025 
THE EFFECT OF MUSIC DURING NON-STRESS TESTING ON WOMEN'S 
COMFORT, VITAL SIGNS AND ANXIETY: A RANDOMİZED CONTROLLED 
STUDY 
Music has direct and indirect positive effects on the mother and fetus during pregnancy and 
perinatal period. This study was aimed at investigating effects of music played during the 
Non-Stress Test (NST) procedure on the mother's comfort, vital signs and anxiety. 
The present study is a randomized controlled experimental study. Pregnant women who 
presented to the NST outpatient clinic of a research hospital in the Central Anatolia region of 
Türkiye between June 2025 and August 2025 comprised the population of the study. The 
study's sample size was calculated using the G*Power 3.1.9.2 software based on data from a 
study by BaĢkurt and Yılmaz [1]. The mean anxiety scores and standard deviation values from 
that study were used, and the effect size was calculated as 0.79. The minimum number of 
pregnant women to be included in the sample of this study was calculated as 70 pregnant 
women, 35 in each group, using the G*Power 3.1.9.2 software, based on an effect size of 
0.79, an alpha value of 0.05, and a power value of 0.95. To increase the analysis power of the 
study, the study sample consisted of 173 pregnant women (music group= 93 and control 
group= 80). 
The inclusion criteria of the study were as follows: being between the ages of 18 and 45 years, 
having completed the 32nd week of gestation, not having any risk factors in their pregnancy 
(such as premature rupture of membranes, preeclampsia, gestational diabetes), not having 
multiple pregnancies, not having low (80/60 mmHg and below) or high (140/90 mmHg) 
blood pressure levels, having eaten at least two hours before the NST procedure, not smoking 
or consuming alcohol at least two hours before the NST procedure, being able to 
communicate, not having any hearing problems, and volunteering to participate in the study. 
The exclusion criteria of the study were as follows: Pregnant women who had a fetus with 
fetal distress, for whom emergency intervention was considered by the physician, who had 
impaired NST and required immediate intervention, who had a psychiatric disease diagnosis 
and hearing impairment were not included in the study (Figure 1).  
 
 
 

29.03.2025 
During NST application  
* Pregnant women were placed in the left 
side or right side position and NST was 
applied for 20-30 minutes along with music 
application. 
During NST application  
*Pregnant women were placed in the left side 
or right side position and no intervention was 
made to the pregnant women during the NST 
application. 
After NST application  
* Prenatal Comfort Scale was applied 
* Vital signs were measured 
*State Anxiety Scale was applied 
After NST application  
*Prenatal Comfort Scale was applied 
* Vital signs were measured 
*State Anxiety Scale was applied 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Figure 1. CONSORT flowchart 
 
 
 
Before NST application 
* Personal Information Form was applied 
* Prenatal Comfort Scale was applied 
* Vital signs were measured 
*State Anxiety Scale was applied 
Before NST application 
*Personal Information Form was applied 
* Prenatal Comfort Scale was applied 
* Vital signs were measured 
*State Anxiety Scale was applied 
Excluded (n: 43) 
Those with risk factors during pregnancy (preeclampsia and 
gestational diabetes (n:5) 
Those with low (80/60 mmHg and below) or high (140/90 
mmHg  and  above) blood pressure (n:13) 
Having eaten at least two hours before the NST procedure 
(n:17) 
Smoker at least two hours before NST procedure (n:5) 
Hearing impaired (n:2) 
Pregnant women with fetal distress and for whom emergency 
intervention is considered by the physician (n:1) 
Enrollment 
Randomized (n:173) 
Included in the analysis (n:93) 
Allocation 
Follow-Up 
Enrollment of pregnant women in the study (n: 216) 
Music Group (n=93) 
Control Group (n=80) 
Included in the analysis (n:80) 
Analysis 

29.03.2025 
Procedure  
Selection of music: The music played to the pregnant women was selected by the researchers 
in accordance with the definition of relaxing music made in the literature. Before the music 
selection, the researchers communicated with the TÜMATA (Turkish acronym for the 
“Research and Promotion of Turkish Music Association). After the meeting held with the 
association, it was decided to use the 'AcemaĢiran' (a musical mode in traditional Turkish 
music). In the study, music prepared by the TÜMATA in the AcemaĢiran mode was played. 
It is stated that AcemaĢiran mode helps balance the body, helps the listener relax, facilitates 
birth, helps correct the wrong position of the fetus in the womb, and has a pain and spasm 
relieving effect [2,3]. 
Randomization: 
Simple randomization method was used in this study.  Pregnant women who met the study 
criteria were randomly assigned to the music or control group with equal probability, 
independently of any previous assignments, on the day they came to the hospital for their 
physical examination. The total number of pregnant women determined by the G*Power 
analysis was entered into the program at ''https://www.randomizer.org,” and randomization 
was conducted using the program. The assignment of the groups was performed on the 
computer, and the pregnant women were randomly assigned to the music and control groups.  
Data collection:  
The data of the study were collected from the pregnant women using the face-to-face 
interview technique at the NST outpatient clinic on the days and hours when the researcher 
was present in the hospital. The participating pregnant women were not informed of the group 
they belonged to. Since only the researcher knew the participants’ groups, single-blindness 
was achieved in the study. 
Music Group: The purpose of the study was explained to the pregnant women who met the 
inclusion criteria. After their written consent was obtained, they were administered the 
Personal Information Form, Prenatal Comfort Scale, Vital Signs Form, and State Anxiety 
Scale used to measure their anxiety level before the NST procedure. They were asked to lie on 
their left or right side. After the pregnant women were positioned, while the NST procedure 
was implemented they listened to music for 20-30 minutes. The pregnant women listened to 
the music on an MP3 player during the application. The duration of the music recorded on the 

