Intervention Nursing Student Mother Heart Connection (NSMHC) to Improve Student Mental Health

Intervention Nursing Student Mother Heart Connection (NSMHC) to Improve Student Mental Health | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Intervention Nursing Student Mother Heart Connection (NSMHC) to Improve Student Mental Health Agus Santoso, Meidiana Dwidiyanti, Badrul Munif This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8922157/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background This study examines the effectiveness of the Nursing Student-Mother Heart Connection (NSMHC) mobile application in enhancing the mental health of university students by improving communication between mothers and their children. Mental health is a critical determinant of academic success and overall well-being among university students, with parent-child relationships, particularly with mothers, playing a significant role. Purpose This study aims to find out the effectiveness of NSMHC applications to improve students' mental health Methods A quasi-experimental design with pretest-posttest control group was canducted with 60 first-year nursing students and their mothers. The intervention group received daily mindfulness-based emotion regulation training for mothers via the NSMHC app over a two-week period, while the control group received no intervention during the study period. Mental health outcomes were measured using the Mental Health Inventory-5 (MHI-5), and communication quality was assessed using the Parent-Adolescent Communication Scale (PACS). Results Sixty participants completed the study. The intervention group showed significant improvements in maternal communication, child communication, and student mental health after the two-week NSMHC program (all p < 0.05). Between-group analysis revealed significantly better mental health outcomes in the intervention group compared with the control group (p = 0.041). Conclusion These findings suggest that NSMHC can enhance mother-child communication and have a positive impact on student mental health. Further research is recommended to explore the long-term effects and mechanisms underlying these outcomes. Trial Registration: The study was registered in TCTR ( TCTR20260304010 ; registration date: 04 March 2026; retrospectively registered) Mental Health Nursing Student Communication Mother-child Relations Mindfulness Figures Figure 1 Introduction Mental health is currently an issue that is still being discussed in various fields because mental health is one of the main factors in determining the quality and satisfaction of life in individuals [ 21 ]. It becomes an integral part of health and well-being, as also defined by the World Health Organization, namely that mental health is a state of well-being in which individuals are aware of their abilities, can cope with the normal stresses of life, can work productively and fruitfully, and can contribute to their communities [ 23 ]. In the university student population, mental health is crucial as it can impact academic achievement and other aspects of their academic life. Academic life is one parameter that can also be used to assess students' psychological well-being, as it is influenced by students' mental health and intrinsic motivation. An active academic life demonstrates the effort students put into their academic tasks, such as improving their knowledge and skills [ 12 ]. Several factors influence the mental health of students. Previous research suggests that factors influencing the mental health of students in higher education encompass psychological, academic, biological, lifestyle, social, and financial aspects [ 21 ]. A harmonious relationship with parents, especially mothers, can foster psychological well-being in college students [ 20 ]. However, recent decades have seen an increase in mental health disorder issues among children, adolescents, and young adults. Rates of impulse control disorders, such as ADHD and anxiety disorders, begin to increase as early as 4 years of age. The increase is most significant in adolescence and young adulthood, with the highest incidence of anxiety, mood, and substance use disorders [ 7 ]. College students are one of the populations with a high incidence of mental health disorders. A comprehensive research investigation conducted in the nation of Bangladesh revealed that the prevalence rates of psychological conditions, specifically depression, stress, and anxiety, among the population of university students exhibited a significant variation. Ranging from a notably low 46.92% to an alarmingly high 96.82%, thereby underscoring the urgent need for further exploration and intervention in the mental health landscape of this demographic [ 2 ]. Psychological factors contribute significantly to mental problems among college students. These include trauma, childhood maltreatment, and emotional maladjustment, which can increase the risk of anxiety and depression in college students [ 15 ]. The dynamics of mother-child interactions, as well as the dimensions of spiritual well-being, have the potential to impact the behavioral disorders observed in children through their effects on maternal mental health [ 22 ]. The establishment of a robust and profound connection between parents and their offspring has the potential to significantly enhance the cultivation of critical social skills, which are indispensable for the successful formation of profound and meaningful personal relationships that individuals will rely upon throughout their lives [ 4 ]. On the other hand, negative relationships between parents and children can elevate the likelihood of developing mental health issues. Individuals who experience high psychological distress are more likely to function negatively in daily life. Good emotion regulation strategies may act as a protective factor that moderates the relationship between childhood trauma and negative thinking in individuals [ 32 ]. A poor relationship between parents and children, characterized by poor communication between the two, can exacerbate a student's mental health problems [ 20 ]. The quality of mother-child communication is mediated by maternal mental health. Thus, maternal mental health is crucial in determining the effectiveness of mother-student communication [ 17 ]. Research shows that mothers with good mental health tend to have more effective communication with their children. The presence of robust and favorable mental health among mothers can significantly contribute to the enhancement of their children’s emotional and social development, in addition to markedly improving their academic performance in educational settings. Current technological developments encourage the integration of technology into various fields, one of which is to improve mother-child communication. However, there are still challenges in optimizing the use of these technologies to support quality interactions between mothers and children. Previous research shows that available applications only focus on disseminating information rather than encouraging direct mother-child communication and improving maternal mental health. [ 22 ]. Further research is needed to identify the app features that are most effective in facilitating positive communication and improving maternal mental health. The Nursing Student-Mother Heart Connection (NSMHC) app provides mindfulness training and emotional support to help mothers manage their emotions, enabling them to enhance the quality of maternal communication with university students. Effective communication between mothers and students is expected to improve students' mental health. This study aims to provide interventions for mothers to foster good communication between mothers and students, thereby improving students' mental health. Methods Research design This study employed a quasi-experimental design, utilizing a pretest and posttest with a control group. To assess the