A Pilot Study on the Effectiveness of Hope-Focused Counselling for Psychological Well-Being in Post-abortion Primigravida Mothers

A Pilot Study on the Effectiveness of Hope-Focused Counselling for Psychological Well-Being in Post-abortion Primigravida Mothers | 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 A Pilot Study on the Effectiveness of Hope-Focused Counselling for Psychological Well-Being in Post-abortion Primigravida Mothers Lina Badran, Alia Mahadeen, Doaa Al-Tamimi, Doaa Noayran, Fatimah S Tarawneh This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8936623/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Abortion is the most common complication during early pregnancy and may increase the risk of various physical and psychological disorders. While psychological interventions can help promote psychological well-being and hope levels among mothers with traumatic histories, a hope-fostering counseling program is considered one of these interventions. This study aims to investigate the potential effectiveness and feasibility of a hope-fostering counseling program on psychological well-being and hope levels among post-abortion primigravida mothers. Methods: This was a quasi-experimental study with a one-group pretest-posttest design. Eight post-abortion primigravida mothers were recruited from two healthcare institutions to participate in this pilot testing. The intervention was adapted from Snyder's Hope theory and included six counseling sessions over six weeks during the post-abortion period. Counseling sessions were conducted via individualized discussion. The Arabic versions of the Ryff Psychological Well-Being Questionnaire (PWB-18) and the Adult Dispositional Hope Scale (ADHS) were administered at three occasions: before the first session and at the third and sixth interviews. Repeated-measures analysis of variance (RM-ANOVA) was used to analyze the study variables. Results: The mean PWB-18 and ADHS scores increased from 35.50 ± 8.77 and 19.25 ± 4.03 at baseline to 54.88 ± 6.64 and 31.00 ± 3.67 at the third-week assessment, and to 78.25 ± 4.53 and 48.88 ± 2.17 after the sessions, respectively. The results demonstrated significant improvement in PWB-18 scores (F (2, 14) = 412.49, p < 0.000) and ADHS scores (F (1.13, 7.922) = 301.19, p = 0.000) among post-abortion primigravida mothers after attending the hope-fostering counseling program. Conclusion: This pilot study demonstrates the program's feasibility. However, a larger sample and inclusion of additional abortion types are needed to confirm its effectiveness and generalizability. Obstetrics & Gynecology Maternal & Fetal Medicine Hope-fostering Counseling Program Psychological Well-Being Hope Level Post-Aborted Primigravida Mothers 1. Introduction Pregnancy is considered one of the most significant events for couples and their families, especially for parents experiencing their first pregnancy. Well-being and care for the new mother and the developing fetus are essential and add significant responsibility for parents and the family ( 1 ). The most common complication during early pregnancy is "abortion." The World Health Organization defines abortion as “pregnancy termination before 20 weeks' gestation or a fetus born weighing less than 500 grams” ( 2 ). Abortion also refers to the termination of pregnancy by medical interventions for any maternal or fetal cause, such as fetal death or specific maternal health status. Spontaneous abortion, or miscarriage, indicates the spontaneous expulsion of the fetus without medical or surgical intervention ( 3 ). The prevalence of abortion worldwide is about 29% of all diagnosed pregnancies ( 4 ), which translates to 23 million abortions reported each year ( 5 ). In the Middle East, one in every four pregnant women has had an abortion ( 6 ). In Jordan, the prevalence of abortion was reported as 17.9% of all diagnosed pregnancies among the Jordanian population ( 7 ). Abortion is associated with many physical and psychological complications, which may extend to weeks or months ( 8 ). In contrast, in some reported cases, the complications could extend to years after the event, especially with vulnerable mothers ( 9 ). The physical complications include infections, bleeding, bladder injury, and an increased risk for ectopic pregnancy ( 10 ). At the same time, the psychological issues were correlated with various psychological morbidities as a reaction to the emotional distress and grief process for the mother and her family ( 11 ). Furthermore, psychological issues of previous abortion experience were reported to be extended to the subsequent pregnancy ( 12 ). Psychological issues after abortion are not uncommon ( 13 ), and the severity and nature of these issues vary among mothers ( 14 ). These variations may be attributed to physical, psychological, and social factors, such as previous pregnancy history, physical well-being ( 15 ), knowledge of the prevalence and causes of pregnancy loss ( 6 , 8 ), social and cultural consequences of the event, and the physical and emotional effects of the hormonal imbalance associated with pregnancy loss ( 16 ). Psychological issues can manifest as grief symptoms in response to loss ( 17 ). The nature and severity of these symptoms vary among mothers with different social, religious, physical, psychological, and educational backgrounds ( 11 ). For example, some mothers may experience emotional distress, while others may not ( 18 ). Previous literature reported several potential psychological challenges that mothers faced during their early post-abortion period, such as depression, anxiety, post-traumatic stress, emotional distress, grief, and relationship tension ( 19 ). These negative psychological issues may be noticed by family, friends, and healthcare providers ( 8 ). Generally, psychological well-being is considered a broad concept with indicators that vary across mothers ( 20 ). Reviewing previous literature highlights indicators such as emotional balance, linked to hormonal imbalance in the post-abortion period, sleep patterns, and overall physical health, which might reflect psychological well-being ( 13 ). Moreover, personal self-esteem reflects the confidence and abilities that support life satisfaction and promote the meaningfulness of life, and it is a strong indicator of psychological well-being ( 21 ). The personal sense of the ability to grow and develop reflects a high level of psychological well-being ( 22 ). In addition to resilience capacity and personal autonomy ( 23 ), all of these indicators reflect psychological well-being, and deterioration in any of them indicates a decline in psychological well-being ( 24 ). Hope is considered a positive phenomenon that helps construct coping strategies during the recovery period after trauma, especially in psychological trauma ( 25 ). The fundamental purpose of hope is to avoid despair, empowering the person to overcome unpleasant or stressful situations ( 26 ). Theoretically, hope is defined as the process by which individuals develop their goals, identify specific strategies to achieve them, and sustain motivation to pursue those strategies ( 21 ). Thus, hope is tied to goals and pathways to achievement. The relationship between hope and psychological well-being appears variable and complex ( 26 ). Previous literature suggests a significant association between hope levels and psychological well-being across several domains ( 27 ). Hope may primarily enhance purposeful perception and positive thoughts about the future ( 28 , 29 ) and promote personal coping skills to overcome guilt and grief ( 21 ). Furthermore, hope may provide creative coping mechanisms to manage challenging emotional experiences, such as sadness, and to foster a positive imagination, thereby promoting resilience and recovery ( 30 ). Thus, having hope might encourage better emotional adaptation and improve psychological well-being ( 31 ). Conversely, psychological well-being was reported to influence hope levels. So, post-aborted mothers who experience significant psychological challenges could encounter challenges maintaining hopeful thoughts ( 27 ). Individuals with higher levels of psychological well-being were found to be better able to foster hope ( 31 ). Globally, healthcare providers seek to promote health by emphasizing primary prevention and early screening to ensure early management and treatment, preventing further complications ( 32 ). Psychological issues following any traumatic experience, such as abortions, could be managed based on pharmacological or non-pharmacological measures; both measures are used ( 26 ). Midwives are essential to the mother's care and crucial in managing such cases ( 33 ). While pharmacological measures require collaboration among gynecologists, pharmacologists, and midwives, well-trained midwives could offer non-pharmacological measures, including various psychological support strategies ( 29 ). Psychological measures such as hope therapy could help support post-abortion mothers, foster coping mechanisms to overcome difficult times, and promote their psychological health ( 34 ). This study focuses on the improvement of psychological well-being and hope levels for post-abortion mothers within the context of individualized counseling based on hope-fostering therapy. Previous literature reported a significant link between hope and psychological well-being, which can help healthcare providers develop therapeutic interventions to enhance psychological well-being levels ( 35 ). Therapeutic hope-fostering approaches were suggested to help post-traumatic persons overcome their psychological challenges, address negative thoughts, and promote hope via empowerment of resilience ( 36 ). Hope-fostering approaches focus on two essential aspects of hope: the personal ability to move toward goal achievement as a pathway, and the personal ability to generate many alternate ways to achieve the goal; the endpoint of this process is goal achievement ( 26 ). Based on the earlier discussion and a review of the literature, a hope-fostering counseling program was developed using Snyder's Hope theory. The program aimed to promote psychological well-being among post-abortion mothers by strengthening hope as part of a holistic approach to midwifery care for those mothers. This pilot study was designed to investigate the feasibility and effectiveness of the hope-fostering counseling program on psychological well-being and hope levels among primigravida mothers during the post-abortion period. This study aimed to provide preliminary evidence to justify a larger trial of the effectiveness of the hope-fostering counseling program. The study hypothesized that psychological well-being and hope levels among post-abortion primigravida mothers would be significantly improved after completing the hope-fostering counseling program sessions. 