Mandala ColoringNCT07448636
The Effect of Postpartum Mandala Coloring on Anxiety, Fatigue, Maternal Attachment and Breastfeeding Self-efficacy
A study testing Mandala coloring in people with Mandala Coloring and Postpartum, run by Nuh Naci Yazgan University at 1 site in Turkey (Türkiye).
Trial summary
The aim of this study is to investigate the effects of mandala coloring on anxiety, fatigue, breastfeeding self-efficacy, and mother-infant bonding in postpartum mothers. The sample consists of women who have had a cesarean section at Kayseri City Hospital within the last year. Read more about this study
- Who is it for?
- Ages 18 years and older, women onlyHealthy volunteers can take part
- Conditions the study is for
- Mandala Coloring, Postpartum
- What is being tested?
- Mandala coloring
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 140 participants
- Where
- 1 siteTurkey (Türkiye)
- Study dates
- 15 Mar 2026to 31 Dec 2026
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- Women only
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- Being 18 years of age or older
- Having had a cesarean delivery after the 37th week of gestation
- The baby being with the mother and the mother being able to breastfeed
- Volunteering to participate in the study
- Having a planned cesarean section
Who cannot join
- The mother is currently or has previously received psychiatric treatment.
- The mother has a physical disability in her upper extremities.
- The mother has a vision problem.
- The newborn has a congenital anomaly.
- The newborn experienced an obstetric complication requiring immediate hospitalization after birth (hemorrhage, infection, bladder damage, preeclampsia, etc.).
- Criteria for terminating the study:
- The baby or mother has a medical condition requiring hospitalization within 6 weeks postpartum.
- Communication with the mother is not possible within 6 weeks postpartum
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Turkey (Türkiye)1 site
Nuh Naci Yazgan University
Kayseri, Kayseri
Didem Kaya, Assistant Professor Doctor, +905343035254, didemkaya86@gmail.com
Didem Kaya, Assistant Professor Doctor
About this study
Official title: The Effect of Mandala Coloring on Anxiety, Fatigue, Maternal Attachment, and Breastfeeding Self-Efficacy in the Postpartum Period: A Randomized Controlled Experimental Study
The aim of this study is to investigate the effects of mandala coloring on anxiety, fatigue, breastfeeding self-efficacy, and mother-infant bonding in postpartum mothers. The sample consists of women who have had a cesarean section at Kayseri City Hospital within the last year. Data will be collected using a Personal Information Form, the Postpartum Specific Anxiety Scale, the Short Form of the Breastfeeding Self-Efficacy Scale, the Chalder Fatigue Scale, and the Maternal Attachment Scale. Mothers meeting the inclusion criteria will be randomly assigned to intervention and control groups. Mothers in the intervention group will be informed that they will begin mandala coloring one week after their cesarean delivery. They will be asked to color a mandala twice a week for a total of 5 weeks, with each coloring session lasting 30 minutes. To eliminate the possibility of mothers forgetting to color the mandala, the researcher will send reminder messages twice a week starting from the end of the first week. The Personal Information Form will be collected through face-to-face interviews while the mothers are in the hospital. Mothers in the control group will receive routine hospital care and will not paint mandalas. Researchers will call all mothers at the end of weeks 1 and 2 to administer the Postpartum Specific Anxiety Scale and the Short Form of the Breastfeeding Self-Efficacy Scale, and at the end of weeks 4 and 6 to administer questions from the Postpartum Specific Anxiety Scale, Short Form of the Breastfeeding Self-Efficacy Scale, Chalder Fatigue Scale, and Maternal Attachment Scale, recording their responses.