improvement in students' mental health, assessments were conducted before and after the intervention in both the experimental and control groups. Setting and samples This research was conducted between February 20 and June 3, 2025, at the Department of Nursing at one of the universities in Indonesia. The sample was taken from students of the Nursing Study Program at Diponegoro University. Sampling was conducted using a probability sampling technique, specifically simple random sampling. The sample size was calculated using the G-Power application version 3.1.9.7, with a significance level (α) = 0.05, power test strength (1-β) = 80% (0.80), and α-effect size (γ) of 0.80 [ 26 ]. Based on the calculation results, a minimum sample size of 27 respondents per group, totaling 54 respondents, was determined. To anticipate the possibility of dropout, an additional three participants were added to each group, bringing the total sample to 60 participants. The inclusion criteria in this study were first-year students who still have mothers and have access to communicate with them, who can be given the intervention. The exclusion criteria set in this study are students who are diagnosed with severe and moderate mental disorders in the acute phase and do not follow the research process from pretest to posttest. The entire participant recruitment process from enrollment to follow-up and data analysis is systematically documented in the CONSORT flowchart (Hopewell et al., 2025; Fig. 1 ). Intervention (applies to experimental studies) The designer of the features in the NSMHC app is the initiator of a spiritual mindfulness intervention focused on emotions. The app features a series of emotion regulation exercises for mothers, utilizing an emotion-focused mindfulness approach. The student's mother was instructed to install the NSMHC application. The student mother was then invited to prepare themselves by being in a quiet place. After that, the student's mother was asked to follow the instructions on the NSMHC application. The intervention lasted about 20–40 minutes, depending on how the student's mother was able to find the emotions she felt. The intervention was carried out repeatedly, as many as once a day for two weeks. The posttest is administered after the mother has routinely conducted emotion regulation exercises using the NSMHC application. Participants in the control group received no interventions. However, they were given a handbook to learn emotional regulation exercises based on spiritual mindfulness, focusing on emotions, after completing a posttest by the intervention group. The control group was still asked to complete a pretest and posttest at the same time as the intervention group. Measurement and Data Collection; The instruments used in this study were a demographic data questionnaire, the Parent-Child Communication Scale (PACS), and the Mental Health Inventory-5 (MHI-5) instrument. Demographic data questionnaires were used to collect basic information from participants (mothers and students). The demographic data requested for mothers included their name, age, religion, occupation, education, and marital status. Meanwhile, for students, the questions asked were: name, mother's name, age, religion, and whether they lived with their parents. The parent version and the child version of the PACS instrument were used to measure parent-child communication before and after the intervention [ 5 ]. Meanwhile, the MHI-5 questionnaire is used to assess the mental health level of students [ 27 ]. The intervention was conducted over a period of two weeks and was monitored daily. The intervention provided was in the form of mindfulness training focused on emotions for mothers through the NSMHC application. Data collection commenced with the selection of samples based on the specified inclusion criteria. The researcher explained the purpose and objectives of the study to obtain the participants' consent. Demographic data, communication, and mental health measurements were completed independently by respondents. Data Analysis The collected data were statistically analyzed using the IBM Statistical Package for the Social Sciences (SPSS) software version 26. Demographic data is reported as a measure of frequency. The data obtained were tested for normality using the Shapiro-Wilk test. Bivariate analysis was conducted to compare pretest and posttest scores within a single group using the Wilcoxon test. To compare scores between groups, the Mann-Whitney test was used. The significance level targeted in this study is < 0.05. Ethical considerations This research has received ethical approval from the Health Research Ethics Committee of Diponegoro University, with the number 078/EC/KEPK/FK-UNDIP/IV/2025. Results A total of 60 participants joined this study after signing informed consent. Participants were divided into an intervention group and a control group with 30 participants in each group. The demographic characteristics of participants are presented in Table 1 . Participants were in the age range of 34 to 51 years, which is the productive age in humans. The majority of student mothers (20%) work in various jobs, and most of them are high school graduates (50%). Table 1 Demographic data of research participants Note: Values are presented as n (%) or mean ± standard deviation (SD) as appropriate. Demographic Data Category Intervention Control n % n % Mother Age 46 ± 7.29 34 ± 59 51 ± 8.608 39 ± 62 Religion Islam 26 86.7 25 83.3 Christian 4 13.7 1 3.3 Catholic - - 4 13.3 Education Elementary school - - 1 3.3 Junior high 2 6.7 3 10.0 Senior High 15 50.0 15 50.0 Bachelor 12 40.0 9 30.0 Master 1 3.3 2 6.7 Work Not working 10 33.3 13 43.3 Civil Servant 4 13.3 5 16.7 Private Employees 5 16.7 6 20 Entrepreneurial 3 10.0 6 20 Other 8 26.7 - - Marital Status Marry 28 93.3 30 100 Divorce of Life/Death 2 6.7 - - STUDENT Age 18.77 ± 0.971 17 ± 22 18.70 ± 0.702 17 ± 20 Gender Man 4 13.3 2 6.7 Woman 26 86.7 28 93.3 Religion Islam 26 86.7 25 83.3 Christian 4 13.3 1 3.3 Catholic - 4 13.3 Living with Parents 3 10.0 6 20.0 Other families 2 6.7 - - Boarding 25 83.3 24 80.0 The results of the Mann-Whitney test showed an improvement in students' mental health after the mother received the intervention, with a p-value of 0.041. Detailed comparisons of maternal communication, child communication, and student mental health scores between groups are presented in Table 2 . This demonstrates that the NSMHC application can significantly enhance students' mental health by improving communication between mothers and students. Table 2 The influence of NSMHC on improving students' mental health Variabel Time Intervention (Mean ± SD) Control (Mean ± SD) P value (Wilcoxon) P-value (Mann-Whitney) Maternal Communication Pretest 64.37 ± 6.173 68.43 ± 7.412 0.000 0.117 Post-tests 78,43 ± 7,128 68,73 ± 7,896 0.000 Children's Communication Pretest 58.23 ± 8.744 65.20 ± 10.829 0.000 0.158 Post-tests 75.40 ± 8.756 68,47 ± 8,905 0.023 Student Mental Health Pretest 17.60 ± 3.276 19.30 ± 3.789 0.001 0.615 Post-tests 21.83 ± 3.696 19.57 ± 3.794 0.041 Note: Within-group comparisons were analyzed using the Wilcoxon test, and between-group comparisons were analyzed using the Mann–Whitney test. SD = standard deviation. Discussion Currently, students' mental health disorders have become very diverse. Previous research has reported that many students experience loneliness, depression, anxiety, and even suicidal ideation [ 6 ]. The results showed that on the student mental health variable, before the intervention, there were still many students who did not have good mental health (17.60 ± 3.276). Good mental health in students can impact their understanding of learning styles. This learning style can affect students' academic performance and overall well-being [ 24 ]. The intricate and multifaceted dynamics of the maternal bond between a mother and her offspring significantly contribute to the overall psychological well-being