Stress Management in Primgravid Women: A Theory of Planned Behavior-Based Supportive-Educational Intervention

Emami Alni, Zeinab; Soltani, Esmail; Mohammadbeigi, Abolfazl; Gharlipour, Zabihollah

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Stress Management in Primgravid Women: A Theory of Planned Behavior-Based Supportive-Educational Intervention

Zeinab Emami Alni

, Esmail Soltani

, Abolfazl Mohammadbeigi

, Zabihollah Gharlipour ^*

Abstract: (24 Views)

Background and Objective: Many of women describe pregnancy as one of the most stressful periods of their lives, and this phenomenon is more intense among primiparous women. On the other hand, pregnant mothers prefer non-pharmacological treatments for managing mood and anxiety disorders. The aim of this study was to assess the impact of a Supportive-Educational Intervention based on the Theory of Planned Behavior on stress management in primiparous women.

Materials and Methods: In this quasi-experimental intervention, of 92 primiparous women from Qom city health centers – Iran spanning from December 2020 to June 2021, was randomly divided into two groups: the intervention group and the control group. Multistage sampling method used in the study. The intervention group participated in a 5-week, 10-session educational program. Data were collected using a set of questionnaires, including those for demographic information, the Zimet Social Support Scale, the Depression Anxiety Stress Scale(DASS-21), and constructs of the Theory of Planned Behavior both before and 6 to 8 weeks after the intervention. Data analysis was conducted using SPSS-23 software and involved a variety of statistical tests, including t-test, paired t-test, chi-square test, and Pearson's correlation coefficient.

Results: The results indicated that, following the intervention, the intervention group demonstrated a significant reduction in stress(P<0.001, Mean± SD:26.08±18.24), anxiety(P=0.03, Mean± SD:17.77±13.09), and depression(P =0.02, Mean± SD: 14.81±15.47) mean scores when compared to the control group. Furthermore, the intervention group exhibited a significant increase in social support (P<0.001, Mean± SD: 78.25±8.14) and mean scores related to the constructs of the Theory of Planned Behavior (P< 0.001) following the intervention.

Conclusion: The findings of this study underscore the effectiveness of employing the Theory of Planned Behavior in mental health promotion programs, particularly for Primigravid women.

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/

Keywords: Primiparous, Stress, Theory of Planned Behavior

Type of Study: Research | Subject: Health Education & Health Promotion
Received: 2025/12/23 | Accepted: 2026/05/31

References

1. Salarvand S, Mousavi MS, Esmaeilbeigy D, Changaee F, Almasian M. The Perceived Health Needs of Primiparous Mothers Referring to Primary Health Care Centers: A Qualitative Study. Int J Womens Health. 2020;12:745-53. [DOI:10.2147/IJWH.S258446] [PMID] [PMCID]

2. Alves AC, Cecatti JG, Souza RT. Resilience and Stress during Pregnancy: A Comprehensive Multidimensional Approach in Maternal and Perinatal Health. ScientificWorldJournal. 2021;2021:9512854. [DOI:10.1155/2021/9512854] [PMID] [PMCID]

3. González-Ochoa R, Sánchez-Rodríguez EN, Chavarría A, Gutiérrez-Ospina G, Romo-González T. Evaluating Stress during Pregnancy: Do We Have the Right Conceptions and the Correct Tools to Assess It? J Pregnancy. 2018;2018:4857065 [DOI:10.1155/2018/4857065] [PMID] [PMCID]

4. Jafarpoor L, Aivazi Aa, shakerian s. Use the e-learning and its Effect on the Perceived Stress on in Primiparous Women Referring to Health Centers in Ilam. Iranian Journal of Health Education and Health Promotion. 2023;10 (4):361-71. [DOI:10.52547/ijhehp.10.4.361]

5. Abedi m, Saboory e, Rabiepour s, Rasoli j. The Realationship Between Stress In Pregnancy, And Pregnancy Outcomes: A Longitudinal Study. Nursing and Midwifery Journal. 2017;14 (12):969-81. [ http://unmf.umsu.ac.ir/article-1-2966-en.html]

6. Wang Y, Gu J, Zhang F, Xu X. The mediating role of social support and resilience between self-efficacy and prenatal stress: a mediational analysis. BMC Pregnancy Childbirth. 2023;23 (1):866. [DOI:10.1186/s12884-023-06184-2] [PMID] [PMCID]

7. Alipour Z, Kheirabadi GR, Kazemi A, Fooladi M. The most important risk factors affecting mental health during pregnancy: a systematic review. East Mediterr Health J. 2018;24 (6):549-59. [DOI:10.26719/2018.24.6.549] [PMID]

8. Ugurlu M, Uctu AK. The Relationship of the Prenatal Distress with Health Literacy and Health Perception of Pregnant Women. Iran J Public Health. 2023;52 (9):1917-24. [DOI:10.18502/ijph.v52i9.13573] [PMID] [PMCID]

