The comparison of the effect of non-pharmacological pain relief and pharmacological analgesia with remifentanil on fear of childbirth and postpartum depression: a randomized controlled clinical trial.

INTRODUCTION: Childbirth may be associated with psychological, social, and emotional effects and provide the background for women's health or illness throughout their life. This research aimed at comparing the impact of non-pharmacological pain relief and pharmacological analgesia with remifentanil on childbirth fear and postpartum depression. MATERIALS AND METHOD: This randomized clinical trial with two parallel arms was conducted on 66 women with term pregnancy referred to Taleghani Hospital in Tabriz for vaginal delivery during September 2022 to September 2023. First, all of the eligible participants were selected through Convenience Sampling. Then, they were randomly assigned into two groups of pharmacological analgesia with remifentanil and non-pharmacological analgesia with a ratio of 1:1 using stratified block randomization based on the number of births. Before the intervention, fear of childbirth (FOC) was measured using Delivery Fear Scale (DFS) between 4 and 6 cm cervical dilatation. Pain and fear during labor in dilatation of 8 cm were measured in both groups using VAS and DFS. After delivery, FOC was assessed using Delivery Fear Scale (W DEQ Version B) and postpartum depression using the Edinburgh's postpartum depression scale (EPDS). Significance level was considered 0.05. Mean difference (MD) was compared with Independent T-test and ANCOVA pre and post intervention. RESULTS: The mean score of FOC in the non-pharmacological analgesia group was significantly lower than that in the pharmacological analgesia group after the intervention by controlling the effect of the baseline score (MD: -6.33, 95%, Confidence Interval (CI): -12.79 to -0.12, p = 0.04). In the postpartum period, the mean score of FOC in the non-pharmacological analgesia group was significantly lower than that in the pharmacological analgesia group after controlling the effect of the baseline score (MD: -21.89; 95% CI: -35.12 to -8.66; p = 0.002). The mean score of postpartum depression in the non-pharmacological analgesia group was significantly lower than that in the pharmacological analgesia group (MD: -1.93, 95% CI: -3.48 to -0.37, p = 0.01). TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT): IRCT20170506033834N10. Date of registration: 05/07/2022 Date of first registration: 05/07/2022. URL: https://www.irct.ir/trial/61030; Date of recruitment start date05/07/2022. CONCLUSION: The study results indicated a reduction in FOC and postpartum depression among parturient women receiving non-pharmacological strategies with active participation in childbirth compared to women receiving pharmacological analgesia. Owing to the possible side effects of pharmacological methods for mother and fetus, non-pharmacological strategies with active participation of the mother in childbirth are recommended to reduce the FOC and postpartum depression.

The effect of in-home supportive counseling on maternal functioning and self-efficacy following cesarean section among primiparous women.

BACKGROUND: Women require follow-up care and ongoing counseling after childbirth. The present study aimed to evaluate the effect of in-home supportive counseling on the maternal functioning and self-efficacy after CS among primiparous women. MATERIALS AND METHODS: This randomized controlled clinical trial was performed on 60 primiparous women aged 18-35 years following CS in Ardabil, Iran from April to November 2021. After convenience sampling, participants were randomly assigned into the intervention and control groups with a ratio of 1:1 by block randomization using Random Allocation Software with block sizes of 4 and 6. The intervention group received in-home supportive counseling during three sessions on days 3, 7, and one month after birth. The control group received only routine postpartum care. The data were collected using the demographic and obstetric characteristics, maternal self-efficacy questionnaire, and Barkin index of maternal functioning, completed by both groups 10-15 days, two, and four months after birth. Independent t-test and RMANOVA were used to analyze the data. RESULTS: The mean score of maternal functioning in the intervention group was significantly higher than that of the control group 10-15 days, 2 and 4 months after birth (AMD: 28.51, 95% CI: 24.91 to 32.10, P < 0.001). There was no significant difference in the mean (SD) score of maternal self-efficacy between the two groups 10-15 days after birth. However, this difference was statistically significant 2 and 4 months after birth and after adjusting the time effect (AMD: 10.56, 95% CI: 9.46 to 11.67, P < 0.001). CONCLUSION: In-home supportive counseling can be effective in improving maternal functioning and maternal self-efficacy after CS. Acquiring functional skills increases mothers' self-confidence and self-efficacy in caring for the newborn.