and mental health of individuals pursuing higher education. It has been observed that when a mother exhibits robust mental health and emotional stability, her child is more likely to experience favorable mental health outcomes, ultimately fostering a more positive and resilient psychological state throughout their collegiate journey [ 11 ]. A good mother-child relationship can foster resilience and self-esteem, which significantly affects the mental health of college students. Mothers with good mental health tend to provide emotional support to their children, thereby improving their children's mental well-being [ 28 ]. Mother-child mental health has a complex and multifaceted relationship as it involves various mechanisms that affect the mental well-being of both parties. Mentally healthy mothers tend to reduce harsh parenting behaviors and improve their children's mental health. (F. Wang et al., 2021). Conversely, poor maternal mental health can increase the risk of family conflict and negatively impact the mental health of children. This can affect their future romantic relationships [ 1 ]. Children of depressed or anxious mothers show impairment and a higher risk of child mental health disorders [ 13 ]. The strength of maternal and child mental health is evident in the quality of communication between mothers and their children [ 18 ]. Effective communication serves as a safeguard against various mental health challenges, creating a nurturing environment that can alleviate stress and improve emotional well-being. In clinical samples of adolescent girls who have been referred to psychiatric services, there is a notable connection between how mothers and daughters communicate and the girls' externalizing and internalizing behaviors, with the former being significant and the latter moderate. Additionally, the quality of communication between mothers and daughters entirely mitigates the effects of maternal depressive symptoms on the adolescents' internalizing and externalizing behaviors [ 33 ]. Improved communication between mothers and daughters might lessen the adverse effects of maternal depressive symptoms on the mental health of adolescents. Specifically, it was found that urban African-American adolescent girls who had strong communication with their mothers showed fewer internalizing and externalizing symptoms, regardless of their mothers' depressive symptoms. This suggests that effective communication is critical to supporting adolescent mental health, and supportive family interactions can reduce the risks associated with maternal mental health problems [ 19 ]. Good mental health in mothers and adolescents is reflected through effective communication, which can reduce depressive symptoms in boys when they receive messages related to cultural awareness. Conversely, high levels of anger and alienation in relationships can exacerbate negative impacts. A higher intensity of positive affect and lower levels of negative affect in mothers and adolescents were associated with better relationship quality and fewer depressive symptoms. Effective communication, characterized by understanding and emotional support, is essential for fostering a healthy mental state in both parties [ 3 ]. Mindfulness is increasingly recognized as a beneficial practice for improving maternal mental health. Through mindfulness practices, maternal well-being can be enhanced by promoting self-awareness and emotion regulation. A study on new mothers with low income showed that mindfulness interventions can improve maternal mental health, including reducing symptoms of depression and anxiety and increasing resilience [ 14 ]. Mindfulness promotes acceptance and awareness without judgment, which can help mothers deal with emotional challenges during motherhood [ 10 ]. Mindfulness practices can also assist mothers in managing stress and anxiety that often arise in the caregiving role (Pan et al., 2023; Zhang et al., 2024). With increased maternal awareness and calmness, interactions with students are likely to become more positive and constructive. This, in turn, can create a more supportive environment for adolescents' emotional development and strengthen the bond between mother and child. This study demonstrates that integrating mindfulness practices into a mobile application called NSMHC can improve the mental health of university students (p-value = 0.041), with mental health being closely aligned with the quality of communication between mothers and their children. These findings highlight the importance of developing technology-based interventions to support the psychological well-being of university students. Furthermore, the results of this study also highlight the crucial role of mother-child communication in shaping children's mental health. Further research is needed to investigate the specific mechanisms by which mindfulness applications can impact family communication dynamics and long-term mental health. Implication and Limitations Using technology for mindfulness can help university mental health programs. Mindfulness can improve mothers' mental health, which can also help students. Better communication between mothers and children can benefit students' well-being and grades over time. The study suggests several important points: 1) Mobile apps with mindfulness practices, like the NSMHC app, can help mothers and college students communicate better, improving students' mental health. 2) Adding technology-based mindfulness to university mental health programs can be helpful, especially for mother-child relationships. 3) Clinicians working with college students should consider looking at mother-child communication as part of treatment. 4) Mental health professionals might suggest mindfulness apps as a cheap and easy way to support mothers' mental health and improve mother-child relationships. 5) Universities and counseling centers could try using similar technology-based methods to help more students. 6) The study shows that improving mothers' mental health with mindfulness can positively affect students' mental health, highlighting the importance of family in mental health care for young adults. 7) Clinicians should know that better mother-child communication can have long-term benefits for students' mental health and grades. These points show that technology-assisted mindfulness can support both mothers' and students' mental health in universities. But more research is needed to confirm the long-term effectiveness of these methods. Limitation in this study is external factors, such as social support, academic environment, and participants' conditions, may influence outcomes; however, these factors were not fully controlled in this study. Conclusion This study demonstrates the significant potential of integrating mindfulness practices through mobile applications, such as NSMHC, in improving the mental health of college students and the quality of mother-child communication. By utilizing smartphone technology, this approach offers a practical and accessible solution for mothers to incorporate mindfulness into their daily lives. The positive impact of this practice is not only limited to the mental well-being of mothers but also has the potential to strengthen the mother-child relationship in the long run. Abbreviations NSMHC Nursing Student Mother Heart Connection MHI-5 Mental Health Inventory 5 PACS Parent Adolescent Communication Scale SPSS Statistical Package for the Social Sciences Declarations Ethics approval and consent to participate This study was approved by the Health Research Ethics Committee of the Faculty of Medicine, Diponegoro University, Indonesia, with ethical approval number 078 EC KEPK FK UNDIP IV 2025. All participants provided written informed consent prior to participation. Participation was voluntary, and confidentiality and anonymity of participants were maintained throughout the study. Consent for publication Not applicable. No identifiable personal