2. Methods 2.1 Design and Participants A one-group pretest-posttest design was utilized in this quasi-experimental study, which included eight primigravida post-abortion mothers admitted for abortion management in two central obstetric wards. The pilot study assessed the effectiveness of a hope-fostering counseling program on psychological well-being and hope levels, as well as the feasibility of the intervention. This pilot represented 20% of the total sample size for a larger quasi-experimental study involving 40 post-abortion primigravida mothers. The sample size for the main study was calculated to achieve 80% statistical power to detect differences in psychological well-being and hope levels before and after the counseling program, with an alpha level of 0.05. Inclusion criteria were: maternal age between 18 and 35 years; post-abortion primigravida mothers diagnosed with missed or incomplete abortion and classified as low-risk pregnancies; proficiency in Arabic; a baseline ADHS score below 21 or a baseline PWB-18 score below 36; and willingness to participate and share personal experiences. Exclusion criteria were: multiparous mothers; mothers with high-risk pregnancies or fertility issues; mothers diagnosed with abortion types other than missed or incomplete; and mothers deemed mentally incompetent as documented in patient records. The study received approval from the Research and Ethics Committees of the participating institutions. Participants were informed of the study protocol before enrollment and provided informed consent. They were assured that all data would remain anonymous and be used solely for research. Participants retained the right to withdraw from the study at any time without penalty. The researchers adhered to the Declaration of Helsinki throughout the study ( 37 ), particularly in their interactions with participants. 2.2 Hope-fostering Counselling Program Following the initial interview, eligible participants who consented to participate in the hope-fostering counseling program were scheduled for individualized, interactive counseling sessions. The sessions were based on the Snyder Hope theory, as adapted by Kitty Chan's doctoral research to evaluate the effectiveness of a brief hope intervention in improving hope and well-being among cancer patients undergoing rehabilitation ( 35 ), with approval for program use. The counseling program underwent peer review by three consultants: An Obstetrics and Gynecology Consultant specializing in high-risk pregnancy, a Midwife with a PhD in Family Counseling, and an Associate Professor in Psychiatric Mental Health Nursing. The themes and objectives of the counselling sessions are illustrated in Table 1 . Program providers encouraged participants to build on existing resilience and growth capacity, acknowledge the past while promoting forward progress, emphasize autonomy in both previous decisions and current recovery, and address emotional, cognitive, and behavioral dimensions. These individualized sessions fostered trust between participants and providers and enabled participants to express their thoughts and feelings, thereby enhancing program outcomes. The program comprised six interactive sessions: three face-to-face interviews lasting 45 to 60 minutes each and three telephone interviews lasting 20 to 25 minutes each. Face-to-face interviews were conducted at discharge, typically within 24 to 48 hours post-abortion, and at two and four weeks post-abortion. Telephone interviews were scheduled at one, three, and six weeks post-abortion. All sessions were conducted by a midwifery consultant with a basic counseling and psychotherapy certificate in the midwife clinic within the obstetric wards of the selected healthcare centers, in collaboration with the clinic psychologist. Table 1 Themes and Objectives of the Counselling Sessions. The session Time Theme Objectives 1st session 24 to 48 hours post-abortion. Creating a supportive environment for healing. • Establish a therapeutic alliance and ensure safety. • Normalize and validate complex emotions. • Introduce self-compassion as a basis for hope. • Complete baseline assessments. 2nd session One-week post-abortion. Clarify the participant's individual path for progress. • Establish practical strategies to facilitate the attainment of specified outcomes. • Evaluate each participant’s strengths and the resources accessible to them. • Decompose overarching objectives into actionable and manageable steps. 3rd session Two weeks post-abortion. Restoring individual voice and autonomy. • Enhance agency-related cognition, with emphasis on willpower and self-efficacy. • Identify and mitigate recurring patterns of self-blame and shame. • Promote autonomy consistently during the recovery process. 4th session Three weeks post-abortion. Incorporating personal experiences into daily life. • Acknowledge grief and loss while sustaining progress toward personal development. • Recognize opportunities to derive meaning from experiences. • Connect previous experiences to ongoing personal growth. 5th session Four weeks post-abortion. Strengthening interpersonal relationships and future planning. • Evaluate the effects of life changes on relationships with partners, family members, and friends. • Enhance communication skills to facilitate appropriate information sharing. • Cultivate a positive and optimistic outlook for future personal development. 6th session Sex weeks post-abortion. Sustaining hope beyond therapeutic sessions. • Facilitate consolidation of acquired skills and insights. • Guide the development of an individualized Hope Maintenance Plan. • Acknowledge and celebrate participant progress and personal growth. • Establish a plan for ongoing support and resources. 2.3 Outcome Measures The Ryff’s Psychological Well-Being Scale (PWB-18) consists of 18 items assessing psychological well-being over the previous four weeks across six subscales: autonomy, environmental mastery, self-acceptance, personal growth, positive relations, and purpose in life ( 37 ). Each subscale contains three items rated on a 1–6 Likert scale, with 1 indicating 'Strongly Disagree' and 6 indicating 'Strongly Agree.' Items 1, 2, 3, 8, 9, 11, 12, 13, 17, and 18 are reverse-scored ( 20 ). The maximum score is 108, with higher scores reflecting greater psychological well-being. For the Arabic version, a cutoff score of 36 is used. The scale demonstrates high internal consistency, with a Cronbach’s alpha of 0.94 ( 38 ). The Adult Dispositional Hope Scale (ADHS) measures hope with 12 items, including four distractor items ( 3 , 5 , 7 , and 11 ) ( 39 ). The scale evaluates two components, agency and pathways, each assessed by four items rated on a 1–8 Likert scale, with 1 representing 'Definitely false' and 8 representing 'Definitely true' ( 40 ). The maximum score is 64, with higher scores indicating greater hope. For the Arabic version, a cutoff score of 21 is used. The scale has an internal consistency of 0.79 ( 38 ). 2.4 Statistical Analysis: Statistical analyses were performed using SPSS version 25 (SPSS Inc.). Descriptive statistics were calculated for background data and baseline measures of psychological well-being and hope. The effectiveness of the hope-fostering counseling program on psychological well-being and hope across sessions was evaluated using Repeated Measures Analysis of Variance (RM-ANOVA). Post hoc tests with Bonferroni correction were applied to assess changes across different assessments. All analyses employed a standard alpha level of 0.05. 3. Results 3.1 Sample Characteristics The mean participant age was 24 ± 4 years, and the mean gestational age at abortion was 12.75 ± 1.91 weeks. Table 2 presents maternal age and gestational age at abortion. The majority of participants (62.5%) held a diploma, and 62.5% were employed. Five participants were diagnosed with missed abortion and three with incomplete abortion; all were admitted for abortion management. Table 3 presents further participant characteristics. Table 2 Participants’ Age and Gestational Age (n = 8). Variable Mean ± SD Age (Year) 24 4.00 Gestational age (weeks 12.75 1.91 Table 3 Other Descriptive Variables of the Participants (n = 8). Variable Sub-category Frequency % Educational Level Secondary Education 2 25 Diploma Degree 5 62.5 BCS 1 12.5 Occupational Status Employee 5 62.5 Not 3 37.5 Abortion Type Missed Abortion 5 62.5 Incomplete Abortion 3 37.5 3.2 Effectiveness of Hope-fostering Counselling Program Table 4 presents the scores for the Psychological Well-Being Scale (PWB-18) and the Adult Dispositional Hope Scale (ADHS) at multiple time points. Table 4 Mean Scores of PWB-18 Scale and ADHS of the participants at Different Time points. Baseline 3rd week 6th week Measure Mean ± SD Mean ± SD Mean ± SD PWB-18 35.50 ± 8.77 54.88 ± 6.64 78.25 ± 4.53 RM-ANOVA 19.25 ± 4.03 31.00 ± 3.67 48.88 ± 2.17 * PWB-18 = Psychological Well-being-18, ADHS = Adult Dispositional Hope Scale. Repeated measures analysis of variance (RM-ANOVA) indicated a significant improvement in psychological well-being among post-abortion primigravida mothers (n = 8) following completion of the Hope-Fostering Counseling Program. Mauchly's Test of Sphericity confirmed that the Sphericity assumption was met ( P = 0.219), with F ( 2 , 14 ) = 412.494, P = 0.000. The interaction effect between time and intervention accounted for approximately 98.3% of the variance in psychological well-being scores, reflecting a large effect size, as detailed in Table 5 . RM-ANOVA results also indicated a significant improvement in hope levels among post-abortion primigravida mothers (n = 8) after completion of the Hope-Fostering Counseling Program. Mauchly's Test of Sphericity revealed a violation of the Sphericity assumption ( P = 0.013); therefore, the Greenhouse-Geisser correction was applied, resulting in F (1.132, 7.922) = 301.197, P = 0.000. The interaction effect between time and intervention explained approximately 97.7% of the variance in hope levels, indicating a large effect size, as shown in Table 5 . Table 5 RM-ANOVA Analysis of PWB-18 and ADHS at Different Time Points (n = 8). Variable Sum of Squares DF* Mean Squares F P- value Effect Size PWB-18 7331.583 2 3665.792 412.494 .000 .983 ADHS 3560.583 1.132 3145.987 301.197*** .000 .977 * Degree of Freedom ** PWB-18 = Psychological Well-being-18, ADHS = Adult Dispositional Hope Scale. *** Greenhouse-Geisser correction. These findings indicate that the Hope-Fostering Counseling Program provides a practical and accessible method for enhancing psychological well-being and hope among post-abortion primigravida mothers. The evidence supports the program’s effectiveness and feasibility in promoting maternal mental health. 