Read the detailed description
The postpartum period is a time of physiological changes as well as the assumption of new roles and responsibilities. Postpartum anxiety has been relatively neglected in recent years. Defined as a condition that causes anxiety and depression of unknown origin, anxiety is seen as a normal reaction to the birth of a new baby in the postpartum period. Clinically, the prevalence of anxiety symptoms in the postpartum period ranges from 12-20%. High levels of anxiety negatively affect the bonding between mother and baby, as well as the baby's behavioral, social, and emotional development. Postpartum fatigue causes women to feel more negative and less competent than usual. Postpartum fatigue negatively impacts the mother's functional recovery, maternal behavior, infant care, relationships with family members, work performance, and self-actualization. While fatigue is common and even expected after childbirth, severe postpartum fatigue can have significant effects on women's health and activities; It has negative effects such as deterioration of maternal health, delayed return to daily life activities, early cessation of breastfeeding, and delayed infant development. Since cesarean delivery is a surgical procedure, postpartum fatigue, pain, and anxiety are higher compared to vaginal delivery. Consequently, the time to start breastfeeding is later, especially in the first 24 hours after cesarean delivery, mothers have lower breastfeeding self-efficacy, and their need for support from healthcare personnel is higher. Art therapy is reported as an effective support method that addresses the physical, mental, social, and emotional aspects of the individual and helps in coping with difficulties. Mandala, one of the art therapy methods, is defined as a method used to transfer emotions and thoughts onto paper, usually in a round shape. Studies conducted on different sample groups have found that mandala painting is effective on anxiety and fatigue. A literature review revealed that anxiety and fatigue are common in the postpartum period, negatively impacting breastfeeding self-efficacy and maternal attachment. Studies have also shown that mandala coloring is effective in reducing anxiety and fatigue. However, the effects of mandala coloring on mothers' anxiety, fatigue, breastfeeding self-efficacy, and maternal attachment in the postpartum period have not been investigated. The aim of this study is to investigate the effects of mandala coloring on anxiety, fatigue, breastfeeding self-efficacy, and maternal attachment in mothers in the postpartum period.
- Conditions
- Mandala Coloring, Postpartum
- Being tested
- Mandala coloring
- Keywords
- Mandala Coloring, postpartum, Anxiety, Fatigue, Maternal Attachment, Breastfeeding Self-Efficacy
- Medical subject headings
- Anxiety Disorders, Fatigue
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Mandala coloringBehavioural
Mothers in the intervention group will be given a circular mandala template coloring book and 12 colored pencils. Mothers in the intervention group will be informed that they will start coloring mandalas one week after giving birth. They will be asked to color one mandala coloring page twice a week for a total of 5 weeks, with each coloring session lasting 30 minutes. To eliminate the possibility of mothers forgetting to color mandalas, the researcher will send reminder messages to the mothers twice a week starting from the end of the first week. Mothers will be asked to send pictures of the mandala pages they have colored to the researcher as a message.
| Study group | Role | What they receive |
|---|---|---|
| Mandala Coloring Group | Experimental | Mothers in this group will color mandalas. Receives: Behavioral: Mandala coloring |
| Control Group | No intervention | Mothers in this group will not color mandalas. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Postpartum Specific Anxiety Scale
The scale was developed by Fallon et al. (2016) as a 56-item scale, and was transformed into a 44-item structure through a Turkish validity and reliability study conducted by Bayri Bingöl et al. (2021). The original version of the scale was developed and validated with mothers who had infants aged 0-6 months. The scale has sub-dimensions of maternal skills and attachment, newborn well-being and safety, infant care practices, and psychosocial adjustment to motherhood. The highest possible score on the Likert-type scale is 176, and the cutoff score is 113.5. Higher scores on the scale indicate a higher incidence of anxiety symptoms. The Cronbach's alpha values for the sub-dimensions of the scale range from 0.83 to 0.90.