data are presented in this manuscript. Competing Interests The authors declare that they have no competing interests. Research Funding This research was funded by a Research Grant from the State Revenue and Expenditure Budget of the Faculty of Medicine, Diponegoro University, with the number 978/UN7.F4/PP/II/2025. The author thanked the participants who agreed to take part in this study. Author Contribution Agus Santoso, Meidiana Dwidiyanti: Conceptualization, Methodology, Writing – original draft; Meidiana Dwidiyanti: Funding Acquisition, Project Administration, Supervision; Badrul Munif: Collect Data, writing-review and editing. Project Administrator, Writing-original draft. Intervention, Investigation; Intervention, writing-original draft; Intervention; Writing-original draft Acknowledgement The authors gratefully acknowledge financial support from the Faculty of Medicine, Diponegoro University through the State Revenue and Expenditure Budget Research Grant (No. 978/UN7.F4/PP/II/2025). We sincerely thank the participating students and their mothers for their commitment and cooperation throughout the study. We also appreciate the institutional support that enabled the successful implementation of this research. 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Zapf H, Boettcher J, Haukeland Y, Orm S, Coslar S, Fjermestad K. A systematic review of the association between parent-child communication and adolescent mental health. JCPP Adv. 2024;4(2). https://doi.org/10.1002/jcv2.12205 . Zhang X, Ren H, Wang C, Zhang Y, Zhou Q, Fan J. The effect of mindfulness-based interventions on mental health outcomes and wellbeing of informal caregivers of people with mental illness: A systematic review and meta‐analysis. Int J Ment Health Nurs. 2024;33(4):797–816. https://doi.org/10.1111/inm.13295 . Additional Declarations No competing interests reported. Supplementary Files mhi5.pdf PACS.pdf Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 13 Apr, 2026 Reviewers agreed at journal 12 Apr, 2026 Reviewers invited by journal 02 Apr, 2026 Editor invited by journal 09 Mar, 2026 Editor assigned by journal 06 Mar, 2026 Submission checks completed at journal 05 Mar, 2026 First submitted to journal 05 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8922157","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":618950951,"identity":"42e86460-1878-47b1-90e5-ca96a495f73c","order_by":0,"name":"Agus Santoso","email":"","orcid":"","institution":"University of Diponegoro","correspondingAuthor":false,"prefix":"","firstName":"Agus","middleName":"","lastName":"Santoso","suffix":""},{"id":618950952,"identity":"516f90ce-e24c-4cc9-9a6f-2f7ae69dfd78","order_by":1,"name":"Meidiana Dwidiyanti","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA30lEQVRIiWNgGAWjYFCCBIYDPAYgBmPjAyDJw0e8FjbGZhDFw0aMFgYeEM3GwCYBoQkA3fYcwwNvCg7Lm8s3t1V+zbGTYWNgfvjoBh4tZmfeGBycY3DYcGcbY9tt2W3JQIexGRvn4NNyI3fDYR6Dw4wbjgG1SG5jBmrhYZMmRos9SEux5LZ64rUkgrQwftx2mAgtZ95/APolPXnDscRmacZtx3nYmAn55Xha8oc3f6xtNxw+/vDjz23V9vzszQ8f49MCBc1gkhkcQcyElYNAHZhk/EGc6lEwCkbBKBhhAACv9k4uHqKpBQAAAABJRU5ErkJggg==","orcid":"","institution":"University of Diponegoro","correspondingAuthor":true,"prefix":"","firstName":"Meidiana","middleName":"","lastName":"Dwidiyanti","suffix":""},{"id":618950953,"identity":"8d4cf972-02f9-40e2-8513-2e1f8bdefee1","order_by":2,"name":"Badrul Munif","email":"","orcid":"","institution":"University of Dr. Soekardjo","correspondingAuthor":false,"prefix":"","firstName":"Badrul","middleName":"","lastName":"Munif","suffix":""}],"badges":[],"createdAt":"2026-02-20 04:09:44","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8922157/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8922157/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106533736,"identity":"88db31b4-b8d0-4268-93f4-73a3e8eb1cde","added_by":"auto","created_at":"2026-04-09 14:58:10","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":83944,"visible":true,"origin":"","legend":"\u003cp\u003eCONSORT flow diagram of participant recruitment and study process\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8922157/v1/41bc19c60be0405493498329.png"},{"id":106726573,"identity":"0284eeee-7120-4f53-9100-7d65d39ab2e9","added_by":"auto","created_at":"2026-04-12 18:36:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":832300,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8922157/v1/924e85ac-0e69-4b1a-a2fb-4a88cee6a65e.pdf"},{"id":106533731,"identity":"eaf7d518-da5d-4907-b07f-4e012d412778","added_by":"auto","created_at":"2026-04-09 14:58:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":98430,"visible":true,"origin":"","legend":"","description":"","filename":"mhi5.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8922157/v1/8e63a69ec42d5b84df17ad3a.pdf"},{"id":106533730,"identity":"1603598b-34da-467a-a1ff-e3de5cf2b024","added_by":"auto","created_at":"2026-04-09 14:58:07","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":71089,"visible":true,"origin":"","legend":"","description":"","filename":"PACS.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8922157/v1/01abdee631d1ede950be4b07.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Intervention Nursing Student Mother Heart Connection (NSMHC) to Improve Student Mental Health","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMental health is currently an issue that is still being discussed in various fields because mental health is one of the main factors in determining the quality and satisfaction of life in individuals [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. It becomes an integral part of health and well-being, as also defined by the World Health Organization, namely that mental health is a state of well-being in which individuals are aware of their abilities, can cope with the normal stresses of life, can work productively and fruitfully, and can contribute to their communities [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In the university student population, mental health is crucial as it can impact academic achievement and other aspects of their academic life. Academic life is one parameter that can also be used to assess students' psychological well-being, as it is influenced by students' mental health and intrinsic motivation. An active academic life demonstrates the effort students put into their academic tasks, such as improving their knowledge and skills [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Several factors influence the mental health of students. Previous research suggests that factors influencing the mental health of students in higher education encompass psychological, academic, biological, lifestyle, social, and financial aspects [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. A harmonious relationship with parents, especially mothers, can foster psychological well-being in college students [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. However, recent decades have seen an increase in mental health disorder issues among children, adolescents, and young adults. Rates of impulse control disorders, such as ADHD and anxiety disorders, begin to increase as early as 4 years of age. The increase is most significant in adolescence and young adulthood, with the highest incidence of anxiety, mood, and substance use disorders [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. College students are one of the populations with a high incidence of mental health disorders. A comprehensive research investigation conducted in the nation of Bangladesh revealed that the prevalence rates of psychological conditions, specifically depression, stress, and anxiety, among the population of university students exhibited a significant variation. Ranging from a notably low 46.92% to an alarmingly high 96.82%, thereby underscoring the urgent need for further exploration and intervention in the mental health landscape of this demographic [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Psychological