4. Discussion and Conclusion 4.1 Discussion The implementation of the hope-fostering counseling program led to significant improvements in psychological well-being and hope among post-abortion primigravida mothers. This counseling approach demonstrates effectiveness in supporting maternal psychological well-being and hope during the post-abortion period. As indicated in Table 4 , baseline data revealed that psychological well-being and hope scores were below the established cutoff, indicating low levels among post-abortion mothers. Following six counseling sessions, these scores increased above the cutoff, demonstrating a statistically significant improvement. The counseling sessions were instrumental in enhancing mental health. Previous studies have similarly reported the effectiveness of hope-based counseling in improving psychological well-being after abortion in Iran ( 26 ). The findings regarding the impact of individualized counseling for post-abortion mothers are consistent with previous research. For instance, a study in Turkey by Palas Karaca and Oskay highlighted the value of supportive care and individualized counseling in improving mental health and psychological well-being among post-abortion mothers ( 41 ). The present study aligns with evidence from Taiwan, where Chang and colleagues found significant reductions in stress and depression among women with recurrent abortions who received face-to-face empathic nursing counseling ( 42 ). Similarly, Barat and colleagues in Iran reported that brief supportive psychotherapy sessions within the first 24 hours post-abortion significantly improved anxiety, depression, and grief at four months post-abortion ( 43 ). Furthermore, findings are consistent with those of Yanık and Kavak Budak in Turkey, where positive psychotherapy-based training among mothers receiving infertility treatment led to significant improvements in hope levels and psychological well-being ( 44 ). Collectively, these results contribute to the growing body of evidence supporting the effectiveness and feasibility of hope-fostering counseling programs across diverse cultural contexts, particularly for primigravida mothers during the post-abortion period. 4.2 Limitation While this study's findings provide worthy insights into the feasibility of delivering the hope-fostering counseling program and its effectiveness in improving psychological well-being and hope levels among post-abortion primigravida mothers, several limitations should be considered. Although the study's quasi-experimental design is feasible in the given circumstances, it primarily limits the ability to establish causality. Randomized controlled trials could provide stronger evidence of the program’s effectiveness. Also, while the study focuses on the program's effects on psychological well-being and hope levels, some potential mediators were not examined and could provide more comprehensive insights into the healing period, such as coping strategies and social support. Finally, the study variables were assessed via self-report questionnaires, which could introduce response bias, as participants may underestimate or overestimate their feelings and emotions due to cultural factors or personal beliefs. 5. Conclusion This pilot study presents the feasibility of providing a hope-fostering counseling program among post-abortion primigravida mothers. Additionally, the results provide significant evidence related to the effectiveness of this counseling program in improving psychological well-being and hope levels among post-abortion primigravida mothers. Considering the cultural context, where post-abortion mental health services are limited, the Hope-fostering counseling program provides an applicable solution to support post-abortion primigravida mothers in their psychological well-being. Future research could examine protective factors that may affect psychological well-being and hope levels, such as social support and coping strategies. Additionally, more researches are recommended to study post-abortion mothers with varying parity and different types of abortions, rather than missed or incomplete abortions. Overall, this study contributed to the growing body of knowledge on the role of counseling programs in post-abortion psychological health. Abbreviations N Abbreviation Definition 1 RM-ANOVA Repeated-measures analysis of variance. 2 ADHS Adult Dispositional Hope Scale. 3 PWB-18 The 18-Item Version of Ryff’s Psychological Well-Being Scale. 4 PPT Positive Psychotherapy. Declarations Ethics Approval and Consent to Participate: Ethical approval for the study was obtained from the Deanship of Scientific Research at the University of Jordan, the Ministry of Health Research and Ethics Committee, and the Royal Medical Services Research and Ethics Committee in the Hashemite Kingdom of Jordan in 2024. The participants were informed about the study protocol before the study began and provided informed consent to participate. The participants were assured that all data would be used in anonymity for research purposes only. Participants could also withdraw from the study at any time without any penalties. Overall, the researchers adhere to the Declaration of Helsinki throughout the study, particularly in their interactions with participants. Consent for Publication: Not applicable. Availability of Data and Materials: The datasets used or analyzed during the current study are available from the corresponding author on reasonable request. Competing Interests: The authors declare that they have no competing interests. Funding: The authors didn’t receive any funding for this work. Authors' contributions: • Lina Badran: Writing- Original draft preparation, Data collection, and providing the counselling program. • Alia Mahadeen: Supervision. • Doaa Al-Tamimi: Data collection, Data analysis and interpretation. • Doaa Noayran: Writing- Reviewing and Editing. • Fatimah Tarawneh: Conceptualization, Methodology. Acknowledgements: The authors are deeply grateful to the anonymous peer reviewer for their dedicated time and expertise. The authors believe that the reviewer feedback and constructive criticism will enhance this research paper’s quality and credibility. The authors appreciate the reviewers through assessment, which will improve the clarity and coherence of the work. Peer reviewers' ideas will contribute significantly to scientific knowledge and academic publications, fostering excellence and integrity in research. References Matud MP, López-Curbelo M, Fortes D (2019) Gender and psychological well-being. Int J Environ Res Public Health 16(19):3531 World Health Organization (2023) Clinical practice handbook for quality abortion care. World Health Organization Marshall JE, Raynor MD (2014) Myles’ Textbook for Midwives E-Book: Myles’ Textbook for Midwives E-Book. Elsevier Health Sciences World Health Organization (2022) WHO recommendations on self-care interventions: self-management of medical abortion. World Health Organization Taybeh E, Hamadneh S, Al-Alami Z, Abu-Huwaij R (2023) Navigating miscarriage in Jordan: understanding emotional responses and coping strategies. BMC Pregnancy Childbirth 23(1):757 Rouzi AA, Alamoudi R, Turkistani J, Almansouri N, Alkafy S, Alsinani N et al (2020) Miscarriage perceptions and experiences among Saudi women. Clin Exp Obstet Gynecol 47(2):208–214 Al-Alami Z, Abu-Huwaij R, Hamadneh S, Taybeh E (2024) Understanding Miscarriage Prevalence and Risk Factors: Insights from Women in Jordan. Medicina 60(7):1044 Negi S, Sharma K, Acharya A, Prabhu A, Dwivedi R, Athe R (2023) Impact of medical, surgical and expectant management on spontaneous miscarriage/abortion on first trimester: A systematic review and meta-analysis of randomized, controlled trials. Qeios Baird S, Gagnon MD, deFiebre G, Briglia E, Crowder R, Prine L (2018) Women’s experiences with early pregnancy loss in the emergency room: A qualitative study. Sex reproductive Healthc 16:113–117 Quenby S, Gallos ID, Dhillon-Smith RK, Podesek M, Stephenson MD, Fisher J et al (2021) Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss. Lancet 397(10285):1658–1667 Gebeyehu NA, Tegegne KD, Abebe K, Asefa Y, Assfaw BB, Adella GA et al (2023) Global prevalence of post-abortion depression: systematic review and Meta-analysis. BMC Psychiatry 23(1):786 Smorti M, Ponti L, Simoncini T, Mannella P, Bottone P, Pancetti F et al (2021) Pregnancy after miscarriage in primiparae and multiparae: implications for women’s psychological well-being. J reproductive infant Psychol 39(4):371–381 Biggs MA, Brown K, Foster DG (2020) Perceived abortion stigma and psychological well-being over five years after receiving or being denied an abortion. PLoS ONE 15(1):e0226417 Ceran MU, Tasdemir U (2022) A comparative prospective study with depression, anxiety and quality of life scales in women with induced abortion and miscarriage before pregnancy termination. J Contemp Med 12(2):364–368 Hsu HW, Huang JP, Au HK, Lin CL, Chen YY, Chien LC et al (2024) Impact of miscarriage and termination of pregnancy on subsequent pregnancies: A longitudinal study of maternal and paternal depression, anxiety and eudaimonia. J Affect Disord 354:544–552 Strumpf E, Lang A, Austin N, Derksen SA, Bolton JM, Brownell MD et al (2021) Prevalence and clinical, social, and health care predictors of miscarriage. BMC Pregnancy Childbirth 21:1–9 UROOJ A, KHAN S, AWAN F. FREQUENCY OF SPONTANEOUS, MISCARRIAGES IN OBESE AND NON-OBESE WOMEN (2024) Biol Clin Sci Res J 2024(1):670–670 deMontigny F, Verdon C, Meunier S, Gervais C, Coté I (2020) Protective and risk factors for women’s mental health after a spontaneous abortion. Rev Latinoam Enferm 28:e3350 Bagheri L, Nazari AM, Chaman R, Ghiasi A, Motaghi Z (2020) The effectiveness of healing interventions for post-abortion grief: A systematic review and meta-analysis. Iran J Public Health Abd-Elsalam Elhgry M, Diab Abd Elwahab Diab G, Elsayed Ibrahim S (2020) Effect of self-compassion based intervention on self-compassion, life satisfaction and psychological well-being among older adults. Egypt J Health Care 11(1):1111–1127 Białek K, Sadowski M, Adamczyk-Gruszka O, Młodawski J, Świercz G (2024) Level of basic hope and symptoms of anxiety and depression in women after miscarriage. Archives Med Science: AMS 20(1):332 Morales-Rodríguez FM, Espigares-López I, Brown T, Pérez-Mármol JM (2020) The relationship between psychological well-being and psychosocial factors in university students. Int J Environ Res Public Health 17(13):4778 Mendes DCG, Fonseca A, Cameirão MS (2023) The psychological impact of Early Pregnancy Loss in Portugal: incidence and the effect on psychological morbidity. Front Public Health 11:1188060 Furtado-Eraso S, Marín‐Fernández B, Escalada‐Hernández P (2024) Perinatal loss, a devastating cyclone: A situation‐specific nursing theory. J Nurs Scholarsh Chan SCY, Ng CW, Huang QL (2024) The role of hope in depressive and anxiety symptoms in emerging and older adults: a network approach. Curr Psychol. ;1–14 Raphi F, Bani S, Farvareshi M, Hasanpour S, Mirghafourvand M (2021) Effect of hope therapy on psychological well-being of women after abortion: a randomized controlled trial. BMC Psychiatry 21:1–10 Colla R, Williams P, Oades LG, Camacho-Morles J (2022) A New Hope for positive psychology: a dynamic systems reconceptualization of hope theory. Front Psychol 13:809053 Ryff CD (1989) Happiness is everything, or is it? Explorations on the meaning of psychological well-being. J Personal Soc Psychol 57(6):1069 Egner TM, Kluck JJ (2019) How Nurse-Midwives Can Best Support Families Who Have Experienced Perinatal Loss Leite A, Medeiros