EJIHPE | Free Full-Text | The Impact of Educational Sessions on Anxiety Levels among Women Undergoing Caesarean Section: A Quasi-Experimental Study
2. Methods and Materials
2.1. Study Design
The study was based on a quantitative quasi-experimental research design. It was conducted at the King Faisal Medical Complex (KFMC) in Taif, Saudi Arabia. The researchers recruited 50 pregnant women undergoing CSs and divided them equally into an intervention group and a control group. The inclusion criteria included pregnant women who were admitted to the antenatal unit, scheduled for elective CS, with no medical and/or surgical complications, aged between 20 and 35 years old, willing to participate in the study at a gestational age of 37 weeks or more, undergoing CS for the first time, and speaking and understanding the Arabic language. The study exclusion criteria included women with psychiatric illnesses and/or who were on any antianxiety or antidepressant medication. The Faculty of Nursing at King Abdulaziz University (KAU) and the Ministry of Health (MOH) approved the research proposal for this study. In addition, permission for data collection was obtained from KFMC. The participants gave their written consent to participate in the study. They were informed about the study’s aim and objectives, that their participation was voluntary, and that they had the right to withdraw at any time during the study without affecting the care provided to them.
2.2. Study Tool
A structured questionnaire was used for data collection. It consisted of two parts: Part I aimed to collect data about the participants’ sociodemographic characteristics, obstetric histories, and vital signs; Part II included the State–Trait Anxiety Inventory (STAI-Y1–Y2) and questions regarding the women’s satisfaction.
2.3. Vital Signs Assessment
The researchers recorded the participants’ vital signs, including the pulse rate, blood pressure, temperature, and respiratory rate. The vital signs were measured twice for the control group: once before routine care, about 3–4 h before CS, and again after routine care, about 15–30 min before CS. The vital signs were also measured twice for the intervention group: once before the educational sessions, about 3–4 h before CS, and again after the educational sessions, about 15–30 min before CS.
2.5. Women’s Satisfaction
In the intervention group, data were collected via interviews to measure their satisfaction with the educational sessions provided to them, using questions such as ‘Are you satisfied with the preoperative information given in the educational booklet?’.
2.6. Validity and Reliability of the Instrument
To evaluate the content validity of the tool, the researchers asked three nursing faculty members who specialised in maternity and women’s health in the faculty of Nursing at KAU, to review the questionnaire. The experts reviewed the tool for its clarity, comprehensiveness, and appropriateness for the research aim. The reliability of the tool was tested using Cronbach’s alpha coefficients. The Cronbach’s alpha for STAI-Y1–Y2 was 0.87, which confirmed its excellent reliability.
2.7. Data Collection Procedure
The study included 50 pregnant women who were purposefully selected to participate in the study. The data collection was conducted over eight months, starting at the beginning of December 2019 and continuing until the end of July 2020, with information gathered three days per week in the morning. The data collection process consisted of two phases.
Pregnant women who met the criteria and agreed to participate in the study were divided into two equal groups: 25 in the intervention group and 25 in the control group. The aim and objectives of the study were explained to each participant, and the participants gave their informed consent to participate prior to the data collection.
Interviews were conducted with all study participants in both the intervention and control groups. The pregnant women in both groups were interviewed before their CS upon admission to the antenatal unit, and their vital signs were measured twice. For the control group, one interview was conducted before routine care, about 3–4 h before CS, and another after routine care, about 15–30 min before CS. For the intervention group, one interview was taken before the educational sessions, about 3–4 h before CS, and again after the educational sessions, about 15–30 min before CS.
The participants’ anxiety levels were measured by a researcher for the intervention group twice (before the educational sessions, 3–4 h before CS, and after the educational sessions, 30–40 min before CS) using the STAI. The anxiety levels of the control group were also measured twice (3–4 h before CS and after routine hospital care, 30–40 min prior to CS) using the STAI. The control and intervention groups received routine hospital care, including nurses asking the mothers to change into hospital gowns and provide urine samples. In addition, an intravenous (IV) line was placed into each mother’s arm or hand to administer necessary fluids and medications.
A researcher conducted individual educational sessions for the intervention group on the days of their surgeries. Each session was used to discuss symptoms with the mother, explain the process and what to expect during the CS and postoperative periods, and help her fully express her fears. The duration of each session ranged from 30 to 60 min.
2.8. Educational Sessions
A simple CS educational booklet was designed in the Arabic language, arranged in a logical sequence for expectant mothers, and supplemented with illustrations to facilitate learning. It covered the definition of CS, information about the types of CS and incisions, and details concerning surgical wound care and complications.
The general objective of formulating the educational booklet was to improve the expectant mothers’ knowledge of CS, decrease their levels of anxiety about the process, and correct any misconceptions about CS. The booklet was reviewed by three experts involved in maternity and women’s health nursing at a nursing faculty at KAU in Jeddah, Saudi Arabia. In addition, the booklet was used to guide and support interactions between the researcher and the pregnant women during the educational sessions.
Each pregnant woman was given simple written, illustrated instructions regarding the objectives, outlines, and expected outcomes of the intervention.
2.9. Statistical Design
The data were collected, coded, categorised, and tabulated using tests of statistical significance, such as percentages, t-tests, chi-squared tests, McNemar tests, and Fisher’s exact or Monte Carlo correction tests, to identify the relationships between the variables using the Statistical Package for the Social Sciences (SPSS®) programme, version 22. Significance was set at p ≤ 0.05 for all tests.
This study had some limitations; the inclusion criteria for this study limited the selection of cases, meaning that some cases in the hospital were excluded, which reduced the sample size and prolonged the data collection period. Hence, the study results cannot be generalised to a wider population.
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