The effect of cognitive-behavioral therapy and haptonomy on fear of childbirth in primigravida women: a randomized clinical trial.

BACKGROUND: Considering the role of fear of childbirth (FOC) in the enhancement of unnecessary cesarean sections (CS), the present study aimed at evaluating the effect of Cognitive-Behavioral Therapy (CBT) and haptonomy on the FOC (as primary outcome) and intended birth method and final birth method (as secondary outcomes) among primigravida women. METHODS: This randomized clinical trial was conducted on 99 primigravida women in Tabriz, Iran 2022. Participants were assigned to three groups with a ratio of 1:1:1 using stratified block randomization based on the fear intensity. One of the intervention groups (n = 33) received eight group sessions of CBT from 24 to 28 weeks of gestation and the other intervention group (n = 33) received haptonomy during seven sessions once a week. The control group (n = 33) received routine prenatal care. The Wijma questionnaire was completed by the participants before the intervention, after the intervention at 35-37 weeks of gestation, and after birth. The intended birth method was investigated before and after the intervention at 35-37 weeks of gestation. The final birth method and the reasons for CS were recorded based on the mother's medical profile. The one-way ANOVA was used before the intervention and RMANOVA after the intervention to compare the mean scores of FOC among the three groups. Further, chi-square test was applied to compare the intended and final birth method. RESULTS: The mean (standard deviation: SD) of FOC in the CBT group changed from 74.09 (11.35) at 24-28 weeks of gestation to 46.50 (18.28) at 35-37 weeks and 48.78 (20.64) after birth (P < 0.001). The means (SDs) of FOC in the haptonomy group were 76.81 (13.09), 46.59 (15.81), and 45.09 (20.11), respectively (P < 0.001). The mean (SD) of FOC in the control group decreased from 70.31 (6.71) to 66.56 (18.92) and then, increased to 71.00 (21.14) after birth (P = 0.878). After the intervention, there was no statistically significant difference among the three groups in terms of the intended birth method (P = 0.278), and final birth method (P = 0.107). CONCLUSION: The findings of the present study revealed that both CBT and haptonomy interventions reduce FOC. Although the desire for vaginal birth and final vaginal birth in the haptonomy group was more than that in the other two groups, there was no statistically significant difference among the three groups. TRIAL REGISTRATION: Iranian Registry of Clinical Trials: IRCT20170506033834N9. Date of registration: 02.01.2022. URL: http://en.irct.ir .

The Effect of Psychological Interventions on the Anxiety and Breastfeeding Self-Efficacy: A Systematic Review and Meta-Analysis.

Background: Maternal anxiety has been accompanied by many unfavorable effects on breastfeeding in the postpartum period. We aimed to provide scientific evidence in identifying effective interventions for anxiety and breastfeeding self-efficacy (BSE) in a systematic review and meta-analysis. Methods: All published studies with inclusion criteria by 2022 were searched in Embase, Cochrane library, Web of Sciences, Google Scholar, PubMed, Scopus, SID and Magiran. The literature search was performed using PRISMA instructions. Further, 20 eligible interventional studies (RCT and pre-posttest) and one case study were included in this systematic review and meta-analysis. Publication bias was checked with Eggers test and funnel plot methods. The collected data were analyzed using stata version16. Results: It is not possible to provide an explicit and accurate conclusion about the effective intervention method in reducing anxiety and increasing BSE among lactating women during the covid19 pandemic. The results indicated a significant increase in BSE among lactating women after educational and psychological interventions (4.20, 95% CI: 3.61 to 4.80, I2 = 26.38%). Conclusion: It is recommended to conduct further studies with a strong methodology and based on intervention methods during the postpartum period, especially in the first month of birth to reduce the symptoms of stress and anxiety in the mother, establish better mother-child attachment, and improve BSE and maternal performance during the Covid-19 pandemic.

The Effect of Decision Aid on Satisfaction With Decision and Anxiety Among Women With Abnormal Cervical Screening Results.

