Effectiveness of Enhancing Childbirth Self-Efficacy Support Program via LINE Official Account among Pregnant Adolescents: A Randomized Controlled Trial
DOI:
https://doi.org/10.60099/prijnr.2025.272780Keywords:
Antenatal care, Childbirth self-efficacy, Fear of childbirth, Labor pain, mHealth, Pain-coping behaviors, Pregnant adolescents, Smartphone applicationAbstract
Pregnancy and childbirth among adolescents present significant challenges during a transitional phase characterized by profound physical, emotional, and social transformations that affect adolescents and their families due to societal norms. In recent years, mobile health (mHealth) applications have gained popularity, offering continuous educational support during pregnancy and significantly enhancing preparedness for childbirth. This study evaluated the effectiveness of an Enhancing Childbirth Self-Efficacy Support Program delivered via the LINE Official Account application on smartphones incorporating childbirth self-efficacy, fear of childbirth, labor pain, and pain-coping behaviors in pregnant adolescents. A randomized controlled trial was conducted with pregnant adolescents receiving antenatal care and delivering at a tertiary hospital in Bangkok between April and September 2024. Participants were randomly assigned to an experimental group (n = 24), which received the program, or a control group (n = 23), which received only usual care. The research instruments included: 1) a Personal Information Questionnaire, 2) the Thai Childbirth Self-Efficacy Inventory, 3) the Fear of Childbirth of Pregnant Adolescents in the Third Trimester Questionnaire, 4) the Fear of Birth Scale, 5) a Numerical Rating Scale for Pain, and 6) a Labor Pain Coping Behavior Assessment. Data were analyzed using descriptive statistics, paired t-test, independent t-test, and the Mann-Whitney U test.
The findings revealed that the program successfully improved self-efficacy in the experimental group. Participants in the experimental group reported significantly less fear of childbirth during pregnancy and labor, experienced lower labor pain, and demonstrated better pain-coping behaviors compared to the control group. Nurses can apply this program to support pregnant adolescents through the developmental process and labor. However, further testing in multi-site studies is necessary.
References
Maheshwari MV, Khalid N, Patel PD, Alghareeb R, Hussain A. Maternal and neonatal outcomes of adolescent pregnancy: a narrative review. Cureus. 2022;14(6):e25921. doi: 10.7759/cureus.25921. DOI: https://doi.org/10.7759/cureus.25921
Strategy and Planning Division. Ministry of Public Health Indicators in Fiscal Year 2021 [Internet]. 2021 [cited 2025 Feb 1]. Available from: https://spd.moph.go.th/health-indicator/
Orukwowu U. The impact of teenage pregnancy on public health in Okposi community, Ogba-Egbema-Ndoni Local Government Area, Rivers State. Curr Res Health Sci. 2024;2(1):1-8. doi: 10.58613/crhs211.
Wahlbeck H, Kvist LJ, Landgren K. Art therapy and counseling for fear of childbirth: a randomized controlled trial. J Am Art Ther Assoc. 2020;37(3):e123-e130. doi: 10.1080/ 07421656.2020.1721399. DOI: https://doi.org/10.1080/07421656.2020.1721399
Howharn C, Mayukhachot S. A study of predicting factors of the fear of childbirth. JHR. 2021;15(1):24-34. Available from: https://he01.tci-thaijo.org/index.php/JHR/article/view/241979/168808 (in Thai).
Cunningham FG, Leveno KJ, Dashe JS, Hoffman BL, Spong CY, Casey BM. Williams obstetrics. 26th ed. New York: McGraw-Hill; 2022.
Dick-Read G. Childbirth without fear. 5th ed. New York: Harper & Row; 1984.
Rattaya M, Ritmontree O. Pain coping behaviors during childbirth of early adolescent pregnant women: Concepts and non-drug management of labor pain. MJSSBH. 2023;34(1):113-126. Available from: https://he02.tci-thaijo.org/index.php/MJSSBH/article/view/185983/130712 (in Thai).
Lowe NK. Maternal confidence for labor: development of the childbirth self-efficacy inventory. Res Nurs Health. 1993;16(2):141-149. doi: 10.1002/nur.4770160209. DOI: https://doi.org/10.1002/nur.4770160209
Lowe NK. Maternal confidence in coping with labor: a self-efficacy concept. J Obstet Gynecol Neonatal Nurs. 1991;20(6):457-463. doi: 10.1111/j.1552-6909.1991.tb01711.x. DOI: https://doi.org/10.1111/j.1552-6909.1991.tb01711.x
Khwanmueang P, Chunuan S, Thitimapong B. Effect of childbirth preparation program with continuous labor support on labor pain of first-time teenage pregnant women. NJPH. 2020;30(3):115-127. Available from: https://www.nur.psu.ac.th/researchdb/file_warasarn/15393journal2.pdf (in Thai).
