Document Type : Original Article
Authors
1 Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Islamic Republic of Iran, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Islamic Republic of Iran
2 Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Islamic Republic of Iran, Research Center for Life and Health Sciences and Biotechnology of the Police Directorate of Health Rescue and Treatment Police Healthquarter, Tehran, Iran
3 Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Islamic Republic of Iran
Abstract
BACKGROUND: Physical changes in high‑risk pregnancy (HRP) can lead to changes in mood and
social relationships and negative effects on women’s well‑being. Individuals in different sociocultural
contexts have different perceptions of well‑being. Yet, there is limited information about perceptions of
well‑being in HRP. This study aimed to explore the Iranian women’s experiences of well‑being in HRP.
MATERIALS AND METHODS: This qualitative study was conducted in 2019–2020 through directed
content analysis based on the conceptual framework of well‑being in HRP. Participants were 26
women with HRP purposively recruited from public and private healthcare settings in Mashhad, Iran.
Face‑to‑face semistructured interviews were held for data collection until data saturation. Data were
analyzed through directed content analysis proposed by Elo and kyngäs (2008) and were managed
using the MAXQDA (v. 10) program.
RESULTS: Well‑being in HRP had seven attributes in the five main dimensions of physical,
mental‑emotional, social, marital, and spiritual well‑being. The seven attributes of well‑being in HRP
were controlled physical conditions, controlled mood, emotions, and affections, perceived threat,
self‑efficacy, and competence for multiple role performance, maintained social relationships, meaning
seeking and relationship with the Creator, and positive marital relationships.
CONCLUSION: The present study provide an in‑depth understanding about well‑being in the Iranian
women with HRP. It is a complex and multidimensional concept with physical, mental‑emotional,
social, marital, and spiritual dimensions. Comprehensive multicomponent interventions are needed to
promote well‑being among women with HRP and designed the guidelines to provide woman‑centered
care.
Keywords
2. Available from: https://www.who.int/en/news‑room/fact‑sheets/detail/maternal‑mortality. Maternal mortality. [Last
accessed on 2019 Sep 19].
3. Bajalan Z, Sabzevari Z, Qolizadeh A, Abdollahi F. Prevalence of
high‑risk pregnancies and the correlation between the method of
delivery and the maternal and neonatal outcomes. Iran J Pediatr
Nurs 2019;5:52‑8.
4. Rodrigues PB, Zambaldi CF, Cantilino A, Sougey EB. Special
features of high‑risk pregnancies as factors in development
of mental distress: A review. Trends Psychiatry Psychother
2016;38:136‑40.
5. Oliveira DdC, Mandú ENT. Women with high‑risk pregnancy:
Experiences and perceptions of needs and care. Escola Anna Nery
2015;19:93‑101.
6. Tsakiridis I, Bousi V, Dagklis T, Sardeli C, Nikolopoulou V,
Papazisis G. Epidemiology of antenatal depression among
women with high‑risk pregnancies due to obstetric complications:
A scoping review. Arch Gynecol Obstet 2019;300:849‑59.
7. Cihan H, Dirilen‑Gumus O, Erkenekli K. Comparison of women
with risk‑free and high‑risk pregnancy and family resilience.
J Psychol Behav Sci 2017;5:25‑30.
8. 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.
9. Allan C, Carrick‑Sen D, Martin CR. What is perinatal well‑being?
A concept analysis and review of the literature. J Reprod Infant
Psychol 2013;31:381‑98.
10. Hatmaker DD, Kemp VH. Perception of threat and subjective
well‑being in low‑risk and high‑risk pregnant women. J Perinat
Neonatal Nurs 1998;12:1‑10.
11. MirzakhaniK, EbadiA, FaridhosseiniF, KhadivzadehT. Well‑being
in high‑risk pregnancy: An integrative review. BMC Pregnancy
Childbirth 2020;20:1‑14. doi: 10.1186/s12884‑020‑03190‑6.
12. Nguyen PH, DiGirolamo AM, Gonzalez‑Casanova I, Pham H,
Hao W, Nguyen H, et al. Impact of preconceptional micronutrient
supplementation on maternal mental health during pregnancy
and postpartum: Results from a randomized controlled trial in
Vietnam. BMC Women’s Health 2017;17:44.
13. NurzaireenaZ, Azalea K, Azirawaty T, Jameela S, Muralitharan G.
Sickle cell disease: Review of managements in pregnancy
and the outcome in ampang hospital, selangor. World Acad
Sci Eng Technol Int J Med Health Biomed Bioeng Pharm Eng
2017;11:461‑5.
14. Linden K. Women with type 1 diabetes during pregnancy
and postpartum Well‑being and diabetes management. 2018.
Available from: https://gupea.ub.gu.se/handle/2077/54536.
15. Bigelow C, Stone J. Bed rest in pregnancy. Mt Sinai J Med
2011;78:291‑302.
16. Dunn LL, Shelton MM. Spiritual well‑being, anxiety, and
depression in antepartal women on bedrest. Issues Ment Health
Nurs 2007;28:1235‑46.
17. Mirzakhani K. Pregnant women’s experiences of the conditions
affecting marital well‑being in high‑risk pregnancy: A qualitative
study. Int J Community Based Nurs Midwifery 2020;8:345‑57.
18. Available from: https://www.nice.org.uk/guidance/ng121/
documents/intrapartum-care-for-high‑risk‑women‑draft‑scope‑f
or‑consultation2. Guideline scope Intrapartum care for high‑risk
women‑NICE. NATIONAL INSTITUTE FOR HEALTH AND
CARE EXCELLENCE Guideline scope. Aug 13, 2015.
