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This randomized controlled trial aims to compare the effects of a web-based compassion-focused writing program and a reflective writing program on psychological well-being, self-compassion, postpartum trauma-related stress symptoms, and post-traumatic growth in midwives working in delivery rooms.
This study is planned as a single-blind, parallel-group randomized controlled trial to evaluate the effects of two different writing-based interventions on psychological outcomes in midwives working in delivery rooms. During the childbirth process, midwives may occasionally witness traumatic events, which may lead to secondary traumatic stress, burnout, and various psychological difficulties. The literature indicates that expressive writing, reflective writing, and compassion-focused writing approaches contribute to individuals' ability to make sense of traumatic experiences, enhance emotional regulation skills, and support psychological well-being. Accordingly, this study aims to examine the effects of writing-based interventions that may support the psychological resilience of midwives. A total of 90 midwives who meet the inclusion criteria will be included in the study and randomly assigned to two groups using a computer-generated random number sequence. One group will receive a web-based compassion-focused writing program, while the other group will receive a web-based reflective writing program. Both programs will consist of five sessions conducted once per week via an online platform. Data will be collected using a Personal Information Form, Psychological Well-Being Scale, Self-Compassion Scale, City Birth Trauma Scale, and Post-Traumatic Growth Scale - Short Form. Measurements will be conducted before the intervention, immediately after the completion of the program, and during the follow-up period. Additionally, after each session, participants will complete a brief questionnaire to evaluate their writing experience. The collected data will be analyzed using appropriate statistical methods to compare the effects of both writing programs on psychological well-being, self-compassion, post-traumatic growth, and trauma-related stress symptoms.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Compassion-Focused Writing Program | Experimental | Participants assigned to this group will complete a five-week web-based compassion-focused writing program consisting of structured writing exercises aimed at enhancing self-compassion, increasing empathy, supporting emotional awareness, and strengthening coping skills related to challenging birth experiences. Sessions will be conducted once per week via an online platform. |
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| Reflective Writing Program | Placebo Comparator | Participants in this group will complete a five-week web-based reflective writing program consisting of structured writing exercises designed to encourage reflection on professional experiences, emotional responses, and thoughts related to delivery room practices. Sessions will be conducted once per week via an online platform. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Compassion-Focused Writing Program | Behavioral | The web-based compassion-focused writing program consists of five structured writing sessions designed to enhance self-compassion, empathy, emotional awareness, and coping skills related to challenging birth experiences. |
| Measure | Description | Time Frame |
|---|---|---|
| Psychological Well-Being | Participants' psychological well-being will be assessed using the Psychological Well-Being Scale developed by Diener et al. (2010) to measure socio-psychological well-being. The scale consists of 8 items rated on a 7-point Likert scale ranging from 1 ("Strongly disagree") to 7 ("Strongly agree"). Total scores range from 8 to 56, with higher scores indicating greater psychological well-being and stronger psychological resources. The Turkish version of the scale demonstrated good internal consistency, with a Cronbach's alpha coefficient of 0.80 (Telef, 2013). | Within 24 hours before the intervention, within 24 hours after the intervention, and 6-8 weeks after the intervention |
| Self-Compassion | Participants' self-compassion will be assessed using the Self-Compassion Scale developed by Neff (2003). The scale measures individuals' levels of self-kindness, acceptance, and compassion toward themselves. The Turkish version consists of 24 items rated on a 5-point Likert scale. It includes six subscales: self-kindness, self-judgment, common humanity, isolation, mindfulness, and over-identification. Total scores range from 24 to 120, with higher scores indicating greater self-compassion. The Turkish version demonstrated good reliability, with a Cronbach's alpha coefficient of 0.89 and a test-retest reliability coefficient of 0.83 (Deniz, Kesici, & Sümer, 2008). | Within 24 hours before the intervention, within 24 hours after the intervention, and 6-8 weeks after the intervention |
| Birth-Related Traumatic Stress Symptoms | Participants' birth-related traumatic stress symptoms will be assessed using the City Birth Trauma Scale - Maternal Health Professional Version, developed by McInnes et al. (2025). The scale is based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for post-traumatic stress disorder and is designed to assess birth-related traumatic stress symptoms among maternal healthcare professionals providing care during the antenatal, intrapartum, and postpartum periods. Total PTSD symptom scores range from 0 (minimum) to 60 (maximum), with higher scores indicating more severe birth-related post-traumatic stress disorder symptoms.The scale consists of 29 items, with higher total scores indicating more severe birth-related post-traumatic stress disorder symptoms. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Gözde Gökçe İsbir | Contact | +905057782319 | gozdegokce@gmail.com | |
| Zehra Yıldırım | Contact | +905464313760 | ebezehrayldrm@gmail.com |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 36058189 | Result | Uddin N, Ayers S, Khine R, Webb R. The perceived impact of birth trauma witnessed by maternity health professionals: A systematic review. Midwifery. 2022 Nov;114:103460. doi: 10.1016/j.midw.2022.103460. Epub 2022 Aug 13. | |
| 35073852 | Result | Hajiesmaello M, Hajian S, Riazi H, Majd HA, Yavarian R. Secondary traumatic stress in iranian midwives: stimuli factors, outcomes and risk management. BMC Psychiatry. 2022 Jan 24;22(1):56. doi: 10.1186/s12888-022-03707-7. |
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| Reflective Writing Program | Behavioral | The web-based reflective writing program consists of structured online writing exercises designed to facilitate reflective thinking, emotional expression, and self-awareness. |
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| Within 24 hours before the intervention and 6-8 weeks after the intervention |
| Posttraumatic Growth | Participants' posttraumatic growth will be assessed using the Posttraumatic Growth Inventory-Short Form, developed by Platte et al. (2023). The scale consists of 10 items rated on a 6-point Likert scale, with total scores ranging from 0 to 50. Higher scores indicate greater positive psychological growth following a traumatic or highly stressful experience. The original version demonstrated good internal consistency, with a Cronbach's alpha coefficient of 0.88. The Turkish version also demonstrated good reliability, with a Cronbach's alpha coefficient of 0.81 (Türk et al., 2025). | Within 24 hours before the intervention and 6-8 weeks after the intervention |
| ID | Term |
|---|---|
| D000092862 | Psychological Well-Being |
| D000068376 | Compassion Fatigue |
| D000073397 | Occupational Stress |
| D014947 | Wounds and Injuries |
| ID | Term |
|---|---|
| D010549 | Personal Satisfaction |
| D001519 | Behavior |
| D005222 | Mental Fatigue |
| D005221 | Fatigue |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D001526 | Behavioral Symptoms |
| D013315 | Stress, Psychological |
| D009784 | Occupational Diseases |
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