factors contribute significantly to mental problems among college students. These include trauma, childhood maltreatment, and emotional maladjustment, which can increase the risk of anxiety and depression in college students [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe dynamics of mother-child interactions, as well as the dimensions of spiritual well-being, have the potential to impact the behavioral disorders observed in children through their effects on maternal mental health [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The establishment of a robust and profound connection between parents and their offspring has the potential to significantly enhance the cultivation of critical social skills, which are indispensable for the successful formation of profound and meaningful personal relationships that individuals will rely upon throughout their lives [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. On the other hand, negative relationships between parents and children can elevate the likelihood of developing mental health issues. Individuals who experience high psychological distress are more likely to function negatively in daily life. Good emotion regulation strategies may act as a protective factor that moderates the relationship between childhood trauma and negative thinking in individuals [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. A poor relationship between parents and children, characterized by poor communication between the two, can exacerbate a student's mental health problems [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe quality of mother-child communication is mediated by maternal mental health. Thus, maternal mental health is crucial in determining the effectiveness of mother-student communication [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Research shows that mothers with good mental health tend to have more effective communication with their children. The presence of robust and favorable mental health among mothers can significantly contribute to the enhancement of their children\u0026rsquo;s emotional and social development, in addition to markedly improving their academic performance in educational settings. Current technological developments encourage the integration of technology into various fields, one of which is to improve mother-child communication. However, there are still challenges in optimizing the use of these technologies to support quality interactions between mothers and children. Previous research shows that available applications only focus on disseminating information rather than encouraging direct mother-child communication and improving maternal mental health. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Further research is needed to identify the app features that are most effective in facilitating positive communication and improving maternal mental health.\u003c/p\u003e \u003cp\u003eThe Nursing Student-Mother Heart Connection (NSMHC) app provides mindfulness training and emotional support to help mothers manage their emotions, enabling them to enhance the quality of maternal communication with university students. Effective communication between mothers and students is expected to improve students' mental health. This study aims to provide interventions for mothers to foster good communication between mothers and students, thereby improving students' mental health.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eResearch design\u003c/h2\u003e \u003cp\u003eThis study employed a quasi-experimental design, utilizing a pretest and posttest with a control group. To assess the improvement in students' mental health, assessments were conducted before and after the intervention in both the experimental and control groups.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSetting and samples\u003c/h3\u003e\n\u003cp\u003eThis research was conducted between February 20 and June 3, 2025, at the Department of Nursing at one of the universities in Indonesia. The sample was taken from students of the Nursing Study Program at Diponegoro University. Sampling was conducted using a probability sampling technique, specifically simple random sampling. The sample size was calculated using the G-Power application version 3.1.9.7, with a significance level (α)\u0026thinsp;=\u0026thinsp;0.05, power test strength (1-β)\u0026thinsp;=\u0026thinsp;80% (0.80), and α-effect size (γ) of 0.80 [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Based on the calculation results, a minimum sample size of 27 respondents per group, totaling 54 respondents, was determined. To anticipate the possibility of dropout, an additional three participants were added to each group, bringing the total sample to 60 participants.\u003c/p\u003e \u003cp\u003eThe inclusion criteria in this study were first-year students who still have mothers and have access to communicate with them, who can be given the intervention. The exclusion criteria set in this study are students who are diagnosed with severe and moderate mental disorders in the acute phase and do not follow the research process from pretest to posttest. The entire participant recruitment process from enrollment to follow-up and data analysis is systematically documented in the CONSORT flowchart (Hopewell et al., 2025; Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \n\u003ch3\u003eIntervention (applies to experimental studies)\u003c/h3\u003e\n\u003cp\u003eThe designer of the features in the NSMHC app is the initiator of a spiritual mindfulness intervention focused on emotions. The app features a series of emotion regulation exercises for mothers, utilizing an emotion-focused mindfulness approach. The student's mother was instructed to install the NSMHC application. The student mother was then invited to prepare themselves by being in a quiet place. After that, the student's mother was asked to follow the instructions on the NSMHC application. The intervention lasted about 20\u0026ndash;40 minutes, depending on how the student's mother was able to find the emotions she felt. The intervention was carried out repeatedly, as many as once a day for two weeks. The posttest is administered after the mother has routinely conducted emotion regulation exercises using the NSMHC application. Participants in the control group received no interventions. However, they were given a handbook to learn emotional regulation exercises based on spiritual mindfulness, focusing on emotions, after completing a posttest by the intervention group. The control group was still asked to complete a pretest and posttest at the same time as the intervention group.\u003c/p\u003e \u003cp\u003e \u003cb\u003eMeasurement and Data Collection;\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe instruments used in this study were a demographic data questionnaire, the Parent-Child Communication Scale (PACS), and the Mental Health Inventory-5 (MHI-5) instrument. Demographic data questionnaires were used to collect basic information from participants (mothers and students). The demographic data requested for mothers included their name, age, religion, occupation, education, and marital status. Meanwhile, for students, the questions asked were: name, mother's name, age, religion, and whether they lived with their parents.\u003c/p\u003e \u003cp\u003eThe parent version and the child version of the PACS instrument were used to measure parent-child communication before and after the intervention [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Meanwhile, the MHI-5 questionnaire is used to assess the mental health level of students [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The intervention was conducted over a period of two weeks and was monitored daily. The intervention provided was in the form of mindfulness training focused on emotions for mothers through the NSMHC application. Data collection commenced with the selection of samples based on the specified inclusion criteria. The researcher explained the purpose and objectives of the study to obtain the participants' consent. Demographic data, communication, and mental health measurements were completed independently by respondents.