The Effect of Using Nature Sounds and Virtual Reality During the Non-Stress Test

The Effect of Using Nature Sounds and Virtual Reality During the Non-Stress Test on Fetal Well-Being, Maternal Anxiety, Comfort, and Satisfaction

The aim of this study is to examine the effect of using nature sounds and virtual reality during the non-stress test on fetal well-being, maternal anxiety, comfort, and satisfaction. The study sample will consist of all pregnant women admitted to the Non-Stress Test (NST) unit. A total of 150 women will be included in the sample: 50 for the virtual reality group, 50 for the nature sounds group, and 50 for the control group.

Study Overview

• Status: Not yet recruiting
• Conditions: Pregnancy - Prenatal Testing
• Intervention / Treatment: Behavioral: Virtual Reality; Behavioral: Nature sounds; Behavioral: Control

Detailed Description

Pregnancy is a multidimensional process characterized not only by physiological changes but also by the restructuring of social roles and psychological adaptation. The changes that occur during this process affect both the mother and the fetus. Increased maternal stress and anxiety may influence fetal development through hormonal mechanisms. Therefore, regular and holistic monitoring of pregnancy is important. Antenatal care is a systematic evaluation process aimed at protecting maternal and fetal health and identifying risk factors. One of the frequently used non-invasive methods for assessing fetal health is the non-stress test. It is widely used because it is easy to administer and considered safe. The test evaluates the relationship between fetal heart rate, fetal movements, and uterine contractions. A reactive result indicates that the fetus is in good condition, whereas a non-reactive result may require further evaluation. Although the non-stress test is non-invasive and painless, it generally lasts at least 20 minutes, and remaining in the same position may lead to hypotension, discomfort, and anxiety. Increased maternal anxiety may affect fetal heart rate patterns, increase false-positive rates, and result in unnecessary interventions. Therefore, non-pharmacological interventions aimed at increasing maternal comfort and reducing anxiety during the NST process are important. Nature sounds may reduce perceived stress by promoting relaxation, while virtual reality may decrease anxiety and increase satisfaction by diverting attention away from the environment. The aim of this study is to determine the effects of using nature sounds and virtual reality during the non-stress test on fetal well-being, maternal anxiety, comfort, and satisfaction. The study sample will consist of all pregnant women admitted to the Non-Stress Test (NST) unit. A total of 150 women will be included in the sample: 50 for the virtual reality group, 50 for the nature sounds group, and 50 for the control group. Personal Information Form, Non Stress Test Evaluation Form, Visual Analog Scale for Satisfaction (VAS-Satisfaction), Visual Analog Scale for Comfort (VAS-Comfort), Spielberger State-Trait Anxiety Inventory (STAI) Scale, Intervention for the experimental group, the Evaluation Form (Virtual reality, Nature sounds) will be used in data collection.

• Study Type: Interventional
• Enrollment (Estimated): 150
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Elif KETEN EDİS, Assoc.Prof, PhD; Phone Number: 4802 +90 358 211 50 05; Email: elifketen05@gmail.com
• Study Contact Backup: Name: Sevgi ARSLAN, BSc, RN; Phone Number: +90 358 211 50 05; Email: sevgiedaarslan@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Being 18 years of age or older
• Being at 32 weeks of gestation or beyond
• Having a healthy pregnancy
• Having a singleton and viable pregnancy
• Not using tobacco or alcohol
• Having eaten at least two hours before the NST procedure

Exclusion Criteria:

• Having any communication impairment (language, vision, hearing, speech, etc.)
• Having a physical or cognitive condition that prevents the use of the virtual reality application and nature sound Having a diagnosis of a high-risk pregnancy Having a diagnosis of a significant chronic (cardiac, renal, neurological, etc.) or psychiatric disorder (psychosis, neurosis, substance dependence, etc.) Having a multiple pregnancy Having a fetus with an anomaly Experiencing fetal distress requiring emergency intervention Having uterine contractions

