Mindfulness Psychoeducation Based on Transtheoretical Model for Fear of Childbirth

The Effect of Mindfulness-Based Psychoeducation Provided According to the Transtheoretical Model on Fear of Childbirth, Self-Perception, and Spiritual Well-Being in Pregnant Women With Fear of Childbirth

Childbirth is a significant life event with important physical and psychological effects on pregnant women. Due to uncertainty during pregnancy, many women experience fear of childbirth. Fear of childbirth is a common condition that may negatively affect maternal well-being. Therefore, various psychosocial interventions have been developed to reduce this condition. Mindfulness-based approaches and psychoeducation programs are considered effective methods for reducing stress, anxiety, and fear by promoting non-judgmental awareness of the present moment.

This study is designed as a randomized controlled experimental trial. The study population will consist of pregnant women attending the Obstetrics and Gynecology Outpatient Clinic of Niğde Ömer Halisdemir Training and Research Hospital who meet the inclusion criteria. The sample size was calculated using G*Power 3.1.9.7 software. Based on an effect size of f = 0.38, 80% statistical power, and a 5% significance level, a minimum of 30 participants was required. Considering a 20% potential dropout rate, a total of 72 pregnant women (36 intervention and 36 control) will be included in the study.

The inclusion criteria are being between 18 and 40 years of age, having a first pregnancy, being between 20 and 34 weeks of gestation, having a singleton and healthy pregnancy, being able to communicate in Turkish, and scoring 38 or higher on the Wijma Delivery Expectancy/Experience Questionnaire (Version A). Women with high-risk pregnancies, a history of psychiatric disorders, illiteracy, communication problems, or unwillingness to participate will be excluded. Withdrawal during the study, development of pregnancy complications, or inability to continue the intervention will be considered exclusion criteria.

Data will be collected using a Sociodemographic Information Form, the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ A), the Self-Perception Scale for Pregnant Women, and the Spiritual Well-Being Scale. The W-DEQ A measures fear of childbirth, the Self-Perception Scale assesses maternal and body perception during pregnancy, and the Spiritual Well-Being Scale evaluates the level of spiritual well-being.

At the beginning of the study, eligible participants will be informed about the research and written informed consent will be obtained. Data collection forms will first be administered face-to-face. Pregnant women scoring 38 or above on the W-DEQ A will then be randomly assigned to intervention and control groups using a computer-based randomization method (randomizer.org).

The intervention group will receive a mindfulness-based psychoeducation program adapted according to the Transtheoretical Model. The intervention will be delivered in group sessions of 6-10 participants, twice a week for 4 weeks, with each session lasting approximately 45-60 minutes. The program includes psychoeducation about pregnancy and childbirth, mindfulness exercises, emotional awareness activities, and coping strategies for fear of childbirth.

The control group will receive routine obstetric care only. Post-intervention assessments will be conducted in both groups using the same measurement tools.

Data analysis will be performed using SPSS version 25.0. Descriptive statistics will be calculated, and depending on data distribution, independent samples t-test, paired samples t-test, ANOVA, Mann-Whitney U test, Kruskal-Wallis test, and chi-square test will be used. The level of statistical significance will be set at p < 0.05.

The aim of this study is to evaluate the effect of a mindfulness-based psychoeducation intervention based on the Transtheoretical Model on fear of childbirth, self-perception, and spiritual well-being in pregnant women experiencing fear of childbirth.

Study Overview

• Status: Not yet recruiting
• Conditions: Pregnancy; Fear of Childbirth
• Intervention / Treatment: Behavioral: Mindfulness-Based Psychoeducation

• Study Type: Interventional
• Enrollment (Estimated): 72
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Büşra Rümeysa Demirel, PhD Student; Phone Number: +90 5551964396; Email: bdemirel@ohu.edu.tr
• Study Contact Backup: Name: Gamze Sarıkoç, Associate Professor; Phone Number: +90 530 642 23 13; Email: gamze.sarikoc@sbu.edu.tr

Study Locations

• Turkey (Türkiye)
  • Niğde, Turkey (Türkiye)
    • Niğde Ömer Halisdemir Eğitim ve Araştırma Hastanesi
    • Contact: Büşra Rümeysa Demirel, PhD Student; Phone Number: +90 5551964396; Email: bdemirel@ohu.edu.tr
    • Contact: Gamze Sarıkoç, Associate Professor; Phone Number: +90 530 642 23 13; Email: gamze.sarikoc@sbu.edu.tr
    • Principal Investigator: Büşra Rümeysa Demirel, PhD Student
    • Sub-Investigator: Gamze Sarıkoç, Associate Professor

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Willing to participate in the study,
• Aged between 18-40 years,
• Primigravida (first pregnancy),
• Not having received any childbirth preparation class,
• Scoring 38 or above on the Wijma Delivery Expectancy/Experience Questionnaire,
• Between 20 and 34 weeks of gestation,
• Having a healthy pregnancy,
• Having a singleton pregnancy,
• Carrying a live fetus,
• Not in active labor,
• Able to speak Turkish and without any language, comprehension, or communication problems to understand and answer the questions.

Exclusion Criteria:

• Those who do not agree to participate in the study,
• Pregnant women under 18 years of age and over 41 years of age,
• Diagnosed with high-risk pregnancy,
• Illiterate,
• Having a contagious disease,
• Having a current or past psychiatric disorder requiring treatment,
• Having mobility, hearing, or psychological disabilities,
• With a gestational age below 20 weeks or above 32 weeks,
• Those who have entered active labor.

