The Effect of the "Empowerment Program for Infertile Women" Developed Based on the Theory of Uncertainty in Illness on the Levels of Coping with Uncertainty and Stress in Women with Infertility: A Randomized Controlled Trial

Nevra Karaca Bıçakçı; Birsen Altay

doi:10.70749/ijbr.v3i10.2562

Authors

Nevra Karaca Bıçakçı Kafkas University, Faculty of Health Sciences, Department of Nursing, Public Health Nursing Division, Kars, Türkiye https://orcid.org/0000-0003-2408-0327
Birsen Altay Ondokuz Mayıs University, Faculty of Health Sciences, Department of Public Health Nursing, Samsun, Türkiye https://orcid.org/0000-0001-5823-1117

DOI:

https://doi.org/10.70749/ijbr.v3i10.2562

Keywords:

Theory of Uncertainty in Illness, Infertility, Infertility Stress, Uncertainty, Structured Education Program

Abstract

Objective: This randomized controlled trial aimed to determine the effect of the "Empowerment Program for Infertile Women," developed based on the Theory of Uncertainty in Illness, on the levels of coping with uncertainty and stress in women diagnosed with infertility. Methods: The study was conducted as a double-blind, pretest-posttest, control group experimental design. It was carried out between January and June 2022 with 35 infertile women in the intervention group and 35 in the control group, all diagnosed with infertility and meeting the inclusion criteria, who applied to the gynecology outpatient clinic of Ondokuz Mayıs University Faculty of Medicine Hospital. Data were collected using the Personal Information Form developed by the researcher based on the literature, the Mishel Uncertainty in Illness Scale–Community Form (MUIS-C), and the Coping with Infertility Stress Scale (CISS). After the pretest was administered to both groups, the intervention group received a four-week face-to-face education program. Three months after the completion of the Empowerment Program for Infertile Women, posttests were administered to both groups. Results: The mean age of women in the intervention group was 29.6 ± 5.0, and 28.9 ± 4.0 in the control group. According to the pretest-posttest results of the control group, the changes in scores related to coping with infertility stress and uncertainty due to infertility were not statistically significant. After the intervention, the mean total score on the Coping with Infertility Stress Scale in the intervention group was 50.3 ± 7.4, min-max = (34–71), indicating an increase compared to the pre-intervention score. The mean total score on the Mishel Uncertainty in Illness Scale–Community Form was 51.5 ± 20.4, min-max = (27–100), indicating a decrease compared to the pre-intervention score. Statistically significant differences were found in both within-group and between-group comparisons of the total scores for both scales in the intervention group (p < 0.001). Conclusion: The results of the study indicated that the Empowerment Program for Infertile Women, developed based on the Theory of Uncertainty in Illness, positively affected the levels of coping with uncertainty and stress in women with infertility.

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References

1. World Health Organization (WHO). Infertility definitions and terminology [Internet]. Geneva: WHO; 2022 [cited 2023 Mar 3].

https://www.who.int/newsroom/factsheets/detail/infertility

2. Özdemir E, Kaplan S. Infertility and nursing approach. J Tradit Complement Med Res (TÜSBAD). 2021;4(1):79–89.

3. Sezgin H, Hocaoglu Ç. Psychiatric aspects of infertility. Curr Approaches Psychiatry. 2014;6(2):165–184.

https://doi.org/10.5455/cap.20131001091415.

4. Kırca N, Pasinlioğlu T. Psychosocial problems encountered in infertility treatment. Curr Approaches Psychiatry. 2013;5(2):162–178.

https://doi.org/10.5455/cap.20130511.

5. Bayley TM, Slade P, Lashen H. Relationships between attachment, appraisal, coping and adjustment in men and women experiencing infertility concerns. Hum Reprod. 2009 Nov;24(11):2827–2837.

https://doi.org/10.1093/humrep/dep235.

6. Gourounti K. Psychological stress and adjustment in pregnancy following assisted reproductive technology and spontaneous conception: a systematic review. Women Health. 2016;56(1):98–118.

https://doi.org/10.1080/03630242.2015.1074642.

7. Stocker LJ, Hardingham KL, Cheong YC. A randomized controlled trial assessing whether listening to music at time of embryo transfer affects anxiety levels. Gynecol Obstet (Sunnyvale). 2016;6(9):1–7.

https://doi.org/10.4172/2161-0932.1000401.

8. Chen D, Zhang JP, Jiang L, Liu H, Shu L, Zhang Q. Factors that influence in vitro fertilization treatment outcomes of Chinese men: a cross-sectional study. Appl Nurs Res. 2016; 32:222–226.

https://doi.org/10.1016/j.apnr.2016.07.003.

