The effect of mindfulness-based nursing support on the psychosocial status of women receiving infertility treatment

The effect of mindfulness-based nursing support on the psychosocial status of women receiving infertility treatment | 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 The effect of mindfulness-based nursing support on the psychosocial status of women receiving infertility treatment Özen İnam, İlkay Güngör Satılmış This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4490798/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 20 Mar, 2025 Read the published version in BMC Women's Health → Version 1 posted 4 You are reading this latest preprint version Abstract Background The aim of the study was to evaluate the effect of mindfulness-based care support on the psychosocial status of women undergoing infertility treatment during the treatment process. Method The sample consisted of women who were about to start in vitro fertilization treatment and met the inclusion criteria. The experimental group used a mobile application specifically designed to practice mindfulness for infertility treatment at the beginning of treatment. Results The gynaecological and infertility characteristics of the experimental and control groups and their scores on the psychosocial scales used in the pretest were similar (p > 0.05). In the post-test, the scores of the participants in the experimental group from mindfulness and infertility self-efficacy scales were higher than the control group, and the scores of infertility adjustment, anxiety and depression were lower (p < 0.05). Conclusions It was observed that the mobile application developed for mindfulness contributed positively to the psychosocial status of infertile women in the treatment process. Preregistration The research was registered on http://clinicaltrials.gov (ID: NCT05708937) Registry: 24.01.2023 Infertility woman in vitro fertilization depression anxiety mindfulness Figures Figure 1 Background Infertility is not only an individual problem but also a couple’s of problem; it is defined as “the failure to conceive after one year of regular, and unprotected intercourse for one year unprotected intercourse” (Zegers Hochschild F. et al., 2009 ). Infertility is a process that has social, cultural, and psychological effects as well as physical conditions. Infertility treatment is stressful and threatening for most couples, and it becomes a life crisis because the procedures are physically painful and financially challenging (Boivin et al., 2011 ). Individuals, particularly women, in the process of infertility diagnosis and treatment need strong social support (Slauson Blevins K., 2011 ). Nurses have a supportive role in keeping the treatment process of infertile women in a harmonious manner and in accepting the situation and preparing for retreatment when the treatment outcome is not successful (Güngör & Beji̇, 2015 ; Örüklü, 2020 ). Mindfulness is a concept that has recently gained popularity and has been defined by Brown and Ryan ( 2003 ) as “focusing an individual’s attention on the present moment in a non-judgmental and accepting manner" (Brown & Ryan, 2003 ). Although mindfulness has been around for many years, it is only in recent years that it has been the subject of research into its effects on health. There are studies showing that mindfulness helps patients especially to cope with stress, pain or chronic diseases (Fanning et al., 2018 ; Garland et al., 2022 ; Hanley et al., 2021 ; Hilton et al., 2017 ; Ngamkham et al., 2019 ; Reiner et al., 2013 ; Sala et al., 2020 ; Tomlinson et al., 2018 ; Zeidan et al., 2019 ). There are also studies in the literature showing that mindfulness-based care is an effective method to improve psychological health such as quality of life, stress, and marital harmony in infertile women (Abedi Shargh et al., 2015 ; Fard et al., 2018 ; Hosseini et al., 2020 ; Sherratt & Lunn, 2013 ). In many studies, it has been observed that mindfulness studies are effective on psychosocial problems (anxiety, stress, self-compassion, marital harmony) experienced in infertility (Boedt et al., 2022 ; Fard et al., 2018 ; Galhardo et al., 2018 ; Hosseini et al., 2020 ; Jensen et al., 2021 ; Jufferie, 2019 ; Monteiro et al., 2016 ; Patel et al., 2020 ). In this study, we measured the effect of a mobile application developed for mindfulness-based psychosocial support in women undergoing infertility treatment on the psychosocial status of infertile women during the treatment process was measured. Materials and methods Participants This study is a randomized controlled experimental type of study. The power analysis calculation of the sample size was based on previous international studies (Hosseini et al., 2020 ) and the optimal number of female participants was determined as 17 experimental groups with an effect size of 0.754. In total, 34 women who met the inclusion criteria were included. Women (n:15) receiving treatment at an IVF (in vitro fertilization) Center Clinic in Istanbul and women who used social media and receiving IVF treatment (n:19) were included in the study. Randomization was performed using random number sequences generated on " www.random.org" . For this purpose, the numbers for the experimental and control groups were generated with random number sequences for a total of 40 people, taking into account the losses. People who met the criteria were assigned to the experimental or control group according to this number sequence in the order of participation in the study. When cases withdrew from the study, new cases were assigned to the corresponding number of people. Inclusion criteria Completion of the informed consent form and voluntary participation in the study Not have a psychiatric diagnosis (schizophrenia, bipolar disorder, major depression, anxiety disorders, etc.) Be at the beginning of IVF treatment (starting ovarian stimulation) or soon to start treatment A maximum of three previous IVF attempts Use a smartphone Speak and understand Turkish Over 18 years of age Exclusion criteria Termination of treatment at any stage Embryo transfer failure Voluntary withdrawal from the study The flow chart created using the Consolidated Standards of Reporting Trials (CONSORT) flow chart for reporting trials for the sample group achieved is shown in Fig. 1. The trial has been registered with Clinical Trials and the ID number is "4802180202". Measures Personal information form The 21-item form was developed by the researchers. It consists of socio-demographic information and questions about infertility and obstetric history. Mindful Attention Awareness Scale (MAAS) This scale, which was developed by Brown and Ryan in 2003, aims to measure mindfulness and attention to momentary experiences in daily life. The scale contains 15 items and is responded to as a 6-point Likert scale. The higher the score on the scale, the higher the level of mindfulness. The Mindful Attention Awareness Scale has a single-factor structure and a single total score. The internal consistency coefficient of the Turkish version of the scale is Cronbach Alpha (α) = 0.80 (Özyeşil et al., 2011 ). The consistency of the scale in our study was found to have a good degree of reliability, with the Cronbach’s Alpha coefficient being 0.872 in the pre-test and 0.957 in the post-test. The Depression Anxiety Stress Scale (DASS 21) This is the abbreviation of the Depression Anxiety Stress Scale (DASS 21), which is used to measure the level of depression, anxiety and stress. The long version of the scale (DASS 42) was developed by Lovibond and Lovibond (1995) (Szabó, 2010 ). The 4-point Likert-type scale, which aims to measure the level of “depression, anxiety and stress” under three headings, consists of a total of 21 items. Scoring 5 points in the depression subdimension, 4 or more points in anxiety and 8 or more points in stress indicates that the individual has a relevant problem. The internal consistency coefficient of the Turkish version of the scale is α = 0.808 for anxiety, 0.819 for depression, and 0.756 for stress (Yılmaz et al., 2017 ). When the scale reliability of our study was examined, the Cronbach alpha coefficient of the DASS 21 Scale in the pre-test was 0.870, while the Cronbach alpha coefficients of the subdimensions were 0.576 for anxiety, 0.838 for depression, and 0.587 for stress. As a result of the analysis, it was determined that the DASS 21 scale and its sub-dimensions were found to have good reliability. Infertility Self-Efficacy Scale-Short Form It was developed in 2006 to assess individuals' self-efficacy perceptions of the strength of their emotional, cognitive, and behavioral skills in relation to infertility (Cousineau et al., 2006 ). The nine-point Likert-type scale consists of a total of 16 items and the short form consists of 10 items. The internal consistency coefficient of the Turkish version of the scale is α:0.78 (Arslan Özkan et al., 2014 ). The scale is unidimensional, and the scores are between 8 and 32. The higher the score, the higher the perceived self-efficacy. The Cronbach alpha coefficient of the scale used in our study was 0.733 in the pre-test. As a result of the analysis, the scale was found to have a good level of reliability. Fertility Adjustment Scale It was developed by Glover et al in 1999 to standardize the measurement of psychological adjustment in infertility (Glover et al., 1999 ). The scale is a 12-item, six-point Likert scale. The minimum scale score is 12 and the maximum score is 72. A high score on the Infertility Adjustment Scale indicates inadequate adjustment. The internal consistency coefficient of the Turkish version of the scale is α:0.77 (Arslan Özkan, 2012 ). In our study, the Cronbach alpha coefficient in the pretest of the scale was 0.689. The scale and its sub-dimensions were found to have good reliability. Data analysis SPSS (Statistical Package for Social Sciences) for Windows 25.0 program was used for the statistical analysis of the data. Descriptive statistics (mean, standard deviation, median, quards, percentage) and chi-square analysis for homogeneity were used to evaluate the data. The Kolmogrov-Smirnov-Shapiro-Wilk method was used to test for normal distribution of quantitative data, and the Mann-Whitney U analysis was used to test for differences between two independent groups when comparing data that were not normally distributed. The Wilcoxon signed-ranks test was used for within-group comparisons of non-normally distributed quantitative variables. Mindfulness therapy content specific to infertility Content texts were prepared by scanning national and international foreign sources for mindfulness meditation specific to the infertility treatment process (Atalay Z., 2018; Bettina Rae, 2022; Bree Taylor Molyneaux, 2015; Fertility from the Soul, 2019; Jackie, 2016; Mindfulness Institute, 2018; MyIVFanswers, 2019). For expert opinions, the opinions of faculty members from the fields of women’s health nursing, psychiatric nursing, psychologists, and linguists working in the field of mindfulness were consulted. The final content of the meditation was determined after receiving the expert opinions. The mindfulness audio recording content specific to infertility has been created as six different meditation contents and they were designed as follows: Breath Awareness (14 minutes) Body Scan (specific to IVF treatment) (28 minutes) Drug Administration and Ovarian Awareness (18 minutes) Diaphragm Breath before Oocyte Pick up (OPU) (13 minutes) Uterine Awareness Before Embryo Transfer (20 minutes) Post-Transfer Embryo and Uterine Awareness (23 minutes). After determining the meditation content, the meditation suggestions were recorded by the researcher using a voice recorder in a quiet environment. Background music was added to the sound recordings by the expert to increase the effect of the meditation suggestions. Interventions in the experimental and control groups and data collection Before all tests were administered to the participants, information was given about the purpose, scope, content and procedure of the study. Pre-tests were administered to the participants at the first interview. A WhatsApp group called IVFMind was created for the participants in the experimental group. In the group where the administrator could send one-way messages, the experimental group was informed of the meeting dates and a daily mindfulness message was sent every morning. At the meeting, information was given about “the IVF treatment process and the stages of infertility, the physical and mental changes experienced during infertility treatment process, the purpose of the study, and how the study would be conducted”. They were then given a training on 'Mindfulness and Mobile Application'. The training lasted 120 minutes on average. At the end of the session, mindfulness breathing and body awareness exercises were done with the women. Participants who completed the training were asked to listen regularly to mindfulness audio recordings through the mobile application during the treatment. The control group received 30 minutes of training about infertility treatments. During the training, women were informed about the IVF treatment process and the stages of infertility, as well as the physical and mental changes that occur during infertility treatment. On the same day, 'scales' were used as a pre-test before the training. After the embryo transfer for all participants, the scales were applied again as a post-test two days before the pregnancy test day. Results A comparison of the socio-demographic characteristics of the participants showed that the experimental and control groups were homogeneously distributed. There was no significant difference in infertility-related characteristics between the experimental and control groups (p > 0.05). Comparison of participants’ scores on the Mindful Attention Awareness Scale (MAAS) scores There was no statistically significant difference between participants' scores on the Mindful Attention Awareness Scale at pre-test (U = 120,000, p = 0.398 > 0.05). In the post-test, it was found that there was a statistically significant difference between the MAAS scores of experimental and control groups (U = 0.000, p = 0.000 < 0.05). Accordingly, it was concluded that the experimental group had a higher score on the Mindful Attention Awareness Scale (MAAS) scale than the control group (Table 1 ). Table 1 Comparison of the MAAS scale pretest-posttest scores of the experimental-control groups N Min Medyan (Q1-Q3) Max \(\stackrel{-}{\varvec{x}}\) Ss Test i statistic p Pre Test experimental 17 30,00 37,00 (32,50 − 47,00) 55,00 40,06 8,63 U = 120,000 0,398 control 17 30,00 42,00 (35,50 − 44,50) 59,00 41,76 7,22 Post Test experimental 17 59,00 68,00 (63,00–70,00) 76,00 66,88 4,59 U = 0,000 0,000* control 17 32,00 42,00 (38,50 − 46,50) 57,00 42,65 6,12 U: Mann Whitney U test statistic *p < 0,05 Comparison of the participants’ infertility adjustment and self-efficacy scale scores There was no statistically significant difference between infertility self-efficacy scale scores of participants in the experimental and control groups in the pre-test (U = 125,500, p = 0.503 > 0.05). In the post-test, there was a statistically significant difference between infertility self-efficacy scale scores of the experimental and control groups (U = 0.000, p = 0.000 < 0.05). Accordingly, it was observed that the experimental group had a higher score on the infertility self-efficacy scale than the control group (Table 2 ). Table 2 Comparison of the infertility self-efficacy scale pretest-posttest scores of the experimental and control groups N Min Medyan (Q1-Q3) Max \(\stackrel{-}{\varvec{x}}\) Ss Test statistic p Pre Test experimental 17 12,00 15,00 (13,00–15,50) 23,00 15,29 2,78 U = 125,500 0,503 control 17 12,00 14,00 (13,50 − 15,00) 23,00 15,35 3,44 Post Test experimental 17 22,00 28,00 (26,00–28,50) 30,00 26,88 2,32 U = 0,000 0,000* control 17 13,00 15,00 (14,50 − 16,50) 21,00 15,71 2,17 U: Mann Whitney U statistic *p < 0,05 In the pre-test, it was found that there was no statistically significant difference between the scores of the participants in the experimental and control groups on the Infertility Adjustment Scale (U = 106.500, p = 0.184 > 0.05). In the post-test, it was found that there was a statistically significant difference between the scores of the participants in the experimental and control groups on the Infertility Adjustment Scale (U = 3,000, p = 0,000 < 0.05). Accordingly, it was observed that the experimental group had lower scores on the Infertility Adjustment Scale than the control group (Table 3 ). Table 3 Comparison of the infertility adjustment scale pretest-posttest scores of the experimental and control groups N Min Medyan (Q1-Q3) Max \(\stackrel{-}{\varvec{x}}\) Ss Test statistic p Pre Test experimental 17 15,00 27,00 (24,50 − 28,00) 31,00 25,94 3,44 U = 106,500 0,184 control 17 14,00 28,00 (25,00–29,00) 31,00 26,53 4,14 Post Test experimental 17 11,00 15,00 (13,00–17,50) 24,00 15,53 3,43 U = 3,000 0,000* control 17 20,00 29,00 (25,00–33,50) 39,00 29,59 5,65 U: Mann Whitney U test statistic *p < 0,05 Comparison of participants’ scores on the Depression Anxiety Stress Scale (DASS 21) There was no statistically significant difference between the pre-test scores of participants in the experimental and control groups on the DASS 21 scale (U = 141,000, p = 0.904 > 0.05) (Table 4 ). Table 4 Comparison of the Depression-Anxiety-Stress Scale (DASS 21) and sub-dimensions pretest-posttest scores of the experimental-control groups Pre Test N Min Medyan (Q1-Q3) Max \(\stackrel{-}{\varvec{x}}\) Ss Test statistic p DASS 21 experimental 17 7,00 28,00 (22,50 − 32,50) 42,00 27,59 9,00 U = 141,000 0,904 control 17 10,00 29,00 (18,00–34,00) 45,00 27,00 9,61 DASS 21 Anxiety experimental 17 2,00 8,00 (6,50 − 10,00) 14,00 8,47 3,00 U = 119,000 0,375 control 17 3,00 9,00 (6,50 − 11,00) 14,00 9,06 2,90 DASS 21 Depression experimental 17 0,00 7,00 (4,50 − 11,00) 14,00 7,12 4,04 U = 126,000 0,519 control 17 1,00 7,00 (5,50 − 11,00) 17,00 7,88 4,20 DASS 21 Stress experimental 17 5,00 13,00 (8,00–15,50) 19,00 12,00 4,83 U = 105,500 0,176 control 17 3,00 11,00 (5,50 − 13,00) 17,00 10,06 4,07 Post Test N Min Medyan (Q1-Q3) Max \(\stackrel{-}{\varvec{x}}\) Ss Test statistic p DASS 21 experimental 17 6,00 17,00 (12,50 − 21,50) 25,00 16,65 5,00 U = 56,500 0,002* control 17 11,00 28,00 (17,00–34,00) 45,00 26,82 9,46 DASS 21 Anxiety experimental 17 2,00 5,00 (3,00–7,00) 9,00 4,88 2,26 U = 39,500 0,000* control 17 2,00 10,00 (7,00–11,00) 13,00 9,00 2,89 DASS 21 Depression experimental 17 1,00 4,00 (2,50 − 7,00) 8,00 4,35 2,23 U = 59,500 0,003* control 17 2,00 8,00 (5,50 − 9,50) 17,00 7,82 3,80 DASS 21 Stress experimental 17 2,00 8,00 (5,50 − 9,00) 13,00 7,41 2,53 U = 89,500 0,057 control 17 3,00 12,00 (5,00–13,00) 17,00 10,00 4,36 U: Mann Whitney U test statistic *p < 0,05 However, it was found that there was a statistically significant difference between the participants post-test scores on the (U = 56.500, p = 0.002 < 0.05). Accordingly, it was found that the experimental group scored lower on the DASS 21 scale than the control group (Table 4 ). Considering the scores of the participants in the experimental and control group participants in the post-test on the sub-dimension of the DASS scale; It was observed that the experimental group had lower scores in the depression sub-dimension of the DASS scale (U = 59.500, p = 0.003 < 0.05) compared to the control group. It was observed that the anxiety sub-dimension score of the experimental group was lower than that of the control group (U = 39.500, p = 0.000 0.05). Discussion The most important and even unique element of holistic care is nursing. By its very nature, nursing observes and assesses patients throughout their lives. Due to many factors, such as the patient's social environment and adaptation to the disease, nursing requires being with the patient in every area and moment of care. In recent years, Western medicine has begun to investigate the effects of meditation-like practices on medical treatments (Coats et al., 2011 ). The benefits of using many practices such as mind-body exercises, relaxation techniques and yoga in the field of health have been demonstrated in many studies (Acevedo et al., 2016 ; Salmon et al., 2009 ; Shattell, 2004 ; Wahbeh et al., 2008 ). Mindfulness is a psychological coping strategy commonly used by infertility patients. Studies in the field of infertility show that mindfulness interventions are an effective way to improve women's psychological health (such as quality of life, stress, and marital harmony) in women (Abedi Shargh et al., 2015 ; Fard et al., 2018 ; Hosseini et al., 2020 ; Sherratt & Lunn, 2013 ). A randomized controlled trial, it was found that infertile women in the experimental group had increased self-compassion and mindfulness skills and higher pregnancy rates (Li et al., 2016 ). Mindfulness can also be chosen as an effective method to reduce stress, anxiety and depression in infertile women and to gain self-efficacy and adjustment to infertility. Our study found that the mindfulness scores of the experimental group were significantly higher than those of the control group (U = 0.000, p = 0.000 < 0.05). Data from two separate randomized controlled trials using mindfulness intervention in infertile women are similar to our study. The level of mindfulness of the experimental group increased significantly compared to the control group (Galhardo et al., 2013 ; Li et al., 2016 ). In a study which investigating the effect of mindfulness-based therapy on the psychological well-being of infertile women, 30 control groups (15 with pretest and 15 without pretest) and 30 experimental groups were evaluated (Fard et al., 2018 ). As a result of the study, it was found that there was a significant difference in the psychological well-being scores of the experimental group and sub-dimension mindfulness scores compared to the control group. In one study, a group of 25 women undergoing IVF treatment underwent the MBSR intervention, 12 weeks of mindfulness and relaxation meditation. At the end of the study, it was found through the interviews with the women revealed that psychological improvements such as general well-being and mindfulness were achieved (Paiva et al., 2015 ). According to the data of our study, the self-efficacy scores of the experimental group increased significantly in the post-test and the infertility adjustment scores decreased. In other words, it was observed that the self-efficacy perceptions of the experimental group increased and their adjustment to infertility improved. Self-efficacy known to be low in infertility (Minucci, 2013 ; Pasha et al., 2013 ). Studies show that mindfulness therapy in infertile women increases their self-efficacy in infertile women (Faramarzi et al., 2008 ; Pasha et al., 2013 ). One study found that mindfulness practice was as effective as a pharmacological treatment in some other psychological outcomes, such as self-efficacy in infertile women, or even more effective in some patients (Fard et al., 2018 ). It can be argued that mindfulness practices not only cause an increase in mindfulness scores, but also have a mediating effect on the improvement of other psychological symptoms. In this regard, another study found that mindfulness has a mediating effect on self-efficacy (Luberto et al., 2014 ). According to the results of the analysis, it was determined that there was a statistically significant difference between the pre-test and post-test DASS scores of the participants in the experimental group (Z=-2.940, p = 0.003 < 0.05). Accordingly, there was a decrease in depression, anxiety and stress scores in the experimental group of our study. In the studies in the literature, it is observed that mindfulness-based practices are used to reduce stress and anxiety in infertility and have effective results (Galhardo et al., 2019 ; Hosseini et al., 2020 ; Kalhori et al., 2020 ; Li et al., 2016 ; Nery et al., 2019 ; Patel et al., 2020 ). The effects of a mindfulness intervention developed by Galhardo et al. specifically for infertile women were followed for 7 years, and it was found that mindfulness skills and self-efficacy improved, and anxiety and depression symptoms decreased in 55 women who received mindfulness (Galhardo et al., 2019 ). In our study, similar to the results of this study, it was observed that the self-efficacy and mindfulness scores of the women in the experimental group increased. That is, the self-efficacy and mindfulness of the experimental group improved, and their depression, anxiety and stress levels decreased. In the study investigating the effect of a mindfulness stress reduction program on “depression, anxiety, stress and tolerance to uncertainty” in infertile women in Iran, an assessment was made using with the DASS scale. In a randomized controlled trial, study participants (n = 15) in the MBSR group received 2 hours of face-to-face mindfulness meditation once a week for 8 weeks. As a result of the study, as in our study, a significant difference was found between the post-test scores of the experimental group and the control groups in terms of depression, anxiety and stress scores (Mousavi et al., 2020 ). In a randomized controlled trial in which Bai et al investigated the effects of a self-administered mindfulness intervention on psychological distress in women undergoing IVF or ICSI and found that the intervention was effective on depression and sleep quality (Bai et al., 2019 ). Scales were administered on the day of regulation, 1 day before embryo transfer and 2 days before the pregnancy testing. The study was similar to our mindfulness practice study, and the patients were listened to 20-minute audio recordings. However, in Bai's study, mindfulness practice included awareness of the breath and the body. In our study, in addition to breath and body awareness, “uterus awareness, needle therapy awareness, pre-oocyte pick-up awareness, pre/post embryo transfer awareness” were applied. In the literature review, when we look at the studies evaluating depression, anxiety and stress levels by presenting the mindfulness-based intervention to infertile women using a mobile application, there are few studies. An application called MoMifer has been developed in Belgium and has similar features to our study. The study aims to measure the effectiveness of applying mindfulness to infertile patients on symptoms of emotional distress (depression, anxiety, stress) symptoms and quality of life (Boedt et al., 2022 ). In contrast to our study, the study was conducted with groups of women, men or couples. In the mobile application, mindfulness exercises are introduced with a short video (talking head) and consist of two audio files. The method of the study and the dependent variables and measurement tools to be analyzed are similar, and the results of the MoMiFer application have not yet been published. Conclusion According to our study, mindfulness-assisted psychosocial support with a mobile application was found to reduce problems such as depression and anxiety in infertile women and increase the level of mindfulness and infertility self-efficacy and compliance. As a result, it was observed that the mobile application developed for mindfulness contributed positively to the psychosocial status of infertile women during the treatment process. As in our study, mindfulness-based interventions improve the mindfulness level of mindfulness in infertile women and affect their general psychosocial status. Mindfulness interventions can be applied in different ways; face-to-face, group therapy, online, or by listening to audio recordings. In our study, mindfulness in the mobile application was found to be advantageous for infertile women because it is easily accessible, free of charge, does not require the woman to go anywhere and can be done in a way specific to her treatment. Abbreviations IVF in vitro fertilization MAAS Mindful Attention Awareness Scale DASS 21 The Depression Anxiety Stress Scale Declarations Ethical approval and constant to participate This work is a doctoral thesis. Ethical approval was obtained with the permission letter numbered E-74555795-050.01.04-52289 dated 08.02.2021 from Istanbul University Social and Human Sciences Ethics Committee. Informed consent was obtained from the patients whose data would be collected in the study. We acknowledge that the research complies with the Declaration of Helsinki Consent for publication All patients have been informed and have consented to publication. Availability of data and materials Data and materials are available when needed by contacting the corresponding author Competing interest The authors have declared no potential conflicts of interest. Funding None. This study received no financial support from any public or private institution. Authors’ contributions Ö.İ collected and analyzed the data and wrote the article. The article was reviewed and conceptualized by Ö.İ and İ.G.S. All authors approved the final manuscript Acknowledgements The research group would like to thank all the generous women for supporting the study during difficult times of infertility treatments and the pandemic. References Abedi Shargh N, Bakhshani NM, Mohebbi MD, Mahmudian K, Ahovan M, Mokhtari M, Gangali A. The Effectiveness of Mindfulness-Based Cognitive Group Therapy on Marital Satisfaction and General Health in Woman With Infertility. Global J Health Sci. 2015;8(3):230. https://doi.org/10.5539/gjhs.v8n3p230 . Acevedo BP, Pospos S, Lavretsky H. The Neural Mechanisms of Meditative Practices: Novel Approaches for Healthy Aging. Curr Behav Neurosci Rep. 2016;3(4):328–39. https://doi.org/10.1007/s40473-016-0098-x . Arslan Özkan İ. (2012). 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Is psychotherapy a reliable alternative to pharmacotherapy to promote the mental health of infertile women? A randomized clinical trial. Eur J Obstet Gynecol Reproductive Biology. 2008;141(1):49–53. https://doi.org/10.1016/j.ejogrb.2008.07.012 . Fard TR, Kalantarkousheh M, Faramarzi M. Effect of mindfulness-based cognitive infertility stress therapy on psychological well-being of women with infertility. Middle East Fertility Soc J. 2018;23(4):476–81. https://doi.org/10.1016/j.mefs.2018.06.001 . Galhardo A, Cunha M, Pinto-Gouveia J. Mindfulness-Based Program for Infertility: Efficacy study. Fertil Steril. 2013;100(4):1059–67. https://doi.org/10.1016/j.fertnstert.2013.05.036 . Galhardo A, Cunha M, Pinto-Gouveia J. A 7‐year follow‐up study of the Mindfulness‐Based Program for Infertility: Are there long‐term effects? Clin Psychol Psychother. 2019;26(4):409–17. https://doi.org/10.1002/cpp.2362 . Galhardo A, Moura-Ramos M, Cunha M, Pinto-Gouveia J. How Does the Mindfulness-Based Program for Infertility (MBPI) Work in Reducing Depressive Symptoms? Mindfulness. 2018;9(2):629–35. https://doi.org/10.1007/s12671-017-0805-z . Garland EL, Hanley AW, Nakamura Y, Barrett JW, Baker AK, Reese SE, Riquino MR, Froeliger B, Donaldson GW. Mindfulness-Oriented Recovery Enhancement vs Supportive Group Therapy for Co-occurring Opioid Misuse and Chronic Pain in Primary Care: A Randomized Clinical Trial. JAMA Intern Med. 2022;182(4):407–17. https://doi.org/10.1001/jamainternmed.2022.0033 . Glover L, Hunter M, Richards J, Katz M. Development of the fertility adjustment scale. Fertil Steril. 1999;72(4):623–8. Güngör İ, Beji̇ NK. Evolving Roles and Certifi cation Requirements of Infertility Nurses. Florence Nightingale J Nurs. 2015;23(2). Article 2. https://doi.org/10.17672/fnhd.76545 . Hanley AW, Gililland J, Garland EL. To be mindful of the breath or pain: Comparing two brief preoperative mindfulness techniques for total joint arthroplasty patients. 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Reprod Biomed Online. 2021;43(2):246–56. https://doi.org/10.1016/j.rbmo.2021.04.018 . Jufferie E. (2019). Effectiveness Of Mindfulness-Based Interventions (Mbıs) On The Psychological Outcomes Of Patients With Infertility: A Systematic Review And Meta-Analysıs [Thesis]. https://scholarbank.nus.edu.sg/handle/10635/153789 . Kalhori F, Masoumi SZ, Shamsaei F, Mohammadi Y, Yavangi M. Effect of Mindfulness-Based Group Counseling on Depression in Infertile Women: Randomized Clinical Trial Study. Int J Fertility Steril. 2020;14(1). https://doi.org/10.22074/ijfs.2020.5785 . Li J, Long L, Liu Y, He W, Li M. Effects of a mindfulness-based intervention on fertility quality of life and pregnancy rates among women subjected to first in vitro fertilization treatment. Behav Res Ther. 2016;77:96–104. https://doi.org/10.1016/j.brat.2015.12.010 . Luberto CM, Cotton S, McLeish AC, Mingione CJ, O’Bryan EM. Mindfulness Skills and Emotion Regulation: The Mediating Role of Coping Self-Efficacy. Mindfulness. 2014;5(4):373–80. https://doi.org/10.1007/s12671-012-0190-6 . Masson N (Director), editor. (2019, May 11). Fertility meditation for inviting your baby into your womb . Fertility from the Soul. https://www.youtube.com/watch?v=qugNRFPipfc . Minucci D. Psychological and ethical implications related to infertility. Int J Gynecol Obstet. 2013;123(52):S36–8. https://doi.org/10.1016/j.ijgo.2013.09.006 . Wiley Online Library. Monteiro B, Galhardo A, Cunha M, Couto M, Fonseca F, Carvalho L. MindfulSpot: A mindfulness mobile app for people dealing with infertility. Eur Psychiatry. 2016;33(S1):S609–10. https://doi.org/10.1016/j.eurpsy.2016.01.2279 . Mousavi E, Hosseini S, Bakhtiyari M, Abasi I, Mohammadi A, Masjedi Arani A. The Effects of Mindfulness-based Stress Reduction Group Therapy on Anxiety, Depression, Stress, and the Intolerance of Uncertainty in Infertile Women. Iran Rehabilitation J. 2020;18(2):137–44. https://doi.org/10.32598/irj.18.2.862.1 . Nery SF, Paiva SPC, Vieira ÉL, Barbosa AB, Sant’Anna EM, Casalechi M, Cruz D, Teixeira C, A. L., Reis FM. Mindfulness-based program for stress reduction in infertile women: Randomized controlled trial. Stress Health. 