Measured: At the end of the 1st, 2nd, 4th and 6th weeks postpartum
Short Form of the Breastfeeding Self-Efficacy Scale
Developed in 1999 by Dennis and Faux to measure mothers' competence regarding breastfeeding in the postpartum period. The scale was initially developed with 33 items. In the internal consistency analysis of the scale, items with a correlation below 0.60 were removed, and the short form of the Breastfeeding Self-Efficacy Scale with 14 items was created. This scale is a 5-point Likert type. All items are scored as 1, 2, 3, 4, 5 (1=Never sure, 5=Always sure). All items in the scale have positive meanings. The lowest possible score on the scale is 14, and the highest is 70, with no cutoff point. A higher score indicates higher breastfeeding self-efficacy. The Turkish validity and reliability of the scale was established by Aluş-Tokat and Okumuş in 2010. The Cronbach's alpha coefficient of the Breastfeeding Self-Efficacy Scale is 0.86.
Measured: At the end of the 1st, 2nd, 4th and 6th weeks postpartum
Chalder Fatigue Scale
Developed by Cella and Chalder in 2010 for use in various populations to assess fatigue, it was adapted into Turkish by Adın et al. in 2022. The scale consists of 11 items, divided into two sub-dimensions: physical fatigue and mental fatigue, and uses a 4-point Likert scale. Scores range from 0-21 for the physical fatigue sub-dimension, 0-12 for the mental fatigue sub-dimension, and 0-33 for the total scale score. Higher scores indicate greater fatigue severity.
Measured: At the end of the 4th and 6th weeks postpartum
Maternal Attachment Scale
The validity and reliability study of the Turkish form of the Maternal Attachment Scale, developed by Mary E. Muller in 1994, was conducted by Kavlak and Şirin in 2009. The scale consists of 26 items on a four-point Likert scale, with higher scores indicating higher maternal attachment. The lowest possible score is 26, and the highest is 104. Cronbach's Alpha internal consistency reliability was found to be 0.77 in 1-month-old infants and 0.82 in 4-month-old infants.
Measured: At the end of the 4th and 6th weeks postpartum
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted4 Mar 2026
- Study start15 Mar 2026 (estimated)
- Primary completion20 May 2026 (estimated)
- Study completion31 Dec 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Mandala ColoringStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Supportive care
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- This study is an experimental study with pre-test and post-test control groups.
- Masking
- None (open label)
- Enrolment
- 140 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Nuh Naci Yazgan University
- Sponsor type
- University, hospital or other
- Collaborators
- TC Erciyes University, Kayseri City Hospital
- Responsible party
- Principal investigator, DİDEM KAYA, Nuh Naci Yazgan University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07448636
- Sponsor's protocol ID
- NuhNaciYazganUdk1
- Status last verified
- Feb 2026
- First submitted
- 26 Feb 2026
- Last updated
- 4 Mar 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 4 Mar 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- The Effect of Mandala Coloring on Anxiety, Fatigue, Maternal Attachment, and Breastfeeding Self-Efficacy in the Postpartum Period: A Randomized Controlled Experimental Study
- ClinicalTrials.gov ID
- NCT07448636
- Acronym / sponsor ID
- NuhNaciYazganUdk1
- Conditions
- Mandala Coloring, Postpartum
- Keywords
- Mandala Coloring, postpartum, Anxiety, Fatigue, Maternal Attachment, Breastfeeding Self-Efficacy
- Study type
- Interventional
- Recruitment status
- Not yet recruiting
- Enrolment
- 140 participants (estimated)
- Lead sponsor
- Nuh Naci Yazgan UniversityUniversity, hospital or other
- Collaborators
- TC Erciyes University, Kayseri City Hospital
- Study start
- 15 Mar 2026 (estimated)
- Primary completion
- 20 May 2026 (estimated)
- Study completion
- 31 Dec 2026 (estimated)
- First posted
- 4 Mar 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The aim of this study is to investigate the effects of mandala coloring on anxiety, fatigue, breastfeeding self-efficacy, and mother-infant bonding in postpartum mothers. The sample consists of women who have had a cesarean section at Kayseri City Hospital within the last year. Data will be collected using a Personal Information Form, the Postpartum Specific Anxiety Scale, the Short Form of the Breastfeeding Self-Efficacy Scale, the Chalder Fatigue Scale, and the Maternal Attachment Scale. Mothers meeting the inclusion criteria will be randomly assigned to intervention and control groups. Mothers in the intervention group will be informed that they will begin mandala coloring one week after their cesarean delivery. They will be asked to color a mandala twice a week for a total of 5 weeks, with each coloring session lasting 30 minutes. To eliminate the possibility of mothers forgetting to color the mandala, the researcher will send reminder messages twice a week starting from the end of the first week. The Personal Information Form will be collected through face-to-face interviews while the mothers are in the hospital. Mothers in the control group will receive routine hospital care and will not paint mandalas. Researchers will call all mothers at the end of weeks 1 and 2 to administer the Postpartum Specific Anxiety Scale and the Short Form of the Breastfeeding Self-Efficacy Scale, and at the end of weeks 4 and 6 to administer questions from the Postpartum Specific Anxiety Scale, Short Form of the Breastfeeding Self-Efficacy Scale, Chalder Fatigue Scale, and Maternal Attachment Scale, recording their responses.
