The Effects of Antenatal Interventions With Artistic Content Given to Pregnant Women
Condition: Antenatal Care; Mental Health
Study type: Interventional

Summary: 
      Aim:This study aimed to evaluate the effects of music listening, laughter therapy, and diary
      keeping, given as group sessions to pregnant women in the last trimester on mothers' overall
      mental health and maternal attachment status in the postpartum period.

      Method: The study was a nonrandomized study including a control group for which the post-test
      procedure was performed alone. The measurements were also repeated at intervals for those in
      the intervention group. The study was conducted in two separate family health centers.The
      women with the following constituted the study inclusion criteria: Pregnant women over the
      age of 18, those with pregnancy between 16-24 weeks of gestation, and those with literacy in
      Turkish. The data were collected through Beck Depression Inventory, Edinburg Postpartum
      Depression Scale, Brief Symptom Inventory, and the Maternal Attachment Scale to
      comprehensively evaluate mental health status. All participants responded to the personal
      information form prepared for the study.

      Keywords:Antenatal care, depression, diary, laughter therapy, maternal attachment, music
      listening
    

Detailed description: 
      The intervention group consists of pregnant women in the second trimester who were registered
      with two family health centers.The Gpower 3.1.9.2. program was used to determine the number
      of participants in both groups. The sample size was found as 25 for each group by accepting
      the effect size to be wide (0.82), the alpha value (0.05), and the power (0.80). In the
      experimental group, sampling adequacy for within comparisons was evaluated with Gpower
      3.1.9.2. program. It was determined that the sample was sufficient for partial eta squared
      values obtained from the study. (10 participants were adequate for each group).The researcher
      (SK) obtained the list of registered women with a pregnancy between 16-24 gestational weeks.
      Based on the inclusion and exclusion criteria, the participants were included in the
      intervention group via face-to-face interviews. Informed written consent was obtained from
      each participant, and the interventions were performed in this group. Mothers receiving
      standard antenatal care in the prenatal period, giving birth, and having a three-month-old
      baby constituted the control group. The control group was created after the procedures were
      completed for those in the intervention group.

      Interventions such as music listening, laughter therapy, and diary keeping were carried out
      for each woman in the intervention group.A six-session antenatal care program included both
      music listening and laughter therapy and was designed for those in the study group as a
      session every week. The program was carried out by arranging a music session for one week and
      a laughter therapy session over the following week. Also, the notes uttered by pregnant women
      were discussed at the week laughter listening sessions were performed. Data from the
      intervention group were collected four times as pretest (after providing informed contest),
      first-interval measurement (fourth week of the intervention), second-interval measurement
      (the first month following the birth), and post-test (the third month following the
      delivery). Even so, the post-test was administered only for the controls.

      The data pooled after the study were analyzed using the computer software of SPSS 22.0,
      OpenMeta[Analyst], and JAPS 09.0 statistical analysis packages. The findings were tested at
      p<0.05 of the significance level.Similarity analyses of the study and control groups were
      performed with chi-square (the Pearson and Yates correction). The post-test scores of BDI,
      EPDS, BSI, and MAS in the intervention and control groups were compared through the t test in
      independent groups, and Cohen's d and confidence interval (CI) was utilized in the assessment
      of effect size. Four measurement results of the intervention group were compared with those
      of variance analysis through repeated measurements, and the partial eta square and CI were
      used to evaluate the effect size. Two-way variance analysis for repeated measurements was
      used in evaluating the group/time interactions of the changes in terms of the overall mental
      health scores of the group with and without depression symptoms in the intervention group at
      the four time-point.In Cohen's d calculation, if d is 0.20, 0.50, and 0.80, the calculation
      demonstrates small, medium, and large effect sizes, respectively (d≤ 0.20 weak, d<0.50 medium
      and d≥ 0.80 large effect size). However, in evaluating the partial eta square, 0.01, 0.06,
      and 0.14 were considered small, medium, and large, respectively.
    

Intervention name(s): Laughter therapy+Music listening+Keeping diary
Intervention type(s): Behavioral
Intervention description(s): Laughter therapy was carried out by the researcher as a total of three sessions every 15 days, and each session lasted 30 minutes.
Participants listened to the types of music that they like (pop, Turkish folk music). In the meeting room in FHC, Two professional artists performed music recitals with a guitar and saz (qopuz) to pregnant women, and pregnant women actively participated in this process. The performance was carried out as three sessions, once every 15 days, and each session took 40 minutes.
In addition to music listening and laughter therapy, the pregnant women were asked to keep a diary to write down their emotions about their health status, pregnancy and baby. Then, each participant had an opportunity to explain her emotions or replies to the questions during the group therapy sessions every 15 days so that pregnant women were able to express their feelings.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Intervention model description: The study was a nonrandomized study including a control group for which the post-test procedure was performed alone. The measurements were also repeated at intervals for those in the intervention group. The study intervention group was carried out with a total of 50 pregnant women, 25 of whom were controls.
Masking: Single (Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: Antenatal care; Depression; Diary; Laughter therapy; Maternal attachment; Music listening