2019;35(1):49–58. https://doi.org/10.1002/smi.2839 . Ngamkham S, Holden JE, Smith EL. A Systematic Review: Mindfulness Intervention for Cancer-Related Pain. Asia-Pacific J Oncol Nurs. 2019;6(2):161–9. https://doi.org/10.4103/apjon.apjon_67_18 . Örüklü C. İnfertilitede Kayıplar Kazanımlar ve Danışmanlık. In: Hotun N, Şahin, editors. Güncel Jinekoloji Hemşireliği. Akademisyen Kitabevi; 2020. p. 65. Özyeşil Z, Arslan C, Kesici Ş, Deniz ME. Bilinçli Farkındalık Ölçeği’ni Türkçeye Uyarlama Çalışması Adaptation of the Mindful Attention Awareness Scale into Turkish. Selçuk Üniversitesi Eğitim ve Bilim. 2011;36(160):224–35. Paiva SPC, Nery SF, Magalhães EB, Couto BGM, Amaral CAV, Campos FMF, Camargos AF, Reis FM. Kısa Süreli, Farkındalık Temelli Stres Azaltma Programının Kısır Kadınların İyiliği Üzerindeki Etkisi: Karma Yöntemli Bir Çalışma. J Endometr Pelvic Pain Disorders. 2015;7(4):136–40. https://doi.org/10.5301/je.5000227 . Pasha H, Faramarzi M, Esmailzadeh S, Kheirkhah F, Salmalian H. Comparison of pharmacological and nonpharmacological treatment strategies in promotion of infertility self-efficacy scale in infertile women: A randomized controlled trial. Iran J Reproductive Med. 2013;11(6):495–502. Patel A, Sharma PSVN, Kumar P. Application of Mindfulness-Based Psychological Interventions in Infertility. J Hum Reproductive Sci. 2020;13(1):3–21. https://doi.org/10.4103/jhrs.JHRS_51_19 . Reiner K, Tibi L, Lipsitz JD. Do Mindfulness-Based Interventions Reduce Pain Intensity? A Critical Review of the Literature. Pain Med. 2013;14(2):230–42. https://doi.org/10.1111/pme.12006 . Sala M, Rochefort C, Lui PP, Baldwin AS. Trait mindfulness and health behaviours: A meta-analysis. Health Psychol Rev. 2020;14(3):345–93. https://doi.org/10.1080/17437199.2019.1650290 . Salmon P, Lush E, Jablonski M, Sephton SE. Yoga and Mindfulness: Clinical Aspects of an Ancient Mind/Body Practice. Cogn Behav Pract. 2009;16(1):59–72. https://doi.org/10.1016/j.cbpra.2008.07.002 . Shattell M. Nurse-patient interaction: A review of the literature. J Clin Nurs. 2004;13(6):714–22. https://doi.org/10.1111/j.1365-2702.2004.00965.x . Sherratt K, Lunn S. Evaluation of a group programme of mindfulness-based cognitive therapy for women with fertility problems. J Obstet Gynaecology: J Inst Obstet Gynecol. 2013;33:499–501. https://doi.org/10.3109/01443615.2013.786031 . Slauson Blevins K. (2011). Infertility Help Seeking and Social Support: Do Conventional Theories Explain Internet Behaviors and Outcomes. Sociology Theses, Dissertations, & Student Research . https://Özkan.unl.edu/sociologydiss/12 . Szabó M. The short version of the Depression Anxiety Stress Scales (DASS-21): Factor structure in a young adolescent sample. J Adolesc. 2010;33(1):1–8. https://doi.org/10.1016/j.adolescence.2009.05.014 . Tomlinson ER, Yousaf O, Vittersø AD, Jones L. Dispositional Mindfulness and Psychological Health: A Systematic Review. Mindfulness. 2018;9(1):23–43. https://doi.org/10.1007/s12671-017-0762-6 . Trigo A (Director), editor. (2019, June 27). Mindfulness in IVF - Fertility Priming with Andreia Trigo . MYIVFanswers. https://www.youtube.com/watch?v=iJUZzm9xVCQ . Wahbeh H, Elsas S-M, Oken BS. Mind–body interventions: Applications in neurology. Neurology. 2008;70(24):2321–8. https://doi.org/10.1212/01.wnl.0000314667.16386.5e . Yılmaz Ö, Boz H, Arslan A. Depresyon Anksiyete Stres Ölçeğinin (DASS 21) Türkçe Kısa Formunun Geçerlilik-Güvenilirlik Çalışması. Finans Ekonomi ve Sosyal Araştırmalar Dergisi. 2017;2:78–91. Zegers Hochschild F, Adamson GD, de Mouzon O, Mansour R, Nygren K, Sullivan E, Vanderpoel S. International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary of ART terminolog. Fertil Steril. 2009;92(5):1520–4. https://doi.org/10.1016/j.fertnstert.2009.09.009 . Zeidan F, Baumgartner JN, Coghill RC. The neural mechanisms of mindfulness-based pain relief: A functional magnetic resonance imaging-based review and primer. Pain Rep. 2019;4(4):e759. https://doi.org/10.1097/PR9.0000000000000759 . Additional Declarations No competing interests reported. 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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-4490798","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":309461160,"identity":"dd27f4ba-ee14-4593-a679-25ca28c47781","order_by":0,"name":"Özen İnam","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYLCCBCDmZ2BgPADlGxCnRbKBgeHAAbiWBCJsMjhArBZ+/sPHHjzcYRdtfO3wg8MfKu7IMbA3b5Ng/HEPpxbJhmPpBolnknO33U4zOHDgzDNjBp5jZRIMCcW43XOwx0wisY0ZqCXB4MDBtsOJDRI5ZkAtuF1mcJj/G1BLfe7m2ekfDhz8d7i+Qf4NAS3HeNiAWg7nbpDOAdrScDiBQYIHvxbJHjaQw47nzridU3DgzLFnhm08acUWCWm4tQBD7Jnkz7bq3P7Z6RsfVNTckednP7zxxgcb3FrQwQEGNhBFvAaQllEwCkbBKBgF6AAArzRb7HlqZf4AAAAASUVORK5CYII=","orcid":"","institution":"Maltepe University","correspondingAuthor":true,"prefix":"","firstName":"Özen","middleName":"","lastName":"İnam","suffix":""},{"id":309461161,"identity":"41cfa4ca-83f9-4b2f-9a01-d775840975be","order_by":1,"name":"İlkay Güngör Satılmış","email":"","orcid":"","institution":"Istanbul University Cerrahpaşa","correspondingAuthor":false,"prefix":"","firstName":"İlkay","middleName":"Güngör","lastName":"Satılmış","suffix":""}],"badges":[],"createdAt":"2024-05-28 12:06:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4490798/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4490798/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12905-025-03659-6","type":"published","date":"2025-03-20T15:58:17+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":58248865,"identity":"f629b8cb-f008-41d0-90fb-b7b45bf2a692","added_by":"auto","created_at":"2024-06-13 02:49:02","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":74503,"visible":true,"origin":"","legend":"\u003cp\u003eConsort flow chart\u003c/p\u003e","description":"","filename":"Figure41.png","url":"https://assets-eu.researchsquare.com/files/rs-4490798/v1/7ce058f1bccf194df81c2c07.png"},{"id":79121261,"identity":"38f7b278-05fb-4aed-98df-394c60119b5c","added_by":"auto","created_at":"2025-03-24 16:11:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1217785,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4490798/v1/14c7ead7-eec4-4a00-9707-77e4bf60930c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The effect of mindfulness-based nursing support on the psychosocial status of women receiving infertility treatment","fulltext":[{"header":"Background","content":"\u003cp\u003eInfertility is not only an individual problem but also a couple\u0026rsquo;s of problem; it is defined as \u0026ldquo;the failure to conceive after one year of regular, and unprotected intercourse for one year unprotected intercourse\u0026rdquo; (Zegers Hochschild F. et al., \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). Infertility is a process that has social, cultural, and psychological effects as well as physical conditions. Infertility treatment is stressful and threatening for most couples, and it becomes a life crisis because the procedures are physically painful and financially challenging (Boivin et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2011\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIndividuals, particularly women, in the process of infertility diagnosis and treatment need strong social support (Slauson Blevins K., \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). Nurses have a supportive role in keeping the treatment process of infertile women in a harmonious manner and in accepting the situation and preparing for retreatment when the treatment outcome is not successful (G\u0026uuml;ng\u0026ouml;r \u0026amp; Beji̇, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; \u0026Ouml;r\u0026uuml;kl\u0026uuml;, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMindfulness is a concept that has recently gained popularity and has been defined by Brown and Ryan (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2003\u003c/span\u003e) as \u0026ldquo;focusing an individual\u0026rsquo;s attention on the present moment in a non-judgmental and accepting manner\" (Brown \u0026amp; Ryan, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2003\u003c/span\u003e). Although mindfulness has been around for many years, it is only in recent years that it has been the subject of research into its effects on health. There are studies showing that mindfulness helps patients especially to cope with stress, pain or chronic diseases (Fanning et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Garland et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Hanley et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Hilton et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Ngamkham et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Reiner et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Sala et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Tomlinson et al., \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Zeidan et al., \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere are also studies in the literature showing that mindfulness-based care is an effective method to improve psychological health such as quality of life, stress, and marital harmony in infertile women (Abedi Shargh et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Fard et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Hosseini et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Sherratt \u0026amp; Lunn, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). In many studies, it has been observed that mindfulness studies are effective on psychosocial problems (anxiety, stress, self-compassion, marital harmony) experienced in infertility (Boedt et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Fard et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Galhardo et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Hosseini et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Jensen et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Jufferie, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Monteiro et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Patel et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this study, we measured the effect of a mobile application developed for mindfulness-based psychosocial support in women undergoing infertility treatment on the psychosocial status of infertile women during the treatment process was measured.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eThis study is a randomized controlled experimental type of study.\u003c/p\u003e \u003cp\u003eThe power analysis calculation of the sample size was based on previous international studies (Hosseini et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2020\u003c/span\u003e) and the optimal number of female participants was determined as 17 experimental groups with an effect size of 0.754. In total, 34 women who met the inclusion criteria were included.\u003c/p\u003e \u003cp\u003eWomen (n:15) receiving treatment at an IVF (in vitro fertilization) Center Clinic in Istanbul and women who used social media and receiving IVF treatment (n:19) were included in the study.\u003c/p\u003e \u003cp\u003eRandomization was performed using random number sequences generated on \"\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e\u003ca href=\"http://clinicaltrials.gov\" target=\"_blank\"\u003ewww.random.org\"\u003c/a\u003e\u003c/span\u003e\u003cspan address=\"http://www.random.org\u0026quot;\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. For this purpose, the numbers for the experimental and control groups were generated with random number sequences for a total of 40 people, taking into account the losses. People who met the criteria were assigned to the experimental or control group according to this number sequence in the order of participation in the study. When cases withdrew from the study, new cases were assigned to the corresponding number of people.