Lebni JY, Farahani FK, Solhi M, Azar FE. Causes and grounds of childbirth fear and coping strategies used by Kurdish adolescent pregnant women in Iran: a qualitative study. J Reprod Infertil. 2021;22(1):47-56. doi: 10.18502/jri.v22i1.4995. DOI: https://doi.org/10.18502/jri.v22i1.4995
Hadaro TS, Alemu H, Yisihak E, Mare KU, Geltore TE. A systematic review and meta-analysis on fear of childbirth and associated factors among pregnant women in Ethiopia. Int J Africa Nurs Sci. 2025;21:100815. doi: 10.1016/j.ijans.2025.100815. DOI: https://doi.org/10.1016/j.ijans.2025.100815
O'Connell MA, Khashan AS, Leahy-Warren P. Women’s experiences of interventions for fear of childbirth in the perinatal period: a meta-synthesis of qualitative research evidence. Women Birth. 2021;34(3):309-321. doi: 10.1016/j.wombi.2020.05.008. DOI: https://doi.org/10.1016/j.wombi.2020.05.008
Kananikandeh S, Shokravi FA, Mirghafourvand M, Jahanfar S. Factors of the childbirth fear among nulliparous women in Iran. BMC Pregnancy Childbirth. 2022;22(1):547. doi: 10.1186/s12884-022-04870-1. DOI: https://doi.org/10.1186/s12884-022-04870-1
Kuo TC, Au HK, Chen SR, Chipojola R, Lee GT, Lee PH, Kuo SY. Effects of an integrated childbirth education program to reduce fear of childbirth, anxiety, and depression, and improve dispositional mindfulness: a single-blind randomised controlled trial. Midwifery. 2022;113:103438. doi: 10.1016/j.midw.2022.103438. DOI: https://doi.org/10.1016/j.midw.2022.103438
Tangsiri. LINE Thailand celebrates 10th anniversary, announces 50 million users. [Internet]. 2021 [cited 2024 May 16]. Available from: https://brandinside.asia/Line-thailand-10-yrs/
Mayer RE. Multimedia Learning. 3rd ed. Cambridge: Cambridge University Press; 2021 DOI: https://doi.org/10.1017/9781108894333.003
Huhom T, Sukphithak P. The effectiveness of implementing clinical practice guideline (CPG) for pain management among women with normal vaginal delivery (NVD)
at Pakphanang Hospital in Nakhon Si Thammarat. J Health Sci Pedagogy. 2022;2(2):32-45. Available from: https://he02.tci-thaijo.org/index.php/JHSP/article/view/257416 (in Thai).
Said AR, Hassan HM, Salama AM. Effect of childbirth preparation classes on women’s knowledge, self-efficacy, and satisfaction to cope with labour pain. Int J Manag. 2022;13(4):471-486. Available from: https://www.bu.edu.eg/portal/uploads/Nursing/Maternal%20and%20Newborn%20Health/1831/publications/Amira%20mohamed%20Salama%20abdelfattah_PAPER%202.pdf
Khademioore S, Ebrahimi E, Khosravi A, Movahedi S. The effect of an mHealth application based on continuous support and education on fear of childbirth, self-efficacy, and birth mode in primiparous women: a randomized controlled trial. PLoS One. 2023;18(11):e0293815. doi: 10.1371/journal.pone.0293815. DOI: https://doi.org/10.1371/journal.pone.0293815
Xu Y, Tang Y, Wang M, et al. Midwives’ perspectives of barriers and facilitators for the practice of promoting women’s positive childbirth experience in China: a qualitative study. Women Birth. 2025;38(1):101867. doi: 10.1016/j.wombi.2025.101867. DOI: https://doi.org/10.1016/j.wombi.2025.101867
Budsaengdee B, Chankhao C. Effect of using an application for enhancing childbirth self-efficacy to cope with labor pain and perception of the childbirth experience of nulliparous pregnant adolescents. TRC Nurse J. 2023;14(1):241-255. Available from: https://he02.tci-thaijo.org/index.php/trcnj/article/view/253344/172250 (in Thai).
Prasan S, Siriarunrat S, Tachasuksri T. Effects of continuous labor support programme on fear of childbirth and childbirth outcomes among primiparous women. NJPH. 2020;31(1):148-160. Available from: https://he02.tci-thaijo.org/index.php/tnaph/article/view/250655/170376 (in Thai).
Tanglakmankhong K, Perrin NA, Lowe NK. Childbirth self-efficacy inventory and childbirth attitudes questionnaire: psychometric properties of Thai language versions. J Adv Nurs. 2011;67(1):193-203. doi: 10.1111/j.1365-2648.2010.05479.x. DOI: https://doi.org/10.1111/j.1365-2648.2010.05479.x
Prabdin J, Phumdoung S, Thitimapong B. Fear of childbirth among pregnant teenagers in the third trimester and its related factors. J Nurs Sci Health. 2017;40(2):96-106. Available from: https://he01.tci-thaijo.org/index.php/nah/article/view/108102/85545 (in Thai).
