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The effect of integrating midwifery counselling with a spiritual content on improving the antenatal quality of life: a randomized controlled trial

Publicado en línea: 20 Jul 2022
Volumen & Edición: AHEAD OF PRINT
Páginas: -
Recibido: 03 Jan 2022
Aceptado: 02 Jun 2022
Detalles de la revista
License
Formato
Revista
eISSN
2719-535X
Primera edición
01 Jan 2020
Calendario de la edición
4 veces al año
Idiomas
Inglés
Abstract Background

Poor antenatal quality of life (QoL) is associated with adverse outcomes.

Objective

This study was performed to examine the effect of integrating midwifery counseling with spiritual content to improve the antenatal quality of life.

Material and methods

This randomised controlled trial was performed on 60 first-time pregnant women who were referred to two childbirth preparation centers in Zanjan city, Iran, in 2019. The counselling was conducted in eight sessions. The QoL SF-36 questionnaire was completed right before and two months after the intervention. Data were analysed using the chi-square test, independent t-test, and paired-samples t-test. The level of significance was p < 0.05.

Results

After intervention based on an independent t-test the total score of QoL was significantly greater in the intervention group compared with the control group (p = 0.001). After the intervention, the mean scores of four domains of QoL (Role-Physical, General Health, Vitality, Role-Emotional, and Mental Health) were significantly higher than the control group (p = 0.001). Whilst in terms of Physical Functioning, Bodily Pain and Social Functioning domains were not statistically significant (p > 0.05).

Conclusion

Integrating midwifery counseling with spiritual content had a positive impact on improving the psychological aspect of quality of life more than the physical and social aspects. It can be used by providers for planning antenatal care programs.

Keywords

Introduction

Pregnancy is a physiological phenomenon in a woman's life. Physical and psychological changes during pregnancy can affect the social and physical performance, as well as the quality of life (QoL), of pregnant women [1]. The quality of life (QoL) reflects the subjective perceptions of the individual's situation in life, based on the cultural and value system, given the individual's goals, expectations, standards, and attitudes [2]. According to the World Health Organization (WHO), health-related QoL refers to the physical, psychological, social, and spiritual dimensions of individuals’ well-being [3]. Furthermore, the QoL of pregnant women could be affected by many factors such as gestational age, social and economic support, and complications before or during pregnancy [4]. On the other hand, poor pregnancy QoL is associated with adverse outcomes – for example, preterm labour pain and pregnancy-related symptoms such as fatigue, and low back and pelvic pain [5]. Additionally, low QoL in pregnancy contributes to low QoL in the postnatal period [6].

Spirituality is known as an important component of health and well-being. Although the concepts of religion and spirituality are similar in some aspects and are often used interchangeably, they have different meanings. Spirituality is a way of perceiving the sublime, understanding certain values and goals of life, and experiencing positive and satisfying behaviours and emotions in life through non-physical methods [7]. In this respect, spiritual care can be educated in nursing and midwifery to be able to provide spiritual care as part of holistic and person-centred care [8, 9].

Childbearing is one of the ideal conditions for enriching spirituality. Some people believe that the process of pregnancy and childbirth is a time to get closer to God and make life more meaningful [10]. Spirituality is defined as sensitivity or attachment to religious values or to things of the spirit as opposed to material or worldly interests. Spiritual experience is unique and includes understanding the meaning of life, positive life experiences, feeling happy, and life satisfaction [11].

In Iran, spiritual care has not been routinely included in antenatal care programs, while in recent years valuable results from the implementation of interventions based on religion and spirituality in improving anxiety, depression, and coping with stress have been reported [12]. The use of spiritual counselling alone or in combination with cognitive behavioural therapy can improve QoL in women with a high-risk pregnancy, postpartum depression, and fear of labour pain [13, 14, 15]. However, there is a gap in the effectiveness of spirituality-based interventions in the culture and context of Iran on health-related QoL in women with the first pregnancy. Given the importance of spiritual care and the presence of limited studies in this field, this study aimed to examine the effect of integrating midwifery counselling with spiritual content on improving the antenatal quality of life.