29.03.2025 
MP3 player was 30 minutes. To avoid hygiene problems, each pregnant woman was provided 
with individual headphones, which were given to them as a gift after the procedure. The 
volume of the music was adjusted by the pregnant women. After the procedure was 
completed, the Prenatal Comfort Scale, Vital Signs Form and State Anxiety Scale were 
administered again. 
Control Group: The purpose of the study was explained to pregnant women who met the 
inclusion criteria. After their written consent was obtained, they were administered the 
Personal Information Form, Prenatal Comfort Scale, Vital Signs Form, and State Anxiety 
Scale used to measure their anxiety level before NST. They were asked to lie on their left or 
right side. They underwent no other intervention during the NST procedure. After the 
procedure was completed, the Prenatal Comfort Scale, Vital Signs Form and State Anxiety 
Scale were administered again. 
Data Collection Tools 
Personal Information Form: The form was administered to determine the participant’s socio-
demographic characteristics such as age, education level, employment status, family type, 
income level, and her obstetric characteristics such as whether her pregnancy was planned, 
what her gestational age was and whether she had undergone NST before. 
Prenatal Comfort Scale (PCS): Takeishi et al. developed the PCS to determine the prenatal 
comfort level of the woman in Japan in 2011 [4]. In the first version, the PCS had 34 items, 
but then they revised it and shortened to 15 items [5]. The short version of the PCS consists of 
15 items and the following 5 subscales: "The impact of developing relations with the spouse 
on the paternity role - Husband" (3,4,7,9), "Interacting with the movements of the fetus - 
Fetus" (13,14), "Social support received from the people around - People” (11,12,15), 
“Acceptance of the maternal role and attachment to the baby-Mother” (1,5,8), “Realizing the 
changes in oneself during pregnancy-Myself” (2,6,10). Response given to the items are rated 
on a six-point Likert type scale ranging from 0 to 5 (0 = Strongly disagree, 1 = Disagree, 2 = 
Undecided, 3 = Somewhat agree, 4 = Agree, 5 = Strongly agree). The minimum and 
maximum possible scores that can be obtained from the PCS are 0 and 75, respectively. The 
higher the score is the higher the comfort level is. ġenol, Özkan and Aslan performed the 
validity and reliability study of the Turkish version of the PCS (2020), the Cronbach’s alpha 
value of the PCS was 0.815 in ġenol, Özkan and Aslan’s study [6]. 

29.03.2025 
Vital Signs Form: The form was used to record the pregnant women's body temperature, pulse 
rate, respiration rate and blood pressure values. 
State Anxiety Scale (SAS): Spielberger et al. developed the SAS to determine how an 
individual feels at a certain moment and under certain conditions (1983). Öner and Le Compte 
performed the validity and reliability study of the Turkish version of the SAS (1998) [7,8]. 
Some of the items are reverse scored. While the reverse scored items question positive 
emotions, the other items question negative emotions. Responses given to the items are as 
follows: "not at all" (1), "somewhat" (2), "moderately" (3), "very much" (4), which indicate 
the degree of severity of the feelings, thoughts or behaviors. In this section, items 1, 2, 5, 8, 
10, 11, 15, 16, 19 and 20 are reverse scored. To calculate the total score of the SAS, the total 
score of the reversed items is subtracted from the total score of the non-reversed items. Then, 
50 points, which is the constant value of the state anxiety scale, are added to this score. The 
result is the score for the overall SAS.  The total score varies between 20 and 80. The higher 
the score is the higher the level of the anxiety is. While a score ranging between 0 and 19 
indicates “no anxiety”, a score ranging between 20 and 39 indicates mild anxiety, a score 
ranging between 40 and 59 indicates moderate anxiety, a score ranging between 60 and 79 
indicates severe anxiety, and a score of 80 indicates very severe anxiety (Panic) [8]. 
Statistical Analysis of the Data 
The data obtained in the present study were analyzed using the SPSS (Statistical Package for 
Social Sciences) 25.0. In the analysis of the data, to compare the homogeneity between the 
groups, cross tables were created for categorical variables, and the Chi square (X2) and 
Fisher's exact test were used. Numerical variables were given as mean±standard deviation 
(𝑋  ±SD) whereas categorical variables were given as number (n) and percentage (%). For 
non-parametric data that were not normally distributed, the Mann-Whitney U test was used to 
evaluate the difference between two groups, and the Kruskal-Wallis H test was used to find 
differences between the variables with three or more categories. Spearman correlation 
analysis was performed to reveal the relationship between the dependent variables. The 
Wilcoxon test (significance test of the difference between two paired groups) was used to test 
the difference in the dependent groups at two different measurement times. The significance 
level was accepted as p<0.05. The confidence interval was 95%.  
 