Detailed description
The postpartum period is a time of physiological changes as well as the assumption of new roles and responsibilities. Postpartum anxiety has been relatively neglected in recent years. Defined as a condition that causes anxiety and depression of unknown origin, anxiety is seen as a normal reaction to the birth of a new baby in the postpartum period. Clinically, the prevalence of anxiety symptoms in the postpartum period ranges from 12-20%. High levels of anxiety negatively affect the bonding between mother and baby, as well as the baby's behavioral, social, and emotional development. Postpartum fatigue causes women to feel more negative and less competent than usual. Postpartum fatigue negatively impacts the mother's functional recovery, maternal behavior, infant care, relationships with family members, work performance, and self-actualization. While fatigue is common and even expected after childbirth, severe postpartum fatigue can have significant effects on women's health and activities; It has negative effects such as deterioration of maternal health, delayed return to daily life activities, early cessation of breastfeeding, and delayed infant development. Since cesarean delivery is a surgical procedure, postpartum fatigue, pain, and anxiety are higher compared to vaginal delivery. Consequently, the time to start breastfeeding is later, especially in the first 24 hours after cesarean delivery, mothers have lower breastfeeding self-efficacy, and their need for support from healthcare personnel is higher. Art therapy is reported as an effective support method that addresses the physical, mental, social, and emotional aspects of the individual and helps in coping with difficulties. Mandala, one of the art therapy methods, is defined as a method used to transfer emotions and thoughts onto paper, usually in a round shape. Studies conducted on different sample groups have found that mandala painting is effective on anxiety and fatigue. A literature review revealed that anxiety and fatigue are common in the postpartum period, negatively impacting breastfeeding self-efficacy and maternal attachment. Studies have also shown that mandala coloring is effective in reducing anxiety and fatigue. However, the effects of mandala coloring on mothers' anxiety, fatigue, breastfeeding self-efficacy, and maternal attachment in the postpartum period have not been investigated. The aim of this study is to investigate the effects of mandala coloring on anxiety, fatigue, breastfeeding self-efficacy, and maternal attachment in mothers in the postpartum period.
Study design
- Primary purpose
- Supportive care
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
- Model description
- This study is an experimental study with pre-test and post-test control groups.
| Arm | Type | Receives |
|---|---|---|
| Mandala Coloring Group | Experimental | Behavioral: Mandala coloringMothers in this group will color mandalas. |
| Control Group | No intervention | –Mothers in this group will not color mandalas. |
Who may qualify
- Ages
- 18 years and older
- Sex
- Female only
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (5 listed)
- Being 18 years of age or older
- Having had a cesarean delivery after the 37th week of gestation
- The baby being with the mother and the mother being able to breastfeed
- Volunteering to participate in the study
- Having a planned cesarean section
Key exclusion criteria (8 listed)
- The mother is currently or has previously received psychiatric treatment.
- The mother has a physical disability in her upper extremities.
- The mother has a vision problem.
- The newborn has a congenital anomaly.
- The newborn experienced an obstetric complication requiring immediate hospitalization after birth (hemorrhage, infection, bladder damage, preeclampsia, etc.).