BACKGROUND: Most women in the face of stressful situations such as risk of a cancer diagnosis (abnormal Papanicolaou smear results) need guidance to choose the appropriate method to follow the diagnosis process, but few studies have identified appropriate interventions to support these women. OBJECTIVE: To determine the effect of decision aid on anxiety and satisfaction with decisions (SWD) regarding the type of follow-up method after receiving an abnormal Papanicolaou smear result. METHODS: This interventional study was conducted on women referred to the oncology clinic in Tabriz, Iran. Women were assigned to the intervention (n = 27) and control groups (n = 27) in a ratio of 1:1 using blocked randomization. The intervention group received a decision aid booklet. Participants in both groups completed questionnaires assessing demographic and obstetric characteristics, anxiety, SWD, and shared decision-making before and after the intervention. RESULTS: The mean score for SWD in the intervention group was significantly higher than that in the control group after the intervention (median, 6.43 with 95% confidence interval of 3.11-7.76; P = .03). There was no significant difference between groups in the mean score of anxiety after intervention (median, 1.14; 95% confidence interval, -0.5 to 2.70; P = .19). CONCLUSION: A decision aid can increase SWD among women with abnormal results in their cervical cancer screening. IMPLICATIONS FOR PRACTICE: It is recommended that healthcare providers use decision aid tools to support and guide patients.

The effect of probiotic supplementation on episiotomy wound healing among primiparous women: a triple-blind randomized clinical trial.

BACKGROUND: Probiotics increase the defense power of immune system and accelerate the wound healing process by anti-inflammatory mechanisms at the wound site. The present study aimed at evaluating the effect of Lactobacillus casei oral supplementation on episiotomy wound healing among primiparous women. METHODS: This triple-blind randomized clinical trial was performed on 74 primiparous women delivered in Alzahra Hospital, Tabriz, Iran. Participants with mediolateral episiotomy (incision length equal to and less than 5 cm) were randomly assigned to the probiotic and placebo groups. The probiotic group received Lactobacillus casei 431 with 1.5 * 109 colony-forming unit /capsule once a day from the day after birth to 14 days. Wound healing as a primary outcome was measured by Redness, Edema, Ecchymosis, Discharge, Approximation and pain as a secondary outcome by the Visual Analogue Scale before discharge, 5 ± 1 and 15 ± 1 days after birth. The data were analyzed using independent t-test and repeated measures one way analysis of variance. RESULTS: The mean (standard deviation: SD) score of wound healing in the probiotic group altered from 4.91(1.86) before discharge to 1.55 (0.99) during 5 ± 1 days after birth and reached to 0.95 (0.27) during 15 ± 1 days after birth. Further, the mean (SD) score of wound healing in the placebo group altered from 4.62 (1.99) before discharge to 2.80 (1.20) during 5 ± 1 days after birth and reached to 1.45(0.71) during 15 ± 1 days after birth (adjusted mean difference: -0.50, confidence interval 95%: -0.96 to -0.05, P = 0.03). CONCLUSION: Lactobacillus casei oral supplementation is effective in healing episiotomy wounds. It is suggested to evaluate the effect of topical use of Lactobacillus casei on episiotomy repair and pain in further studies. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT): IRCT20170506033834N7. Date of registration: 11/08/2021.

The effect of mindfulness-based counseling on the childbirth experience of primiparous women: a randomized controlled clinical trial.

INTRODUCTION: Unpleasant childbirth experience is considered as one of the important factors for cesarean preference. Limited studies have been investigated the impact of psycho-based interventions on the childbirth experience and the most effective counseling approach to promote a pleasant childbirth experience has not been clearly identified. OBJECTIVE: The present study aimed to evaluate the impact of mindfulness-based counseling on the childbirth experience of primiparous women. METHODS AND MATERIALS: This randomized controlled clinical trial was conducted on 64 primiparous with gestational age of 32 to 34 weeks referred to the perinatology clinic of Al-Zahra and Taleghani educational-treatment hospital, affiliated to Tabriz University of Medical sciences, Iran. Participants were randomly assigned into the intervention and control groups. The intervention group received eight mindfulness-based counseling sessions. The intensity of childbirth pain with VAS (Visual Analog Scale) in the active phase of labor at 8 cm dilatation and the childbirth experience questionnaire were completed by interview after childbirth. Independent t-test and ANCOVA were used to compare the outcomes between the two groups. RESULTS: After controlling the effect of confounding variables, the mean score of childbirth experience in the intervention group was significantly higher than that in control group [Mean Difference (MD): 1.79, 95% CI: 2.52 to 1.07, P < 0.01]. The mean score of labor pain in the intervention group was significantly lower than that in the control group after controlling the effect of baseline score and confounding variables [MD: -2.21, 95% CL: -3.35 to -1.10, P < 0.001]. CONCLUSION: The findings indicated that providing mindfulness-based counseling improves the childbirth experience and reduces labor pain during childbirth. However, further randomized clinical trials are needed before making a definitive conclusion. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT): IRCT20171007036615N9. Date of registration: 16/03/2022, 25/12/1400.