Material and methods
Study aim and design

This parallel randomised controlled trial was performed to examine the effect of integrating midwifery counselling with spiritual content on improving the antenatal quality of life among first-time pregnant women.

Setting

The study was performed on 60 first-time pregnant women who were referred to two childbirth preparation centres in Zanjan, a city in northwest Iran, in 2019. There are three childbirth preparation centres in Zanjan. One of the childbirth preparations centres is located in a hospital and covers most high-risk pregnancies, so sampling was done from only two centres that provide services in the urban health community centre.

Participants

The study population included first-time pregnant women who were referred to two childbirth preparation centres in Zanjan. Inclusion criteria consisted of living in Zanjan City, gestational age of 20–24 weeks, willingness to participate in the study, obtaining scores ≤ 10 according to the Edinburgh Postnatal Depression Scale (EPDS) [16], scores of 19 to 37 based on the Cohen Perceived Stress Scale (PSS-14) [17], and having a normal pregnancy with a singleton foetus.

Exclusion criteria before randomisation were the presence of medical or obstetric complications, psychiatric disorders, or use of psychiatric drugs, and lack of access to telephone for follow-up. There was no attrition in the study and after the interventions.

Procedure

Pregnant women who met the inclusion criteria and signed the informed consent form were allocated into two intervention and control groups using randomised a block size of four. To ensure the concealment of the sequence of enrolment, an opaque sealed envelope system was used [18]. Envelope preparation and random allocation sequencing were performed by a person not involved in the research process. In the present study, the participants and researcher were not blinded; only outcome assessors were blinded. The research process is shown in Figure 1.

Figure 1

Flow chart of the participant's selection

The counselling was conducted by a midwife (the first author) familiar with counselling approaches. The content of the sessions was developed under the supervision of a spiritual advisor by following the study of Khodakamari et al. [19] and the method suggested by Richard and Bergin [20]. The intervention group received eight sessions of counselling in addition to routine care. The counselling was held over eight sessions as group counselling (8–10 people) for 4 weeks (2 times per week for 45 minutes) in preparation classrooms. Educational content was prepared using the Holy Quran and religious books (Hadis) and integrated with routine midwifery counselling. The main topic of counselling is reported in Table 1.

Details of the intervention

Sessions Counselling content Session homework
First The first session was to meet the participants and researcher, to explain the aim, the rules, and the brief full programme. Providing pre-test. Talking about the concept of quality of life, self-concept in pregnancy, and checking misconceptions. Focus on human creation and discussing concerning the status of women in the continuity of creation Practise looking at their life issues from other angles. Prepare a list of pregnancy stressors. Be aware of the stresses that accumulate all over your body and make you suffer.
Second Assessing attitudes and beliefs of the pregnant woman on spiritual issues, the role of god, and religion in her life. Talking about the spiritual aspects of pregnancy and childbearing. Listening to the physical and mental problems, worries, fears, ambivalence sense in early pregnancy and her actions in daily life. Visualise unfavourable conditions and try to switch appropriate and positive reactions in your mind to inappropriate ones.
Third Discussing the positive effects of helping each other in our life. Finding the truth of their existence, not just addressing personal desires in pregnancy Focus on the concepts of trust, resort, patience, and kindness. Listening to positive statements of participants based on reading the holy book and spiritual issues in overcoming or feeling calm in stressful situations. Create a daily spiritual space of time or place at home. Reflect on what others are saying and pay attention to the root cause of others' behaviour or speech and try not to react too quickly.
Fourth Blessings of God and the role of it in reinterpreting the concept of pregnancy and overcoming the worrisome symptoms of pregnancy. Strengthening individuals' inner hope and powers for coping with pregnancy and childbearing. Teaching relaxing muscles with deep breathing for getting rid of the stress. Repeat twice daily for 10 to 15 minutes. Book therapy / listening to Qur'an voices for 10 min.
Fifth Discussing the role of patience and trust in God in enduring the pain of childbirth and the spiritual reward of pregnancy, childbirth, and breastfeeding for the mother. Encouraging her to express her feelings after/ whilst creating a daily spiritual space. Talking about the experience of participating in religious programmes or doing spiritual issues. Discuss the effect of spiritual beliefs on eating habits on the foetus, taking care of oneself in pregnancy. Listening to ‘Nature's Music’ – the sound of birds, rivers, and waterfalls...
Sixth Encouraging her to refer to people who create a positive atmosphere with which she feels comfortable. Illustration and slowly moving tone using a meditation-based relaxation technique along with listening to relaxing music. Take a realistic look at the issues and changes that have taken place in their pregnancies. Do not be strict or easy-going. Allocate as much attention and time as needed to each issue. Book therapy / listening to Qur'an voices for 10 min.
Seventh Pay attention to the concepts of resentment, lack of forgiveness, guilt, and forgiving oneself and others. Discuss the strategy of prayer therapy to reduce some symptoms of pregnancy related to pregnancy and increase hope. Express the pleasure and responsibility of being a mother from the point of view of the Quran’s ‘Divine Responsibility Reward’ Focus on motherhood and look at pregnancy in terms of your productive and fertile period. Enjoy the hardships of pregnancy and childbirth happily. Face these hardships and endure them.
Eighth Reviewing and summarising the previous sessions' topics. Relaxing muscles with deep breathing for getting rid of the stress. Repeat twice daily for 10 to 15 minutes.