9. Dafei M, Mojahed S, Dastjerdi G, Dehghani A, Ardakani TS. The effect of cognitive-behavioral counseling of pregnant women with the presence of a spouse on stress, anxiety, and postpartum depression. J Educ Health Promot. 2021;10:131. [DOI:10.4103/jehp.jehp_926_20]

10. Arch JJ. Cognitive behavioral therapy and pharmacotherapy for anxiety: treatment preferences and credibility among pregnant and non-pregnant women. Behav Res Ther. 2014;52:53-60. [DOI:10.1016/j.brat.2013.11.003] [PMID]

11. Abera M, Hanlon C, Daniel B, Tesfaye M, Workicho A, Girma T, et al. Effects of relaxation interventions during pregnancy on maternal mental health, and pregnancy and newborn outcomes: A systematic review and meta-analysis. PLoS One. 2024;19 (1):e0278432. [DOI:10.1371/journal.pone.0278432] [PMID] [PMCID]

12. Maddahi MS, Dolatian M, Khoramabadi M, Talebi A. Correlation of maternal-fetal attachment and health practices during pregnancy with neonatal outcomes. Electron Physician. 2016;8 (7):2639-44. [DOI:10.19082/2639] [PMID] [PMCID]

13. Bedaso A, Adams J, Peng W, Sibbritt D. Prevalence and determinants of low social support during pregnancy among Australian women: a community-based cross-sectional study. Reprod Health. 2021;18 (1):158. [DOI:10.1186/s12978-021-01210-y] [PMID] [PMCID]

14. Ruohandeh S, Tadayon M, Javadnoori M, Haghighizadeh Mh, Zarea K. Association between Social Support and Mental Health in Pregnant Women in Ahvaz. Jundishapur Scientific Medical Journal. 2025;24 (3):258-69.

15. Ginja S, Coad J, Bailey E, Kendall S, Goodenough T, Nightingale S, et al. Associations between social support, mental wellbeing, self-efficacy and technology use in first-time antenatal women: data from the BaBBLeS cohort study. BMC pregnancy and childbirth. 2018;18 (1):441. [DOI:10.1186/s12884-018-2049-x] [PMID] [PMCID]

16. Taghani R, Ashrafizaveh A, Ghanbari Soodkhori M, Azmoude E, Tatari M. Marital satisfaction and its associated factors at reproductive age women referred to health centers. J Educ Health Promot. 2019;8:133. [DOI:10.4103/jehp.jehp_172_18] [PMID] [PMCID]

17. Al-Mutawtah M, Campbell E, Kubis HP, Erjavec M. Women's experiences of social support during pregnancy: a qualitative systematic review. BMC Pregnancy Childbirth. 2023;23 (1):782. [DOI:10.1186/s12884-023-06089-0] [PMID] [PMCID]

18. Asselmann E, Kunas SL, Wittchen HU, Martini J. Maternal personality, social support, and changes in depressive, anxiety, and stress symptoms during pregnancy and after delivery: A prospective-longitudinal study. PLoS One. 2020;15 (8):e0237609. [DOI:10.1371/journal.pone.0237609] [PMID] [PMCID]

19. Khani Jeihooni A, Moayedi ZS, Momenabadi V, Ghalegolab F, Afzali Harsini P. Effect of Educational Intervention Based on Theory of Planned Behavior (TPB) on Doing Breast Self-examination in a Sample of Iranian Women. Breast Cancer (Auckl). 2023;17:11782234221145417. [DOI:10.1177/11782234221145417] [PMID] [PMCID]

20. McKenzie JF, Neiger BL, Thackeray R. Planning, Implementing and Evaluating Health Promotion Programs with Navigate Advantage Access: Jones & Bartlett Learning; 2022.

21. Ajzen I. The theory of planned behavior: Frequently asked questions. Human behavior and emerging technologies. 2020;2 (4):314-24. [DOI:10.1002/hbe2.195]

22. Sobhani A, Shahnazi H, Mostafavi F. The Efficiency of Theory-Based Education on Mental Health Subscales in Elders: Application of Theory of Planned Behavior. Iranian Journal of Health Education and Health Promotion. 2019;6 (4):367-75. [DOI:10.30699/acadpub.ijhehp.6.4.367]

23. Fakhri A, Morshedi H, Mohammadi Zeidi I. Effect of education based on health belief model with relaxation on anxiety of nulliparouse women. Scientific Journal of Kurdistan University of Medical Sciences. 2017;22 (2):32-47.