The effect of cognitive-behavioral therapy and sexual health education on sexual assertiveness of newly married women.

BACKGROUND: The present study aimed at investigating the effect of sexual health education and cognitive-behavioral therapy (CBT) on sexual assertiveness (primary outcome) and sexual satisfaction (secondary outcome) of newly married women. METHOD: This RCT was conducted on 66 newly married women with cases in pre-marriage counseling centers in Tabriz, Iran. Participants were assigned into three groups using block randomization. Eight group sessions of CBT were held for one of the intervention groups (n = 22) and 5-7 sessions of sexual health education for other intervention group (n = 22). The control group (n = 22) received neither education nor counseling during the research. The data were collected using the demographic and obstetric characteristics, Hulbert sexual assertiveness index, and Larson sexual satisfaction questionnaires, and analyzed using ANOVA and ANCOVA tests. RESULTS: The mean (standard deviation: SD) score of the sexual assertiveness and sexual satisfaction in the CBT group enhanced from 48.77 (13.94) and 73.13 (13.53) before the intervention to 69.37 (7.28) and 86.57 (7.5) after the intervention, respectively. The mean (SD) score of the sexual assertiveness and sexual satisfaction in the sexual health education group increased from 48.9(11.39) and 74.95 (8.30) before the intervention to 66. 94 (7.42) and 84.93 (6.34) after the intervention, respectively. The mean (SD) score of the sexual assertiveness and sexual satisfaction in the control group changed from 45.04 (15.87) and 69.04 (10.75) before the intervention to 42.74 (14.11) and 66.44 (10.11) after the intervention, respectively. Eight weeks after the intervention, the mean scores of sexual assertiveness and sexual satisfaction in two intervention groups were more than that in the control group (P < 0.001), However, there was no significant difference between the two intervention groups (P > 0.05). CONCLUSION: The results of this research indicated that CBT and sexual health education are effective in improving women's sexual assertiveness and sexual satisfaction. Considering that sexual health education, does not require complex counseling skills compared to CBT, it can be used as a preferred intervention in promoting sexual assertiveness and satisfaction of newly married women. TRIAL REGISTRATION: Iranian Registry of Clinical Trials: IRCT20170506033834N8. Date of registration: 11.09.2021. URL: http://en.irct.ir .

Predictors of the worry about cancer recurrence among women with breast cancer.

INTRODUCTION: Worry about cancer recurrence is identified as the most common psychological burdens experienced by cancer patients and survivors. The present study aimed to determine the predictors of worry about cancer recurrence among women with breast cancer. MATERIALS AND METHODS: This cross-sectional study was conducted on 166 women with breast cancer undergoing chemotherapy and radiotherapy, who referred to private and public oncology centers in Tabriz, Iran using the convenience sampling. Data collection tools were demographic and disease characteristics questionnaire, cancer worry scale, social support questionnaire, brief illness perception questionnaire, international physical activity questionnaire-short form, and The EORTC-in-patsat32. The data were analyzed using SPSS 25 software. Pearson correlation coefficient, independent t-test, ANOVA, and multivariate linear regression were used. RESULTS: In the present study, the mean (standard deviation) of score of worry about cancer recurrence was 17.41 (7.88), ranging from 8-32. The results revealed that the type of surgery, illness perception, satisfaction with care, and place of treatment were the most important predictors of worry about cancer recurrence, which explained 44.3% of the variance. CONCLUSION: The enhancement of satisfaction with care and training coping strategies among individuals with high perceived severity of the illness contribute to the reduction of worry about cancer recurrence and adaptation to breast cancer.

The Effect of Psychological Interventions on Sexual and Marital Satisfaction: A Systematic Review and Meta-Analysis.