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Mandala coloringMothers in the intervention group will be given a circular mandala template coloring book and 12 colored pencils. Mothers in the intervention group will be informed that they will start coloring mandalas one week after giving birth. They will be asked to color one mandala coloring page twice a week for a total of 5 weeks, with each coloring session lasting 30 minutes. To eliminate the possibility of mothers forgetting to color mandalas, the researcher will send reminder messages to the mothers twice a week starting from the end of the first week. Mothers will be asked to send pictures of the mandala pages they have colored to the researcher as a message. | Behavioural | Mandala Coloring Group |
Primary outcome
Postpartum Specific Anxiety Scale
Time frame: At the end of the 1st, 2nd, 4th and 6th weeks postpartum
The scale was developed by Fallon et al. (2016) as a 56-item scale, and was transformed into a 44-item structure through a Turkish validity and reliability study conducted by Bayri Bingöl et al. (2021). The original version of the scale was developed and validated with mothers who had infants aged 0-6 months. The scale has sub-dimensions of maternal skills and attachment, newborn well-being and safety, infant care practices, and psychosocial adjustment to motherhood. The highest possible score on the Likert-type scale is 176, and the cutoff score is 113.5. Higher scores on the scale indicate a higher incidence of anxiety symptoms. The Cronbach's alpha values for the sub-dimensions of the scale range from 0.83 to 0.90.
Short Form of the Breastfeeding Self-Efficacy Scale
Time frame: At the end of the 1st, 2nd, 4th and 6th weeks postpartum
Developed in 1999 by Dennis and Faux to measure mothers' competence regarding breastfeeding in the postpartum period. The scale was initially developed with 33 items. In the internal consistency analysis of the scale, items with a correlation below 0.60 were removed, and the short form of the Breastfeeding Self-Efficacy Scale with 14 items was created. This scale is a 5-point Likert type. All items are scored as 1, 2, 3, 4, 5 (1=Never sure, 5=Always sure). All items in the scale have positive meanings. The lowest possible score on the scale is 14, and the highest is 70, with no cutoff point. A higher score indicates higher breastfeeding self-efficacy. The Turkish validity and reliability of the scale was established by Aluş-Tokat and Okumuş in 2010. The Cronbach's alpha coefficient of the Breastfeeding Self-Efficacy Scale is 0.86.
Chalder Fatigue Scale
Time frame: At the end of the 4th and 6th weeks postpartum
Developed by Cella and Chalder in 2010 for use in various populations to assess fatigue, it was adapted into Turkish by Adın et al. in 2022. The scale consists of 11 items, divided into two sub-dimensions: physical fatigue and mental fatigue, and uses a 4-point Likert scale. Scores range from 0-21 for the physical fatigue sub-dimension, 0-12 for the mental fatigue sub-dimension, and 0-33 for the total scale score. Higher scores indicate greater fatigue severity.
Maternal Attachment Scale
Time frame: At the end of the 4th and 6th weeks postpartum
The validity and reliability study of the Turkish form of the Maternal Attachment Scale, developed by Mary E. Muller in 1994, was conducted by Kavlak and Şirin in 2009. The scale consists of 26 items on a four-point Likert scale, with higher scores indicating higher maternal attachment. The lowest possible score is 26, and the highest is 104. Cronbach's Alpha internal consistency reliability was found to be 0.77 in 1-month-old infants and 0.82 in 4-month-old infants.
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 4 Mar 2026.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Mandala coloring in people with Mandala Coloring and Postpartum, run by Nuh Naci Yazgan University at 1 site in Turkey (Türkiye).
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 8 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: opening soon, as of the sponsor's last update on 4 Mar 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Turkey (Türkiye). Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Didem Kaya, Assistant Professor Doctor (+905343035254, didemkaya86@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Postpartum Specific Anxiety Scale (time frame: At the end of the 1st, 2nd, 4th and 6th weeks postpartum). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Mar 2026.