The Effect of Postpartum Mandala Coloring on Anxiety, Fatigue, Maternal Attachment and Breastfeeding Self-efficacy

Condition(s) studied

Investigational drug(s) / intervention(s)

Mandala coloring: Mothers in the intervention group will be given a circular mandala template coloring book and 12 colored pencils. Mothers in the intervention group will be informed that they will start coloring mandalas one week after giving birth. They will be asked to color one mandala coloring page twice a week for a total of 5 weeks, with each coloring session lasting 30 minutes. To eliminate the possibility of mothers forgetting to color mandalas, the researcher will send reminder messages to the mothers twice a week starting from the end of the first week. Mothers will be asked to send pictures of the mandala pages they have colored to the researcher as a message.

Study summary

The aim of this study is to investigate the effects of mandala coloring on anxiety, fatigue, breastfeeding self-efficacy, and mother-infant bonding in postpartum mothers. The sample consists of women who have had a cesarean section at Kayseri City Hospital within the last year. Data will be collected using a Personal Information Form, the Postpartum Specific Anxiety Scale, the Short Form of the Breastfeeding Self-Efficacy Scale, the Chalder Fatigue Scale, and the Maternal Attachment Scale. Mothers meeting the inclusion criteria will be randomly assigned to intervention and control groups. Mothers in the intervention group will be informed that they will begin mandala coloring one week after their cesarean delivery. They will be asked to color a mandala twice a week for a total of 5 weeks, with each coloring session lasting 30 minutes. To eliminate the possibility of mothers forgetting to color the mandala, the researcher will send reminder messages twice a week starting from the end of the first week. The Personal Information Form will be collected through face-to-face interviews while the mothers are in the hospital. Mothers in the control group will receive routine hospital care and will not paint mandalas. Researchers will call all mothers at the end of weeks 1 and 2 to administer the Postpartum Specific Anxiety Scale and the Short Form of the Breastfeeding Self-Efficacy Scale, and at the end of weeks 4 and 6 to administer questions from the Postpartum Specific Anxiety Scale, Short Form of the Breastfeeding Self-Efficacy Scale, Chalder Fatigue Scale, and Maternal Attachment Scale, recording their responses.

Eligibility

Primary outcome measure(s)

• Postpartum Specific Anxiety Scale — At the end of the 1st, 2nd, 4th and 6th weeks postpartum
  The scale was developed by Fallon et al. (2016) as a 56-item scale, and was transformed into a 44-item structure through a Turkish validity and reliability study conducted by Bayri Bingöl et al. (2021). The original version of the scale was developed and validated with mothers who had infants aged 0-6 months. The scale has sub-dimensions of maternal skills and attachment, newborn well-being and safety, infant care practices, and psychosocial adjustment to motherhood. The highest possible score on the Likert-type scale is 176, and the cutoff score is 113.5. Higher scores on the scale indicate a higher incidence of anxiety symptoms. The Cronbach's alpha values for the sub-dimensions of the scale range from 0.83 to 0.90.
• Short Form of the Breastfeeding Self-Efficacy Scale — At the end of the 1st, 2nd, 4th and 6th weeks postpartum
  Developed in 1999 by Dennis and Faux to measure mothers' competence regarding breastfeeding in the postpartum period. The scale was initially developed with 33 items. In the internal consistency analysis of the scale, items with a correlation below 0.60 were removed, and the short form of the Breastfeeding Self-Efficacy Scale with 14 items was created. This scale is a 5-point Likert type. All items are scored as 1, 2, 3, 4, 5 (1=Never sure, 5=Always sure). All items in the scale have positive meanings. The lowest possible score on the scale is 14, and the highest is 70, with no cutoff point. A higher score indicates higher breastfeeding self-efficacy. The Turkish validity and reliability of the scale was established by Aluş-Tokat and Okumuş in 2010. The Cronbach's alpha coefficient of the Breastfeeding Self-Efficacy Scale is 0.86.
• Chalder Fatigue Scale — At the end of the 4th and 6th weeks postpartum
  Developed by Cella and Chalder in 2010 for use in various populations to assess fatigue, it was adapted into Turkish by Adın et al. in 2022. The scale consists of 11 items, divided into two sub-dimensions: physical fatigue and mental fatigue, and uses a 4-point Likert scale. Scores range from 0-21 for the physical fatigue sub-dimension, 0-12 for the mental fatigue sub-dimension, and 0-33 for the total scale score. Higher scores indicate greater fatigue severity.
• Maternal Attachment Scale — At the end of the 4th and 6th weeks postpartum
  The validity and reliability study of the Turkish form of the Maternal Attachment Scale, developed by Mary E. Muller in 1994, was conducted by Kavlak and Şirin in 2009. The scale consists of 26 items on a four-point Likert scale, with higher scores indicating higher maternal attachment. The lowest possible score is 26, and the highest is 104. Cronbach's Alpha internal consistency reliability was found to be 0.77 in 1-month-old infants and 0.82 in 4-month-old infants.

Trial sites (1)

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