Background: Sexual and marital satisfaction play an important role in the stability of couples' relationships, so it is necessary to take a proper approach to promote them. This study aimed to identify and categorize psychological interventions affecting sexual satisfaction and marital satisfaction of women in Iran. Methods: An electronic systematic review search was conducted using the Persian and English databases of SID, Embase, PubMed, Scopus, Web of Science, Medline, Cochran library, and Google Scholar motor engine until 2021 to identify all relevant clinical trials and experimental and quasi-experimental studies assessing the effect of psychological interventions on sexual and marital satisfaction. Results: Totally, we retrieved 528 studies from the previously mentioned databases, of which, 38 met the eligibility criteria. The subgroup meta-analysis of 4 studies conducted showed that interventions based on individual consultations increase sexual satisfaction (MD: 2.94, 95% CI: -0.36 to 6.24, P= .23), (I 2 =30.83%). The subgroup meta-analysis of 10 studies conducted revealed that couple-based consultations increase marital satisfaction (MD: 5.93, 95% CI: -2.59 to 9.27, P=.95), (I 2 = 0%). Conclusion: The results of meta-analysis demonstrated the effect of counseling-based psychological interventions on increasing sexual and marital satisfaction of couples. However, further clinical trials are required before making a definitive conclusion.

The effect of shared decision-making in choosing the method of labor analgesia on childbirth experience among primiparous women.

BACKGROUND: Childbearing women reported moderate and sometimes low levels of autonomy in decision-making with their health care providers especially about their pain relief type and which may affect their childbirth experience. There is limited evidence about the effect of shared decision-making about childbirth pain relief on childbirth experience and satisfaction. OBJECTIVE: The present study aimed to assess the effect of shared decision-making in choosing the method of labor analgesia on childbirth experience and satisfaction among primiparous women. METHODS: This interventional study was conducted on 66 primiparous women with 38-42 weeks gestational age and with symptoms of labor and childbirth onset. Women were assigned into the intervention and control groups in a ratio of 1: 1 using blocked randomization. The intervention group received shared decision making about the advantages and disadvantages of labor analgesia methods, and the control group received routine care. Questionnaires, including obstetrics and demographic characteristics, Labor Agentry Scale (LAS), McKay Childbirth Satisfaction Rating Scale (MCSRS), Support and Control In Birth (SCIB) were completed. Data were analyzed by SPSS24 software and independent t-test and ANCOVA were used. RESULT: After the intervention, the mean score of childbirth experience in the intervention group was significantly higher than that in the control group [Mean Difference (MD): 6.77, 95% CI: 2.72 to 10.82, (P <0.001)]. Further, the mean score of childbirth satisfaction in the intervention group was significantly higher than that in the control group [MD: 19.06, 95% CI: 9.63 to 28.49, (P<0.001)]. The mean score of control and support during childbirth and its subscales in the intervention group was significantly higher than that in the control group after the intervention [MD: 17.21, 95% CI: 9.40 to 25.03, (P <0.001)]. CONCLUSION: It is recommended that mothers should be involved in treatment decisions during childbirth since they are considered an important part of providing care during labor and childbirth.

The effect of counseling with stress management approach on postpartum anxiety and distress and breastfeeding self-efficacy during COVID-19 pandemic: a ramdomized controlled trial.

BACKGROUND: Successful breastfeeding is related to the psychosocial conditions of the mother. Covid19 pandemic resulted in psychological consequences in women during postpartum period. Maternal anxiety and distress reduce the chances of exclusive breastfeeding. The present study aimed to investigate the effect of counseling with stress management approach on postpartum anxiety and distress and breastfeeding self-efficacy (BSE) during COVID-19 pandemic. METHOD: This randomized controlled clinical trial was conducted on 64 breastfeeding mothers referred to health care centers in Tabriz, Iran in 2021. Participants were assigned into the intervention and control groups in a ratio of 1: 1 using block randomization in a block size of 4 and 6. The intervention group participated in six individual 60-90 min sessions. Spielberger State-Trait Anxiety Inventory (STAI), postpartum distress (PMD), and BSE questionnaires were completed before and 4-week after the intervention by the control and intervention groups. Independent t-test and ANCOVA were used to compare the outcomes between two groups. RESULTS: According to the ANCOVA results by controlling the baseline values and after the intervention, the mean score of anxiety in the intervention group was lower than that in the control group [Adjusted Mean Difference (AMD): -13.82, 95%, confidence interval (CI): -12.35 to -15.29, (p < 0.001)]. Further, the mean score of postpartum distress after intervention was lower in the intervention group compared with that in the control group [AMD:5.31 95% CI: -3.00 to -7.37 (p < 0.001)]. After the intervention, the mean score of BSE in the intervention group was significantly higher than that in the control group [AMD: 25.57, 95% CI: 22.85 to 28.29 (p < 0.001)]. CONCLUSION: Stress management counseling can improve postpartum anxiety and distress and BSE and increase breastfeeding. However, more studies are needed for a definitive conclusion. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT): IRCT20171007036615N6. Date of registration: 15/09/2021.

