Effects of Mandala Coloring and Music Listening on Fear of Childbirth

Fear of childbirth is a common concern during pregnancy and may negatively affect women's psychological well-being and childbirth experiences. Non-pharmacological approaches that are simple, accessible, and easy to implement may help pregnant women cope with childbirth-related fear.

This study is designed as a randomized controlled trial to evaluate and compare the effectiveness of two art-based interventions, mandala coloring and music listening, in reducing fear of childbirth among pregnant women. Eligible participants are randomly assigned to three groups: the mandala coloring group, the music listening group, and the control group.

Participants assigned to the mandala coloring group complete a structured mandala coloring intervention. Participants assigned to the music listening group receive a structured music listening intervention. Participants in the control group receive routine care without either of these additional interventions.

Fear of childbirth is assessed using validated measurement instruments before and after the intervention period. Changes in outcome measures are compared within and between the study groups to determine the effects of the interventions. The study also compares mandala coloring and music listening to determine whether one approach is more effective in reducing fear of childbirth.

The findings are expected to provide evidence regarding the use of simple, non-pharmacological, art-based approaches for managing fear of childbirth during pregnancy.

• Mandala Coloring (Behavioral), also known as Mandala Art Intervention: Participants in the mandala coloring group received a structured mandala coloring intervention in addition to routine care. The intervention involved coloring predetermined mandala patterns and was implemented as a non-pharmacological, art-based approach to reduce fear of childbirth.
• Music Listening (Behavioral), also known as Music Intervention: Participants in the music listening group received a structured music listening intervention in addition to routine care. The intervention involved listening to music and was implemented as a non-pharmacological approach to promote relaxation and reduce fear of childbirth.

Primary outcomes

• Fear of Childbirth Assessed Using the Wijma Delivery Expectancy/Experience Questionnaire Version A [Baseline and immediately after the intervention]: Fear of childbirth was assessed using the Wijma Delivery Expectancy/Experience Questionnaire Version A. The questionnaire consists of 33 items and provides a total score ranging from 0 to 165. Higher scores indicate a higher level of fear of childbirth. The questionnaire was administered before and after the intervention to evaluate changes in fear of childbirth among the mandala coloring, music listening, and control groups.

Secondary outcomes

• Pain Level Assessed Using the Visual Analog Scale [Baseline and immediately after the intervention]: Pain level was assessed using the Visual Analog Scale. Participants rated their perceived pain on a scale from 0 to 10, where 0 indicates no pain and 10 indicates the worst possible pain. The scale was administered before and after the intervention to evaluate changes in pain levels among the mandala coloring, music listening, and control groups.

Sex: Female, ages: 18 Years to 35 Years

Inclusion Criteria:

* Pregnant women aged 18-35 years
* Primiparous pregnant women
* Pregnant women who met the gestational week criteria specified in the study protocol
* Pregnant women with fear of childbirth
* Ability to communicate in Turkish
* Voluntary agreement to participate in the study

Exclusion Criteria:

* Presence of a high-risk pregnancy or pregnancy-related complication
* Presence of a diagnosed psychiatric disorder or use of psychiatric medication
* Presence of a condition that could prevent participation in the interventions
* Participation in another intervention aimed at reducing fear of childbirth
* Withdrawal from the study or failure to complete the intervention and outcome assessments