19. Elo S, Kyngäs H. The qualitative content analysis process. J Adv
Nurs 2008;62:107‑15.
20. Lincoln YS, Guba EG. Naturalistic Inquiry. Sage, USA; 1985.
21. Polit D, Beck C. Study Guide for Essentials of Nursing Research:
Appraising Evidence for Nursing Practice. Lippincott Williams
& Wilkins, Singapore; 2020.
22. Kiefer RA. An integrative review of the concept of well‑being.
Holist Nurs Pract 2008;22:244‑52.
23. Mirzakhani K, Hejazinia Z, Golmakani N, Mirteimouri M,
Sardar MA, Shakeri MT. The effect of execution of exercise
program with birth ball during pregnancy on anxiety rate in
nulliparous women. Iran J Obstet Gynecol Infertil 2014;17:8‑16.
24. Mirzakhani K, HejaziniaZ, Golmakani N, Sardar MA, Shakeri MT.
The effect of birth ball exercises during pregnancy on mode of
delivery in primiparous women. J Midwifery Reprod Health
2015;3:269‑75.
25. Gallup I. Gallup-Healthways Well-Being Index: Methodology
Report for Indexes. Washington, DC: Gallup, Inc.; 2009.
26. Pinto S, Fumincelli L, Mazzo A, Caldeira S, Martins JC. Comfort,
well‑being and quality of life: Discussion of the differences and
similarities among the concepts. Porto Biomed J 2017;2:6‑12.
27. Van Den Heuvel J, Teunis C, Franx A, Crombag N, Bekker M.
Home‑based telemonitoring versus hospital admission in high risk
pregnancies: A qualitative study on women’s experiences. BMC
Pregnancy Childbirth 2020;20:1‑9. doi: 10.1186/s12884‑020‑2779‑4.
28. Ryff CD. Happiness is everything, or is it? Explorations on the
meaning of psychological well‑being. J Personal Soc Psychol
1989;57:1069.
29. Cárdenas EF, Kujawa A, Humphreys KL. Neurobiological
changes during the peripartum period: Implications for health
and behavior. Soc Cogn Affect Neurosci 2020;15:1097‑110.
30. Larson LM, Seipel MT, Shelley MC, Gahn SW, Ko SY,
Schenkenfelder M, et al. The academic environment and faculty
well‑being: The role of psychological needs. J Career Assess
2019;27:167‑82.
31. Mc Mahon S, Fleury J, editors. Wellness in Older Adults:
A Concept Analysis. InNursing forum. 2012; 47, 1: 39‑51.
32. Roberts RM, Muller T, Sweeney A, Bratkovic D, Gannoni A.
Promoting psychological well‑being in women with
phenylketonuria: Pregnancy‑related stresses, coping strategies
and supports. Mol Genet Metab Rep 2014;1:148‑57.
33. Giurgescu C, Penckofer S, Maurer MC, Bryant FB. Impact
of uncertainty, social support, and prenatal coping on the
psychological well‑being of high‑risk pregnant women. Nurs Res
2006;55:356‑65.
34. Levy‑Shiff R, Lerman M, Har‑Even D, Hod M. Maternal
adjustment and infant outcome in medically defined high‑risk
pregnancy. Dev Psychol 2002;38:93‑103.
35. Keyes, C. L. M., & Magyar‑Moe JL. (2003). The measurement
and utility of adult subjective well‑being. In S. J. Lopez & C.
R. Snyder (Eds.), Positive psychological assessment: A handbook
of models and measures (pp. 411–425). American Psychological
Association. https://doi.org/10.1037/10612‑026.
36. Alishah A, Ganji J, Mohammadpour R, Kiani Z, Shahhosseini Z.
Women’s reproductive empowerment: A comparative study of
urban and rural females in Iran. Int J Women’s Health Reprod
Sci 2019;7:294‑300.
37. Wang F. Ingredients of a Happy Marriage: Dyadic Trust,
Relational Repair, Emotional Intelligence, and Humility. Biola
University, Pro Quest Dissertations Publishing, 2019. 22583239
38. Ramsdell EL, Franz M, Brock RL. A multifaceted and dyadic
examination of intimate relationship quality during pregnancy:
Implications for global relationship satisfaction. Fam Process
2020;59:556‑70.
39. Doorley JD, KashdanTB, AlexanderLA, BlalockDV, McKnightPE.
Distress tolerance in romantic relationships: A daily diary
exploration with methodological considerations. Motiv Emot
2019;43:505‑16.
40. Ibrahim SM, Lobel M. Conceptualization, measurement, and
effects of pregnancy‑specific stress: Review of research using the
original and revised prenatal distress questionnaire. J Behav Med
2020;43:16‑33.
41. Frankl VE. Man’s Search for Meaning. Simon and Schuster;
New york, 1985.
42. Kaufman SB. Self‑actualizing people in the 21st century: Integration with contemporary theory and research on personality
and well‑being. J Humanist Psychol 2018:0022167818809187. doi:
10.1177/0022167818809187.
43. Rastad Z, Golmohammadian M, Jalali A, Kaboudi B, Kaboudi M.
The effect of positive psychology intervention on quality of life
among women with unintended pregnancy. J Educ Health Promot
2021;10:165.
44. Gholami M, Tafazoli M, Mohebbi‑Dehnavi Z, Kamali Z. Effect of
spiritual care education on the spiritual health of preeclamptic
women with postpartum stress disorder. J Educ Health Promot
2021;10:443.
45. Tanhan A. Acceptance and commitment therapy with ecological
systems theory: Addressing Muslim mental health issues and
wellbeing. J Posit Sch Psychol 2019;3:197‑219.
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