A, Rolim C, Pinheiro K, Beilfuss M, Leão M et al (2019) Hope theory and its relation to depression: a systematic review. Annals Psychiatry Clin Neurosci. ;2(2) Murphy ER (2023) Hope and well-being. Curr Opin Psychol 50:101558 Shaohua L, Shorey S (2021) Psychosocial interventions on psychological outcomes of parents with perinatal loss: a systematic review and meta-analysis. Int J Nurs Stud 117:103871 Fernández-Basanta S, Coronado C, Bondas T, Movilla-Fernández MJ (2021) Primary healthcare midwives’ experiences of caring for parents who have suffered an involuntary pregnancy loss: a phenomenological hermeneutic study. Midwifery 92:102863 Hammood HJ, Kadhim ST, Washeel OF (2020) Awareness of Nurse Midwives’ toward Post-miscarriage Care at Bint Al-Huda Hospital in Al-Nasiriya City. Indian J Forensic Med Toxicol 14(3):2666–2672 Pleeging E, Burger M, van Exel J (2021) The relations between hope and subjective well-being: A literature overview and empirical analysis. Appl Res Qual Life 16(3):1019–1041 Chan K, Wong FK, Lee PH (2019) A brief hope intervention to increase hope level and improve well-being in rehabilitating cancer patients: A feasibility test. SAGE Open Nurs 5:2377960819844381 Chodankar D, Bhatt A, Davis S (2025) Declaration of Helsinki 2024: Too much too late? Perspect Clin Res 16(1):1–2 Aziz IA, Hassan SS (2019) Investigating the association between psychological well-being and hope among the IDPs in Erbil. Zanco J Humanity Sci 23(3):539–548 Snyder CR, Harris C, Anderson JR, Holleran SA, Irving LM, Sigmon ST et al (1991) The will and the ways: development and validation of an individual-differences measure of hope. J Personal Soc Psychol 60(4):570 Vinueza-Solórzano AM, Campoverde RE, Portalanza-Chavarría CA, de Freitas CP, Hutz CS, Vazquez ACS (2023) Adaptation and validation of the Adult Dispositional Hope Scale in the Ecuadorian context. Psicologia: Reflexão e Crítica 36:3 Palas Karaca P, Oskay ÜY (2021) Effect of supportive care on the psychosocial health status of women who had a miscarriage. Perspect Psychiatr Care 57(1):179–188 Chang SC, Kuo PL, Chen CH (2021) Effectiveness of empathic caring on stress and depression for women with recurrent miscarriage: A randomized controlled trial. Complement Ther Clin Pract 43:101367 Barat S, Yazdani S, Faramarzi M, Khafri S, Darvish M, Rad MN et al (2020) The effect of brief supportive psychotherapy on prevention of psychiatric morbidity in women with miscarriage: a randomized controlled trial about the first 24-hours of hospitalization. Oman Med J 35(3):e130 Yanık D, Kavak Budak F (2024) The effect of positive psychotherapy-based training on psychological well-being and hope level in women receiving infertility: experimental study. J Reproductive Infant Psychol 42(3):381–394 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted 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-8936623","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":595025824,"identity":"f9c94490-cbf2-45b5-a482-e274f3a3f681","order_by":0,"name":"Lina Badran","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+UlEQVRIie3QsUoDMRjA8e8I3C3BcwxI7St8aRaHw2fJcXBTFKGLWyNdq3MFwVfoI3wQqIvuHa8ITh3uAQqaK0UXTW8Umv8UwvdLSABisX/YCUDStCjOh/mU0G8kFkAHSQrA5PymUHK+1L1JesbburRkOrEj4VJxtRQcXXJnX9sxh2KwIFg3YXJdXQh0LGP3C8WhVp5UGCZGrhBdmti3jrjSk1ocICg0Og5kGk8+e5GRIPRDZMAT6kH4RkmLBfpPRvmElXp0B96SZ0a+b7di8pxPP3Bzezl4eJmVTYjAqf65EaE7nnH91/D+Gvpesv3hGf02GIvFYsfbF8qMSqHFrIXoAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0001-9837-8703","institution":"Mutah University","correspondingAuthor":true,"prefix":"","firstName":"Lina","middleName":"","lastName":"Badran","suffix":""},{"id":595025825,"identity":"ab2dd6d7-0115-4bd1-9a72-f98feb9e4e9c","order_by":1,"name":"Alia Mahadeen","email":"","orcid":"","institution":"The University of Jordan","correspondingAuthor":false,"prefix":"","firstName":"Alia","middleName":"","lastName":"Mahadeen","suffix":""},{"id":595025826,"identity":"0bba70bb-5cd1-436e-9b8e-375b754bc988","order_by":2,"name":"Doaa Al-Tamimi","email":"","orcid":"","institution":"Mutah University","correspondingAuthor":false,"prefix":"","firstName":"Doaa","middleName":"","lastName":"Al-Tamimi","suffix":""},{"id":595025827,"identity":"d37825fe-bd10-4e49-9a14-b5661ee5af94","order_by":3,"name":"Doaa Noayran","email":"","orcid":"","institution":"Mutah University","correspondingAuthor":false,"prefix":"","firstName":"Doaa","middleName":"","lastName":"Noayran","suffix":""},{"id":595025828,"identity":"02bdb64f-977a-4ede-9768-f00a0ce97bb1","order_by":4,"name":"Fatimah S Tarawneh","email":"","orcid":"","institution":"Mutah University","correspondingAuthor":false,"prefix":"","firstName":"Fatimah","middleName":"S","lastName":"Tarawneh","suffix":""}],"badges":[],"createdAt":"2026-02-22 03:16:25","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":true,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-8936623/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8936623/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103319375,"identity":"2768587c-3a58-4126-9aff-4424d5ec5d3b","added_by":"auto","created_at":"2026-02-24 11:37:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":745847,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8936623/v1/3e4d25ca-f2f5-4151-b4ef-f3fc334f69c2.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eA Pilot Study on the Effectiveness of Hope-Focused Counselling for Psychological Well-Being in Post-abortion Primigravida Mothers\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003ePregnancy is considered one of the most significant events for couples and their families, especially for parents experiencing their first pregnancy. Well-being and care for the new mother and the developing fetus are essential and add significant responsibility for parents and the family (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The most common complication during early pregnancy is \"abortion.\" The World Health Organization defines abortion as \u0026ldquo;pregnancy termination before 20 weeks' gestation or a fetus born weighing less than 500 grams\u0026rdquo; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Abortion also refers to the termination of pregnancy by medical interventions for any maternal or fetal cause, such as fetal death or specific maternal health status. Spontaneous abortion, or miscarriage, indicates the spontaneous expulsion of the fetus without medical or surgical intervention (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe prevalence of abortion worldwide is about 29% of all diagnosed pregnancies (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), which translates to 23\u0026nbsp;million abortions reported each year (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). In the Middle East, one in every four pregnant women has had an abortion (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). In Jordan, the prevalence of abortion was reported as 17.9% of all diagnosed pregnancies among the Jordanian population (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAbortion is associated with many physical and psychological complications, which may extend to weeks or months (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In contrast, in some reported cases, the complications could extend to years after the event, especially with vulnerable mothers (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The physical complications include infections, bleeding, bladder injury, and an increased risk for ectopic pregnancy (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). At the same time, the psychological issues were correlated with various psychological morbidities as a reaction to the emotional distress and grief process for the mother and her family (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Furthermore, psychological issues of previous abortion experience were reported to be extended to the subsequent pregnancy (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePsychological issues after abortion are not uncommon (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), and the severity and nature of these issues vary among mothers (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). These variations may be attributed to physical, psychological, and social factors, such as previous pregnancy history, physical well-being (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), knowledge of the prevalence and causes of pregnancy loss (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), social and cultural consequences of the event, and the physical and emotional effects of the hormonal imbalance associated with pregnancy loss (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePsychological issues can manifest as grief symptoms in response to loss (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The nature and severity of these symptoms vary among mothers with different social, religious, physical, psychological, and educational backgrounds (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). For example, some mothers may experience emotional distress, while others may not (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Previous literature reported several potential psychological challenges that mothers faced during their early post-abortion period, such as depression, anxiety, post-traumatic stress, emotional distress, grief, and relationship tension (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). These negative psychological issues may be noticed by family, friends, and healthcare providers (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGenerally, psychological well-being is considered a broad concept with indicators that vary across mothers (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Reviewing previous literature highlights indicators such as emotional balance, linked to hormonal imbalance in the post-abortion period, sleep patterns, and overall physical health, which might reflect psychological well-being (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Moreover, personal self-esteem reflects the confidence and abilities that support life satisfaction and promote the meaningfulness of life, and it is a strong indicator of psychological well-being (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). The personal sense of the ability to grow and develop reflects a high level of psychological well-being (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). In addition to resilience capacity and personal autonomy (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e), all of these indicators reflect psychological well-being, and deterioration in any of them indicates a decline in psychological well-being (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHope is considered a positive phenomenon that helps construct coping strategies during the recovery period after trauma, especially in psychological trauma (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). The fundamental purpose of hope is to avoid despair, empowering the person to overcome unpleasant or stressful situations (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Theoretically, hope is defined as the process by which individuals develop their goals, identify specific strategies to achieve them, and sustain motivation to pursue those strategies (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Thus, hope is tied to goals and pathways to achievement.