Therapeutic Touch and Foot Reflexology on Sleep Quality and Menopausal Symptoms

Natural disasters can have substantial effects on individual and public health. Türkiye is frequently exposed to earthquakes because of its location within the active Mediterranean-Alpine seismic belt. On February 6, 2023, two major earthquakes with magnitudes of 7.7 and 7.6 occurred in the Pazarcık and Elbistan districts of Kahramanmaraş, respectively. The earthquakes affected multiple provinces and disrupted access to healthcare and other essential services. Such disruptions may increase the healthcare needs of vulnerable populations, including women.

The health effects of disasters may vary according to the characteristics of the disaster, preparedness, access to healthcare services, and individual and community resilience. Postmenopausal women may have specific healthcare needs following disasters because menopause-related physiological changes can be accompanied by symptoms such as hot flashes, sleep disturbances, anxiety, and other physical and psychological complaints. Exposure to stressful events may also influence sleep and menopause-related health concerns.

Previous research on women's health following earthquakes has primarily focused on reproductive health, while information regarding menopausal symptoms and sleep problems among postmenopausal women exposed to disasters is limited. Therefore, assessment of these health concerns and evaluation of interventions intended to address them are important for informing post-disaster healthcare practices.

Therapeutic touch is a noninvasive complementary practice involving the practitioner's use of the hands in relation to the individual's body. Reflexology is a complementary practice involving the application of pressure to specific reflex areas, particularly on the feet. Both approaches have been investigated in different populations in relation to symptoms such as stress, sleep disturbances, and menopause-related complaints.

This randomized controlled trial was designed to compare therapeutic touch, reflexology, and a control condition with respect to sleep quality and menopausal symptoms among postmenopausal women affected by the February 6, 2023 Kahramanmaraş earthquakes.

A total of 155 postmenopausal women were included in the study. Participants were assigned to therapeutic touch, reflexology, or control groups. Data were collected using the Participant Information Form, the Women's Health Initiative Insomnia Scale (WHIIS), and the Menopausal Symptom Assessment Scale (MSAS). Sleep quality and menopausal symptoms were assessed at prespecified time points.

The planned statistical analyses included descriptive statistics, Pearson chi-square test, one-way analysis of variance (ANOVA), paired-sample t-test, and repeated-measures analysis of covariance (ANCOVA). Pre-intervention scores and income level were included as covariates in the model, and Bonferroni correction was applied for pairwise comparisons. The analyses were planned to evaluate and compare changes in sleep quality and menopausal symptoms among the study groups.

Inclusion criteria

• Women aged 45-64 years.
• Affected by the February 6, 2023 Kahramanmaraş earthquakes.
• Natural postmenopause (no spontaneous menstruation for at least 12 consecutive months).
• Living in the container settlement during the study period.
• Able to communicate in Turkish.
• Provided written informed consent.

Exclusion criteria

• History of surgical menopause.
• Current menopausal hormone therapy.
• Diagnosis of a psychiatric disorder.
• Use of antidepressants, benzodiazepines, hypnotics, narcotic analgesics, or antihistamines.
• Current use of Reiki, acupressure, phytoestrogens, or other complementary therapies.
• Foot wounds, infection, or open lesions preventing reflexology.
• Refusal to participate or withdrawal of consent.