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Virtual reality group; After obtaining written informed consent from the women, data collection forms will be administered (Personal Information Form, Spielberger State-Trait Anxiety Inventory-STAI). This group will include 50 pregnant women. Following the administration of the survey form, the virtual reality headset will be introduced. The headset will be fitted before the procedure begins, and women will be instructed on how to continue watching the video while wearing the headset during the procedure. Women treated with virtual reality will be presented with videos of natural scenes (forest and sea) accompanied by nature sounds and asked to watch. After the procedure is complete, final tests will be conducted: Non-Stress Test Evaluation Form, Visual Analog Scale for Satisfaction (VAS-Satisfaction), Visual Analog Scale for Comfort (VAS-Comfort), Spielberger State-Trait Anxiety Inventory (STAI) Scale, Intervention for the experimental group, and the Evaluation Form (virtual reality, nature sounds).	Behavioral: Virtual Reality; Women treated with virtual reality will be presented with videos of natural scenes (forest and sea) accompanied by nature sounds and asked to watch. The headset will be fitted before the procedure begins, and women will be instructed on how to continue watching the video while wearing the headset during the procedure.
Experimental: Nature sounds group; After obtaining written informed consent from the women, data collection forms will be administered (Personal Information Form, Spielberger State-Trait Anxiety Inventory-STAI). This group will include 50 pregnant women. Women in the nature sounds group will be provided with the opportunity to listen to relaxing nature sounds (sea, rain, wind, river, birds) using MP3 players and headphones, according to their preferences. After the procedure is complete, final tests will be conducted: Non-Stress Test Evaluation Form, Visual Analog Scale for Satisfaction (VAS-Satisfaction), Visual Analog Scale for Comfort (VAS-Comfort), Spielberger State-Trait Anxiety Inventory (STAI) Scale, Intervention for the experimental group, and the Evaluation Form (virtual reality, nature sounds).	Behavioral: Nature sounds; Women in the nature sounds group will be given the opportunity to listen to relaxing nature sounds (sea, rain, wind, river, birds) using MP3 players and headphones according to their preferences throughout the non-stress test.
Experimental: Control group; After obtaining written informed consent from the women, data collection forms will be administered (Personal Information Form, Spielberger State-Trait Anxiety Inventory-STAI). This group will include 50 pregnant women. Women in the control group will not receive any intervention. After the non-stress test is complete, final tests will be conducted: Non-Stress Test Evaluation Form, Visual Analog Scale for Satisfaction (VAS-Satisfaction), Visual Analog Scale for Comfort (VAS-Comfort), Spielberger State-Trait Anxiety Inventory (STAI) Scale, Intervention for the experimental group, and the Evaluation Form (virtual reality, nature sounds).	Behavioral: Control; Participants in the control group received standard care (verbal information about procedure and a short written information about the procedure) and no intervention will perform.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
State-Trait Anxiety Inventory (STAI) Scale	The inventory was developed by Spielberger, Gorsuch, and Lushene in 1970. An adaptation, validity, and reliability study of the State-Trait Anxiety Scale in Turkish was conducted by Oner and Le Compte in 1983. The scale consists of two subdimensions: the state anxiety has 20 items and is used to determine what is felt at a specific moment under certain conditions, and the trait anxiety has 20 items and is used to determine what has been felt in the last 7 days. High scores from each subscale indicate a high level of anxiety. The Cronbach's a for the STAI ranges from 0.83 to 0.87	Before the non-stress test and after the procedure is completed (20 minutes after the start of the procedure)
Visual Analog Scale for Comfort (VAS-Comfort)	The Visual Analog Scale (VAS) will be used to determine the comfort levels of the participants. Developed by Price et al. in 1983 for the purpose of evaluating subjective pain, the VAS is an easy-to-apply measurement method whose validity and reliability are accepted in the international literature (Price et al., 1987; Akbay, 2026). Based on the individual's subjective evaluation, the VAS is used not only to determine the level of pain but also to evaluate subjective conditions such as fatigue and discomfort. The Visual Analog Scale (VAS) is a 10 cm long scale that can be arranged vertically or horizontally, with endpoints defined by different expressions. In this study, to evaluate the comfort levels of individuals, the leftmost end of the scale will be defined as "0 = Not comfortable at all" and the rightmost end as "10 = Very comfortable". To make the scale more understandable and applicable, vertical lines and numerical values will be used on the horizontal line.	After the non-stress test is completed (20 minutes after the start of the procedure)
Visual Analog Scale for Satisfaction (VAS-Satisfaction)	The VAS satisfaction form will be used to determine the satisfaction levels of the participants. The Visual Analog Scale (VAS) is a reliable and easily applicable measurement method with endpoints defined by different expressions, and is 10 cm long. VAS is also used to evaluate subjective states such as satisfaction. In this study, to evaluate the satisfaction levels of individuals, the leftmost end of the scale will be defined as "0 = Not satisfied at all" and the rightmost end as "10 = Very satisfied". In order to make the scale more understandable and applicable, vertical lines and numerical values will be used on the horizontal line.	After the non-stress test is completed (20 minutes after the start of the procedure)
Non Stress Test Evaluation Form	The NST Evaluation Form will be used to determine the emotional state of participants during the NST procedure and to evaluate the results of the non-stress test (NST). The form includes variables such as NST recording time, basal fetal heart rate (FHR), presence and number of accelerations and decelerations, and whether it is evaluated as reactive or non-reactive. The National Institute of Child Health and Human Development 2008 guidelines will be used to evaluate the NST results.	After the non-stress test is completed (20 minutes after the start of the procedure)
Intervention for the experimental group The Evaluation Form (Virtual reality, Nature sounds)	In this study, an intervention evaluation form prepared by the researcher will be used for the virtual reality and nature sounds groups. Separate intervention evaluation forms will be used for the nature sounds and virtual reality groups. The form includes questions about the participants' emotional state during the intervention, whether they would like to use it again, and whether they would recommend the application to other pregnant women.	After the non-stress test is completed (20 minutes after the start of the procedure)

Collaborators and Investigators

• Sponsor: Amasya University
• Investigators: Study Director: Elif Keten Edis, PhD, Amasya University

Study record dates

Study Major Dates

• Study Start (Estimated): July 1, 2026
• Primary Completion (Estimated): March 1, 2027
• Study Completion (Estimated): March 31, 2027

Study Registration Dates

• First Submitted: March 30, 2026
• First Submitted That Met QC Criteria: April 3, 2026
• First Posted (Actual): April 6, 2026

Study Record Updates

• Last Update Posted (Actual): April 6, 2026
• Last Update Submitted That Met QC Criteria: April 3, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Anxiety; Pregnancy; Fetal health; Non-Stress Test
• Additional Relevant MeSH Terms: Mental Disorders; Anxiety Disorders
• Other Study ID Numbers: S-Tez

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No