The effect of counseling on women's coping with unplanned pregnancy.

INTRODUCTION: The responses to a life-changing event can be different. The study aimed to determine the effect of counseling on coping strategies among women facing unplanned pregnancy. METHODS: This quasi-experimental study was conducted on 70 unplanned pregnant women with a gestational age <10 weeks, who scored ≥ 15 in the avoidance pattern of Revised Prenatal Coping Inventory (NU-PCI). The participants were randomly assigned into the intervention and control groups. Three counseling sessions were held for the intervention group. Data were gathered using questionnaires of the women's perceptions of unplanned pregnancy, decision-making style and strategies, NU-PCI, and the checklist for the type of decision. Independent t-tests, ANCOVA, and Chi-square were used. RESULTS: After intervention, the mean score of the avoidance pattern in the intervention group was significantly lower than that in the control group [AMD: - 4.35, 95% CI: -8.7 to -0.13, P=0.03]. In addition, the continuation rate of pregnancy in the intervention group, 28 subjects (80%), was significantly higher than that in the control group, 21 (60%) (P = 0.03). CONCLUSION: The counseling leads to a decrease in the use of avoidance strategies among women facing unplanned pregnancies. Development of supportive interventions for women experiencing unplanned pregnancies is recommended specially in societies with induced abortion restrictions.

The impact of effective communication-based care on the childbirth experience and satisfaction among primiparous women: an experimental study.

BACKGROUND: There is insufficient scientific evidence on the effect of communication skills of childbirth care providers on maternal childbirth experience and satisfaction. The present study aimed to determine the effect of communication-based care on the childbirth experience and satisfaction among primiparous women. METHODS: A total of 80 primiparous women participated in this experimental study who were randomly assigned into the intervention and control groups. According to the World Health Organization (WHO) care model, the intervention group received effective communication-based care, and the control group received the routine care. Data were collected using demographic and obstetric questionnaires, Labor Agentry Scale (LAS) and Birth Satisfaction Scale-Revised (BSS-R), and Support and Control in Birth (SCIB) scale applied 12 to 24 h after the intervention. RESULTS: After controlling the effect of confounding variables, the mean scores of childbirth experience (51.23(1.54) and satisfaction (26.03(0.81) in the intervention group were significantly higher than that in the control group (45.33 (1.54) and 22.66 (0.81) respectively; [adjusted mean difference (AMD) = 5.90, CI = 95%: 1.17 to 10.62, P = 0.01] versus AMD =3.37, CI: 95%: 0.87 to 5.87, P = 0.001]. CONCLUSION: Eeffective communication-based care improved childbirth experience and satisfaction of primiparous women. Therefore, it is recommended that health-care providers should be trained on the communication skills in the delivery room especially during a vital threatened crises such as the Covid pandemic.

The effect of decision-aid-based counseling on cervical cancer screening behavior among women: An interventional study.