\u003c/p\u003e \u003cp\u003eThe relationship between hope and psychological well-being appears variable and complex (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Previous literature suggests a significant association between hope levels and psychological well-being across several domains (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Hope may primarily enhance purposeful perception and positive thoughts about the future (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) and promote personal coping skills to overcome guilt and grief (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Furthermore, hope may provide creative coping mechanisms to manage challenging emotional experiences, such as sadness, and to foster a positive imagination, thereby promoting resilience and recovery (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Thus, having hope might encourage better emotional adaptation and improve psychological well-being (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eConversely, psychological well-being was reported to influence hope levels. So, post-aborted mothers who experience significant psychological challenges could encounter challenges maintaining hopeful thoughts (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Individuals with higher levels of psychological well-being were found to be better able to foster hope (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGlobally, healthcare providers seek to promote health by emphasizing primary prevention and early screening to ensure early management and treatment, preventing further complications (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Psychological issues following any traumatic experience, such as abortions, could be managed based on pharmacological or non-pharmacological measures; both measures are used (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMidwives are essential to the mother's care and crucial in managing such cases (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). While pharmacological measures require collaboration among gynecologists, pharmacologists, and midwives, well-trained midwives could offer non-pharmacological measures, including various psychological support strategies (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Psychological measures such as hope therapy could help support post-abortion mothers, foster coping mechanisms to overcome difficult times, and promote their psychological health (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis study focuses on the improvement of psychological well-being and hope levels for post-abortion mothers within the context of individualized counseling based on hope-fostering therapy. Previous literature reported a significant link between hope and psychological well-being, which can help healthcare providers develop therapeutic interventions to enhance psychological well-being levels (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Therapeutic hope-fostering approaches were suggested to help post-traumatic persons overcome their psychological challenges, address negative thoughts, and promote hope via empowerment of resilience (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Hope-fostering approaches focus on two essential aspects of hope: the personal ability to move toward goal achievement as a pathway, and the personal ability to generate many alternate ways to achieve the goal; the endpoint of this process is goal achievement (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e Based on the earlier discussion and a review of the literature, a hope-fostering counseling program was developed using Snyder's Hope theory. The program aimed to promote psychological well-being among post-abortion mothers by strengthening hope as part of a holistic approach to midwifery care for those mothers. This pilot study was designed to investigate the feasibility and effectiveness of the hope-fostering counseling program on psychological well-being and hope levels among primigravida mothers during the post-abortion period. This study aimed to provide preliminary evidence to justify a larger trial of the effectiveness of the hope-fostering counseling program. The study hypothesized that psychological well-being and hope levels among post-abortion primigravida mothers would be significantly improved after completing the hope-fostering counseling program sessions.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Design and Participants\u003c/h2\u003e \u003cp\u003eA one-group pretest-posttest design was utilized in this quasi-experimental study, which included eight primigravida post-abortion mothers admitted for abortion management in two central obstetric wards. The pilot study assessed the effectiveness of a hope-fostering counseling program on psychological well-being and hope levels, as well as the feasibility of the intervention. This pilot represented 20% of the total sample size for a larger quasi-experimental study involving 40 post-abortion primigravida mothers. The sample size for the main study was calculated to achieve 80% statistical power to detect differences in psychological well-being and hope levels before and after the counseling program, with an alpha level of 0.05.\u003c/p\u003e \u003cp\u003eInclusion criteria were: maternal age between 18 and 35 years; post-abortion primigravida mothers diagnosed with missed or incomplete abortion and classified as low-risk pregnancies; proficiency in Arabic; a baseline ADHS score below 21 or a baseline PWB-18 score below 36; and willingness to participate and share personal experiences. Exclusion criteria were: multiparous mothers; mothers with high-risk pregnancies or fertility issues; mothers diagnosed with abortion types other than missed or incomplete; and mothers deemed mentally incompetent as documented in patient records.\u003c/p\u003e \u003cp\u003e The study received approval from the Research and Ethics Committees of the participating institutions. Participants were informed of the study protocol before enrollment and provided informed consent. They were assured that all data would remain anonymous and be used solely for research. Participants retained the right to withdraw from the study at any time without penalty. The researchers adhered to the Declaration of Helsinki throughout the study (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e), particularly in their interactions with participants.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Hope-fostering Counselling Program\u003c/h2\u003e \u003cp\u003e Following the initial interview, eligible participants who consented to participate in the hope-fostering counseling program were scheduled for individualized, interactive counseling sessions. The sessions were based on the Snyder Hope theory, as adapted by Kitty Chan's doctoral research to evaluate the effectiveness of a brief hope intervention in improving hope and well-being among cancer patients undergoing rehabilitation (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e), with approval for program use. The counseling program underwent peer review by three consultants: An Obstetrics and Gynecology Consultant specializing in high-risk pregnancy, a Midwife with a PhD in Family Counseling, and an Associate Professor in Psychiatric Mental Health Nursing. The themes and objectives of the counselling sessions are illustrated in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Program providers encouraged participants to build on existing resilience and growth capacity, acknowledge the past while promoting forward progress, emphasize autonomy in both previous decisions and current recovery, and address emotional, cognitive, and behavioral dimensions. These individualized sessions fostered trust between participants and providers and enabled participants to express their thoughts and feelings, thereby enhancing program outcomes.\u003c/p\u003e \u003cp\u003eThe program comprised six interactive sessions: three face-to-face interviews lasting 45 to 60 minutes each and three telephone interviews lasting 20 to 25 minutes each. Face-to-face interviews were conducted at discharge, typically within 24 to 48 hours post-abortion, and at two and four weeks post-abortion. Telephone interviews were scheduled at one, three, and six weeks post-abortion. All sessions were conducted by a midwifery consultant with a basic counseling and psychotherapy certificate in the midwife clinic within the obstetric wards of the selected healthcare centers, in collaboration with the clinic psychologist.\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\u003eThemes and Objectives of the Counselling Sessions.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe session\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\u003eTheme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eObjectives\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1st session\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 to 48 hours post-abortion.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCreating a supportive environment for healing.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; Establish a therapeutic alliance and ensure safety.\u003c/p\u003e \u003cp\u003e\u0026bull; Normalize and validate complex emotions.\u003c/p\u003e \u003cp\u003e\u0026bull; Introduce self-compassion as a basis for hope.\u003c/p\u003e \u003cp\u003e\u0026bull; Complete baseline assessments.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2nd session\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOne-week post-abortion.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eClarify the participant's individual path for progress.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; Establish practical strategies to facilitate the attainment of specified outcomes.\u003c/p\u003e \u003cp\u003e\u0026bull; Evaluate each participant\u0026rsquo;s strengths and the resources accessible to them.\u003c/p\u003e \u003cp\u003e\u0026bull; Decompose overarching objectives into actionable and manageable steps.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3rd session\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTwo weeks post-abortion.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRestoring individual voice and autonomy.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; Enhance agency-related cognition, with emphasis on willpower and self-efficacy.\u003c/p\u003e \u003cp\u003e\u0026bull; Identify and mitigate recurring patterns of self-blame and shame.\u003c/p\u003e \u003cp\u003e\u0026bull; Promote autonomy consistently during the recovery process.