Each session was started with a focus on breathing exercises or the sacred name ‘Allah’.

Next, the counsellor described the subject of the meeting and encouraged the mothers to express their emotions, needs, concerns, and thoughts on pregnancy. At the same time, the counsellor guided the participants to increase their knowledge to choose the appropriate remedy for emotional reactions during pregnancy and pay attention to spiritual aspects of life. Further advice was given as homework. At the end of each session, explanations and summaries were provided, and the women discussed the topic.

According to the guidelines of the Iranian Ministry of Health, routine childbirth preparation classes were held from the 20th week of gestation every two weeks until the 32nd week of gestation. The sessions focused on making the mothers familiar with the different stages of pregnancy, from fertilisation to delivery, personal hygiene, nutrition, mental and physical changes during pregnancy, pregnancy risks, childbirth planning, postpartum health, breastfeeding, and childcare. However, no spiritual content was included. The control group only received routine care.

Outcomes

The main outcome of this study was to determine the antenatal QoL of first-time pregnant women, who were studied using the SF-36 as a standard questionnaire of QoL, which was completed by the participants before and two months after the last session.

Demographic charateristics

It included personal information about a woman's age, education, occupation, and spouse’s occupational status.

Health-related quality of life (HRQoL) -SF-36

SF-36 is a multidimensional measure evaluating health-related quality of life. It is widely used in clinical research and is a reliable and valid measure of health-related QoL in different populations [21, 22]. It measures the perceptions of health-related QoL in eight domains of health status: physical functioning (10 items); physical role limitations (four items); bodily pain (two items); general health perceptions (five items); energy/vitality (four items); social functioning (two items); emotional role limitations (three items) and mental health (five items). Responses are scored on a 5-point scale, which is transformed into a score of 0–100 with higher scores indicating better functioning or wellbeing. The validity and reliability of the Persian version of the questionnaire have been assessed by Montazeri et al. [21].

Data analysis

The statistical analysis was performed using SPSS software version 16. For the 95% confidence level – Z (1-α) = 1.96 – the test power of 80% – Z (1-β) = 0.85 – based on the QoL variable in Zamani's study with the mean and standard deviation in the intervention group (M1 = 32.10 and S1 = 2.63) and the control group (M2 = 25.90 and S2 = 2.33), as well as an attrition rate of 15%, the sample size of was calculated for 30 pregnant women in each group [15].

Descriptive statistics were employed to describe demographic data. The chi-square test was used to compare the demographic characteristics of the groups. The Kolmogorov-Smirnov test revealed that the scores of QoL and its components had normal distributions. Therefore, to compare total scores and all domains between and within the groups before and after intervention, an independent t-test and paired sample t-test were applied, respectively. The level of significance was p < 0.05.