BACKGROUND: Performing appropriate and regular screening can effectively reduce cervical cancer and mortality rate, however, the available evidence suggests that women's participation in cervical cancer screening remains low in middle- and low-income countries, and that it is necessary to identify appropriate intervention methods to change behavior. The present study was designed to determine the effect of decision-aid-based counseling on cervical cancer screening behavior among women. MATERIALS AND METHODS: This trial study was conducted on 154 women with no history of Pap smear during the past 3 years and refers to Tabriz health care centers. The participants were assigned to the intervention (decision aid based counseling) and control (routine health education) groups through randomized block design with block sizes of 4 and 6 and a 1:1 allocation ratio. The data were collected using the sociodemographic and fertility characteristics, stages of change checklist, and shared decision-making (SDM) and decisional conflict (DC) questionnaire before and 6 months after the intervention by interview and then, analyzed by SPSS24 software. The independent t-test, ANCOVA tests were used. RESULTS: A significant difference was observed between the two groups in terms of changing the stages of cervical cancer screening behavior 6 months after the intervention. As after the intervention, the frequency of individuals entered the preparation or action stage was more than the control group (P = 0.001). The mean score of SDM in the intervention group was significantly higher than the control group after intervention ([45.49 ± 1.18] vs. [27.56 ± 1.18] [Mean Difference (MD): 17.92; 95% confidence interval [CI]: 14.59-21.25; P < 0.001]). The mean score of DC in the intervention group was significantly lower than the control group after intervention ([29.16 ± 1.09] vs. [34.14 ± 1.09] [MD: -4.97; 95% CI: 1.09-8.04; P < 0.002]). CONCLUSIONS: This study revealed that evidence-based information communicated between clients and clinicians has very important role in clients' health-related behavior. It is recommended, health care providers apply decision-aid-based counseling for promoting the cervical cancer screening behavior among women.

The Effect of Face-to-Face and Phone Call Motivational Interviewing on Cervical Cancer Screening.

BACKGROUND: Having regular screening tests largely depends on motivational factors. Motivational interviewing (MI) facilitates the movement through the stages of the transtheoretical model of change. OBJECTIVE: The aim of this study was to compare the effect of face-to-face and phone call MI on cervical cancer screening. METHODS: This experimental study was conducted on 150 eligible women referred to health centers in Tabriz, Iran. The women were assigned into 3 groups (face-to-face MI, phone MI, or control) using blocked randomization. The face-to-face MI group participated in 3 weekly group counseling sessions, and the motivational phone call group received 3 weekly phone calls. The participants completed the demographic and obstetric questionnaire and stages of change checklist. Adherence to Pap smear was checked, according to the health profile, 6 months after the intervention. The data were analyzed using SPSS 24 software. Chi-square, homogeneity test, and sequential logistic regression by the generalized estimating equations were used. RESULTS: After the intervention, about 32% women from the face-to-face MI group, 22% from the motivational phone call group, and 4% from the control group underwent Pap smear screening ( P = .002). There was no significant difference between the 2 interventional groups in Pap smear frequency ( P = .36). CONCLUSION: The study results indicated that both face-to-face and phone call MI are effective in motivating women to have a Pap smear. Further studies are recommended to consider long-term follow-up (3-5 years). IMPLICATIONS FOR PRACTICE: It is recommended that healthcare providers use motivational phone call to encourage cancer screening behaviors.

The effect of motivational interviewing on the change of breast cancer screening behaviors among rural Iranian women.

OBJECTIVE: The study aimed to determine the effect of motivational interviewing on the change of breast cancer screening behaviors among rural Iranian women. METHODS: This Randomized controlled trial (RCT) was performed on 120 Iranian rural women selected through cluster random sampling method. Out of all 20 rural health centers of Abish Ahmad District, in the northwest of Iran, about one third (six clusters) were randomly selected; out of which three were randomly assigned to the control group and three to the intervention group. A list of women aged 40-69 years in the selective health centers was prepared and 60 participants were selected for each group through the convenience sampling method based on the inclusion and exclusion criteria. Then, six group sessions (two educational and four motivational interviewing sessions) were held for the intervention group. The data were collected using demographic and obstetric questionnaire, paper-based health records, and the stages of change checklist and analyzed in SPSS 24. The groups were compared through the chi square test, homogeneity test, and the sequential logistic regression with generalized estimating equations. RESULTS: Two months after the intervention, a significant difference was found between the two groups in terms of the stages of change for clinical breast examination and mammography by taking into account the pre-intervention stages (p = 0.001). CONCLUSION: MI-based counseling increased the Iranian rural women's motivation for displaying breast cancer screening behaviors. PRACTICE IMPLICATIONS: The application of MI for enhancing cancer screening programs among Iranian women is suggested.

The Effect of Motivational Interviewing on Women with Overweight and Obesity Before Conception.