\u003c/p\u003e \u003cdiv id=\"Sec4\" class=\"Section3\"\u003e \u003ch2\u003eInclusion criteria\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eCompletion of the informed consent form and voluntary participation in the study\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eNot have a psychiatric diagnosis (schizophrenia, bipolar disorder, major depression, anxiety disorders, etc.)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eBe at the beginning of IVF treatment (starting ovarian stimulation) or soon to start treatment\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eA maximum of three previous IVF attempts\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eUse a smartphone\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eSpeak and understand Turkish\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eOver 18 years of age\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003eExclusion criteria\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eTermination of treatment at any stage\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eEmbryo transfer failure\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eVoluntary withdrawal from the study\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe flow chart created using the Consolidated Standards of Reporting Trials (CONSORT) flow chart for reporting trials for the sample group achieved is shown in Fig.\u0026nbsp;1. The trial has been registered with Clinical Trials and the ID number is \"4802180202\".\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eMeasures\u003c/h2\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003ePersonal information form\u003c/h2\u003e \u003cp\u003eThe 21-item form was developed by the researchers. It consists of socio-demographic information and questions about infertility and obstetric history.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003eMindful Attention Awareness Scale (MAAS)\u003c/h2\u003e \u003cp\u003eThis scale, which was developed by Brown and Ryan in 2003, aims to measure mindfulness and attention to momentary experiences in daily life. The scale contains 15 items and is responded to as a 6-point Likert scale. The higher the score on the scale, the higher the level of mindfulness. The Mindful Attention Awareness Scale has a single-factor structure and a single total score. The internal consistency coefficient of the Turkish version of the scale is Cronbach Alpha (α)\u0026thinsp;=\u0026thinsp;0.80 (\u0026Ouml;zyeşil et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). The consistency of the scale in our study was found to have a good degree of reliability, with the Cronbach\u0026rsquo;s Alpha coefficient being 0.872 in the pre-test and 0.957 in the post-test.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003eThe Depression Anxiety Stress Scale (DASS 21)\u003c/h2\u003e \u003cp\u003eThis is the abbreviation of the Depression Anxiety Stress Scale (DASS 21), which is used to measure the level of depression, anxiety and stress. The long version of the scale (DASS 42) was developed by Lovibond and Lovibond (1995) (Szab\u0026oacute;, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2010\u003c/span\u003e). The 4-point Likert-type scale, which aims to measure the level of \u0026ldquo;depression, anxiety and stress\u0026rdquo; under three headings, consists of a total of 21 items. Scoring 5 points in the depression subdimension, 4 or more points in anxiety and 8 or more points in stress indicates that the individual has a relevant problem. The internal consistency coefficient of the Turkish version of the scale is α\u0026thinsp;=\u0026thinsp;0.808 for anxiety, 0.819 for depression, and 0.756 for stress (Yılmaz et al., \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). When the scale reliability of our study was examined, the Cronbach alpha coefficient of the DASS 21 Scale in the pre-test was 0.870, while the Cronbach alpha coefficients of the subdimensions were 0.576 for anxiety, 0.838 for depression, and 0.587 for stress. As a result of the analysis, it was determined that the DASS 21 scale and its sub-dimensions were found to have good reliability.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003eInfertility Self-Efficacy Scale-Short Form\u003c/h2\u003e \u003cp\u003eIt was developed in 2006 to assess individuals' self-efficacy perceptions of the strength of their emotional, cognitive, and behavioral skills in relation to infertility (Cousineau et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). The nine-point Likert-type scale consists of a total of 16 items and the short form consists of 10 items. The internal consistency coefficient of the Turkish version of the scale is α:0.78 (Arslan \u0026Ouml;zkan et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). The scale is unidimensional, and the scores are between 8 and 32. The higher the score, the higher the perceived self-efficacy. The Cronbach alpha coefficient of the scale used in our study was 0.733 in the pre-test. As a result of the analysis, the scale was found to have a good level of reliability.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eFertility Adjustment Scale\u003c/h2\u003e \u003cp\u003eIt was developed by Glover et al in 1999 to standardize the measurement of psychological adjustment in infertility (Glover et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e1999\u003c/span\u003e). The scale is a 12-item, six-point Likert scale. The minimum scale score is 12 and the maximum score is 72. A high score on the Infertility Adjustment Scale indicates inadequate adjustment. The internal consistency coefficient of the Turkish version of the scale is α:0.77 (Arslan \u0026Ouml;zkan, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). In our study, the Cronbach alpha coefficient in the pretest of the scale was 0.689. The scale and its sub-dimensions were found to have good reliability.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eSPSS (Statistical Package for Social Sciences) for Windows 25.0 program was used for the statistical analysis of the data. Descriptive statistics (mean, standard deviation, median, quards, percentage) and chi-square analysis for homogeneity were used to evaluate the data. The Kolmogrov-Smirnov-Shapiro-Wilk method was used to test for normal distribution of quantitative data, and the Mann-Whitney U analysis was used to test for differences between two independent groups when comparing data that were not normally distributed. The Wilcoxon signed-ranks test was used for within-group comparisons of non-normally distributed quantitative variables.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eMindfulness therapy content specific to infertility\u003c/h2\u003e \u003cp\u003eContent texts were prepared by scanning national and international foreign sources for mindfulness meditation specific to the infertility treatment process (Atalay Z., 2018; Bettina Rae, 2022; Bree Taylor Molyneaux, 2015; Fertility from the Soul, 2019; Jackie, 2016; Mindfulness Institute, 2018; MyIVFanswers, 2019). For expert opinions, the opinions of faculty members from the fields of women\u0026rsquo;s health nursing, psychiatric nursing, psychologists, and linguists working in the field of mindfulness were consulted. The final content of the meditation was determined after receiving the expert opinions.\u003c/p\u003e \u003cp\u003eThe mindfulness audio recording content specific to infertility has been created as six different meditation contents and they were designed as follows:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eBreath Awareness (14 minutes)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eBody Scan (specific to IVF treatment) (28 minutes)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eDrug Administration and Ovarian Awareness (18 minutes)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eDiaphragm Breath before Oocyte Pick up (OPU) (13 minutes)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eUterine Awareness Before Embryo Transfer (20 minutes)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePost-Transfer Embryo and Uterine Awareness (23 minutes).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eAfter determining the meditation content, the meditation suggestions were recorded by the researcher using a voice recorder in a quiet environment. Background music was added to the sound recordings by the expert to increase the effect of the meditation suggestions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eInterventions in the experimental and control groups and data collection\u003c/h2\u003e \u003cp\u003eBefore all tests were administered to the participants, information was given about the purpose, scope, content and procedure of the study. Pre-tests were administered to the participants at the first interview.\u003c/p\u003e \u003cp\u003eA WhatsApp group called IVFMind was created for the participants in the experimental group. In the group where the administrator could send one-way messages, the experimental group was informed of the meeting dates and a daily mindfulness message was sent every morning. At the meeting, information was given about \u0026ldquo;the IVF treatment process and the stages of infertility, the physical and mental changes experienced during infertility treatment process, the purpose of the study, and how the study would be conducted\u0026rdquo;. They were then given a training on 'Mindfulness and Mobile Application'. The training lasted 120 minutes on average. At the end of the session, mindfulness breathing and body awareness exercises were done with the women. Participants who completed the training were asked to listen regularly to mindfulness audio recordings through the mobile application during the treatment.\u003c/p\u003e \u003cp\u003eThe control group received 30 minutes of training about infertility treatments. During the training, women were informed about the IVF treatment process and the stages of infertility, as well as the physical and mental changes that occur during infertility treatment. On the same day, 'scales' were used as a pre-test before the training.\u003c/p\u003e \u003cp\u003eAfter the embryo transfer for all participants, the scales were applied again as a post-test two days before the pregnancy test day.