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eThe collected data were statistically analyzed using the IBM Statistical Package for the Social Sciences (SPSS) software version 26. Demographic data is reported as a measure of frequency. The data obtained were tested for normality using the Shapiro-Wilk test. Bivariate analysis was conducted to compare pretest and posttest scores within a single group using the Wilcoxon test. To compare scores between groups, the Mann-Whitney test was used. The significance level targeted in this study is \u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical considerations\u003c/h3\u003e\n\u003cp\u003e This research has received ethical approval from the Health Research Ethics Committee of Diponegoro University, with the number 078/EC/KEPK/FK-UNDIP/IV/2025.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e A total of 60 participants joined this study after signing informed consent. Participants were divided into an intervention group and a control group with 30 participants in each group. The demographic characteristics of participants are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Participants were in the age range of 34 to 51 years, which is the productive age in humans. The majority of student mothers (20%) work in various jobs, and most of them are high school graduates (50%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic data of research participants \u003cem\u003eNote: Values are presented as n (%) or mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) as appropriate.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDemographic Data\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eControl\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46\u0026thinsp;\u0026plusmn;\u0026thinsp;7.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34\u0026thinsp;\u0026plusmn;\u0026thinsp;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e51\u0026thinsp;\u0026plusmn;\u0026thinsp;8.608\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e39\u0026thinsp;\u0026plusmn;\u0026thinsp;62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eReligion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIslam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e83.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChristian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCatholic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e13.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eElementary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJunior high\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSenior High\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e50.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e30.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaster\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eWork\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot working\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e43.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCivil Servant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e16.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrivate Employees\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEntrepreneurial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMarital Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorce of Life/Death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSTUDENT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.971\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17\u0026thinsp;\u0026plusmn;\u0026thinsp;22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.70\u0026thinsp;\u0026plusmn;\u0026thinsp;0.702\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e17\u0026thinsp;\u0026plusmn;\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWoman\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e93.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eReligion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIslam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e83.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChristian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCatholic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e13.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eLiving with\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eParents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther families\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBoarding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e80.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe results of the Mann-Whitney test showed an improvement in students' mental health after the mother received the intervention, with a p-value of 0.041. Detailed comparisons of maternal communication, child communication, and student mental health scores between groups are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. This demonstrates that the NSMHC application can significantly enhance students' mental health by improving communication between mothers and students.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe influence of NSMHC on improving students' mental health\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariabel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntervention (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value (Wilcoxon)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value (Mann-Whitney)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMaternal Communication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePretest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64.37\u0026thinsp;\u0026plusmn;\u0026thinsp;6.173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68.43\u0026thinsp;\u0026plusmn;\u0026thinsp;7.412\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.117\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePost-tests\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78,43\u0026thinsp;\u0026plusmn;\u0026thinsp;7,128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68,73\u0026thinsp;\u0026plusmn;\u0026thinsp;7,896\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eChildren's Communication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePretest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58.23\u0026thinsp;\u0026plusmn;\u0026thinsp;8.744\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65.20\u0026thinsp;\u0026plusmn;\u0026thinsp;10.829\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.158\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePost-tests\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75.40\u0026thinsp;\u0026plusmn;\u0026thinsp;8.756\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68,47\u0026thinsp;\u0026plusmn;\u0026thinsp;8,905\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStudent Mental Health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePretest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.60\u0026thinsp;\u0026plusmn;\u0026thinsp;3.276\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.30\u0026thinsp;\u0026plusmn;\u0026thinsp;3.789\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.615\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePost-tests\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.83\u0026thinsp;\u0026plusmn;\u0026thinsp;3.696\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.57\u0026thinsp;\u0026plusmn;\u0026thinsp;3.794\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cem\u003eNote: Within-group comparisons were analyzed using the Wilcoxon test, and between-group comparisons were analyzed using the Mann\u0026ndash;Whitney test. SD\u0026thinsp;=\u0026thinsp;standard deviation.