Ji Kemeng, Li Zhizhen, Zhao Ying, Sun Liping, Min Hui
School of Nursing, Fudan University, Shanghai 200032, China.
Obstetrics and Gynecology Hospital of Fudan, Shanghai 200032, China.
Sichuan Da Xue Xue Bao Yi Xue Ban. 2023 Jul;54(4):837-842. doi: 10.12182/20230760506.
To explore the mediating effect of childbirth self-efficacy on the impact pathway of intolerance of uncertainty on the fear of childbirth in primiparas in the second and third trimesters and the potential moderating effect of perceived partner responsiveness.
A total of 429 primiparas in their second and third trimesters completed the survey, which included general information questionnaire, Intolerance of Uncertainty Scale, Childbirth Self-Efficacy Inventory, Perceived Partner Responsiveness Scale, and Childbirth Attitudes Questionnaire. Rank sum test was used to compare the scores for the fear of childbirth among different groups and Spearman's correlation was used to analyze the scores for all the scales. In addition, the data were centrally processed by using PROCESS V3.4.1 Model 4 (a simple mediation model), Model 5 (the direct path of the mediation model was regulated), and non-parametric Bootstrap method to test the mediation effect and moderation effect.
The study showed that 54.31% of the participants experienced fear of childbirth. Their scores for intolerance of uncertainty, childbirth self-efficacy, and perceived partner responsiveness were 15.00 (8.00), 240.00 (75.00), and 72.00 (19.00), respectively. There were significant differences in the scores for the fear of childbirth scale among pregnant women of different age groups, gestational weeks, employment statuses, and average per capita monthly income of the family ( <0.05). According to our findings, intolerance of uncertainty directly and positively impacted on fear of childbirth ( =0.76, <0.001), with childbirth self-efficacy playing partial mediation role between them, its indirect effect being 0.05 and the contribution rate being 6.17%. In addition, after the scores of Perceived Partner Responsiveness Scale were added to the model, perceived partner responsiveness had no significant predictive effect for fear of childbirth, but the product term of the scores for Perceived Partner Responsiveness Scale and Intolerability Uncertainty Scale had significant predictive effect for fear of childbirth ( =0.01, <0.05), which suggested that perceived partner responsiveness also played a moderating role between intolerance of uncertainty and fear of childbirth.
Health care providers can help primiparas reduce fear of childbirth and improve their childbirth experience by reducing perceived intolerance of uncertainty, improving family support, and teaching coping strategies.
探讨分娩自我效能感在初产妇孕中晚期不确定性不耐受对分娩恐惧的影响路径中的中介作用，以及伴侣感知响应性的潜在调节作用。
共有429名孕中晚期初产妇完成调查，调查内容包括一般情况问卷、不确定性不耐受量表、分娩自我效能量表、伴侣感知响应性量表和分娩态度问卷。采用秩和检验比较不同组间分娩恐惧得分，采用Spearman相关性分析各量表得分。此外，使用PROCESS V3.4.1模型4（简单中介模型）、模型5（调节中介模型的直接路径）和非参数Bootstrap方法对数据进行集中处理，以检验中介效应和调节效应。
研究显示，54.31%的参与者经历过分娩恐惧。她们的不确定性不耐受、分娩自我效能感和伴侣感知响应性得分分别为15.00（8.00）、240.00（75.00）和72.00（19.00）。不同年龄组、孕周、就业状况和家庭月人均收入的孕妇在分娩恐惧量表得分上存在显著差异（<0.05）。根据研究结果，不确定性不耐受直接正向影响分娩恐惧（=0.76，<0.001），分娩自我效能感在二者之间起部分中介作用，其间接效应为0.05，贡献率为6.17%。此外，将伴侣感知响应性量表得分加入模型后，伴侣感知响应性对分娩恐惧无显著预测作用，但伴侣感知响应性量表得分与不确定性不耐受量表得分的乘积项对分娩恐惧有显著预测作用（=0.01，<0.05），这表明伴侣感知响应性在不确定性不耐受和分娩恐惧之间也起调节作用。
医护人员可以通过降低感知到的不确定性不耐受、改善家庭支持和教授应对策略，帮助初产妇减轻分娩恐惧，改善分娩体验。