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA comparison of the socio-demographic characteristics of the participants showed that the experimental and control groups were homogeneously distributed. There was no significant difference in infertility-related characteristics between the experimental and control groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eComparison of participants\u0026rsquo; scores on the Mindful Attention Awareness Scale (MAAS) scores\u003c/h2\u003e \u003cp\u003eThere was no statistically significant difference between participants' scores on the Mindful Attention Awareness Scale at pre-test (U\u0026thinsp;=\u0026thinsp;120,000, p\u0026thinsp;=\u0026thinsp;0.398\u0026thinsp;\u0026gt;\u0026thinsp;0.05). In the post-test, it was found that there was a statistically significant difference between the MAAS scores of experimental and control groups (U\u0026thinsp;=\u0026thinsp;0.000, p\u0026thinsp;=\u0026thinsp;0.000\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Accordingly, it was concluded that the experimental group had a higher score on the Mindful Attention Awareness Scale (MAAS) scale than the control group (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\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\u003eComparison of the MAAS scale pretest-posttest scores of the experimental-control groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eN\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eMin\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eMedyan\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(Q1-Q3)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eMax\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\stackrel{-}{\\varvec{x}}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003eSs\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003eTest i statistic\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePre Test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eexperimental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37,00 (32,50\u0026thinsp;\u0026minus;\u0026thinsp;47,00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e55,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e40,06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e8,63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eU\u0026thinsp;=\u0026thinsp;120,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,398\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003econtrol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42,00 (35,50\u0026thinsp;\u0026minus;\u0026thinsp;44,50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e59,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e41,76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e7,22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePost Test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eexperimental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e59,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e68,00 (63,00\u0026ndash;70,00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e76,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e66,88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e4,59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eU\u0026thinsp;=\u0026thinsp;0,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003econtrol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42,00 (38,50\u0026thinsp;\u0026minus;\u0026thinsp;46,50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e57,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e42,65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e6,12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003e\u003cem\u003eU: Mann Whitney U test statistic *p\u0026thinsp;\u0026lt;\u0026thinsp;0,05\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eComparison of the participants\u0026rsquo; infertility adjustment and self-efficacy scale scores\u003c/h2\u003e \u003cp\u003eThere was no statistically significant difference between infertility self-efficacy scale scores of participants in the experimental and control groups in the pre-test (U\u0026thinsp;=\u0026thinsp;125,500, p\u0026thinsp;=\u0026thinsp;0.503\u0026thinsp;\u0026gt;\u0026thinsp;0.05). In the post-test, there was a statistically significant difference between infertility self-efficacy scale scores of the experimental and control groups (U\u0026thinsp;=\u0026thinsp;0.000, p\u0026thinsp;=\u0026thinsp;0.000\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Accordingly, it was observed that the experimental group had a higher score on the infertility self-efficacy scale than the control group (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\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\u003eComparison of the infertility self-efficacy scale pretest-posttest scores of the experimental and control groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eN\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eMin\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eMedyan\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(Q1-Q3)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eMax\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\stackrel{-}{\\varvec{x}}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003eSs\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003eTest statistic\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePre Test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eexperimental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15,00 (13,00\u0026ndash;15,50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e23,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e15,29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2,78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eU\u0026thinsp;=\u0026thinsp;125,500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,503\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003econtrol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14,00 (13,50\u0026thinsp;\u0026minus;\u0026thinsp;15,00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e23,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e15,35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e3,44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePost Test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eexperimental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28,00 (26,00\u0026ndash;28,50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e30,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e26,88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2,32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eU\u0026thinsp;=\u0026thinsp;0,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003econtrol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15,00 (14,50\u0026thinsp;\u0026minus;\u0026thinsp;16,50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e21,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e15,71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2,17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003e\u003cem\u003eU: Mann Whitney U statistic *p\u0026thinsp;\u0026lt;\u0026thinsp;0,05\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the pre-test, it was found that there was no statistically significant difference between the scores of the participants in the experimental and control groups on the Infertility Adjustment Scale (U\u0026thinsp;=\u0026thinsp;106.500, p\u0026thinsp;=\u0026thinsp;0.184\u0026thinsp;\u0026gt;\u0026thinsp;0.05). In the post-test, it was found that there was a statistically significant difference between the scores of the participants in the experimental and control groups on the Infertility Adjustment Scale (U\u0026thinsp;=\u0026thinsp;3,000, p\u0026thinsp;=\u0026thinsp;0,000\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Accordingly, it was observed that the experimental group had lower scores on the Infertility Adjustment Scale than the control group (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\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\u003eComparison of the infertility adjustment scale pretest-posttest scores of the experimental and control groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eN\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eMin\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eMedyan\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(Q1-Q3)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eMax\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\stackrel{-}{\\varvec{x}}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003eSs\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cem\u003eTest statistic\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePre Test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eexperimental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27,00 (24,50\u0026thinsp;\u0026minus;\u0026thinsp;28,00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e31,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e25,94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e3,44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eU\u0026thinsp;=\u0026thinsp;106,500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,184\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003econtrol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28,00 (25,00\u0026ndash;29,00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e31,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e26,53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e4,14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePost Test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eexperimental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15,00 (13,00\u0026ndash;17,50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e24,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e15,53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e3,43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eU\u0026thinsp;=\u0026thinsp;3,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003econtrol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29,00 (25,00\u0026ndash;33,50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e39,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e29,59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e5,65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003e\u003cem\u003eU: Mann Whitney U test statistic *p\u0026thinsp;\u0026lt;\u0026thinsp;0,05\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eComparison of participants\u0026rsquo; scores on the Depression Anxiety Stress Scale (DASS 21)\u003c/h2\u003e \u003cp\u003eThere was no statistically significant difference between the pre-test scores of participants in the experimental and control groups on the DASS 21 scale (U\u0026thinsp;=\u0026thinsp;141,000, p\u0026thinsp;=\u0026thinsp;0.904\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\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\u003eComparison of the Depression-Anxiety-Stress Scale (DASS 21) and sub-dimensions pretest-posttest scores of the experimental-control groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePre Test\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMin\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMedyan\u003c/p\u003e \u003cp\u003e(Q1-Q3)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMax\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\stackrel{-}{\\varvec{x}}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSs\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTest statistic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDASS 21\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eexperimental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28,00 (22,50\u0026thinsp;\u0026minus;\u0026thinsp;32,50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e42,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e27,59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eU\u0026thinsp;=\u0026thinsp;141,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,904\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003econtrol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29,00 (18,00\u0026ndash;34,00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e45,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e27,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9,61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDASS 