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Completed

NCT Number: NCT07788508

Mandala Coloring and Resilience in Midwives

Midwives working in delivery rooms are exposed to occupational and psychological stressors associated with high workloads, shift work, time pressure, obstetric emergencies, and traumatic perinatal events. These working conditions may adversely affect their psychological resilience and well-being. Mandala coloring is a simple, low-cost, art-based activity that may promote relaxation and psychological well-being; however, evidence regarding its effect on psychological resilience among midwives is limited.

The aim of this study was to evaluate the effect of mandala coloring on psychological resilience among midwives working in delivery rooms. Secondary outcomes included depression, anxiety, stress, and psychological well-being.

The study was conducted as a two-arm, pretest-posttest, matched cluster randomized controlled trial involving midwives working in the delivery rooms of eight hospitals. Hospitals were treated as clusters and matched into four pairs according to the number of midwives working in the delivery room and the annual number of births. Within each matched pair, one hospital was randomly assigned to the intervention group and the other to the control group. A total of 91 midwives participated in the study, with 45 midwives from four hospitals allocated to the intervention group and 46 midwives from four hospitals allocated to the control group.

Midwives in the intervention group participated in a six-week mandala coloring program. They were asked to complete two mandala coloring sessions per week, for a total of 12 sessions, with each session lasting approximately 20-30 minutes. Participants in the control group continued their usual routines during the six-week study period.

Psychological resilience was assessed as the primary outcome using the Resilience Scale for Adults. Depression, anxiety, and stress were assessed using the Depression Anxiety Stress Scale-21, and psychological well-being was assessed using the Psychological Well-Being Scale. Outcomes were assessed at baseline and at the end of the six-week intervention period.

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Key information

Conditions

Psychological Resilience Among Midwives Working in Delivery Rooms Anxiety Disorders Behavior Behavioral Symptoms Depression Mental Disorders

Sex eligibility

Female

Study type

Interventional

Phase

Not applicable

Primary location

Medipol Bahçelievler Üniversity Hospital, Istanbul, Bahçelievler, Turkey (Türkiye)

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About this study

Midwives working in delivery rooms may be exposed to substantial occupational and psychological stressors due to high workloads, shift work, time pressure, obstetric emergencies, and exposure to traumatic perinatal events. These demands may adversely affect their psychological well-being and resilience. Psychological resilience is particularly important for midwives because it may support their ability to adapt to stressful working conditions while maintaining professional functioning and well-being.

Art-based activities have been investigated as non-pharmacological approaches for reducing psychological distress and promoting well-being. Mandala coloring is a structured art-based activity involving the coloring of repetitive and geometric patterns. It is inexpensive, easy to implement, requires minimal resources, and can potentially be incorporated into workplace settings without extensive training.

Previous studies have suggested that mandala-based interventions may have beneficial effects on outcomes such as stress, anxiety, psychological well-being, and coping in different populations. However, evidence regarding the effect of mandala coloring specifically on psychological resilience remains limited and inconsistent. Furthermore, there is limited evidence evaluating mandala coloring as a workplace-based intervention among midwives working in delivery rooms.

This study was therefore designed to evaluate whether a six-week mandala coloring intervention could improve psychological resilience among midwives working in delivery rooms. The study also examined the effects of the intervention on depression, anxiety, stress, and psychological well-being as secondary outcomes. By evaluating a simple, low-cost, and easily applicable intervention within the clinical work environment, the study aimed to contribute evidence regarding strategies that may support the psychological well-being of midwives.

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Working as a midwife in the delivery room of one of the participating hospitals
  • Voluntarily agreeing to participate in the study
  • Providing informed consent

Exclusion criteria

  • Having difficulty communicating in Turkish or having a hearing, speech, or comprehension impairment that could interfere with communication and participation in the study
  • Having a physical or visual impairment that could prevent participation in the mandala coloring activity
  • Having a psychiatric disorder
  • Routinely engaging in stress-reduction or relaxation practices, such as meditation or yoga

Treatment and study plan

Mandala Coloring

Behavioral

Participants completed mandala coloring twice per week for six consecutive weeks, for a total of 12 sessions. Each session lasted approximately 20-30 minutes and was conducted during working hours at a time suitable for the participant. Participants selected one of the provided mandala designs and colored it according to their own preferences using a 12-color felt-tip pen set. Adherence was monitored through messages sent before each session and photographs of the completed mandalas sent to the researcher after each session. Reminder messages were sent twice weekly.

Primary outcomes

  1. Resilience Scale for Adults (RSA)

    Time frame: Baseline and immediately after the 6-week intervention

    Psychological resilience was assessed using the Resilience Scale for Adults (RSA). The scale consists of 33 items and yields a total score ranging from 33 to 165. Higher scores indicate higher levels of psychological resilience. The primary outcome was the change in the total RSA score from baseline to the end of the six-week intervention.

Secondary outcomes

  1. Depression Anxiety Stress Scale-21 (DASS-21)

    Time frame: Baseline and immediately after the 6-week intervention

    The scale is a 21-item self-report instrument used to assess symptoms of depression, anxiety, and stress. It consists of three sub-dimensions: depression, anxiety, and stress, with seven items in each sub-dimension. Items are rated from 0 to 3, with a raw score ranging from 0 to 21 for each sub-dimension. Higher scores indicate a higher level of depression, anxiety, or stress symptoms in that sub-dimension.

  2. Psychological Well-Being Scale

    Time frame: Baseline and immediately after the 6-week intervention

    Psychological well-being was assessed using the 8-item Psychological Well-Being Scale. Total scores range from 8 to 56, with higher scores indicating greater psychological well-being.

Sponsors and collaborators

Lead sponsor

Istanbul University - Cerrahpasa

Other

Registry information

Official study title

Effect of Mandala Coloring on Psychological Resilience Among Midwives Working in Delivery Rooms: A Matched Cluster Randomized Controlled Trial

Acronym: MCR-Midwives

Important dates

Study start
2025
Primary completion
2025
Study completion
2025
First posted
Aug 26, 2026
Registry last updated
Aug 28, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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