OBJECTIVE: To investigate the efficacy of motivational interviewing (MI) to elicit change in eating and physical activity behaviors in women with overweight and obesity before conception. DESIGN: A randomized controlled trial was conducted. The participants were randomly divided into intervention and comparison groups. Data were gathered using the Three-Factor Eating Questionnaire Revised 18-item version (TFEQ-R18), International Physical Activity Questionnaire (IPAQ), and Stages of Change checklist. SETTING: Primary health centers of Tabriz, Iran. PARTICIPANTS: The participants were 70 women with overweight or obesity, aged 18-35 years, who were referred for preconception care. INTERVENTION(S): The intervention group received 6 MI sessions, and the comparison group received routine preconception care. MAIN OUTCOME MEASURE(S): Variables of primary outcomes were eating behavior measures and physical activity levels 8 weeks after intervention. ANALYSIS: Independent t test, ANCOVA, Fisher exact test, Mann-Whitney U test, and Wilcoxon test were used. RESULTS: The MI had a positive effect on physical activity in the moderate and vigorous levels in the intervention group (P = .01, P = .02, respectively). After the intervention, the mean score of cognitive restraint in the intervention group was higher than in the comparison group (adjusted mean difference, 16.9; 95% CI, 10.8 to 23.0; P < .001), whereas there were no significant differences between the 2 groups in terms of emotional and uncontrolled eating (P = .33 and P = .25, respectively). CONCLUSIONS AND IMPLICATIONS: The MI had a positive effect on physical activity and eating behavior change, except for uncontrolled and emotional eating. Future studies to examine differences between overweight and women with obesity and within other populations is warranted.

The Effect of Counseling on Breast Cancer Awareness in Rural Iranian Women: a Randomized Controlled Clinical Trial.

In a community such as Iran where late presentation is predominant and the majority of breast cancer patients are diagnosed at advanced stages of the disease, there is an urgent need for improving the level of awareness about breast cancer and early detection measures. Given that rural residents are at higher risk for late diagnosis of breast cancer because they have less education, income, and access to advanced screening technologies, this study was conducted to determine the effect of counseling on breast cancer awareness of rural Iranian women. This randomized clinical trial was conducted on 60 rural women from the Abish Ahmad area in northwestern Iran in 2017. The randomized cluster method was used for sampling. From 20 rural health houses and centers, about one third were selected randomly. From the six selected clusters, three were randomly allocated as the control group and three as the intervention group. Using convenience sampling, 30 women between the ages of 40 and 69 were selected from the control group and 30 from the intervention group. The intervention group attended six group counseling sessions. Data was gathered using a demographic and obstetrical information questionnaire and breast cancer awareness measures. The chi-square, independent t test and ANCOVA by controlling for the baseline scores were used to analyze the data. After counseling, the mean knowledge about breast cancer score was significantly higher in the intervention group than in the control group (adjusted mean difference, 17.02; confidence interval (CI) 95%, 15.44 to 18.59; p < 0.001). The mean barriers to breast cancer screening score showed a significant decrease in the intervention group compared to the control group (AMD, - 1.74; 95% CI - 3.12 to - 0.36, p < 0.001). After intervention, the frequency of breast self-exam showed a significant difference between groups (p < 0.001); but for confidence about noticing breast changes, no significant difference was observed between groups (p = 0.08). Group counseling had a significant effect on enhancing breast cancer awareness of rural Iranian women, except for confidence about noticing breast changes.

Coping Strategies and Experiences in Women with a Primary Breast Cancer Diagnosis

Background: Women with breast cancer experience problems in multiple aspects of their lives, but applying effective strategies can result in enhancing their quality of life and their psychosocial adaptation to the disease. However, there is little information about the strategies that women use to cope with complications associated with their experiences following a breast cancer diagnosis. Objectives: The aim of this study was to explore the experience of coping behavior and the main strategies that women use in dealing with a breast cancer diagnosis. Methods: This study was conducted according to a qualitative phenomenological design to investigate women's experiences in living with breast cancer and the related complications and how they cope with these issues. Purposive sampling was used for recruiting participants with breast cancer, and data collection was conducted by semi-structured, in-depth interviews with 22 patients. The transcribed interviews were analyzed using Van Manen's thematic approach. Results: The age range of the women was 32-68. Most were married and received adjuvant therapy (i.e., mastectomy surgery and chemo-radiation). Three dominant themes that emerged from the interviews were emotional turmoil, avoidance, and logical efforts. Conclusion: The findings highlight the importance of addressing psycho-oncology intervention programs to address the unmet pyscho-social and palliative care needs of patients suffering from breast cancer.