无法忍受不确定性对初产妇分娩恐惧的影响:有调节的中介模型

Effect of Intolerance of Uncertainty on Fear of Childbirth in Primiparas:A Moderated Mediating Model

目的探讨分娩自我效能在无法忍受不确定性对孕中晚期初产妇分娩恐惧的影响路径中的中介效应,以及感知伴侣回应可能的调节效应。方法采用一般资料调查表、无法忍受不确定性量表、简版分娩自我效能量表、感知伴侣回应性量表和分娩恐惧量表对429例孕中晚期初产妇进行调查。采用秩和检验比较不同组间分娩恐惧得分是否有差异,采用Spearman相关性分析各量表得分。并对数据进行中心化处理,使用PROCESS v3.4.1 Model 4(简单中介模型)、Model 5(中介模型的直接路径受到调节)和非参数Bootstrap法检验中介效应和调节效应。结果孕中晚期初产妇分娩恐惧总体发生率为54.31%,无法忍受不确定性、分娩自我效能、感知伴侣回应性得分的中位数(四分位间距)依次为15.00(8.00)、240.00(75.00)、72.00(19.00)。不同年龄、孕周、工作状态及家庭人均月收入的孕妇之间分娩恐惧量表得分差异有统计学意义(P<0.05)。结果显示,无法忍受不确定性对分娩恐惧有直接正向作用(β=0.76,P<0.001),分娩自我效能在两者中发挥部分中介效应,间接效应为0.05,贡献率为6.17%;将感知伴侣回应性量表得分放入模型之后,感知伴侣回应性对分娩恐惧的预测作用不显著,但感知伴侣回应性量表与无法忍受不确定性量表得分的乘积项对分娩恐惧的预测作用显著(β=0.01,P<0.05),说明感知伴侣回应性在两者中发挥调节作用。结论医护人员应重视孕中晚期初产妇的分娩恐惧,通过降低无法忍受不确定性感知,提高家庭支持和分娩应对策略,帮助初产妇减轻分娩恐惧,提升分娩体验。

Objective 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.Methods 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.Results 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(P<0.05).According to our findings,intolerance of uncertainty directly and positively impacted on fear of childbirth(β=0.76,P<0.001),with childbirth selfefficacy 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(β=0.01,P<0.05),which suggested that perceived partner responsiveness also played a moderating role between intolerance of uncertainty and fear of childbirth.Conclusion 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.