This randomized controlled trial evaluates the effects of a mandala-based intervention on mother-infant bonding and parenting self-efficacy in primiparous women (first-time mothers) who experienced a negative birth experience.
Study Design and Population The study was conducted in the obstetrics clinic of a hospital. Power analysis indicated a minimum sample size of 44 participants to achieve 80% power at a 0.05 significance level. To account for potential attrition, the study aimed for 70 participants and was completed with 66 mothers (34 in the Mandala Group and 32 in the Free Coloring Group).
Inclusion Criteria Eligible participants included women who had a vaginal delivery, were within the first seven days postpartum, were primiparous with a singleton pregnancy, and self-reported a negative birth experience confirmed by a score of 37 or above on the Wijma Delivery Expectancy/Experience Questionnaire Version B. Participants were required to have no diagnosed psychological disorders and no communication difficulties.
Randomization and Procedure Participants were randomly assigned to either the Mandala Coloring Group or the Free Coloring Group using random allocation software. Data collection occurred at two time points: before and after the intervention.
Intervention Protocols The intervention was conducted face-to-face in a quiet, supportive environment under researcher supervision, typically when the infant was asleep. Each session lasted approximately 30 minutes.
Mandala Coloring Group: This structured relaxation process included brief information on mandala philosophy, five minutes of "box breathing" relaxation, and guided imagery of a seaside scene. Participants created and colored a "wish mandala" representing personal intentions, accompanied by shamanic drum rhythm music. The session concluded with the creation of a "stress mandala" using spiral drawings to symbolically release stress.
Free Coloring Group: This activity allowed participants to express emotions spontaneously without guidance. Participants began drawing without prior planning, and the resulting images were evaluated as personal reflections rather than artistic products.
Outcome Assessments The primary outcomes include changes in the Mother-Infant Bonding Scale and the Karitane Parenting Confidence Scale. Secondary outcomes include changes in anxiety levels measured by the State-Trait Anxiety Inventory. Ethical approval was obtained prior to the study, and all participants provided written informed consent in accordance with the Declaration of Helsinki.
