[[alternative]]Incorporating of Solution-Focused-Brief-Therapy into Childbirth Education Program on Women’s Fear of Childbirth and Self-efficacy

[[abstract]]本研究目的為焦點解決短期諮商取向生產教育方案對孕婦生產害怕、自我效能之成效探討。採實驗性研究設計法，資料收集時間為2013年02月至2013年08月，研究對象為南部某區域教學醫院的32-36週第一胎準母親，且年滿18歲以上，本身及胎兒無合併症者，排除剖腹產者，共計87人隨機分派至實驗組與對照組，其中實驗組44人接受單次3小時之「焦點解決短期諮商生產教育方案」，對照組43人予以「入院待產須知」指導單張。收案時準母親完成基本資料、生產期望/經驗問卷調查量表(W-DEQ，A版)、生產自我效能量表及視覺類比疼痛量表(VASP)預期未來生產過程的疼痛指數；產時以視覺類比疼痛量表(VASP)評估第一產程進入活動期時子宮頸口擴張3-5公分及10公分時之疼痛感受；產後兩天完成生產期望/經驗問卷調查量表(W-DEQ，B版)、生產自我效能量表、簡易型麥克吉爾疼痛量表。 研究結果顯示，在生產害怕程度方面，兩組在前測統計分析上達顯著差異(t = 2.63, p = .010)，兩組在後測統計分析上有顯著差異(t = - 4.48, p < .001)；在生產自我效能之結果期望/效能期望方面，兩組在前測統計分析上無顯著差異(t = -.39, p = .691) / (t = - 1.36, p =.178)，兩組在後測統計分析上有顯著差異(t = 3.34, p < .001) / (t = 2.93, p = .004)；在第一產程子宮頸擴張3-5公分之疼痛感受，兩組在統計分析上有顯著差異(t = - 2.51, p = .014)，在第一產程子宮頸口擴張10公分的疼痛指數，兩組在統計分析上無顯著差異(t = - 1.06, p = .291)；在第二產程用力階段的疼痛指數方面，兩組在統計分析上達顯著差異(t = - 3.04, p = .003)。綜合上述得知，「焦點解決短期諮商生產教育方案」可有效降低產婦之生產害怕程度，提升生產自我效能以及降低第一產程子宮頸擴張3-5公分、第二產程用力階段的疼痛感受。整體而言，本研究結果可提供臨床醫護人員為未來生產教育課程參考之依據，發揮實質的效能，提供生、心理上的支持，幫助產婦正向面對生產，獲得正向的生產經驗。[[abstract]]This study was aimed to evaluate the effectiveness of Solution Focused Brief Therapy Childbirth Education Program to relieve the fear of childbirth and to enhance the self-efficacy of expectant mothers. An experimental design was used. We recruited subjects from a regional teaching hospital in southern Taiwan. Expectant mothers who were primipara, at their 32 to 36 weeks of gestational age, 18 years old or older, without any maternal or fetal complications were included. Those who would receive Cesarean section were excluded. A total number of 87 participants were randomly assigned into an experimental group and a control group. All 44 participants in the experimental group underwent a single 3-hour-long course of Solution Focused Brief Therapy Childbirth Education Program, and all 43 participants in the control group received an instruction leaflet Request for Admission for Labor. All participants completed basic personal information, Wijma Delivery Expectancy/ Experience Questionnaire 2005 (W-DEQ, version A), Self-efficacy Questionnaire and Visual Analog Scale for Pain (VASP) to access expected pain when delivery. In labor, VASP were used to measure the intensity of pain when the cervical os dilated to 3~5cm and 10cm during the active phase of the first stage. Wijma Delivery Expectancy/ Experience Questionnaire 2005 (W-DEQ, version B), Self-efficacy Questionnaire and short form McGill pain questionnaire (MPQ-SF) were completed two days after delivery. The duration of this study was from February 2013 to August 2013.The result showed that in the aspect of fear of childbirth, the difference between the two groups was statistically significant in pre-test(t = 2.63, p = .010), and the difference between the two groups was also statistically significant in post-test(t = - 4.48, p < .001). In the aspect of outcome expectations and efficacy expectations of self-efficacy, the difference between the two groups did not reach statistical significance in pre-test (t = -.39, p = .691) / (t = - 1.36, p =.178), yet the difference in post-test was statistically significant (t = 3.34, p < .001) / (t = 2.93, p = .004). The difference of pain when the cervical os dilated to 3~5cm during the first stage was statistically significant (t = - 2.51, p = .014), but not when the cervical os dilated to 10cm (t = - 1.06, p = .291). The difference of pain when bearing down during the second stage was statistically significant (t = - 3.04, p = .003). In conclusion, Solution Focused Brief Therapy Childbirth Education Program was able to effectively relieve the fear of childbirth, to enhance self-efficacy, and to relieve pain when the cervical os dilated to 3~5cm during the first stage and when bearing down during the second stage of labor. In general, the result of this study could offer healthcare providers some references to future childbirth education programs, as well as both physical and psychological support for expectant mothers. It could help them adopt a positive attitude toward the challenge of labor, and gain a more enjoyable childbirth experience