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4th session\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThree weeks post-abortion.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIncorporating personal experiences into daily life.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; Acknowledge grief and loss while sustaining progress toward personal development.\u003c/p\u003e \u003cp\u003e\u0026bull; Recognize opportunities to derive meaning from experiences.\u003c/p\u003e \u003cp\u003e\u0026bull; Connect previous experiences to ongoing personal growth.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5th session\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFour weeks post-abortion.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStrengthening interpersonal relationships and future planning.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; Evaluate the effects of life changes on relationships with partners, family members, and friends.\u003c/p\u003e \u003cp\u003e\u0026bull; Enhance communication skills to facilitate appropriate information sharing.\u003c/p\u003e \u003cp\u003e\u0026bull; Cultivate a positive and optimistic outlook for future personal development.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6th session\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSex weeks post-abortion.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSustaining hope beyond therapeutic sessions.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026bull; Facilitate consolidation of acquired skills and insights.\u003c/p\u003e \u003cp\u003e\u0026bull; Guide the development of an individualized Hope Maintenance Plan.\u003c/p\u003e \u003cp\u003e\u0026bull; Acknowledge and celebrate participant progress and personal growth.\u003c/p\u003e \u003cp\u003e\u0026bull; Establish a plan for ongoing support and resources.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Outcome Measures\u003c/h2\u003e \u003cp\u003eThe Ryff\u0026rsquo;s Psychological Well-Being Scale (PWB-18) consists of 18 items assessing psychological well-being over the previous four weeks across six subscales: autonomy, environmental mastery, self-acceptance, personal growth, positive relations, and purpose in life (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). Each subscale contains three items rated on a 1\u0026ndash;6 Likert scale, with 1 indicating 'Strongly Disagree' and 6 indicating 'Strongly Agree.' Items 1, 2, 3, 8, 9, 11, 12, 13, 17, and 18 are reverse-scored (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). The maximum score is 108, with higher scores reflecting greater psychological well-being. For the Arabic version, a cutoff score of 36 is used. The scale demonstrates high internal consistency, with a Cronbach\u0026rsquo;s alpha of 0.94 (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe Adult Dispositional Hope Scale (ADHS) measures hope with 12 items, including four distractor items (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, and \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). The scale evaluates two components, agency and pathways, each assessed by four items rated on a 1\u0026ndash;8 Likert scale, with 1 representing 'Definitely false' and 8 representing 'Definitely true' (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). The maximum score is 64, with higher scores indicating greater hope. For the Arabic version, a cutoff score of 21 is used. The scale has an internal consistency of 0.79 (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Statistical Analysis:\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using SPSS version 25 (SPSS Inc.). Descriptive statistics were calculated for background data and baseline measures of psychological well-being and hope. The effectiveness of the hope-fostering counseling program on psychological well-being and hope across sessions was evaluated using Repeated Measures Analysis of Variance (RM-ANOVA). Post hoc tests with Bonferroni correction were applied to assess changes across different assessments. All analyses employed a standard alpha level of 0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Sample Characteristics\u003c/h2\u003e \u003cp\u003eThe mean participant age was 24\u0026thinsp;\u0026plusmn;\u0026thinsp;4 years, and the mean gestational age at abortion was 12.75\u0026thinsp;\u0026plusmn;\u0026thinsp;1.91 weeks. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents maternal age and gestational age at abortion. The majority of participants (62.5%) held a diploma, and 62.5% were employed. Five participants were diagnosed with missed abortion and three with incomplete abortion; all were admitted for abortion management. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents further participant characteristics.\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\u003eParticipants\u0026rsquo; Age and Gestational Age (n\u0026thinsp;=\u0026thinsp;8).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e SD\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (Year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGestational age (weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.91\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\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOther Descriptive Variables of the Participants (n\u0026thinsp;=\u0026thinsp;8).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSub-category\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiploma Degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBCS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccupational Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbortion Type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMissed Abortion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncomplete Abortion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Effectiveness of Hope-fostering Counselling Program\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e presents the scores for the Psychological Well-Being Scale (PWB-18) and the Adult Dispositional Hope Scale (ADHS) at multiple time points.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean Scores of PWB-18 Scale and ADHS of the participants at Different Time points.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBaseline\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3rd week\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6th week\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeasure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePWB-18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.50\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;8.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54.88\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;6.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78.25\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;4.53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRM-ANOVA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19.25\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;4.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.00\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;3.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48.88\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;2.17\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\u003e* PWB-18\u0026thinsp;=\u0026thinsp;Psychological Well-being-18, ADHS\u0026thinsp;=\u0026thinsp;Adult Dispositional Hope Scale.\u003c/p\u003e \u003cp\u003eRepeated measures analysis of variance (RM-ANOVA) indicated a significant improvement in psychological well-being among post-abortion primigravida mothers (n\u0026thinsp;=\u0026thinsp;8) following completion of the Hope-Fostering Counseling Program. Mauchly's Test of Sphericity confirmed that the Sphericity assumption was met (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.219), with F (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u0026thinsp;=\u0026thinsp;412.494, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.000. The interaction effect between time and intervention accounted for approximately 98.3% of the variance in psychological well-being scores, reflecting a large effect size, as detailed in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eRM-ANOVA results also indicated a significant improvement in hope levels among post-abortion primigravida mothers (n\u0026thinsp;=\u0026thinsp;8) after completion of the Hope-Fostering Counseling Program. Mauchly's Test of Sphericity revealed a violation of the Sphericity assumption (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.013); therefore, the Greenhouse-Geisser correction was applied, resulting in F (1.132, 7.922)\u0026thinsp;=\u0026thinsp;301.197, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.000. The interaction effect between time and intervention explained approximately 97.7% of the variance in hope levels, indicating a large effect size, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRM-ANOVA Analysis of PWB-18 and ADHS at Different Time Points (n\u0026thinsp;=\u0026thinsp;8).\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=\"char\" char=\".\" 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=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" 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\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSum of Squares\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDF*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean Squares\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP- value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eEffect Size\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePWB-18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7331.583\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3665.792\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e412.494\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.983\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eADHS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3560.583\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3145.987\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e301.197***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.977\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e* Degree of Freedom\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e** PWB-18\u0026thinsp;=\u0026thinsp;Psychological Well-being-18, ADHS\u0026thinsp;=\u0026thinsp;Adult Dispositional Hope Scale.\u003c/p\u003e \u003cp\u003e*** Greenhouse-Geisser correction.\u003c/p\u003e \u003cp\u003eThese findings indicate that the Hope-Fostering Counseling Program provides a practical and accessible method for enhancing psychological well-being and hope among post-abortion primigravida mothers. The evidence supports the program\u0026rsquo;s effectiveness and feasibility in promoting maternal mental health.