Withdrawal / Exclusion Criteria

• Participants who withdraw consent and wish to leave the study during the study period,
• Participants who are unable to adapt to the intervention process,
• Participants experiencing communication or internet connectivity problems,
• Participants who develop complications during the intervention (e.g., onset of labor, decreased fetal movements, etc.) requiring hospitalization will be excluded from the study.

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

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Mindfulness-Based Psychoeducation Group; Participants will receive a mindfulness-based psychoeducation program adapted according to the Transtheoretical Model. The intervention will be delivered in groups of 6-10 pregnant women twice a week for 4 weeks in an online format. Each session will last approximately 45-60 minutes. The program includes psychoeducation about pregnancy and childbirth, mindfulness exercises, emotional awareness activities, and coping strategies for fear of childbirth. The aim of the intervention is to reduce fear of childbirth and improve self-perception and spiritual well-being. The intervention will be conducted online to increase participant comfort and accessibility.	Behavioral: Mindfulness-Based Psychoeducation; Participants in this arm will receive a mindfulness-based psychoeducation program adapted according to the Transtheoretical Model. The intervention will be delivered in groups of 6-10 pregnant women twice a week for 4 weeks in an online format. Each session will last approximately 45-60 minutes. The program includes psychoeducation about pregnancy and childbirth, mindfulness exercises, emotional awareness activities, and coping strategies for fear of childbirth. The aim is to reduce fear of childbirth and improve self-perception and spiritual well-being.
No Intervention: Control Group; Participants in this arm will receive routine obstetric care provided by the hospital during pregnancy. No additional psychological, educational, or mindfulness-based intervention will be applied throughout the study period.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Fear of childbirth (W-DEQ A score)	Developed by Wijma et al. in 1988 (Wijma et al., 1998), the scale was adapted into Turkish by Körükçü et al. in 2012. Fear of childbirth will be measured using the Wijma Delivery Expectancy/Experience Questionnaire Version A (W-DEQ A). The scale assesses the fear of childbirth, with higher scores indicating higher levels of fear. The scale consists of 33 items and 6 subscales, utilizing a 6-point Likert-type format (0 = completely, 5 = not at all). The total score obtainable from the scale ranges from a minimum of 0 to a maximum of 165. Scores between 0-37 indicate mild fear, 38-65 indicate moderate fear, 66-84 indicate severe fear, and scores of 85 and above indicate clinical-level fear. In this study, participants scoring 38 or above (corresponding to moderate and severe fear levels) will be included. Measurements will be conducted at baseline (pre-intervention) and immediately after the completion of the intervention.	Baseline and immediately post-intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Self-Perception of Pregnant Women	The Self-Perception of Pregnant Women Scale was developed by Kumcağız et al. in 2017.The scale evaluates maternal perception related to pregnancy, including maternal identity and body image. It consists of 12 items and utilizes a 4-point Likert-type format (4: always, 3: mostly, 2: sometimes, 1: never). The scale comprises two subdimensions: In the "Maternal Perception of Pregnancy" subscale, the maximum obtainable score is 28, and the minimum is 7. Higher scores in this subscale indicate a higher level of positive maternal perception, whereas lower scores indicate a lower level of maternal perception. In the "Body Image of Pregnancy" subscale, the maximum obtainable score is 20, and the minimum is 5. Higher scores in this subscale indicate a more negative body image, whereas lower scores indicate a more positive body image (Kumcağız et al., 2017). Measurements will be conducted at baseline (pre-intervention) and immediately after the completion of the intervention.	Baseline and immediately post-intervention
Spiritual Well-Being	It is a scale developed by Ekşi and Kardaş in 2017. The scale consists of 29 items across 3 subdimensions: "transcendence", "harmony with nature", and "anomie", and utilizes a 5-point Likert-type format (1 = Not at all suitable for me, 2 = Not suitable for me, 3 = Somewhat suitable for me, 4 = Quite suitable for me, 5 = Completely suitable for me). The total score obtainable from the scale ranges from a minimum of 29 to a maximum of 145. Items in the anomie subdimension are reverse scored. As the total scores increase, spiritual well-being increases. While higher scores in the "transcendence" and "harmony with nature" subscales represent positive spiritual well-being, higher scores in the "anomie" subdimension indicate lower spiritual well-being (Ekşi and Kardaş, 2017). Measurements will be conducted at baseline (pre-intervention) and immediately after the completion of the intervention.	Baseline and immediately post-intervention

Collaborators and Investigators

• Sponsor: Nigde Omer Halisdemir University
• Collaborators: Saglik Bilimleri Universitesi
• Investigators: Principal Investigator: Gamze Sarıkoç, Associate Professor, Saglik Bilimleri University

Study record dates

Study Major Dates

• Study Start (Estimated): July 15, 2026
• Primary Completion (Estimated): January 15, 2027
• Study Completion (Estimated): July 15, 2028

Study Registration Dates

• First Submitted: May 22, 2026
• First Submitted That Met QC Criteria: May 31, 2026
• First Posted (Actual): June 3, 2026

Study Record Updates

• Last Update Posted (Actual): June 3, 2026
• Last Update Submitted That Met QC Criteria: May 31, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: pregnancy; mindfulness; spiritual well-being; fear of childbirth; psychoeducation; self-perception
• Other Study ID Numbers: Not assigned yet; 22504254-050.04 (Other Identifier: Nigde Omer Halisdemir University Ethics Committee)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data (IPD) will not be shared due to ethical and privacy reasons. The dataset contains sensitive health information collected from pregnant women, and sharing IPD could compromise participant confidentiality. The data will be utilized solely for the purposes of this study and will not be made publicly available.

Drug and device information, study documents

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