The Effect of a Mandala-Based Intervention on Mother-Infant Bonding and Parenting Self-Efficacy in Primiparous Women With a Negative Birth Experience: A Randomized Controlled Trial
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 66
- 试验地点
- 1
- 主要终点
- Mother-Infant Bonding Scale (MIBS)
研究概览
简要总结
The purpose of this randomized controlled trial is to evaluate the impact of a mandala-based art intervention on mother-infant bonding and parenting self-efficacy among primiparous women (first-time mothers) who have had a negative birth experience. The study focuses on how structured creative activities can support emotional recovery and maternal confidence in the early postpartum period. A total of 66 participants were randomly assigned to either a Mandala Coloring Group or a Free Coloring Group. The intervention group participated in a structured session involving guided breathing, imagery, and symbolic mandala drawing designed for stress reduction and emotional expression. The control group engaged in a non-guided, free coloring activity. Data were collected using standardized tools, including the Mother-Infant Bonding Scale, the Karitane Parenting Confidence Scale, and the State-Trait Anxiety Inventory. The primary goal is to determine if the mandala-based intervention leads to significant improvements in the bond between mother and infant and increases the mother's confidence in her parenting abilities. Secondary outcomes include changes in anxiety levels following the intervention. All procedures were conducted in a supportive environment under researcher supervision to ensure participant safety and data integrity.
详细描述
This randomized controlled trial evaluates the effects of a mandala-based intervention on mother-infant bonding and parenting self-efficacy in primiparous women (first-time mothers) who experienced a negative birth experience.
Study Design and Population The study was conducted in the obstetrics clinic of a hospital. Power analysis indicated a minimum sample size of 44 participants to achieve 80% power at a 0.05 significance level. To account for potential attrition, the study aimed for 70 participants and was completed with 66 mothers (34 in the Mandala Group and 32 in the Free Coloring Group).
Inclusion Criteria Eligible participants included women who had a vaginal delivery, were within the first seven days postpartum, were primiparous with a singleton pregnancy, and self-reported a negative birth experience confirmed by a score of 37 or above on the Wijma Delivery Expectancy/Experience Questionnaire Version B. Participants were required to have no diagnosed psychological disorders and no communication difficulties.
Randomization and Procedure Participants were randomly assigned to either the Mandala Coloring Group or the Free Coloring Group using random allocation software. Data collection occurred at two time points: before and after the intervention.
Intervention Protocols The intervention was conducted face-to-face in a quiet, supportive environment under researcher supervision, typically when the infant was asleep. Each session lasted approximately 30 minutes.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Supportive Care
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 35 Years（Adult）
- 性别
- Female
- 接受健康志愿者
- 是
入选标准
- •Having had a vaginal delivery
- •Scoring 37 or above on the Wijma Delivery Expectancy/Experience Questionnaire Version B (W-DEQ-B)
- •Being within the first seven days postpartum
- •Being primiparous (first-time mother) with a singleton pregnancy
- •Self-reporting a negative or adverse birth experience
- •The infant being rooming-in with the mother
- •Having no diagnosed psychological disorders or problems
- •Voluntarily agreeing to participate in the research
- •Having no communication difficulties
排除标准
- •Having a diagnosed psychiatric disorder or currently receiving psychiatric treatment
- •Use of psychotropic medication during the postpartum period
- •Experiencing severe obstetric complications (e.g., postpartum hemorrhage, eclampsia, emergency hysterectomy)
- •Neonatal complications requiring admission to the neonatal intensive care unit (NICU)
- •Having a multiple pregnancy (twins, triplets, etc.) or a cesarean delivery
- •Severe communication difficulties or inability to understand study procedures
- •Participation in another psychosocial or art-based intervention during the study period
- •Withdrawal of consent at any stage of the study
研究组 & 干预措施
Free Cloring
The free painting activity aims to allow the mother to freely express her feelings without any guidance.
Initiation: The participant began drawing without any plan. Creative Flow: The drawings reflected the participant's current mood and emotional state.
Exploration and Expression: Inner exploration was achieved through the images and themes that emerged during the process.
Completion: Upon completion of the work, the participant evaluated the resulting picture as a personal reflection. This activity was evaluated solely for the purpose of emotional expression, not based on artistic skill.
干预措施: Free Coloring (Other)
Mandala Coloring
The mandala practice was carried out as a structured relaxation and expression process with the following steps (Sarı Öztürk et al., 2022):
Information: The participant was given brief information about the philosophy of mandalas.
Breathing Exercise: Relaxation was practiced for approximately 5 minutes using the "square breath" technique.
Guided Visualization: The participant was asked to imagine a scene by the sea and clear their mind.
Wish Mandala: The participant was asked to draw and color a mandala representing their own feelings and wishes. It was suggested that the mandala be named and hung in their room if desired. Visualization and Music: The guided visualization process was supported by the rhythm of a shamanic drum in the background.
Stress Mandala: The participant released their stress with drawings spiraling outwards from the center, and if desired, completed this work symbolically by tearing it or releasing it into water.
干预措施: Mandala Coloring (Other)
结局指标
主要结局
Mother-Infant Bonding Scale (MIBS)
时间窗: Immediately after the intervention (Day 1) and post intervention
The Mother-Infant Bonding Scale (MIBS) is an 8-item self-report instrument used to evaluate a mother's feelings toward her infant during the early postpartum period. Each item is scored on a 4-point Likert scale (0 to 3). Total scores range from a minimum of 0 to a maximum of 24. The scale includes five reverse-scored items reflecting negative emotions (e.g., anger, disappointment). A higher total score indicates a higher level of bonding difficulties or problematic attachment, which represents a worse outcome. A score of 13 or higher is used as a threshold to predict problematic bonding.
次要结局
- Karitane Parenting Confidence Scale (KPSCS)(Immediately after the intervention (Day 1) and post intervention)
- State-Trait Anxiety Inventory (STAI)(Immediately after the intervention (Day 1) and post intervention)
研究者
Fatma Şule Bilgiç
Assistant Professor
Çanakkale Onsekiz Mart University