| Objective:Based on investigation,literature and books,the intervention program was constructed.Then the program was completed through experts’meeting and pre-trial.What’s more,the effect of internet-based synchronous cognitive behavioral therapy of spouse on the depression,anxiety and fear of childbirth in the third trimester of pregnancy was validated,so as to provide new methods for relieving depression,anxiety and fear of childbirth.Methods:1.Cross-sectional studyWe selected pregnant women who met the criteria from a Grade III,Class A hospital clinic from May to June of 2021 using the convenience sampling method.The pregnant women were investigated by general data questionnaire,Edinburgh Postnatal Depression Scale,the 7-item Generalized Anxiety Disorder scale and Childbirth Attitude Questionnaire to analyze the status quo of depression,anxiety,fear of childbirth and its influencing factors in late pregnant women.Descriptive statistics,Spearman correlation analysis and Logistic regression were used for statistical analysis,and the test level was0.05.2.Study on the construction of intervention program(1)Literature and book analysis:two nursing researchers searched databases at home and abroad for literature on web-based cognitive behavioral therapy interventions for pregnant women,according to the literature inclusion and exclusion criteria.The general characteristics and intervention plans of the literature were extracted according to the data extraction table developed by the research group,and the contents of the cognitive behavior therapy instruction manual were supplemented,developing a first draft of the intervention programme.(2)Expert meeting method:experts are invited to hold meetings according to the purpose of the study and the area of expertise involved.The researchers reported on the purpose,process,background of the project and the first draft of the intervention program.After the experts completed the general information and the self-assessment of the experts’authority,the subjects of the intervention program were discussed.They made recommendations until reach a consensus.The other members of the research group are responsible for recording the improvement of the intervention program,summarizing the experts’proposals and revising the first version of the program.(3)Pre-trial:21 pregnant women who met the criteria were randomly divided into 3groups.Baseline survey and intervention program were carried out,and psychological test was carried out to evaluate the effectiveness of the intervention.3.Quasi-experimental studyBy convenience sampling method selecting pregnant women who met the exclusion criteria for prenatal examination from June to October in Grade III,Class A hospital,2021,according to the sample size calculation,204 subjects were finally determined.Random numbers were generated by non-researchers through Excel tables,and the subjects were divided into three groups.The control group was given routine mental health education,and the pregnant women in the network cognitive behavior therapy group were given instructional network cognitive behavior therapy intervention,the group of internet-based synchronous cognitive behavioral therapy of spouse were treated guided network cognitive behavior therapy intervention for pregnant women and their spouses.Psychological state was assessed by self-rating depression scale,self-rating anxiety scale and Wijma delivery expectancy/experience questionnaire at 28 weeks,36weeks of pregnancy and 3 days after delivery.Results:1.Cross-sectional study:(1)The prevalence of depression in early,middle and late pregnancy was 13.1%,9.7%and 17.2%respectively.The anxiety detection rate was 11.5%,8.7%,22.7%,the detection rate of fear of childbirth were 36.1%,28.2%and 33.6%respectively.There was no significant difference in the detection rate of three stages in maternal depression(P=0.256)and fear of childbirth(P=0.521),but the anxiety detection rate was not same in the three stages,and the difference was statistically significant(P=0.009).(2)The results of Spearman correlation analysis showed that the total scores of depression,anxiety and fear of childbirth were positively correlated with each other,and the correlation coefficients were 0.765,0.462 and 0.470(P<0.001)。(3)Dependent variables are depression,anxiety and fear of childbirth among women in the third trimester,the independent variables were first pregnancy,first delivery,religion,educational level,occupational status,monthly family income per capita,health insurance status,planned pregnancy,history of adverse pregnancy and delivery,complications or complications of pregnancy,and logistic forward stepwise regression was included.The results showed that unplanned pregnancy increased the risk of depression(OR=3.170,95%CI 1.185-8.482,P=0.022).The factor of primipara increased the risk of fear of delivery(OR=0.398,95%CI 0.164-0.966,P=0.042)。2.Study on the construction of intervention program(1)Literature and book analysis:the first draft of the intervention,which was summarized through literature and book analysis,covered six major themes.The presentation focuses on the basic principles of cognitive behavioral therapy and some of the basic concepts involved;the topic of pregnancy and childbirth gives pregnant women a correct scientific understanding of pregnancy and childbirth and corrects negative myths about childbirth;Cognitive changes enable pregnant women to recognize thinking traps,identify thinking patterns,choose alternative thinking,and challenge automatic thinking.Behavioral therapy is a continuation of cognitive therapy,which involves taking action to change the mind set,for depression,mainly taking behavior activation and behavior experiment,and for anxiety and fear of childbirth,mainly taking behavior experiment,exposure technology and relaxation technology and other behavior skills;Situational interventions introduce structured approaches to potentially solvable problems;finally,review the consolidation,review the treatment process,and think about gains.(2)Expert meeting method:a total of 10 experts were invited to participate in the discussion,the total authority coefficient CR of the expert group was 0.9,and the credibility of expert advice was high.The experts suggested the following:(1)the complications of the pregnancy delivery module should be removed;(2)the content of the intervention should be gradual,the order of the content in the topic of behavior change should be adjusted and too much content should be divided,depression,anxiety and fear of childbirth should be classified;(3)cognitive and behavioural changes can be divided into compulsory and elective subjects;(4)interaction between midwives or psychologists and pregnant women should be intensified,by emails or online voice chat.