نویسندگان:

صفورا کیوانلو¹ ، فریبرز دوستی پور² ، مائده هنربخش³ ، پریسا اسدی نیا⁴ ، ساناز عینی⁵ .

¹دانشجوی دکتری روانشناسی، گروه روانشناسی، دانشکده علوم تربیتی و روانشناسی، دانشگاه محقق اردبیلی، اردبیل، ایران.

²کارشناسی ارشد روانشناسی، گروه روانشناسی، دانشکده علوم تربیتی و روانشناسی، دانشگاه علامه طباطبائی، تهران، ایران.

³کارشناسی ارشد روانشناسی بالینی، گروه روانشناسی، واحد زنجان، دانشگاه آزاد اسلامی، زنجان، ایران

⁴کارشناسی ارشد روانشناسی بالینی، گروه روانشناسی، واحد اردبیل، دانشگاه آزاد اسلامی، اردبیل، ایران

⁵استادیار، گروه روانشناسی، دانشکده علوم انسانی و اجتماعی، دانشگاه کردستان، سنندج، ایران

چکیده فارسی: پژوهش حاضر با هدف بررسی نقش انسجام روانی و تحمل پریشانی در رفتارهای سلامت باروری زنان با میانجی‌گری استرس والدگری انجام شد. این مطالعه از نظر هدف، کاربردی و به روش تحلیل مسیر اجرا گردید. جامعه آماری شامل تمامی زنان بارداری بود که در شش‌ماهه نخست سال ۱۴۰۳ برای دریافت مراقبت‌های دوران بارداری به مراکز بهداشتی شهر مشهد مراجعه کردند. از میان آن‌ها ۲۳۸ نفر به روش نمونه‌گیری دردسترس انتخاب شدند. ابزارهای پژوهش شامل پرسشنامه رفتارهای سلامت بارداری (PHBS) ، احساس انسجام (SOC) ، تحمل پریشانی (DTS) و استرس والدگری–فرم کوتاه (PSI-SF) بود. داده‌ها در نرم‌افزارهای SPSS 27 وLISREL 8.8 تحلیل شد. یافته‌ها نشان داد انسجام روانی و تحمل پریشانی بر رفتارهای ارتقادهنده سلامت باروری اثر مستقیم مثبت و معنادار و بر رفتارهای مخرب سلامت باروری اثر مستقیم منفی و معنادار نشان داد. همچنین، اثر غیرمستقیم انسجام روانی و تحمل پریشانی بر هر دو دسته رفتارهای سلامت باروری از طریق میانجی‌گری استرس والدگری معنادار بود (05/0>P). بر اساس نتایج، تقویت انسجام روانی و مهارت‌های تحمل پریشانی می‌تواند به بهبود سلامت باروری و کاهش آسیب‌پذیری زنان در برابر استرس والدگری کمک کند. بنابراین توصیه می‌شود متخصصان حوزه بارداری در کنار مراقبت‌های پزشکی، به عوامل روان‌شناختی مؤثر بر سلامت باروری نیز توجه بیشتری داشته باشند.

کلمات کلیدی: استرس ‎والدگری ، تحمل پریشانی ، انسجام روانی ، رفتارهای سلامت باروری .

Causal Model Testing of Women’s Reproductive Health Behaviors Based on Sense of Coherence and Distress Tolerance with the Mediating Role of Parenting Stress