\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion and Conclusion","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Discussion\u003c/h2\u003e \u003cp\u003eThe implementation of the hope-fostering counseling program led to significant improvements in psychological well-being and hope among post-abortion primigravida mothers. This counseling approach demonstrates effectiveness in supporting maternal psychological well-being and hope during the post-abortion period.\u003c/p\u003e \u003cp\u003eAs indicated in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, baseline data revealed that psychological well-being and hope scores were below the established cutoff, indicating low levels among post-abortion mothers. Following six counseling sessions, these scores increased above the cutoff, demonstrating a statistically significant improvement. The counseling sessions were instrumental in enhancing mental health. Previous studies have similarly reported the effectiveness of hope-based counseling in improving psychological well-being after abortion in Iran (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe findings regarding the impact of individualized counseling for post-abortion mothers are consistent with previous research. For instance, a study in Turkey by Palas Karaca and Oskay highlighted the value of supportive care and individualized counseling in improving mental health and psychological well-being among post-abortion mothers (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe present study aligns with evidence from Taiwan, where Chang and colleagues found significant reductions in stress and depression among women with recurrent abortions who received face-to-face empathic nursing counseling (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). Similarly, Barat and colleagues in Iran reported that brief supportive psychotherapy sessions within the first 24 hours post-abortion significantly improved anxiety, depression, and grief at four months post-abortion (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). Furthermore, findings are consistent with those of Yanık and Kavak Budak in Turkey, where positive psychotherapy-based training among mothers receiving infertility treatment led to significant improvements in hope levels and psychological well-being (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCollectively, these results contribute to the growing body of evidence supporting the effectiveness and feasibility of hope-fostering counseling programs across diverse cultural contexts, particularly for primigravida mothers during the post-abortion period.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Limitation\u003c/h2\u003e \u003cp\u003eWhile this study's findings provide worthy insights into the feasibility of delivering the hope-fostering counseling program and its effectiveness in improving psychological well-being and hope levels among post-abortion primigravida mothers, several limitations should be considered. Although the study's quasi-experimental design is feasible in the given circumstances, it primarily limits the ability to establish causality. Randomized controlled trials could provide stronger evidence of the program\u0026rsquo;s effectiveness. Also, while the study focuses on the program's effects on psychological well-being and hope levels, some potential mediators were not examined and could provide more comprehensive insights into the healing period, such as coping strategies and social support. Finally, the study variables were assessed via self-report questionnaires, which could introduce response bias, as participants may underestimate or overestimate their feelings and emotions due to cultural factors or personal beliefs.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThis pilot study presents the feasibility of providing a hope-fostering counseling program among post-abortion primigravida mothers. Additionally, the results provide significant evidence related to the effectiveness of this counseling program in improving psychological well-being and hope levels among post-abortion primigravida mothers.\u003c/p\u003e \u003cp\u003eConsidering the cultural context, where post-abortion mental health services are limited, the Hope-fostering counseling program provides an applicable solution to support post-abortion primigravida mothers in their psychological well-being. Future research could examine protective factors that may affect psychological well-being and hope levels, such as social support and coping strategies. Additionally, more researches are recommended to study post-abortion mothers with varying parity and different types of abortions, rather than missed or incomplete abortions. Overall, this study contributed to the growing body of knowledge on the role of counseling programs in post-abortion psychological health.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbbreviation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 444px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDefinition\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eRM-ANOVA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 444px;\"\u003e\n \u003cp\u003eRepeated-measures analysis of variance.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003eADHS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 444px;\"\u003e\n \u003cp\u003eAdult Dispositional Hope Scale.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003ePWB-18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 444px;\"\u003e\n \u003cp\u003eThe 18-Item Version of Ryff\u0026rsquo;s Psychological Well-Being\u0026nbsp;Scale.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003ePPT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 444px;\"\u003e\n \u003cp\u003ePositive Psychotherapy.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEthical approval for the study was obtained from the Deanship of Scientific Research at the University of Jordan, the Ministry of Health Research and Ethics Committee, and the Royal Medical Services Research and Ethics Committee in the Hashemite Kingdom of Jordan in 2024.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe participants were informed about the study protocol before the study began and provided informed consent to participate. The participants were assured that all data would be used in anonymity for research purposes only. Participants could also withdraw from the study at any time without any penalties. Overall, the researchers adhere to the Declaration of Helsinki throughout the study, particularly in their interactions with participants.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNot applicable.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe datasets used or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe authors declare that they have no competing interests.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe authors didn’t receive any funding for this work.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e• \u003cem\u003eLina Badran: Writing- Original draft preparation, Data collection, and providing the counselling program. \u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e•\u0026nbsp; \u0026nbsp;Alia Mahadeen: Supervision.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e•\u0026nbsp; \u0026nbsp;Doaa Al-Tamimi: Data collection, Data analysis and interpretation.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e•\u0026nbsp; \u0026nbsp;Doaa Noayran: Writing- Reviewing and Editing.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e•\u0026nbsp; \u0026nbsp;Fatimah Tarawneh: Conceptualization, Methodology.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe authors are deeply grateful to the anonymous peer reviewer for their dedicated time and expertise. The authors believe that the reviewer feedback and constructive criticism will enhance this research paper’s quality and credibility.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe authors appreciate the reviewers through assessment, which will improve the clarity and coherence of the work. Peer reviewers' ideas will contribute significantly to scientific knowledge and academic publications, fostering excellence and integrity in research.\u003c/em\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMatud MP, L\u0026oacute;pez-Curbelo M, Fortes D (2019) Gender and psychological well-being. Int J Environ Res Public Health 16(19):3531\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization (2023) Clinical practice handbook for quality abortion care. World Health Organization\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarshall JE, Raynor MD (2014) Myles\u0026rsquo; Textbook for Midwives E-Book: Myles\u0026rsquo; Textbook for Midwives E-Book. Elsevier Health Sciences\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization (2022) WHO recommendations on self-care interventions: self-management of medical abortion. World Health Organization\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTaybeh E, Hamadneh S, Al-Alami Z, Abu-Huwaij R (2023) Navigating miscarriage in Jordan: understanding emotional responses and coping strategies. BMC Pregnancy Childbirth 23(1):757\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRouzi AA, Alamoudi R, Turkistani J, Almansouri N, Alkafy S, Alsinani N et al (2020) Miscarriage perceptions and experiences among Saudi women. Clin Exp Obstet Gynecol 47(2):208\u0026ndash;214\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl-Alami Z, Abu-Huwaij R, Hamadneh S, Taybeh E (2024) Understanding Miscarriage Prevalence and Risk Factors: Insights from Women in Jordan. Medicina 60(7):1044\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNegi S, Sharma K, Acharya A, Prabhu A, Dwivedi R, Athe R (2023) Impact of medical, surgical and expectant management on spontaneous miscarriage/abortion on first trimester: A systematic review and meta-analysis of randomized, controlled trials. Qeios\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaird S, Gagnon MD, deFiebre G, Briglia E, Crowder R, Prine L (2018) Women\u0026rsquo;s experiences with early pregnancy loss in the emergency room: A qualitative study. Sex reproductive Healthc 16:113\u0026ndash;117\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQuenby S, Gallos ID, Dhillon-Smith RK, Podesek M, Stephenson MD, Fisher J et al (2021) Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss. Lancet 397(10285):1658\u0026ndash;1667\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGebeyehu NA, Tegegne KD, Abebe K, Asefa Y, Assfaw BB, Adella GA et al (2023) Global prevalence of post-abortion depression: systematic review and Meta-analysis. BMC Psychiatry 23(1):786\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmorti M, Ponti L, Simoncini T, Mannella P, Bottone P, Pancetti F et al (2021) Pregnancy after miscarriage in primiparae and multiparae: implications for women\u0026rsquo;s psychological well-being. J reproductive infant Psychol 39(4):371\u0026ndash;381\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBiggs MA, Brown K, Foster DG (2020) Perceived abortion stigma and psychological well-being over five years after receiving or being denied an abortion. PLoS ONE 15(1):e0226417\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCeran MU, Tasdemir U (2022) A comparative prospective study with depression, anxiety and quality of life scales in women with induced abortion and miscarriage before pregnancy termination. J Contemp Med 12(2):364\u0026ndash;368\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHsu HW, Huang JP, Au HK, Lin CL, Chen YY, Chien LC et al (2024) Impact of miscarriage and termination of pregnancy on subsequent pregnancies: A longitudinal study of maternal and paternal depression, anxiety and eudaimonia. J Affect Disord 354:544\u0026ndash;552\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStrumpf E, Lang A, Austin N, Derksen SA, Bolton JM, Brownell MD et al (2021) Prevalence and clinical, social, and health care predictors of miscarriage. BMC Pregnancy Childbirth 21:1\u0026ndash;9\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUROOJ A, KHAN S, AWAN F. FREQUENCY OF SPONTANEOUS, MISCARRIAGES IN OBESE AND NON-OBESE WOMEN (2024) Biol Clin Sci Res J 2024(1):670\u0026ndash;670\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003edeMontigny F, Verdon C, Meunier S, Gervais C, Cot\u0026eacute; I (2020) Protective and risk factors for women\u0026rsquo;s mental health after a spontaneous abortion. Rev Latinoam Enferm 28:e3350\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBagheri L, Nazari AM, Chaman R, Ghiasi A, Motaghi Z (2020) The effectiveness of healing interventions for post-abortion grief: A systematic review and meta-analysis. Iran J Public Health\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbd-Elsalam Elhgry M, Diab Abd Elwahab Diab G, Elsayed Ibrahim S (2020) Effect of self-compassion based intervention on self-compassion, life satisfaction and psychological well-being among older adults. Egypt J Health Care 11(1):1111\u0026ndash;1127\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBiałek K, Sadowski M, Adamczyk-Gruszka O, Młodawski J, Świercz G (2024) Level of basic hope and symptoms of anxiety and depression in women after miscarriage. Archives Med Science: AMS 20(1):332\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorales-Rodr\u0026iacute;guez FM, Espigares-L\u0026oacute;pez I, Brown T, P\u0026eacute;rez-M\u0026aacute;rmol JM (2020) The relationship between psychological well-being and psychosocial factors in university students. Int J Environ Res Public Health 17(13):4778\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMendes DCG, Fonseca A, Cameir\u0026atilde;o MS (2023) The psychological impact of Early Pregnancy Loss in Portugal: incidence and the effect on psychological morbidity. Front Public Health 11:1188060\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFurtado-Eraso S, Mar\u0026iacute;n‐Fern\u0026aacute;ndez B, Escalada‐Hern\u0026aacute;ndez P (2024) Perinatal loss, a devastating cyclone: A situation‐specific nursing theory. J Nurs Scholarsh\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChan SCY, Ng CW, Huang QL (2024) The role of hope in depressive and anxiety symptoms in emerging and older adults: a network approach. Curr Psychol. ;1\u0026ndash;14\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRaphi F, Bani S, Farvareshi M, Hasanpour S, Mirghafourvand M (2021) Effect of hope therapy on psychological well-being of women after abortion: a randomized controlled trial. BMC Psychiatry 21:1\u0026ndash;10\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eColla R, Williams P, Oades LG, Camacho-Morles J (2022) A New Hope for positive psychology: a dynamic systems reconceptualization of hope theory. Front Psychol 13:809053\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRyff CD (1989) Happiness is everything, or is it? Explorations on the meaning of psychological well-being. J Personal Soc Psychol 57(6):1069\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEgner TM, Kluck JJ (2019) How Nurse-Midwives Can Best Support Families Who Have Experienced Perinatal Loss\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeite A, Medeiros A, Rolim C, Pinheiro K, Beilfuss M, Le\u0026atilde;o M et al (2019) Hope theory and its relation to depression: a systematic review. Annals Psychiatry Clin Neurosci. ;2(2)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMurphy ER (2023) Hope and well-being. Curr Opin Psychol 50:101558\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShaohua L, Shorey S (2021) Psychosocial interventions on psychological outcomes of parents with perinatal loss: a systematic review and meta-analysis. Int J Nurs Stud 117:103871\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFern\u0026aacute;ndez-Basanta S, Coronado C, Bondas T, Movilla-Fern\u0026aacute;ndez MJ (2021) Primary healthcare midwives\u0026rsquo; experiences of caring for parents who have suffered an involuntary pregnancy loss: a phenomenological hermeneutic study. Midwifery 92:102863\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHammood HJ, Kadhim ST, Washeel OF (2020) Awareness of Nurse Midwives\u0026rsquo; toward Post-miscarriage Care at Bint Al-Huda Hospital in Al-Nasiriya City. Indian J Forensic Med Toxicol 14(3):2666\u0026ndash;2672\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePleeging E, Burger M, van Exel J (2021) The relations between hope and subjective well-being: A literature overview and empirical analysis. Appl Res Qual Life 16(3):1019\u0026ndash;1041\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChan K, Wong FK, Lee PH (2019) A brief hope intervention to increase hope level and improve well-being in rehabilitating cancer patients: A feasibility test. SAGE Open Nurs 5:2377960819844381\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChodankar D, Bhatt A, Davis S (2025) Declaration of Helsinki 2024: Too much too late? Perspect Clin Res 16(1):1\u0026ndash;2\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAziz IA, Hassan SS (2019) Investigating the association between psychological well-being and hope among the IDPs in Erbil. Zanco J Humanity Sci 23(3):539\u0026ndash;548\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSnyder CR, Harris C, Anderson JR, Holleran SA, Irving LM, Sigmon ST et al (1991) The will and the ways: development and validation of an individual-differences measure of hope. J Personal Soc Psychol 60(4):570\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVinueza-Sol\u0026oacute;rzano AM, Campoverde RE, Portalanza-Chavarr\u0026iacute;a CA, de Freitas CP, Hutz CS, Vazquez ACS (2023) Adaptation and validation of the Adult Dispositional Hope Scale in the Ecuadorian context. Psicologia: Reflex\u0026atilde;o e Cr\u0026iacute;tica 36:3\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePalas Karaca P, Oskay \u0026Uuml;Y (2021) Effect of supportive care on the psychosocial health status of women who had a miscarriage. Perspect Psychiatr Care 57(1):179\u0026ndash;188\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChang SC, Kuo PL, Chen CH (2021) Effectiveness of empathic caring on stress and depression for women with recurrent miscarriage: A randomized controlled trial. Complement Ther Clin Pract 43:101367\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarat S, Yazdani S, Faramarzi M, Khafri S, Darvish M, Rad MN et al (2020) The effect of brief supportive psychotherapy on prevention of psychiatric morbidity in women with miscarriage: a randomized controlled trial about the first 24-hours of hospitalization. Oman Med J 35(3):e130\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYanık D, Kavak Budak F (2024) The effect of positive psychotherapy-based training on psychological well-being and hope level in women receiving infertility: experimental study. J Reproductive Infant Psychol 42(3):381\u0026ndash;394\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"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":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hope-fostering Counseling Program, Psychological Well-Being, Hope Level, Post-Aborted Primigravida Mothers","lastPublishedDoi":"10.21203/rs.3.rs-8936623/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8936623/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Abortion is the most common complication during early pregnancy and may increase the risk of various physical and psychological disorders. While psychological interventions can help promote psychological well-being and hope levels among mothers with traumatic histories, a hope-fostering counseling program is considered one of these interventions. This study aims to investigate the potential effectiveness and feasibility of a hope-fostering counseling program on psychological well-being and hope levels among post-abortion primigravida mothers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This was a quasi-experimental study with a one-group pretest-posttest design. Eight post-abortion primigravida mothers were recruited from two healthcare institutions to participate in this pilot testing. The intervention was adapted from Snyder's Hope theory and included six counseling sessions over six weeks during the post-abortion period. Counseling sessions were conducted via individualized discussion. The Arabic versions of the Ryff Psychological Well-Being Questionnaire (PWB-18) and the Adult Dispositional Hope Scale (ADHS) were administered at three occasions: before the first session and at the third and sixth interviews. Repeated-measures analysis of variance (RM-ANOVA) was used to analyze the study variables.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The mean PWB-18 and ADHS scores increased from 35.50 ± 8.77 and 19.25 ± 4.03 at baseline to 54.88 ± 6.64 and 31.00 ± 3.67 at the third-week assessment, and to 78.25 ± 4.53 and 48.88 ± 2.17 after the sessions, respectively. The results demonstrated significant improvement in PWB-18 scores (F (2, 14) = 412.49, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.000) and ADHS scores (F (1.13, 7.922) = 301.19, \u003cem\u003ep \u003c/em\u003e= 0.000) among post-abortion primigravida mothers after attending the hope-fostering counseling program.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e This pilot study demonstrates the program's feasibility. However, a larger sample and inclusion of additional abortion types are needed to confirm its effectiveness and generalizability.\u003c/p\u003e","manuscriptTitle":"A Pilot Study on the Effectiveness of Hope-Focused Counselling for Psychological Well-Being in Post-abortion Primigravida Mothers","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-24 11:37:30","doi":"10.21203/rs.3.rs-8936623/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4ad34189-6d17-4df4-85b3-94fafa9fc4d5","owner":[],"postedDate":"February 24th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":63320460,"name":"Obstetrics \u0026 Gynecology"},{"id":63320461,"name":"Maternal \u0026 Fetal Medicine"}],"tags":[],"updatedAt":"2026-02-24T11:37:30+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-24 11:37:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8936623","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8936623","identity":"rs-8936623","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}