24. Zimet GD, Powell SS, Farley GK, Werkman S, Berkoff KA. Psychometric characteristics of the Multidimensional Scale of Perceived Social Support. J Pers Assess. 1990;55 (3-4):610-7 [DOI:10.1080/00223891.1990.9674095] [PMID] [PMCID]

25. Besharat MA. Multidimensional scale of perceived social support: questionnaire, instruction and scoring. 2019. [Link]

26. Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour research and therapy. 1995;33 (3):335-43. [DOI:10.1016/0005-7967(94)00075-U] [PMID] [PMCID]

27. Sahebi A, Asghari MJ, Salari RS. Validation of depression anxiety and stress scale (DASS-21) for an Iranian population. 2005. [Link]

28. Alni ZE, Soltani E, Mohammadbeigi A, Gharlipour Z. Designing and Assessing the Validity and Reliability of a Tool for Assessing Stress Management in Primigravida Pregnant Women in Iran Based on the Theory of Planned Behavior. Qom University of Medical Sciences Journal. 2023;17 (1):45-. [DOI:10.32598/qums.17.2868.1]

29. Antoni MH IG, Schneiderman N. Cognitive-behavioral stress management: Oxford University Press; 2007. [DOI:10.1093/med:psych/9780195327908.001.0001]

30. Brazeal M, Blackmon BJ, Zakaras L. The Role of Mood in the Self-Care Activities of Primary Care Patients with Type 2 Diabetes. Soc Work Public Health. 2022;37 (5):397-406. [DOI:10.1080/19371918.2021.2017380] [PMID]

31. Romero-Gonzalez B, Puertas-Gonzalez JA, Strivens-Vilchez H, Gonzalez-Perez R, Peralta-Ramirez MI. Effects of cognitive-behavioural therapy for stress management on stress and hair cortisol levels in pregnant women: A randomised controlled trial. J Psychosom Res. 2020;135:110162. [DOI:10.1016/j.jpsychores.2020.110162] [PMID]

32. Li J, Shao D, Xu X, Zhang Y, Jiang Y, Hall J. Cognitive behavior stress management during pregnancy: a randomized controlled trial. Contemp Nurse. 2019;55 (6):543-53. [DOI:10.1080/10376178.2020.1729827] [PMID]

33. Bright KS, Charrois EM, Mughal MK, Wajid A, McNeil D, Stuart S, et al. Interpersonal Psychotherapy to Reduce Psychological Distress in Perinatal Women: A Systematic Review. Int J Environ Res Public Health. 2020;17 (22). [DOI:10.3390/ijerph17228421] [PMID] [PMCID]

34. Khodabakhsh M, Rajaei T. Progressive Muscle Relaxation Training and Mindfulness-Based Stress Reduction on Pregnancy-related Anxiety. Complementary Medicine Journal. 2025;15 (2):148-58. [DOI:10.32592/cmja.15.2.148]

35. Shadi M, Peyman N, Taghipour A, Tehrani H. Predictors of the academic stress and its determinants among students based on the theory of planned behavior. Fundamentals of Mental Health. 2017;20 (1):69-76.

36. Cynthia Logsdon M, Myers J, Rushton J, Gregg JL, Josephson AM, Davis DW, et al. Efficacy of an Internet-based depression intervention to improve rates of treatment in adolescent mothers. Arch Womens Ment Health. 2018;21 (3):273-85. [DOI:10.1007/s00737-017-0804-z] [PMID] [PMCID]

37. Zorrilla MM, Modeste N, Gleason PC, Sealy D-A, Banta JE, Trieu SL. Depression and Help-Seeking Intention Among Young Adults: The Theory of Planned Behavior. American Journal of Health Education. 2019;50 (4):236-44. [DOI:10.1080/19325037.2019.1616014]

38. Joveini H, Dehdari T, Hashemian M, Maheri M, Shahrabadi R, Rohban A, et al. Effects of an Educational Intervention on Male Students' Intention to Quit Water Pipe Smoking: an Application of the Theory of Planned Behavior (TPB) and Health Action Process Approach (HAPA). J Educ Community Health. 2020;7 (2):73-80. [DOI:10.29252/jech.7.2.73]

39. Engelhardt EC, Bicknell G, Oliver M, Flaherty C, Line K, King E. Theory of Planned Behavior and Active Duty Air Force Members' Mental Health Help-Seeking. Mil Med. 2023;188 (7-8):e2217-e22. [DOI:10.1093/milmed/usac326] [PMID]

40. Adams C, Gringart E, Strobel N. Explaining adults' mental health help-seeking through the lens of the theory of planned behavior: a scoping review. Syst Rev. 2022;11 (1):160. [DOI:10.1186/s13643-022-02034-y] [PMID] [PMCID]

41. Yu M, Qiu T, Liu C, Cui Q, Wu H. The mediating role of perceived social support between anxiety symptoms and life satisfaction in pregnant women: a cross-sectional study. Health Qual Life Outcomes. 2020;18 (1):223. [DOI:10.1186/s12955-020-01479-w] [PMID] [PMCID]

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