English Abstract: Introduction Pregnancy is one of the most sensitive periods in women’s lives, accompanied by simultaneous physical, psychological, and social changes. It can seriously affect behavioral patterns related to maternal and fetal health. Reproductive health behaviors during this period range from health-promoting practices such as having proper nutrition, following prenatal care, and adhering to health recommendations to health-damaging behaviors such as smoking, neglecting medical care, and other high-risk behaviors (Morris et al., 2020). Reproductive health, as a fundamental part of public health, includes not only physical health but also the psychological and social well-being of women in the reproductive process. In this vein, research evidence shows that a healthy lifestyle, proper nutrition, regular physical activity, and avoiding unhealthy behaviors are associated with reducing risky pregnancy outcomes and improving maternal and child health (Braun et al., 2022). Psychological factors affecting reproductive health behaviors include sense of coherence and distress tolerance. Sense of coherence refers to an individual’s perception of the world as an understandable, manageable, and meaningful context. According to the health-generating theory, it is considered an important source of coping in stressful situations (Antonovsky, 2002). Research has shown that higher levels of sense of coherence are associated with less anxiety and depression, better adjustment to pregnancy, and more favorable health outcomes (Alcantara et al., 2023; Bäckström et al., 2018). On the other hand, distress tolerance refers to an individual’s capacity to be resilient and continue to function adaptively in the face of negative emotions and stressful situations (Simons & Gaher, 2005). Women with higher distress tolerance use more adaptive coping strategies in the face of pregnancy-related stress and are less likely to engage in avoidant or damaging behaviors (Costa et al., 2020). In addition to these variables, parenting stress can act as an explanatory mechanism in the relationship between maternal psychological resources and reproductive health behaviors. Parenting stress occurs when an individual evaluates the demands of the parenting role beyond psychological and emotional resources (Wang et al., 2020). Despite the importance of these variables, most previous studies have examined them separately, and fewer have presented an integrated model to explain reproductive health behaviors. Therefore, the present study aimed to test a causal model of women’s reproductive health behaviors based on sense of coherence and distress tolerance mediated by parenting stress. Method The present study was applied in terms of purpose and descriptive-correlational in terms of method of implementation, using path analysis. The statistical population included all pregnant women who attended healthcare centers in Mashhad for prenatal care during the first six months of 2024. Among them, 250 women were selected using convenience sampling method. Finally, after removing 12 incomplete questionnaires, the data of 238 women were analyzed. The mean age of the participants was 29.15 years. The research instruments included the Pregnancy Health Behaviors Questionnaire (Lobel et al., 2008), the Sense of Coherence Scale (Antonovsky, 1996), the Distress Tolerance Scale (Simons & Gaher, 2005), and the Parenting Stress Index–Short Form (Abidin, 1995). Cronbach’s alpha coefficients for health-promoting behaviors, health-damaging behaviors, sense of coherence, distress tolerance, and parenting stress were 0.92, 0.90, 0.83, 0.82, and 0.87, respectively. Data were analyzed using SPSS (version 27) and LISREL (version 8.8) software. Pearson’s correlation coefficient was used to examine the relationships between variables, and path analysis was used to test the structural model. In addition, to test the significance of indirect effects, the bootstrap method with a 95% confidence interval was used. Findings Descriptive and inferential findings showed that the data were in a favorable state in terms of univariate and multivariate normality, and the assumptions of structural equation analysis, including the absence of outliers and multiple noncollinearity, were met. Pearson correlation results showed that health-promoting behaviors had a positive and significant relationship with sense of coherence (p < 0.01, r = 0.45) and distress tolerance (p < 0.01, r = 0.53) and a negative and significant relationship with parenting stress (p < 0.01, r = -0.55). Furthermore, health-damaging behaviors had a negative relationship with sense of coherence (p < 0.01, r = -0.37) and distress tolerance (p < 0.01, r = -0.49) and a positive and significant relationship with parenting stress (p < 0.01, r = 0.56). The model fit indices also indicated the optimal fit of the proposed model; the ratio χ 2/df = 1.85, the indices CFI = 0.91, NFI = 0.92, IFI = 0.91, TLI = 0.90, GFI = 0.86, and RMSEA = 0.065 all showed that the model had acceptable adequacy. The results of the direct path coefficients showed that sense of coherence had a positive and significant direct effect on health-promoting behaviors (β = 0.19, T = 3.43, p = 0.01) and a negative and significant direct effect on health-damaging behaviors (β = -0.12, T = -2.17, p = 0.03). Moreover, sense of coherence showed a negative and significant relationship with parenting stress (β = -0.22, T = -3.57, p = 0.001). Regarding distress tolerance, the results showed that this variable had a positive and significant direct effect on health-promoting behaviors (β = 0.27, T = 4.53, p = 0.001) and a negative and significant direct effect on health-damaging behaviors (β = -0.25, T = -4.01, p = 0.001). In addition, distress tolerance had a negative and significant effect on parenting stress (β = -0.39, T = -6.20, p = 0.001). The results also showed that parenting stress directly reduced health-promoting behaviors (β = -0.35, T = -6.01, p > 0.05) and increased health-destructive behaviors (β = 0.40, T = 6.73, p > 0.05). In examining indirect effects, bootstrap results showed that parenting stress played a significant mediating role in the relationship between sense of coherence and distress tolerance with reproductive health behaviors. The indirect effect of sense of coherence on health-promoting behaviors through parenting stress was positive and significant ([0.148, 0.007]CI95%, β = 0.077), while its indirect effect on health-damaging behaviors was negative and significant ([-0.014, -0.162]CI95%, β = 0.088). Similarly, the indirect effect of distress tolerance on health-promoting behaviors was positive and significant ([0.202, 0.071]CI95%, β = 0.137), and its indirect effect on health-damaging behaviors was negative and significant ([-0.075, -0.237]CI95%, β = 0.156). Since none of the confidence intervals included zero, the significance of these effects was confirmed. Overall, the findings indicated that higher levels of sense of coherence and distress tolerance, through reducing parenting stress, increased health-oriented behaviors and reduced reproductive health-damaging behaviors in pregnant women. Conclusion The objective of the present study was to test the causal model of women’s reproductive health behaviors based on sense of coherence and distress tolerance mediated by parenting stress. The results showed that sense of coherence and distress tolerance played important roles in promoting reproductive health behaviors and reducing health-damaging behaviors, both directly and indirectly through reducing parenting stress. These findings are consistent with the literature (Costa et al., 2020; Manouchehri et al., 2024; Mousavi et al., 2023) and showed that women who perceived pregnancy as more understandable, controllable, and meaningful, and had a greater ability to tolerate negative emotions and stressful situations, exhibited more caring and health-oriented behaviors in the face of the challenges of this period (Alcantara et al., 2023). Moreover, the mediating role of parenting stress indicates that individual psychological resources affected health behaviors, in part, by reducing the mental and emotional pressures associated with the maternal role. Considering the implications of this study, the results emphasize the need to simultaneously pay attention to psychological dimensions and medical care in reproductive health programs. Accordingly, it is suggested that specialists in the fields of gynecology, midwifery, health psychology, and counseling, in addition to training in physical care during pregnancy, design and implement interventions to strengthen sense of coherence, increase distress tolerance, and reduce parenting stress. Holding educational workshops, interventions based on emotion regulation, mindfulness, acceptance and commitment, and training in coping skills can be beneficial in this regard. It is also suggested that future research use larger samples, longitudinal methods, and examine other mediating and moderating variables to gain a more accurate understanding of the mechanisms affecting women’s reproductive health. Conflict of interest According to the authors, this study had no conflict of interest. Acknowledgements The authors sincerely appreciate all pregnant women who participated in this study as well as the officials and staff of the health centers in Mashhad who cooperated in this study.