Chuchuay B. The effects of continuous support program in labor by nurses on pain levels and pain coping behaviors in primiparous adolescents [Thesis]. Songkhla: Prince of Songkla University; 2015. Available from: https://kb.psu.ac.th/psukb/bitstream/2016/10669/1/404526.pdf (in Thai).
Matabane SE, Musie MR, Mulaudzi MF. Childbirth preparation: Knowledge of the use of non-pharmacological pain relief methods during childbirth in Tshwane District, South Africa: A cross-sectional study. Nursing Rep. 2023;14(1):1-11. doi: 10.3390/nursrep14010001. DOI: https://doi.org/10.3390/nursrep14010001
Onchonga D, Várnagy Á, Keraka M, Wainaina P. Midwife-led integrated pre-birth training and its impact on the fear of childbirth: a qualitative interview study. Sex Reprod Healthc. 2020;25:100512. doi: 10.1016/j.srhc.2020.100510. DOI: https://doi.org/10.1016/j.srhc.2020.100512
Esfandiari M, Faramarzi M, Nasiri-Amiri F, Parsian H, Chehrazi M, Pasha H, Omidvar S, Gholinia H. Effect of supportive counseling on pregnancy-specific stress, general stress, and prenatal health behaviors: a multicenter randomized controlled trial. Patient Educ Couns. 2020;103(11):2297-2304. doi: 10.1016/j.pec.2020.04.024. DOI: https://doi.org/10.1016/j.pec.2020.04.024
Nooied B, Chunuan S, Phumdoung S. Effectiveness of a nurse-led program to enhance self-efficacy of pregnant adolescents and reduce their fear of childbirth: A randomized controlled trial. Pac Rim Int J Nurs Res. 2022;27(1):4-18. doi: 10.60099/prijnr.2023.260325. DOI: https://doi.org/10.60099/prijnr.2023.260325
Maneewong S, Junprasert T, Peungposop N. A study to understand the adaptation and conditions among unintended pregnancy adolescents. The Periodical of Behav Sci. 2024;30(2):20-34. Available from: https://so06.tci-thaijo.org/index.php/BSRI/ article/view/266484 (in Thai).
Wigert H, Nilsson C, Dencker A, Begley C, Jangsten E, Sparud-Lundin C, et al. Women’s experiences of fear of childbirth: a metasynthesis of qualitative studies. Int J Qual Stud Health Well-being. 2020;15(1):1704484. doi: 10.1080/17482631.2019.1704484. DOI: https://doi.org/10.1080/17482631.2019.1704484
Alsomali Z, Bajamal E, Esheaba O. The effect of structured antenatal education on childbirth self-efficacy. Cureus. 2023;15(5). doi: 10.7759/cureus.39285. DOI: https://doi.org/10.7759/cureus.39285
Cankaya S, Simşek B. Effects of antenatal education on fear of birth, depression, anxiety, childbirth self-efficacy, and mode of delivery in primiparous pregnant women: a prospective randomized controlled study. Clin Nurs Res. 2021;30(6):818-829. doi: 10.1177/1054773820916984. DOI: https://doi.org/10.1177/1054773820916984
Nanji JA, Carvalho B. Pain management during labor and vaginal birth. Best Pract Res Clin Obstet Gynaecol. 2020;67:100-112. doi: 10.1016/j.bpobgyn.2020.03.002. DOI: https://doi.org/10.1016/j.bpobgyn.2020.03.002
Masroor P, Mehrabi E, Nourizadeh R, Pourfathi H, Asghari-Jafarabadi M. The comparison of the effect of non-pharmacological pain relief and pharmacological analgesia with remifentanil on fear of childbirth and postpartum depression: a randomized controlled clinical trial. BMC Pregnancy Childbirth. 2024;24(1):305. doi: 10.1186/s12884-024-06270-z. DOI: https://doi.org/10.1186/s12884-024-06270-z
Bahribinabaj N, Latifnejad R, Abdollahian E, Esmaeeli H. The effect of one to one midwife support on labor pain. J Inflamm Dis. 2024;8(4):59-64. Available from: https://brieflands.com/articles/jid-155097.
Kerr PL, Sirbu C, Gregg JM, editors. Endogenous opioids: from basic science to biopsychosocial applications. 1st ed. Cham: Springer; 2024. doi: 10.1007/978-3-031-45493-6. DOI: https://doi.org/10.1007/978-3-031-45493-6_1
Bist L, Viswanath L, Nautiyal R, Agarwal S. Childbirth preparedness and childbirth anxiety among primigravida in a lower-middle income country: a phenomenological qualitative study. Clin Epidemiol Glob Health. 2025;32:101918. doi: 10.1016/j.cegh.2025.101918. DOI: https://doi.org/10.1016/j.cegh.2025.101918
Downloads
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2025 Pacific Rim International Journal of Nursing Research
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright: The Pacific Rim International Journal of Nursing Research, Thailand Nursing & Midwifery Council has exclusive rights to publish, reproduce and distribute the manuscript and all contents therein.
.png)