Results

Among 146 pregnant women evaluated by the researcher, sixty women met the eligibility criteria for the study.

Demographic characteristics

The demographic data are shown in Table 2. Most of the participants were housewives and have university level education. There were no statistically significant differences between the two groups before the intervention in terms of demographic characteristics. The mean and standard deviation of gestational age in the counselling group and the control group were 21.80 ± 1.27 and 21.60 ± 1.40 weeks, respectively. Also, the mean age of the participants and gestational age were not statistically significant between the two groups (p < 0.05) (Table 2).

The comparison of number (percent) of social and demographic characteristics between two groups

Variable
Groups
P-value
Intervention
Control Number (percent)
Frequency
Percentage
Frequency
Percentage
Women's Education Guidance 2 6.7 2 6.7 0.44
High school 1 3.3 1 3.3
Diploma 12 40 10 33.3
University 15 50 17 56.7

Women's Employment Employed 14 46.7 10 33.3 0.43
Housewife 16 53.3 20 66.7

Spouses’ employment Employed 17 56.7 21 70 0.42
Unemployed 13 43.3 9 30

Age (years)
Mean ± standard deviation 25.80 ± 6.37
24.30 ± 6.80
0.38
Gestational age (week) 21.80 ± 1.27 21.60 ± 1.40 0.56

The mean ± SD of PSS-14 in the intervention group was 23.57 ± 3.81, and in the control group it was 23.09 ± 4.29. Before intervention, based on an independent t-test, the total score of PSS-14 was not statistically significant between the two groups (p = 0.399).

The mean ± SD of the Edinburgh Postnatal Depression Score (EPDS) of the intervention and control groups was 8.43 ± 1.56 and 8.40 ± 1.68, respectively. Prior to intervention, according to an independent t-test, the total score of EPDS was not statistically significant between the two groups (p = 0.092). All participants met the eligibility criteria for the study owing to the scores of EPDS being lower than 10 and the scores of PSS-14 being between 19 to 37.

Health-Related Quality of Life (HRQoL)

In the intervention group before counselling the mean score of overall QoL was 85.66 ± 5.44, which increased to 96.46 ± 4.44; in the control group, it was 86.86 ± 3.36 before intervention that decreased to 85.76 ± 4.04 two months after the intervention. The observed differences between the two groups were statistically significant after intervention (p = 0.001).

After intervention, according to an independent t-test, the mean score of four domains of QoL (Physical Role Limitations, General Health, Vitality, Role-Emotional Health, and Mental Health) in the counselling group was significantly higher than for the control group (p = 0.001). But in terms of the Physical Functioning, Bodily Pain, and Social Functioning domains, the differences were not statistically significant (p > 0.05).

A comparison of the within-group (before and after) scores of QoL and its domains in the control group showed no statistically significant differences (p > 0.05).

A comparison, however, of the within-group (before and after) scores of QoL and the domains of Physical Functioning, Physical Role Limitations, General Health, Vitality, Role-Emotional, and Mental Health in the intervention group showed statistically significant improvements (p < 0.05). Only the scores of the two domains of Bodily Pain and Social Functioning were not statistically significant (p > 0.05) (Table 3).

The comparison of quality-of-life (QoLSF-36) and its domain scores between two groups

