Document Type : Original Article


1 Reproductive Health (Ph.D.) and Clinical Psycologist, Research Center for Nursing and Midwifery Care, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

2 Counseling (Ph.D.), Department of Psycology and Educational Sciences, Yazd University, Yazd, Iran


BACKGROUND: In the COVID‑19 outbreak, women with a history of miscarriage need more mental
health. Anxiety and meta‑worry as consequences of miscarriage, besides concerns due to pregnancy
during coronavirus, show the necessity of appropriate online and face‑to‑face educational counseling.
This study aimed to evaluate the effectiveness of online metacognitive educational counseling versus
face‑to‑face method on anxiety and meta‑worry in these women.
MATERIALS AND METHODS: In this randomized clinical trial, 80 women with a history of
miscarriage, anxiety, and meta‑worry referred to Imam Jafar Sadegh hospital (labor, women ward
and women clinic), Meybod, Iran, were selected conveniently and randomly assigned into two
groups (n = 20/each). The participants received 8‑session metacognitive educational counseling
package online or face‑to‑face. Data were collected by Beck Anxiety Inventory, Wellz meta‑worry
questionnaire at baseline, week eight, and follow up as primary outcomes and analyzed via SPSS
software (Anova and Repeated measure statistic tests).
RESULTS: Anxiety in the 12th week (online group 13.75 ± 3.59 vs. face to face 18.25 ± 5.91,
P = 0.04) was statistical significantly less than baseline (respectively 22.15 ± 5.67 vs. 22.35 ± 4.93,
P =  0.56); with fewer anxiety scores in the online group. Meta‑worry in the 12th week (online
group 11.90 ± 2.59 vs. face to face 15.70 ± 4.06, P = 0.03) was statistically significant compared to
baseline (respectively 17.15 ± 2.70 vs. 18.50 ± 3.47, P = 0.36); with fewer meta‑worry scores in the
online group. Belief about worry in 12th week (online group 66.50 ± 14.60 vs. face to face 78.45 ± 9.27,
P = 0.01) was statistical significantly less than baseline (respectively 85.50 ± 8.87 vs. 86.05 ± 8.85,
P = 0.96); with less score of belief about worry in the online group.
CONCLUSION: Online and face‑to‑face metacognitive educational counseling methods decreased
anxiety, meta‑worry, and belief about worry in women with miscarriage. But online educational
counseling was more effective. Distance online counseling in COVID‑19 can help the mental health
of women with miscarriage.


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