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Background <p>Tokophobia affects up to 14% of pregnant women globally and is linked to high cesarean rates, particularly in Egypt. This study evaluated the efficacy of a culturally adapted Internet-based Cognitive Behavioral Therapy program on fear of childbirth and maternal self-efficacy among Egyptian pregnant women.</p> Methods <p>A randomized controlled trial was conducted in Damanhur City, Egypt, involving 96 pregnant women with moderate to severe tokophobia. Participants were randomly assigned to an intervention group (<i>n</i> = 48) receiving a six-week program via WhatsApp or a control group (<i>n</i> = 48) receiving routine antenatal care. The intervention included cognitive restructuring, exposure therapy, relaxation techniques, and psychoeducation grounded in Bandura’s Self-Efficacy Theory. Outcomes were assessed using the Childbirth Attitude Questionnaire and Childbirth Self-Efficacy Inventory at baseline and post-intervention.</p> Results <p>Post-intervention, the intervention group demonstrated a significant reduction in fear of childbirth scores (mean decrease: 14.32 ± 5.55; <i>p</i> &lt; 0.001) and an increase in maternal self-efficacy (mean increase: 38.3 ± 35.7; <i>p</i> &lt; 0.001). Large effect sizes were observed for both fear reduction (η²=0.876) and self-efficacy enhancement (η²=0.600). The control group showed no significant changes.</p> Conclusion <p>The culturally adapted Internet-based Cognitive Behavioral Therapy program significantly reduced tokophobia and enhanced maternal self-efficacy, supporting its integration into perinatal care. These findings align with Bandura’s Self-Efficacy Theory and suggest the potential of digital interventions in improving psychological outcomes, especially in resource-limited settings.</p> Implications for practice <p>Integrating the program into routine antenatal care could provide accessible, cost-effective support for women experiencing tokophobia, potentially reducing unnecessary cesarean sections and informing health policy regarding the effectiveness of the ICBT program. Future research should assess long-term outcomes and generalizability in diverse populations.</p> Trial Registration <p>The study was registered on ClinicalTrials.gov under the identifier (NCT06640608) on October 15, 2024</p>

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Digital intervention for tokophobia: a randomized controlled trial of internet-based cognitive behavioral therapy on fear of childbirth and self-efficacy among Egyptian pregnant women

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年3月3日

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  • Enas Mahrous Abdelaziz,
  • Afrah Madyan Alshammari,
  • Nadia Bassuoni Elsharkawy,
  • Fatma Ali Oraby,
  • Osama Mohamed Elsayed Ramadan

摘要

Background

Tokophobia affects up to 14% of pregnant women globally and is linked to high cesarean rates, particularly in Egypt. This study evaluated the efficacy of a culturally adapted Internet-based Cognitive Behavioral Therapy program on fear of childbirth and maternal self-efficacy among Egyptian pregnant women.

Methods

A randomized controlled trial was conducted in Damanhur City, Egypt, involving 96 pregnant women with moderate to severe tokophobia. Participants were randomly assigned to an intervention group (n = 48) receiving a six-week program via WhatsApp or a control group (n = 48) receiving routine antenatal care. The intervention included cognitive restructuring, exposure therapy, relaxation techniques, and psychoeducation grounded in Bandura’s Self-Efficacy Theory. Outcomes were assessed using the Childbirth Attitude Questionnaire and Childbirth Self-Efficacy Inventory at baseline and post-intervention.

Results

Post-intervention, the intervention group demonstrated a significant reduction in fear of childbirth scores (mean decrease: 14.32 ± 5.55; p < 0.001) and an increase in maternal self-efficacy (mean increase: 38.3 ± 35.7; p < 0.001). Large effect sizes were observed for both fear reduction (η²=0.876) and self-efficacy enhancement (η²=0.600). The control group showed no significant changes.

Conclusion

The culturally adapted Internet-based Cognitive Behavioral Therapy program significantly reduced tokophobia and enhanced maternal self-efficacy, supporting its integration into perinatal care. These findings align with Bandura’s Self-Efficacy Theory and suggest the potential of digital interventions in improving psychological outcomes, especially in resource-limited settings.

Implications for practice

Integrating the program into routine antenatal care could provide accessible, cost-effective support for women experiencing tokophobia, potentially reducing unnecessary cesarean sections and informing health policy regarding the effectiveness of the ICBT program. Future research should assess long-term outcomes and generalizability in diverse populations.

Trial Registration

The study was registered on ClinicalTrials.gov under the identifier (NCT06640608) on October 15, 2024