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e "},{"header":"Discussion","content":"\u003cp\u003eCurrently, students' mental health disorders have become very diverse. Previous research has reported that many students experience loneliness, depression, anxiety, and even suicidal ideation [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The results showed that on the student mental health variable, before the intervention, there were still many students who did not have good mental health (17.60\u0026thinsp;\u0026plusmn;\u0026thinsp;3.276). Good mental health in students can impact their understanding of learning styles. This learning style can affect students' academic performance and overall well-being [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The intricate and multifaceted dynamics of the maternal bond between a mother and her offspring significantly contribute to the overall psychological well-being and mental health of individuals pursuing higher education. It has been observed that when a mother exhibits robust mental health and emotional stability, her child is more likely to experience favorable mental health outcomes, ultimately fostering a more positive and resilient psychological state throughout their collegiate journey [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. A good mother-child relationship can foster resilience and self-esteem, which significantly affects the mental health of college students. Mothers with good mental health tend to provide emotional support to their children, thereby improving their children's mental well-being [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMother-child mental health has a complex and multifaceted relationship as it involves various mechanisms that affect the mental well-being of both parties. Mentally healthy mothers tend to reduce harsh parenting behaviors and improve their children's mental health. (F. Wang et al., 2021). Conversely, poor maternal mental health can increase the risk of family conflict and negatively impact the mental health of children. This can affect their future romantic relationships [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Children of depressed or anxious mothers show impairment and a higher risk of child mental health disorders [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe strength of maternal and child mental health is evident in the quality of communication between mothers and their children [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Effective communication serves as a safeguard against various mental health challenges, creating a nurturing environment that can alleviate stress and improve emotional well-being. In clinical samples of adolescent girls who have been referred to psychiatric services, there is a notable connection between how mothers and daughters communicate and the girls' externalizing and internalizing behaviors, with the former being significant and the latter moderate. Additionally, the quality of communication between mothers and daughters entirely mitigates the effects of maternal depressive symptoms on the adolescents' internalizing and externalizing behaviors [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Improved communication between mothers and daughters might lessen the adverse effects of maternal depressive symptoms on the mental health of adolescents. Specifically, it was found that urban African-American adolescent girls who had strong communication with their mothers showed fewer internalizing and externalizing symptoms, regardless of their mothers' depressive symptoms. This suggests that effective communication is critical to supporting adolescent mental health, and supportive family interactions can reduce the risks associated with maternal mental health problems [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Good mental health in mothers and adolescents is reflected through effective communication, which can reduce depressive symptoms in boys when they receive messages related to cultural awareness. Conversely, high levels of anger and alienation in relationships can exacerbate negative impacts. A higher intensity of positive affect and lower levels of negative affect in mothers and adolescents were associated with better relationship quality and fewer depressive symptoms. Effective communication, characterized by understanding and emotional support, is essential for fostering a healthy mental state in both parties [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMindfulness is increasingly recognized as a beneficial practice for improving maternal mental health. Through mindfulness practices, maternal well-being can be enhanced by promoting self-awareness and emotion regulation. A study on new mothers with low income showed that mindfulness interventions can improve maternal mental health, including reducing symptoms of depression and anxiety and increasing resilience [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Mindfulness promotes acceptance and awareness without judgment, which can help mothers deal with emotional challenges during motherhood [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Mindfulness practices can also assist mothers in managing stress and anxiety that often arise in the caregiving role (Pan et al., 2023; Zhang et al., 2024). With increased maternal awareness and calmness, interactions with students are likely to become more positive and constructive. This, in turn, can create a more supportive environment for adolescents' emotional development and strengthen the bond between mother and child. This study demonstrates that integrating mindfulness practices into a mobile application called NSMHC can improve the mental health of university students (p-value\u0026thinsp;=\u0026thinsp;0.041), with mental health being closely aligned with the quality of communication between mothers and their children. These findings highlight the importance of developing technology-based interventions to support the psychological well-being of university students. Furthermore, the results of this study also highlight the crucial role of mother-child communication in shaping children's mental health. Further research is needed to investigate the specific mechanisms by which mindfulness applications can impact family communication dynamics and long-term mental health.\u003c/p\u003e\n\u003ch3\u003eImplication and Limitations\u003c/h3\u003e\n\u003cp\u003eUsing technology for mindfulness can help university mental health programs. Mindfulness can improve mothers' mental health, which can also help students. Better communication between mothers and children can benefit students' well-being and grades over time. The study suggests several important points: 1) Mobile apps with mindfulness practices, like the NSMHC app, can help mothers and college students communicate better, improving students' mental health. 2) Adding technology-based mindfulness to university mental health programs can be helpful, especially for mother-child relationships. 3) Clinicians working with college students should consider looking at mother-child communication as part of treatment. 4) Mental health professionals might suggest mindfulness apps as a cheap and easy way to support mothers' mental health and improve mother-child relationships. 5) Universities and counseling centers could try using similar technology-based methods to help more students. 6) The study shows that improving mothers' mental health with mindfulness can positively affect students' mental health, highlighting the importance of family in mental health care for young adults. 7) Clinicians should know that better mother-child communication can have long-term benefits for students' mental health and grades. These points show that technology-assisted mindfulness can support both mothers' and students' mental health in universities. But more research is needed to confirm the long-term effectiveness of these methods.