Effects of Solution-Oriented Approach on Psychosocial Health, Fear of Childbirth and Postnatal Senses of Security
Condition: Fear of Childbirth; Psychosocial Health; Pregnancy; Postpartum; Childbirth
Study type: Interventional

Summary: 
      This study was planned as a randomized controlled experimental study with posttest and
      control group in order to evaluate the effect of the solution focused approach method applied
      to primigravidas on psychosocial health, fear of childbirth and postnatal security sensations
    

Detailed description: 
      Pregnancy and childbirth process is a natural life event for women, as well as a period of
      physiological, psychological and social changes. Biopsychosocial changes experienced during
      this period increase the risk of encountering factors that may cause anxiety and stress. For
      this reason, psychosocial health can be negatively affected during pregnancy. One of the most
      important factors threatening psychosocial health during pregnancy is the fear of childbirth.
      Fear of childbirth emerges especially in the last trimester, causing the woman to spend the
      unique and special pregnancy process in restlessness and tension. Fear of childbirth may
      cause consequences such as preferring not to pregnant, as well as bring about complications
      related to the childbirth process and postpartum period. Within the scope of studies to
      manage the fear of childbirth, many approaches are used, such as childbirth preparation
      classes, breathing techniques, hydrotherapy, hypnosis, doula support, holistic care and
      support, cognitive and behavioral therapies, psychoeducation. One of the most current methods
      used in the management of childbirth fear is solution-oriented approach. Solution Focused
      Approach leads the individual to solution again and again instead of focusing on solving the
      problem as a separate method, it offers an approach focused on the solution itself. It is
      stated that the philosophy of solution-oriented approach in line with the individual-centered
      perspective, principles and values is compatible with the basic value and philosophy of
      nursing. As a result of the studies, it has been determined that the solution-oriented
      approach method is a shorter-term and effective counseling approach compared to other
      alternative approaches, after the approach, improvement / decrease in related behavioral
      problems is observed and it provides significant positive benefits. It is also stated to be
      more economical due to its wide application areas. This study was planned as a randomized
      controlled experimental study with posttest and control group in order to evaluate the effect
      of the solution focused approach method applied to primigravidas on psychosocial health, fear
      of childbirth and postnatal security sensations.

      Preliminary evaluation in the study will be made in the pregnant policlinic of a university
      hospital in the city center of Konya. Verbal and written permission will be obtained from
      pregnant women who meet the inclusion criteria according to the result of the preliminary
      evaluation made in the outpatient clinic. For the sample calculation of the study, an
      experimental study evaluating the effect of childbirth preparation education on the fear of
      childbirth, postpartum self-efficacy and posttraumatic stress disorder was taken as
      reference. The sample calculation of the research was made in G * Power (3.1.9.2) program. In
      the calculation based on the reference study data (90% power, effect size 0.96, alpha level
      0.05, beta level 0.90), it was found that a total of 48 cases, 24 for the experimental group
      and 24 for the control group, were suitable for statistical analysis.

      In the literature, it has been determined in the experimental studies on this issue that
      there is loss of subjects between 10% and 40%. In this study, considering the loss rates in
      the literature, assuming that there would be 40% loss, it was decided to take 68 pregnant
      women, 34 to the experimental group and 34 to the control group. Pregnant women included in
      the research will be assigned to the experimental and control groups by block randomization
      method according to the randomization list.

      In the collection of the data,

        -  The introductory information form developed by the researcher using the literature,

        -  The Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ version A and B)

        -  Psychosocial Health Assessment Scale in Pregnancy,

        -  The Mother's Postnatal Sense of Security Scale will be used.

      İmplementation of the Research

      Four sessions (one session per week) Solution Focused Approach program will be applied to the
      pregnants in the experimental group. The duration of each session is planned as 60 minutes.
      The program will be implemented in groups of five. The first session will start at the 32nd
      week of pregnancy, and the program will be completed at the end of the 35th week of
      pregnancy. After the program is completed, a training booklet prepared by the researcher will
      be given to the pregnant women in the experimental group so that they can repeat the
      information they have learned until delivery. After the training program is completed (WDEQ)
      version A and Psychosocial Health Assessment Scale in Pregnancy will be applied again (2nd
      measurement).With pregnant women, 37-40. between gestational weeks, they will be contacted
      again, and when they come to the hospital for routine pregnancy follow-up, face-to-face
      interview method (WDEQ) version A and Psychosocial Health Assessment Scale in Pregnancy (3rd
      measurement) again will be evaluated. The pregnant women will inform the researcher by phone
      after the delivery and the researcher will visit the hospital within the first 24 hours after
      the delivery to evaluate the mothers' birth fear levels (WDEQ) version B (only the posttest).
      At the end of the first postpartum week, the postnatal senses of security of the mothers
      (only post-test) will be evaluated by telephone follow-up counseling.

      Evaluation of the Data

      Coding and evaluation of data will be done in computer environment with SPSS 22.0
      (Statistical Program for Social Sciences) package program. The suitability of the research
      data to normal distribution will be determined by Kolmogorov-Smirnov test with Lilliefor,
      normal distribution curve, Skewness and Kurtosis test. Descriptive statistics will be
      evaluated by the number, percentage, average and standard deviation. For the implementation
      of the study, the ethics committee permission numbered 2020/2352 was obtained from Necmettin
      Erbakan University Meram Medical Faculty Pharmaceuticals and Non-Medical Research Ethics
      Committee and the institutional permission numbered E.33709 from Necmettin Erbakan University
      Meram Medical Faculty Hospital Chief Physician. Pregnant women who will be included in the
      research sample will be informed before the study that the purpose of the study and
      participation in the study is in line with the principle of volunteering, and "Informing and
      Consent of Volunteers Consent Form" will be signed.

      Dependent Variables

        -  Pregnant women (W-DEQ) A version scale mean scores,

        -  Pregnant women (W-DEQ) B version scale mean scores,

        -  Psychosocial Health Assessment Scale in Pregnancy mean scores,

        -  The mean scores of the Postnatal Sense of Security Scale of the pregnant women.

      Independent variable

      • Solution Focused Approach Program
    

Intervention name(s): Solution-Oriented Approach
Intervention type(s): Other
Intervention description(s): First Session: Sharing thoughts about perception of childbirth, Creating positive goals, Informing about Birth, Birth Process, Basic Breathing Exercises and Deep Relaxation Exercises, Homework Second Session: Evaluating homework, Sharing thoughts about fear of childbirth, Miracle Question Technique, Evaluating with the Rating Questions Technique, Reframing the problem, Briefing on 'Body-Mind Connection at Birth, Fear-Tension-Pain Cycle, Hormones of Birth' and Breathing exercises, Homework Third session: Evaluating homework, Sharing thoughts about positive birth story, Information on symptoms indicating that the childbirth is approaching, pushing techniques, delivery positions, endorphin massage and breathing exercises (4/8 breaths, full breath when baby moves), Homework Fourth Session: Evaluating homework, Mother Baby Friendly Caesarean and Breathing exercises (3 candles a feather breath), Sharing feelings about the counseling process
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Posttest and control grouped randomized controlled clinical trial
Masking: Single (Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: Solution-oriented approach; Fear of childbirth; Psychosocial health; mothers; Feelings of security; Pregnancy