SF-36 Domains Intervention Control P-value
Mean SD Mean SD
Physical functioning Pre-test 26.75 8.43 30.25 5.14 0.05
Posttest 31.08 8.29 27.58 5.62 0.06
P-value Paired t-test = 0.0001 Paired t-test = 0.07
Bodily pain Pre-test 32.91 22.62 33.75 16.78 0.87
Posttest 33.75 25.24 38.33 20.74 0.44
P-value Paired t-test = 0.73 Paired t-test = 0.34
physical role limitations Pre-test 6.25 5.91 5.20 5.46 0.48
Posttest 13.33 7.65 6.25 5.44 0.0001
P-value Paired t-test = 0.0001 Paired t-test = 0.16
Emotional role Pre-test 16.66 8.47 16.66 8.47 1
functioning Posttest 29.16 9.22 16.94 8.32 0.0001
P-value Paired t-test = 0.0001 Paired t-test = 0.91
Social role functioning Pre-test 35.41 12.74 37.08 8.97 0.56
Posttest 38.33 11.80 37.91 8.97 0.87
P-value Paired t-test =0.18 Paired t-test =0.72
Mental health Pre-test 57.00 7.61 58.50 6.45 0.41
Posttest 62.33 8.78 57.16 6.78 0.01
P-value Paired t-test = 0.0001 Paired t-test = 0.45
Vitality Pre-test 49.79 8.44 49.16 8.64 0.77
Posttest 63.33 4.85 49.16 8.64 0.0001
P-value Paired t-test = 0.0001 Paired t-test = 0.18
General health Pre-test 35.16 7.59 33.83 5.20 0.43
perceptions Posttest 46.66 7.46 32.33 4.09 0.0001
P-value Paired t-test = 0.0001 Paired t-test = 0.34
Total Quality of Life Pre-test 85.66 5.44 86.86 3.36 0.31
Score Posttest 96.46 4.44 85.76 4.04 0.0001
P-value Paired t-test = 0.0001 Paired t-test = 0.23
Discussion

The study was done to examine the effect of integrating midwifery counselling with spiritual content on improving the antenatal quality of life among first-time pregnant women. Our results showed that integrating midwifery counselling with spiritual content could improve the overall QoL. However, three domains of SF-36 QoL (physical function, bodily pain, and social function) showed no improvements. The current study emphasised that integrating midwifery counselling with spiritual content improved the psychological aspects of QoL more than the physical and social aspects. Limited information is available on the effectiveness of spirituality-based education for improving the QoL of first-time healthy pregnant women. However, our results were consistent with some studies that were conducted on multiparous or high-risk pregnancy samples. In this regard, Moazedi et al 2018, showed that Islamic teaching-based religious and spiritual psychotherapy could improve the quality of life of infertile women [13]. The content of the counselling in our study was similar to their study and included religious and spiritual instruction in increasing the acceptance of pregnancy and responsibility through attention to the spiritual reward of pregnancy in the presence of God, the increase of trust, reflection on human creation and the greatness of creation, the blessings of God and their role in reinterpreting the concept of pregnancy and overcoming the worrisome symptoms of pregnancy. Strengthening individuals' inner hope and powers for coping with pregnancy and childbearing was the goal.

Zamani et al. (2018) in a semi-experimental study with a pre-test/post-test design showed that integrating cognitive and behavioural therapy with Islamic spirituality instructions had an effective impact on the quality of life of pregnant women [15]. Beigi et al. (2015) showed that the implementation of group spiritual therapy was effective in reducing anxiety and increasing the quality of life of women with gestational diabetes [23]. Also, similar efficacy has been reported in another study by Niaz Azari et al. in 2017 [14]. Constituency in results emphasised that the spirituality-based approach can be used to improve the quality of life of women in the antenatal and postpartum periods. According to the World Health Organization recommendation, ‘every woman has the right to the highest attainable standard of health, which includes the right to dignified, respectful health care throughout pregnancy and childbirth’. The respect for pregnant women’s overall needs and their satisfaction leads to a holistic women-centred approach to care [24].

Various ideas that have been reported concerning the biological and psychological effects of spiritual experience on diseases have been emphasised in some studies. It can be claimed that some cognitive patterns, psychological characteristics, and behavioural patterns created by spirituality-oriented methods lead to strengthening health and improving the physiological functioning of the body and consequently increase the psychological resistance of the person in poor physical and social situations. Accordingly, spiritual practices and the religious aspects of spirituality lead to increased tolerance, patience, self-control, satisfaction, emotional control, optimism, self-efficacy (based on trust in God's blessing), altruism, kindness, and love [25, 26]. Religion and spirituality can increase QoL by changing people’s attitudes, increasing their sense of responsibility towards themselves and others, promoting the search for meaning in life, and having a greater sense of happiness and self-esteem [27].