\u003c/p\u003e \u003cp\u003eLimitation in this study is external factors, such as social support, academic environment, and participants' conditions, may influence outcomes; however, these factors were not fully controlled in this study.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrates the significant potential of integrating mindfulness practices through mobile applications, such as NSMHC, in improving the mental health of college students and the quality of mother-child communication. By utilizing smartphone technology, this approach offers a practical and accessible solution for mothers to incorporate mindfulness into their daily lives. The positive impact of this practice is not only limited to the mental well-being of mothers but also has the potential to strengthen the mother-child relationship in the long run.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNSMHC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNursing Student Mother Heart Connection\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMHI-5\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMental Health Inventory 5\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePACS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eParent Adolescent Communication Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSPSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStatistical Package for the Social Sciences\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e \u003cp\u003e This study was approved by the Health Research Ethics Committee of the Faculty of Medicine, Diponegoro University, Indonesia, with ethical approval number 078 EC KEPK FK UNDIP IV 2025. All participants provided written informed consent prior to participation. Participation was voluntary, and confidentiality and anonymity of participants were maintained throughout the study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable. No identifiable personal data are presented in this manuscript.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting Interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eResearch Funding\u003c/h2\u003e \u003cp\u003eThis research was funded by a Research Grant from the State Revenue and Expenditure Budget of the Faculty of Medicine, Diponegoro University, with the number 978/UN7.F4/PP/II/2025. The author thanked the participants who agreed to take part in this study.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAgus Santoso, Meidiana Dwidiyanti: Conceptualization, Methodology, Writing \u0026ndash; original draft; Meidiana Dwidiyanti: Funding Acquisition, Project Administration, Supervision; Badrul Munif: Collect Data, writing-review and editing. Project Administrator, Writing-original draft. Intervention, Investigation; Intervention, writing-original draft; Intervention; Writing-original draft\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors gratefully acknowledge financial support from the Faculty of Medicine, Diponegoro University through the State Revenue and Expenditure Budget Research Grant (No. 978/UN7.F4/PP/II/2025). We sincerely thank the participating students and their mothers for their commitment and cooperation throughout the study. We also appreciate the institutional support that enabled the successful implementation of this research.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAdjei NK, Schl\u0026uuml;ter DK, Melis G, Straatmann VS, Fleming KM, Wickham S, Munford L, McGovern R, Howard LM, Kaner E, Wolfe I, Taylor-Robinson DC. Impact of Parental Mental Health and Poverty on the Health of the Next Generation: A Multi-Trajectory Analysis Using the UK Millennium Cohort Study. 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The effect of mindfulness-based interventions on mental health outcomes and wellbeing of informal caregivers of people with mental illness: A systematic review and meta‐analysis. Int J Ment Health Nurs. 2024;33(4):797\u0026ndash;816. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/inm.13295\u003c/span\u003e\u003cspan address=\"10.1111/inm.13295\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Mental Health, Nursing Student, Communication, Mother-child Relations, Mindfulness","lastPublishedDoi":"10.21203/rs.3.rs-8922157/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8922157/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThis study examines the effectiveness of the Nursing Student-Mother Heart Connection (NSMHC) mobile application in enhancing the mental health of university students by improving communication between mothers and their children. Mental health is a critical determinant of academic success and overall well-being among university students, with parent-child relationships, particularly with mothers, playing a significant role.\u003c/p\u003e\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eThis study aims to find out the effectiveness of NSMHC applications to improve students' mental health\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA quasi-experimental design with pretest-posttest control group was canducted with 60 first-year nursing students and their mothers. The intervention group received daily mindfulness-based emotion regulation training for mothers via the NSMHC app over a two-week period, while the control group received no intervention during the study period. Mental health outcomes were measured using the Mental Health Inventory-5 (MHI-5), and communication quality was assessed using the Parent-Adolescent Communication Scale (PACS).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eSixty participants completed the study. The intervention group showed significant improvements in maternal communication, child communication, and student mental health after the two-week NSMHC program (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Between-group analysis revealed significantly better mental health outcomes in the intervention group compared with the control group (p\u0026thinsp;=\u0026thinsp;0.041).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThese findings suggest that NSMHC can enhance mother-child communication and have a positive impact on student mental health. Further research is recommended to explore the long-term effects and mechanisms underlying these outcomes.\u003c/p\u003e\u003ch2\u003eTrial Registration:\u003c/h2\u003e \u003cp\u003eThe study was registered in TCTR (\u003cb\u003eTCTR20260304010\u003c/b\u003e; registration date: 04 March 2026; retrospectively registered)\u003c/p\u003e","manuscriptTitle":"Intervention Nursing Student Mother Heart Connection (NSMHC) to Improve Student Mental Health","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-09 14:57:52","doi":"10.21203/rs.3.rs-8922157/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-13T23:19:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"27217573373625287949863008539489609491","date":"2026-04-12T23:14:20+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-02T11:39:09+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-09T08:20:50+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-06T05:44:46+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-06T00:54:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nursing","date":"2026-03-05T21:17:11+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nursing","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nurs","sideBox":"Learn more about [BMC Nursing](http://bmcnurs.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/nurs/default.aspx","title":"BMC Nursing","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"79fae886-4a81-4f56-ac11-caa9227b3f68","owner":[],"postedDate":"April 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-09T14:57:53+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-09 14:57:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8922157","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8922157","identity":"rs-8922157","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}