21 Anxiety\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eexperimental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8,00 (6,50\u0026thinsp;\u0026minus;\u0026thinsp;10,00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8,47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eU\u0026thinsp;=\u0026thinsp;119,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,375\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003econtrol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9,00 (6,50\u0026thinsp;\u0026minus;\u0026thinsp;11,00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9,06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2,90\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDASS 21 Depression\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eexperimental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7,00 (4,50\u0026thinsp;\u0026minus;\u0026thinsp;11,00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7,12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4,04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eU\u0026thinsp;=\u0026thinsp;126,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,519\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003econtrol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7,00 (5,50\u0026thinsp;\u0026minus;\u0026thinsp;11,00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7,88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4,20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDASS 21 Stress\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eexperimental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13,00 (8,00\u0026ndash;15,50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4,83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eU\u0026thinsp;=\u0026thinsp;105,500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,176\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003econtrol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11,00 (5,50\u0026thinsp;\u0026minus;\u0026thinsp;13,00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10,06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4,07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePost Test\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eN\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eMin\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eMedyan\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(Q1-Q3)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eMax\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\stackrel{-}{\\varvec{x}}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003eSs\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003eTest statistic\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDASS 21\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eexperimental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17,00 (12,50\u0026thinsp;\u0026minus;\u0026thinsp;21,50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e16,65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eU\u0026thinsp;=\u0026thinsp;56,500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,002*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003econtrol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28,00 (17,00\u0026ndash;34,00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e45,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e26,82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9,46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDASS 21 Anxiety\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eexperimental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5,00 (3,00\u0026ndash;7,00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4,88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2,26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eU\u0026thinsp;=\u0026thinsp;39,500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,000*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003econtrol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10,00 (7,00\u0026ndash;11,00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2,89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDASS 21 Depression\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eexperimental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4,00 (2,50\u0026thinsp;\u0026minus;\u0026thinsp;7,00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4,35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2,23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eU\u0026thinsp;=\u0026thinsp;59,500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,003*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003econtrol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8,00 (5,50\u0026thinsp;\u0026minus;\u0026thinsp;9,50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7,82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3,80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDASS 21 Stress\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eexperimental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8,00 (5,50\u0026thinsp;\u0026minus;\u0026thinsp;9,00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7,41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2,53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eU\u0026thinsp;=\u0026thinsp;89,500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,057\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003econtrol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12,00 (5,00\u0026ndash;13,00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10,00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4,36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"10\"\u003e\u003cem\u003eU: Mann Whitney U test statistic *p\u0026thinsp;\u0026lt;\u0026thinsp;0,05\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eHowever, it was found that there was a statistically significant difference between the participants post-test scores on the (U\u0026thinsp;=\u0026thinsp;56.500, p\u0026thinsp;=\u0026thinsp;0.002\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Accordingly, it was found that the experimental group scored lower on the DASS 21 scale than the control group (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eConsidering the scores of the participants in the experimental and control group participants in the post-test on the sub-dimension of the DASS scale;\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eIt was observed that the experimental group had lower scores in the depression sub-dimension of the DASS scale (U\u0026thinsp;=\u0026thinsp;59.500, p\u0026thinsp;=\u0026thinsp;0.003\u0026thinsp;\u0026lt;\u0026thinsp;0.05) compared to the control group.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eIt was observed that the anxiety sub-dimension score of the experimental group was lower than that of the control group (U\u0026thinsp;=\u0026thinsp;39.500, p\u0026thinsp;=\u0026thinsp;0.000\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHowever, it was found that there was no statistically significant difference between the participants' scores on the Stress sub-dimension of the DASS scale (U\u0026thinsp;=\u0026thinsp;89.500, p\u0026thinsp;=\u0026thinsp;0.057\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe most important and even unique element of holistic care is nursing. By its very nature, nursing observes and assesses patients throughout their lives. Due to many factors, such as the patient's social environment and adaptation to the disease, nursing requires being with the patient in every area and moment of care.\u003c/p\u003e \u003cp\u003eIn recent years, Western medicine has begun to investigate the effects of meditation-like practices on medical treatments (Coats et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2011\u003c/span\u003e). The benefits of using many practices such as mind-body exercises, relaxation techniques and yoga in the field of health have been demonstrated in many studies (Acevedo et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Salmon et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Shattell, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2004\u003c/span\u003e; Wahbeh et al., \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e2008\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMindfulness is a psychological coping strategy commonly used by infertility patients. Studies in the field of infertility show that mindfulness interventions are an effective way to improve women's psychological health (such as quality of life, stress, and marital harmony) in women (Abedi Shargh et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Fard et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Hosseini et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Sherratt \u0026amp; Lunn, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). A randomized controlled trial, it was found that infertile women in the experimental group had increased self-compassion and mindfulness skills and higher pregnancy rates (Li et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Mindfulness can also be chosen as an effective method to reduce stress, anxiety and depression in infertile women and to gain self-efficacy and adjustment to infertility.\u003c/p\u003e \u003cp\u003eOur study found that the mindfulness scores of the experimental group were significantly higher than those of the control group (U\u0026thinsp;=\u0026thinsp;0.000, p\u0026thinsp;=\u0026thinsp;0.000\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Data from two separate randomized controlled trials using mindfulness intervention in infertile women are similar to our study. The level of mindfulness of the experimental group increased significantly compared to the control group (Galhardo et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Li et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn a study which investigating the effect of mindfulness-based therapy on the psychological well-being of infertile women, 30 control groups (15 with pretest and 15 without pretest) and 30 experimental groups were evaluated (Fard et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). As a result of the study, it was found that there was a significant difference in the psychological well-being scores of the experimental group and sub-dimension mindfulness scores compared to the control group. In one study, a group of 25 women undergoing IVF treatment underwent the MBSR intervention, 12 weeks of mindfulness and relaxation meditation. At the end of the study, it was found through the interviews with the women revealed that psychological improvements such as general well-being and mindfulness were achieved (Paiva et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAccording to the data of our study, the self-efficacy scores of the experimental group increased significantly in the post-test and the infertility adjustment scores decreased. In other words, it was observed that the self-efficacy perceptions of the experimental group increased and their adjustment to infertility improved. Self-efficacy known to be low in infertility (Minucci, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Pasha et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Studies show that mindfulness therapy in infertile