The effectiveness of the spiritual approach on improving QoL in the different populations [28, 29, 30] has been shown that spirituality is a universal element [31]. Belief in God creates a change in one’s perspective towards life [19]. The spiritual aspects of pregnancy and childbearing are often neglected in the literature. Integration of midwifery-led counselling with the spiritual approach for improving the quality of life of women is necessary. It can be concluded that spiritual counselling had a positive impact on improving the QoL of first-time pregnant women. The integration of spiritual counselling with the educational content of childbirth preparation can improve the psychological aspects of QoL of pregnant women more than the physical and social aspects. Therefore, it can be used for planning suitable interventions among pregnant women.

Strengths of study

All the principles of control trial studies were observed in this study and we didn’t have a loss of following in participants. Data collection tools were standard and psychometric properties of the Persian form of the questionnaires have been evaluated based on Iranian culture.

Limitations

The sample size was small, and the follow-up period was short. Also, samples were limited to the participants of childbirth preparation classes with moderate levels of perceived stress, which can affect the generalisability of findings. Also, the long duration of each session could lead to the exhaustion of mothers. However, the women were allowed to have rest and walk for a few minutes during the sessions.

In the present study, the spiritual intelligence of the participants was not examined before the intervention, and this fact is considered a limitation. It is suggested that additional studies should be performed to measure spiritual intelligence and perceived stress with the long follow-up period, along with the participation of their spouses in the future. Furthermore, for better conclusions about the long-term effects of the spirituality-based intervention on antenatal QoL, studies with a mixed-method design need to be conducted in the future.

Key points

Poor antenatal Quality of Life (QoL) is associated with adverse outcomes.

The integration of spiritual counselling with antenatal care can improve the QoL of pregnant women.

Figure 1

Flow chart of the participant's selection
Flow chart of the participant's selection

Details of the intervention

Sessions Counselling content Session homework
First The first session was to meet the participants and researcher, to explain the aim, the rules, and the brief full programme. Providing pre-test. Talking about the concept of quality of life, self-concept in pregnancy, and checking misconceptions. Focus on human creation and discussing concerning the status of women in the continuity of creation Practise looking at their life issues from other angles. Prepare a list of pregnancy stressors. Be aware of the stresses that accumulate all over your body and make you suffer.
Second Assessing attitudes and beliefs of the pregnant woman on spiritual issues, the role of god, and religion in her life. Talking about the spiritual aspects of pregnancy and childbearing. Listening to the physical and mental problems, worries, fears, ambivalence sense in early pregnancy and her actions in daily life. Visualise unfavourable conditions and try to switch appropriate and positive reactions in your mind to inappropriate ones.
Third Discussing the positive effects of helping each other in our life. Finding the truth of their existence, not just addressing personal desires in pregnancy Focus on the concepts of trust, resort, patience, and kindness. Listening to positive statements of participants based on reading the holy book and spiritual issues in overcoming or feeling calm in stressful situations. Create a daily spiritual space of time or place at home. Reflect on what others are saying and pay attention to the root cause of others' behaviour or speech and try not to react too quickly.
Fourth Blessings of God and the role of it in reinterpreting the concept of pregnancy and overcoming the worrisome symptoms of pregnancy. Strengthening individuals' inner hope and powers for coping with pregnancy and childbearing. Teaching relaxing muscles with deep breathing for getting rid of the stress. Repeat twice daily for 10 to 15 minutes. Book therapy / listening to Qur'an voices for 10 min.
Fifth Discussing the role of patience and trust in God in enduring the pain of childbirth and the spiritual reward of pregnancy, childbirth, and breastfeeding for the mother. Encouraging her to express her feelings after/ whilst creating a daily spiritual space. Talking about the experience of participating in religious programmes or doing spiritual issues. Discuss the effect of spiritual beliefs on eating habits on the foetus, taking care of oneself in pregnancy. Listening to ‘Nature's Music’ – the sound of birds, rivers, and waterfalls...
Sixth Encouraging her to refer to people who create a positive atmosphere with which she feels comfortable. Illustration and slowly moving tone using a meditation-based relaxation technique along with listening to relaxing music. Take a realistic look at the issues and changes that have taken place in their pregnancies. Do not be strict or easy-going. Allocate as much attention and time as needed to each issue. Book therapy / listening to Qur'an voices for 10 min.
Seventh Pay attention to the concepts of resentment, lack of forgiveness, guilt, and forgiving oneself and others. Discuss the strategy of prayer therapy to reduce some symptoms of pregnancy related to pregnancy and increase hope. Express the pleasure and responsibility of being a mother from the point of view of the Quran’s ‘Divine Responsibility Reward’ Focus on motherhood and look at pregnancy in terms of your productive and fertile period. Enjoy the hardships of pregnancy and childbirth happily. Face these hardships and endure them.
Eighth Reviewing and summarising the previous sessions' topics. Relaxing muscles with deep breathing for getting rid of the stress. Repeat twice daily for 10 to 15 minutes.

