Stress Ball Intervention During Active Labor

Visual Analogue Scale (VAS) The VAS was used to assess perceived pain intensity. The scale consists of a 10 cm (100 mm) horizontal line, anchored by "no pain" (0 mm) at one end and "the worst pain imaginable" (100 mm) at the other. Participants were asked to indicate their level of pain by drawing a line, placing a mark, or indicating a point along the scale. The distance from the starting point to the marked point was measured in millimetres, and analyses were conducted on a 0-100 mm scale. On the VAS, scores between 0-44 mm indicate mild pain, 45-74 mm indicate moderate pain, and 75-100 mm indicate severe pain (Jensen, 2003). Assessments were performed hourly throughout the active phase of labour.

Childbirth Comfort Scale Based on Kolcaba's Comfort Theory, the scale was developed by Schuiling et al. (Schuiling et al., 2011), and its Turkish validity and reliability were established by Potur et al. (Coşkuner Potur et al., 2015). The instrument consists of nine items rated on a 5-point Likert scale and comprises three subdimensions: physical, psychospiritual, and environmental comfort. Before calculating the total score, items 5, 7, and 8 must be reverse-coded. The total score ranges from 9 to 45, with higher scores indicating higher levels of comfort and lower scores reflecting lower levels of comfort. In the Turkish validity and reliability study, the Cronbach's alpha coefficient was reported as 0.75 (Coşkuner Potur et al., 2015). In the present study, the Cronbach's alpha coefficient was likewise calculated as 0.75. In this research, the scale was administered as a pre-test and as a post-test within 24 hours after childbirth.

Self-Efficacy Scale Developed by Sherer et al. (Sherer et al., 1982) to assess self-efficacy beliefs-one of the core constructs of Social Cognitive Theory-the scale was adapted into Turkish by Yıldırım and İlhan (Yıldırım & İlhan, 2010), who established its validity and reliability. The instrument consists of 17 items rated on a 5-point Likert scale. Items 2, 4, 5, 6, 7, 10, 11, 12, 14, 16, and 17 are reverse-scored. The total score ranges from 17 to 85, with higher scores indicating stronger self-efficacy beliefs. Although the scale identifies three subdimensions-initiation, persistence in the face of adversity (non-withdrawal), and maintenance of effort/insistence-it is recommended that the instrument be evaluated as a whole rather than treating each factor as a separate subscale. Accordingly, analyses are based on a single total score derived from the entire scale. The Cronbach's alpha coefficient of the original scale was reported as 0.80. In the present study, the Cronbach's alph