(3)Pre-trial:through the pre-trial on 21 pregnant women,the inspiration of the intervention program is:(1)midwives need to strictly control the online class time,the proposed control class time is less than 30 minutes;(2)the psychological doctor needs to control the on-line consultation time suitably,the suggestion consultation time is about40 minutes.(3)adding a case or story to make the theoretical knowledge and skills of CBT more vivid and interesting can avoid monotony.(4)pregnant women or their spouses are reminded to attend the course 15 minutes before each activity.3.Quasi-experimental study(1)A total of 204 pregnant women were included in the study.The final sample loss rate was 4.41%.Finally,there were 68 cases in the control group,64 cases in the network cognitive behavior therapy group and 63 cases in the group of internet-based synchronous cognitive behavioral therapy of spouse.Of the 195 pregnant women,132(67.69%)were primipara,4(2.05%)had religious belief,159(81.54%)were planned pregnancy,and 45(23.08%)had adverse pregnancy history,there was no significant difference among the three groups(P>0.05).(2)Depression score:there was no significant difference among the three groups before intervention(F=1.378,P=0.260).After intervention,there were significant differences in depression scores among the three groups at 36 weeks of gestation and 3 days after delivery(P<0.05),the scores of the group of internet-based synchronous CBT of spouse decreased gradually from(50.43±11.00)to(32.90±7.12)and(32.25±6.87),the score of internet-based cognitive-behavior therapy in pregnant women decreased from(47.11±11.13)to(37.35±9.12)and(36.27±8.88),and the score of control group changed from(49.33±10.02)to(47.2±9.47)and(46.75±9.42),the trend of depression score in the group of internet-based synchronous CBT of spouse was most significant in the three groups.The results of repeated measures analysis of variance showed that the scores of depression of women after three different interventions were different,that is,the intergroup effect was statistically significant(F=20.169,P<0.001).There were significant differences in the scores of depression among the three groups at different time points(F=566.968,P<0.001),and the interaction between intergroup effect and time effect was statistically significant(F=197.401,P<0.001).(3)Anxiety score:there was no significant difference between the three groups before intervention(F=0.317,P=0.729).After intervention,there were significant differences in anxiety scores among the three groups at 36 weeks of gestation and 3 days after delivery(P<0.05).The scores of the group of internet-based synchronous CBT of spouse decreased gradually from(44.79±6.70)to(27.78±3.99)and(27.94±4.00),the score of Internet cognitive behavior therapy group decreased from(44.14±8.35)to(34.40±7.99)and(34.32±7.73),while that of control group decreased from(43.84±6.40)to(41.33±6.29)and(41.19±6.33),the change trend of anxiety score in the group of internet-based synchronous CBT of spouse was most significant in three groups.The results of repeated measures analysis of variance showed that there were significant differences in anxiety scores among women after three different interventions(F=37.288,P<0.001).There were significant differences in anxiety scores among the three groups at different time points(F=632.800,P<0.001),the interaction between intergroup effect and time effect was statistically significant(F=211.486,P<0.001).(4)The score of fear of childbirth:there was no significant difference in fear of childbirth before intervention among the three groups(F=1.552,P=0.216).After intervention,there were significant differences in the scores of fear of delivery among the three groups at 36weeks of gestation and 3 days after delivery(P<0.05).The scores of the group of internet-based synchronous CBT of spouse decreased gradually from(78.73±13.04)to(58.35±12.22)and(46.94±11.65),the score of Internet cognitive behavior therapy group decreased from(82.32±11.98)to(69.11±12.06)and(58.13±10.02),while the score of control group changed from(82.14±12.98)to(78.51±13.42)and(69.41±12.52).The scores of the group of internet-based synchronous CBT of spouse were significantly higher than those of the other two groups.The results of repeated measures analysis of variance showed that there were significant differences in the scores of fear of birth after three different interventions(F=23.235,P<0.001).The scores of fear of childbirth in three groups at different time points were different,that is,the time effect was statistically significant(F=1786.461,P<0.001),the interaction between intergroup effect and time effect was statistically significant(F=236.995,P<0.001).(5)Outcome of labor:there was no significant difference in the mode of labor among the three groups(X~2=1.714,P>0.05).And no significant difference in the first stage of labor(F=0.111,P=0.895),there was no significant difference in the second stage of labor(F=0.414,P=0.662),the third stage of labor(F=0.414,P=0.662),and the total stage of labor(F=0.086,P=0.917).It can not be considered that the three groups of delivery methods and delivery time are different.(6)Compliance comparison:in the pregnant CBT group,18 pregnant women completed 3activities or less,46 pregnant women completed 4-6 activities,and 4 pregnant women completed 7-8 activities.In the group of internet-based synchronous CBT of spouse,10pregnant women completed 3 or fewer activities,38 completed 4-6 activities,and 20completed 7-8 activities.Chi-square test showed that there was significant difference in treatment compliance between the two groups(P=0.001).Conclusion:This study first found that the prevalence of depressive and anxiety symptoms fluctuated throughout pregnancy,reaching a high level in the early pregnancy,falling in the middle pregnancy,reaching a peak in the late pregnancy,and there was a positive correlation among depression,anxiety and the fear of childbirth.Therefore,reseacher group decided to choose the late stage of pregnancy to interfere depression,anxiety,fear of childbirth emotions.Secondly,through the literature review method,reseacher group sorted out the domestic and foreign literature in the network cognitive behavioral therapy intervention for pregnant women,and summarized the intervention measures in the literature.At the same time,according to the related theoretical works,the first draft of the intervention plan is constructed.The final draft of the intervention plan is formed by revising the plan with expert meeting method and pre-trial.Finally,quasi-experimental study was conducted to validate the efficacy of the internet-based synchronous CBT of spouse in the treatment of depression,anxiety,and fear of childbirth in late pregnant women,further research is needed to find out the efficacy in delivery outcomes.It is better to track the long-term effects of postpartum and develop software or websites related in the future. |
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