9. Fawcett J, DeSanto-Madeya S, editors. Implementing nursing models and theories in practice. In: Fawcett J. Contemporary nursing knowledge: analysis and evaluation of nursing models and theories. 3rd ed. Philadelphia: F.A. Davis Company; 2013.

https://doi.org/10.1177/0894318417708424

10. Zhang Y. Uncertainty in illness: theory review, application, and extension. Oncol Nurs Forum. 2017 Nov;44(6):645–649.

https://doi.org/10.1188/17.ONF.645-649.

11. Mishel MH. Uncertainty in illness. J Nurs Scholarsh. 1988;20(4):225–232.

https://doi.org/10.1111/j.1547-5069.1988.tb00082.x

12. Mishel MH. Reconceptualization of the uncertainty in illness theory. J Nurs Scholarsh. 1990;22(4):256–262.

https://doi.org/10.1111/j.1547-5069.1990.tb00225.x

13. Pan L, Wang L, Huang X. How to face the novel coronavirus infection during the 2019–2020 epidemic: the experience of Sichuan Provincial People’s Hospital. Intensive Care Med. 2020;46(4):573–575.

https://doi.org/10.1007/s00134-020-05964-0.

14. Seymenler S, Siyez DM. Infertility psychological counseling. J Educ Couns Res. 2018;10(2):186–197.

https://doi.org/10.18863/pgy.358095.

15. Çal A, Aydın Avci İ. Turkish adaptation of the Mishel uncertainty in illness scale–community form. Perspect Psychiatr Care. 2021;1–8.

https://doi.org/10.1111/ppc.12874.

16. Doğaner Karakuş T. The effect of personality traits on coping with infertility stress in infertile women [master’s thesis]. Istanbul: Istanbul University-Cerrahpaşa Graduate School of Education; 2019.

17. Şahin Yılmaz T. Coping methods of infertile couples with infertility stress [dissertation]. Istanbul: Istanbul University, Institute of Health Sciences; 2012.

18. Cui C, Li Y, Wang L. The association of illness uncertainty and hope with depression and anxiety symptoms in women with systemic lupus erythematosus: a cross-sectional study of psychological distress in systemic lupus erythematosus women. J Clin Rheumatol. 2021;27(8):299–305.

https://doi.org/10.1097/RHU.0000000000001280.

19. Karaca A, Unsal G. Psychosocial problems and coping strategies among Turkish women with infertility. Asian Nurs Res (Korean Soc Nurs Sci). 2015;9(3):243–250.

https://doi.org/10.1016/j.anr.2015.04.007.

20. Zorlu S, Erbaş N. The relationship between the effect of infertility on infertile women, their coping with stress, and perceived social support. Ege Univ Nurs Fac J. 2021;37(2):95–105.

https://doi.org/10.53490/EGEHEMSIRE.899608.

21. Nuri Turhal G, Sis Çelik A. Determining the relationship between perceived social support and the impact of infertility in women with primary infertility. J Health Sci Prof. 2019;6(1):91–104.

https://doi.org/10.17681/hsp.410980.

22. Jafarzadeh Kenarsari F, Ghahiri A, Habibi M, Boroujeni AZ. Exploration of infertile couples' support requirements: a qualitative study. Int J Fertil Steril. 2015;9(1):81–92.

https://doi.org/10.22074/ijfs.2015.4212.

23. Fahami F, Hosseini Quchani S, Ehsanpour S, Zargham Boroujeni A. Lived experience of infertile men with male infertility cause. Iran J Nurs Midwifery Res. 2010;15(Suppl 1):265–271. PMID:22069398.

24. Mosalanejad L, Khodabakshi Koolee A. Looking at infertility treatment through the lens of the meaning of life: the effect of group logotherapy on psychological distress in infertile women. Int J Fertil Steril. 2013;6(4):224–231. PMID:24520444.

25. Faramarzi M, Pasha H, Esmailzadeh S, Kheirkhah F, Heidary S, Afshar Z. The effect of the cognitive behavioral therapy and pharmacotherapy on infertility stress: a randomized controlled trial. Int J Fertil Steril. 2013;7(3):199–206. PMID:24520487.

26. Domar AD, Gross J, Rooney K, Boivin J. Exploratory randomized trial on the effect of a brief psychological intervention on emotions, quality of life, discontinuation, and pregnancy rates in in vitro fertilization patients. Fertil Steril. 2015;104(2):440–451.

https://doi.org/10.1016/j.fertnstert.2015.05.031.

27. Afyonkale Talay N. The effect of an infertility coping skills development program on perceived stress caused by infertility [dissertation]. Samsun: Ondokuz Mayıs University, Institute of Educational Sciences; 2018.

28. Eroğlu N, Temiz G. The effect of education on stress and coping status in patients undergoing infertility treatment. Cukurova Med J. 2020;45(4):1309–1317.

https://doi.org/10.17826/cumj.702020.

29. Karpat C, Erensoy H. A pilot study on stress and coping strategies in infertile individuals undergoing IVF treatment. Turk J Fam Pract. 2020;14(3):461–467.

https://doi.org/10.21763/tjfmpc.737420.