women increases their self-efficacy in infertile women (Faramarzi et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Pasha et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). One study found that mindfulness practice was as effective as a pharmacological treatment in some other psychological outcomes, such as self-efficacy in infertile women, or even more effective in some patients (Fard et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). It can be argued that mindfulness practices not only cause an increase in mindfulness scores, but also have a mediating effect on the improvement of other psychological symptoms. In this regard, another study found that mindfulness has a mediating effect on self-efficacy (Luberto et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAccording to the results of the analysis, it was determined that there was a statistically significant difference between the pre-test and post-test DASS scores of the participants in the experimental group (Z=-2.940, p\u0026thinsp;=\u0026thinsp;0.003\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Accordingly, there was a decrease in depression, anxiety and stress scores in the experimental group of our study. In the studies in the literature, it is observed that mindfulness-based practices are used to reduce stress and anxiety in infertility and have effective results (Galhardo et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Hosseini et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Kalhori et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Li et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Nery et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Patel et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe effects of a mindfulness intervention developed by Galhardo et al. specifically for infertile women were followed for 7 years, and it was found that mindfulness skills and self-efficacy improved, and anxiety and depression symptoms decreased in 55 women who received mindfulness (Galhardo et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). In our study, similar to the results of this study, it was observed that the self-efficacy and mindfulness scores of the women in the experimental group increased. That is, the self-efficacy and mindfulness of the experimental group improved, and their depression, anxiety and stress levels decreased.\u003c/p\u003e \u003cp\u003eIn the study investigating the effect of a mindfulness stress reduction program on \u0026ldquo;depression, anxiety, stress and tolerance to uncertainty\u0026rdquo; in infertile women in Iran, an assessment was made using with the DASS scale. In a randomized controlled trial, study participants (n\u0026thinsp;=\u0026thinsp;15) in the MBSR group received 2 hours of face-to-face mindfulness meditation once a week for 8 weeks. As a result of the study, as in our study, a significant difference was found between the post-test scores of the experimental group and the control groups in terms of depression, anxiety and stress scores (Mousavi et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn a randomized controlled trial in which Bai et al investigated the effects of a self-administered mindfulness intervention on psychological distress in women undergoing IVF or ICSI and found that the intervention was effective on depression and sleep quality (Bai et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Scales were administered on the day of regulation, 1 day before embryo transfer and 2 days before the pregnancy testing. The study was similar to our mindfulness practice study, and the patients were listened to 20-minute audio recordings. However, in Bai's study, mindfulness practice included awareness of the breath and the body. In our study, in addition to breath and body awareness, \u0026ldquo;uterus awareness, needle therapy awareness, pre-oocyte pick-up awareness, pre/post embryo transfer awareness\u0026rdquo; were applied.\u003c/p\u003e \u003cp\u003eIn the literature review, when we look at the studies evaluating depression, anxiety and stress levels by presenting the mindfulness-based intervention to infertile women using a mobile application, there are few studies. An application called MoMifer has been developed in Belgium and has similar features to our study. The study aims to measure the effectiveness of applying mindfulness to infertile patients on symptoms of emotional distress (depression, anxiety, stress) symptoms and quality of life (Boedt et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). In contrast to our study, the study was conducted with groups of women, men or couples. In the mobile application, mindfulness exercises are introduced with a short video (talking head) and consist of two audio files. The method of the study and the dependent variables and measurement tools to be analyzed are similar, and the results of the MoMiFer application have not yet been published.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAccording to our study, mindfulness-assisted psychosocial support with a mobile application was found to reduce problems such as depression and anxiety in infertile women and increase the level of mindfulness and infertility self-efficacy and compliance. As a result, it was observed that the mobile application developed for mindfulness contributed positively to the psychosocial status of infertile women during the treatment process.\u003c/p\u003e \u003cp\u003eAs in our study, mindfulness-based interventions improve the mindfulness level of mindfulness in infertile women and affect their general psychosocial status. Mindfulness interventions can be applied in different ways; face-to-face, group therapy, online, or by listening to audio recordings. In our study, mindfulness in the mobile application was found to be advantageous for infertile women because it is easily accessible, free of charge, does not require the woman to go anywhere and can be done in a way specific to her treatment.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIVF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ein vitro fertilization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMAAS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMindful Attention Awareness Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDASS 21\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eThe Depression Anxiety Stress Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and constant to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work is a doctoral thesis. Ethical approval was obtained with the permission letter numbered E-74555795-050.01.04-52289 dated 08.02.2021 from Istanbul University Social and Human Sciences Ethics Committee. Informed consent was obtained from the patients whose data would be collected in the study. We acknowledge that the research complies with the Declaration of Helsinki\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll patients have been informed and have consented to publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData and materials are available when needed by contacting the corresponding author\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have declared no potential conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone. This study received no financial support from any public or private institution.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026Ouml;.İ collected and analyzed the data and wrote the article. The article was reviewed and conceptualized by \u0026Ouml;.İ and İ.G.S. All authors approved the final manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research group would like to thank all the generous women for supporting the study during difficult times of infertility treatments and the pandemic.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAbedi Shargh N, Bakhshani NM, Mohebbi MD, Mahmudian K, Ahovan M, Mokhtari M, Gangali A. The Effectiveness of Mindfulness-Based Cognitive Group Therapy on Marital Satisfaction and General Health in Woman With Infertility. 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The neural mechanisms of mindfulness-based pain relief: A functional magnetic resonance imaging-based review and primer. Pain Rep. 2019;4(4):e759. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/PR9.0000000000000759\u003c/span\u003e\u003cspan address=\"10.1097/PR9.0000000000000759\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Infertility, woman, in vitro fertilization, depression, anxiety, mindfulness","lastPublishedDoi":"10.21203/rs.3.rs-4490798/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4490798/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e The aim of the study was to evaluate the effect of mindfulness-based care support on the psychosocial status of women undergoing infertility treatment during the treatment process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e The sample consisted of women who were about to start in vitro fertilization treatment and met the inclusion criteria. The experimental group used a mobile application specifically designed to practice mindfulness for infertility treatment at the beginning of treatment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e The gynaecological and infertility characteristics of the experimental and control groups and their scores on the psychosocial scales used in the pretest were similar (p \u0026gt; 0.05). In the post-test, the scores of the participants in the experimental group from mindfulness and infertility self-efficacy scales were higher than the control group, and the scores of infertility adjustment, anxiety and depression were lower (p \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e It was observed that the mobile application developed for mindfulness contributed positively to the psychosocial status of infertile women in the treatment process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePreregistration \u003c/strong\u003eThe research was registered on http://clinicaltrials.gov (ID: NCT05708937) Registry: 24.01.2023\u003c/p\u003e","manuscriptTitle":"The effect of mindfulness-based nursing support on the psychosocial status of women receiving infertility treatment","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-13 02:48:58","doi":"10.21203/rs.3.rs-4490798/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvited","content":"","date":"2024-05-30T11:46:09+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-30T04:20:15+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-30T04:20:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2024-05-28T12:04:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8855871e-27ac-4d4b-9bdb-4c9cdde926d1","owner":[],"postedDate":"June 13th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-03-24T16:09:25+00:00","versionOfRecord":{"articleIdentity":"rs-4490798","link":"https://doi.org/10.1186/s12905-025-03659-6","journal":{"identity":"bmc-womens-health","isVorOnly":false,"title":"BMC Women's Health"},"publishedOn":"2025-03-20 15:58:17","publishedOnDateReadable":"March 20th, 2025"},"versionCreatedAt":"2024-06-13 02:48:58","video":"","vorDoi":"10.1186/s12905-025-03659-6","vorDoiUrl":"https://doi.org/10.1186/s12905-025-03659-6","workflowStages":[]},"version":"v1","identity":"rs-4490798","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4490798","identity":"rs-4490798","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}