29.03.2025 
Reference 
1. BaĢkurt H, Yılmaz, FA. Effect of Listening to Music on Mother's Non-Stress Test 
Results and Anxiety Levels. Altern Ther Health Med 2024; 30(8):22-26. 
2. Shafqat N, Agrawal A, Pushpalatha K, Singh B, Verma R, Podder L,  et al. Effect of 
Music Therapy on Anxiety in Pregnancy: A Systematic Review of Randomized 
Controlled Trials. Cureus 2024; 16(9):e69066. 
3. Mumcu B, Aydın A. The effect of music on pain and anxiety during 
hysterosalpingography: a randomized controlled trial. BMC nursing 2025; 24(1): 862. 
4. Takeishi Y, Nakamura Y, Atogami F, Yoshizawa T. Development of the prenatal 
comfort scale. J Japan Matern Nurs 2011;11:11–8. 
5. Nakamura Y, Takeishi Y, Ito N, Ito M, Atogami F, Yoshizawa T. Comfort with 
motherhood in late pregnancy facilitates maternal role attainment in early postpartum. 
Tohoku J Exp Med 2015;235:53–9. 
6. ġenol DK, Özkan SA, Aslan E. Adaptation of the prenatal comfort scale into Turkish: 
A validity and reliability study. Florence Nightingale J Nurs, 2020; 29(2): 221. 
7. Spielberger CD, Gorsuch RL, Lushene R, Vagg PR, Jacobs GA. Manual for the State-
Trait Anxiety Inventory; Palo Alto, CA, Ed. Palo Alto Spielberger 1983. 
8. Öner N, Lecompte WA. Handbook of state-trait anxiety inventory. 2nd ed. Ġstanbul: 
Boğaziçi University Publishing; 1998. 
 
 
 

29.03.2025 
Informed Consent Form 
A text explaining the purpose of the study, that participation in the study is voluntary, that no personal 
information such as name, surname, or school number should be included, and that the survey should 
be completed, was placed at the beginning of the survey form developed for the collection of research 
data as a consent text. 
If you agree to participate in the study, please mark the box below with an X and continue. 
I accept. 
Dear Participant, 
This study, titled " The Effect Of Music During Non-Stress Testing on Women's Comfort, Vital Signs 
and Anxıety: A Randomized Controlled Study" is being conducted by Dr. Gamze GÖKE ARSLAN, 
Assistant Professor of Nursing at Karamanoğlu Mehmetbey University, Faculty of Health Sciences; 
Assoc. Prof. Dr. Yasemin ġANLI, Assistant Professor of Midwifery at Karamanoğlu Mehmetbey 
University; Dr. Nuran Nur AYPAR AKBAĞ, Assistant Professor of Midwifery at Sinop University; 
Assoc. Prof. Dr. Eda ERGĠN, Associate Professor of Nursing at Bakırçay University; and Prof. Dr. 
ġebnem ÇINAR YÜCEL, Assistant Professor of Nursing at Ege University. The study aimed to 
evaluate the effect of music played during NST on maternal comfort, vital signs, and anxiety. 
Therefore, it is crucial that you answer all questions sincerely. 
Your participation in the study is voluntary. The information obtained through this form will remain 
confidential and will be used only for research purposes (or "scientific purposes"). You may choose 
not to participate in the study or discontinue the survey if you do not wish to participate. 
Do not write your first and last name on the survey form. 
Our survey consists of four sections. This 48-question survey, which will take approximately 40 
minutes, will require you to complete the survey. Please indicate your answers by circling the 
appropriate option below the questions or, for open-ended questions, by writing in the space provided 
below the question. For questions where you can select more than one option, select all the options 
that apply to you. If the answer to the question is "other" and your answer is not among the available 
options, please write your answer in the space provided next to "other." 
Thank you for completing the survey. If you have any questions about the study, you can contact the 
following person(s): 
Gamze GÖKE ARSLAN 
Karamanoğlu Mehmetbey University, Faculty of Health Sciences,  
Department of Fundamentals of Nursing 
Phone:+905064941982  mail: gamzegoke@kmu.edu.tr 
Research Team 
Gamze GÖKE ARSLAN & Yasemin ġANLI & Nuran Nur AYPAR AKBA & Eda Ergin & ġebnem 
ÇINAR YÜCEL