The comparison of number (percent) of social and demographic characteristics between two groups

Variable
Groups
P-value
Intervention
Control Number (percent)
Frequency
Percentage
Frequency
Percentage
Women's Education Guidance 2 6.7 2 6.7 0.44
High school 1 3.3 1 3.3
Diploma 12 40 10 33.3
University 15 50 17 56.7

Women's Employment Employed 14 46.7 10 33.3 0.43
Housewife 16 53.3 20 66.7

Spouses’ employment Employed 17 56.7 21 70 0.42
Unemployed 13 43.3 9 30

Age (years)
Mean ± standard deviation 25.80 ± 6.37
24.30 ± 6.80
0.38
Gestational age (week) 21.80 ± 1.27 21.60 ± 1.40 0.56

The comparison of quality-of-life (QoLSF-36) and its domain scores between two groups

SF-36 Domains Intervention Control P-value
Mean SD Mean SD
Physical functioning Pre-test 26.75 8.43 30.25 5.14 0.05
Posttest 31.08 8.29 27.58 5.62 0.06
P-value Paired t-test = 0.0001 Paired t-test = 0.07
Bodily pain Pre-test 32.91 22.62 33.75 16.78 0.87
Posttest 33.75 25.24 38.33 20.74 0.44
P-value Paired t-test = 0.73 Paired t-test = 0.34
physical role limitations Pre-test 6.25 5.91 5.20 5.46 0.48
Posttest 13.33 7.65 6.25 5.44 0.0001
P-value Paired t-test = 0.0001 Paired t-test = 0.16
Emotional role Pre-test 16.66 8.47 16.66 8.47 1
functioning Posttest 29.16 9.22 16.94 8.32 0.0001
P-value Paired t-test = 0.0001 Paired t-test = 0.91
Social role functioning Pre-test 35.41 12.74 37.08 8.97 0.56
Posttest 38.33 11.80 37.91 8.97 0.87
P-value Paired t-test =0.18 Paired t-test =0.72
Mental health Pre-test 57.00 7.61 58.50 6.45 0.41
Posttest 62.33 8.78 57.16 6.78 0.01
P-value Paired t-test = 0.0001 Paired t-test = 0.45
Vitality Pre-test 49.79 8.44 49.16 8.64 0.77
Posttest 63.33 4.85 49.16 8.64 0.0001
P-value Paired t-test = 0.0001 Paired t-test = 0.18
General health Pre-test 35.16 7.59 33.83 5.20 0.43
perceptions Posttest 46.66 7.46 32.33 4.09 0.0001
P-value Paired t-test = 0.0001 Paired t-test = 0.34
Total Quality of Life Pre-test 85.66 5.44 86.86 3.36 0.31
Score Posttest 96.46 4.44 85.76 4.04 0.0001
P-value Paired t-test = 0.0001 Paired t-test = 0.23

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