30. Bulut Kamalı M, Şen S. Evaluation of depression and coping levels with infertility in infertile couples. Int Arch Health Sci Res (IAA0J). 2022;8(2).

31. Aflakseir A, Mahdiyar M. The role of religious coping strategies in predicting depression among a sample of women with fertility problems in Shiraz. J Reprod Infertil. 2016;17(2):117–122.

32. Li J, Long L, Liu Y, He W, Li M. Effects of a mindfulness-based intervention on fertility quality of life and pregnancy rates among women subjected to first in vitro fertilization treatment. Behav Res Ther. 2016; 77:96–104.

https://doi.org/10.1016/j.brat.2015.12.010.

33. Peterson BD, Eifert GH. Using acceptance and commitment therapy to treat infertility stress. Cogn Behav Pract. 2011;18(4):577–587.

https://doi.org/10.1016/j.cbpra.2010.03.004.

34. Lykeridou K, Gourounti K, Sarantaki A, Loutradis D, Vaslamatzis G, Deltsidou A. Occupational social class, coping responses, and infertility-related stress of women undergoing infertility treatment. J Clin Nurs. 2011;20(13–14):1971–1980.

https://doi.org/10.1111/j.1365-2702.2011.03696.x.

35. Rasoulzadeh Bidgoli M, Latifnejad Roudsari R. The effect of the collaborative infertility counseling model on coping strategies in infertile women undergoing in vitro fertilization: a randomized controlled trial. Int J Women's Health Reprod Sci. 2018;6(1):47–54.

https://doi.org/10.15296/ijwhr.2018.09.

36. Dağ H, Yigitoğlu S, Aksakal Bİ, Kavlak O. The association between coping method and distress in infertile women: a cross-sectional study from Turkey. Pak J Med Sci. 2015;31(6):1457–1462.

https://doi.org/10.12669/pjms.316.8605.

37. Cypress BS. Understanding uncertainty among critically ill patients in the intensive care unit. Dimens Crit Care Nurs. 2015;34(3):145–155.

https://doi.org/10.1097/DCC.0000000000000118.

38. Özkan S. The effect of nursing interventions based on the theory of uncertainty in illness on uncertainty, hopelessness, coping and adaptation in caregivers of children with cancer [dissertation]. Konya: Selçuk University, Institute of Health Sciences; 2020.

39. Özkan S, Taş Arslan F. The effects of nursing interventions based on Mishel’s theory of uncertainty in illness on the caregivers of children diagnosed with cancer: a randomized controlled trial. Genel Tıp Derg. 2022;32(3):221–228.

https://doi.org/10.54005/geneltip.1128563.

40. Chen TY, Kao CW, Cheng SM, Chang YC. Uncertainty and depressive symptoms as mediators of quality of life in patients with heart failure. PLoS One. 2018;13(11):e0205953.

https://doi.org/10.1371/journal.pone.0205953.

41. Guan T, Santacroce SY, Chen DG, Song L. Illness uncertainty, coping, and quality of life among patients with prostate cancer. Psychooncology. 2020;29(6):1019–1025.

https://doi.org/10.1002/pon.5372.

42. Turgut Y, Güdül H, Akgün M, Boz İ, Yangın H. Qualitative exploration of nurses' experiences of the COVID-19 pandemic using the reconceptualized uncertainty in illness theory: an interpretive descriptive study. J Adv Nurs. 2022;78(6):2111–2122.

https://doi.org/10.1111/jan.15153.

43. Taş Bora S, Buldukoğlu K. Using the uncertainty in illness theory to provide care for the caregiver: a case report. J Psychiatr Nurs. 2020;11(1):70–77.

https://doi.org/10.14744/phd.2019.44365.

44. Çamlıca T, Coşkun Erçelik H. Nursing care in the treatment decision of a patient diagnosed with chronic renal failure according to the theory of uncertainty in illness. Turkiye Klinikleri J Nurs Sci. 2021;14(2):621–626.

https://doi.org/10.5336/nurses.2021-84101.

45. Çınar D, Yıldırım Y, Şenuzun Aykar F. Nursing care for a cancer patient based on Merle Mishel’s theory of uncertainty in illness: a case report. ACU Sağlık Bil Derg. 2020;11(3):553–559.

https://doi.org/10.31067/0.2020.30662.

46. Goutzamanis S, Joseph S, Doyle JS, Thompson A, Dietze P, Hellard M, Higgs P. Experiences of liver health-related uncertainty and self-reported stress among people who inject drugs living with hepatitis C virus: a qualitative study. BMC Infect Dis. 2018;18(1):151.

https://doi.org/10.1186/s12879-018-3057-1.

47. Reinoso H. Uncertainty and the treatment experience of individuals with chronic hepatitis C. J Nurse Pract. 2016;12(7):445–451. https://doi.org/10.1016/j.nurpra.2016.01.0