Psychological Resilience Among Midwives Working in Delivery RoomsMCR-MidwivesNCT07788508
Mandala Coloring and Resilience in Midwives
A study testing Mandala Coloring in people with Psychological Resilience Among Midwives Working in Delivery Rooms, run by Istanbul University - Cerrahpasa at 8 sites in Turkey (Türkiye).
Trial summary
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. Read more about this study
- Who is it for?
- Any age, women onlyHealthy volunteers can take part
- Conditions the study is for
- Psychological Resilience Among Midwives Working in Delivery Rooms
- 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
- 91 participants
- Where
- 8 sitesTurkey (Türkiye)
- Study dates
- 1 Jan 2025to 30 Aug 2025
- Phase
- Interventional
- Are there results?
- None posted in the registry
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 Any age
- Women only
- Healthy volunteers accepted
- Child, Adult, Older adult
Who may be able to join
- Working as a midwife in the delivery room of one of the participating hospitals
- Voluntarily agreeing to participate in the study
- Providing informed consent
Who cannot join
- 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
Trial locations and contacts
8 sites in 1 country.
8 sites in 1 country
Turkey (Türkiye)8 sites
Medipol Bahçelievler Üniversity Hospital
Istanbul, Bahçelievler
Medipol Mega Üniversity Hospital
Istanbul, Bağcılar
Medipol Esenler Üniversity Hospital
Istanbul, Esenler
MEDIPOL Acıbadem Regional Hospital
Istanbul, Kadıköy
Medipol Koşuyolu Hospital
Istanbul, Kadıköy
Medipol Sefaköy Üniversity Hospital
Istanbul, Küçükçekmece
Medipol Pendik Üniversity Hospital
Istanbul, Pendik
Medipol Çamlıca Üniversity Hospital
Istanbul, Uskudar
About this study
Official title: Effect of Mandala Coloring on Psychological Resilience Among Midwives Working in Delivery Rooms: A Matched Cluster Randomized Controlled Trial
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.
Read more
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.
Read the detailed description
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.
- Being tested
- Mandala Coloring
- Keywords
- Psychological resilience, Mandala coloring, Midwives, Delivery room, depression, anxiety, stress
- Medical subject headings
- Depression, Anxiety Disorders
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Mandala ColoringBehavioural
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.
| Study group | Role | What they receive |
|---|---|---|
| Mandala Coloring Group | Experimental | Participants in this arm completed a six-week mandala coloring intervention. They were instructed to color a mandala twice per week for approximately 20-30 minutes per session, resulting in a total of 12 planned sessions. Participants selected a mandala design and colored it according to their own preferences. Adherence was monitored by asking participants to notify the researcher before each session and to send a photograph of the completed mandala after each session. Reminder messages were sent twice weekly. Receives: Behavioral: Mandala Coloring |
| Control Group | No intervention | Participants in this arm continued their usual routines and did not receive the mandala coloring intervention during the six-week study period. They were contacted twice weekly to determine whether they had engaged in any relaxation or stress-reducing activities during the study period. After completion of the final assessment, participants were provided with information about mandala coloring and were offered the opportunity to engage in the activity. |
What is being measured
The primary outcome is the main question the study is designed to answer.
Resilience Scale for Adults (RSA)
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.
Measured: Baseline and immediately after the 6-week intervention
Secondary outcomes (2)
Depression Anxiety Stress Scale-21 (DASS-21)
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.
Measured: Baseline and immediately after the 6-week intervention
Psychological Well-Being Scale
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.
Measured: Baseline and immediately after the 6-week intervention
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted26 Aug 2026
- Study start1 Jan 2025
- Primary completion30 Aug 2025
- Study completion30 Aug 2025
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Psychological Resilience Among Midwives Working in Delivery RoomsStudies 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
- Eight hospitals were matched into four pairs based on 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.
- Masking
- None (open label)
- Enrolment
- 91 participants (actual)
Sponsor and investigators
- Lead sponsor
- Istanbul University - Cerrahpasa
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Neriman Guducu, Istanbul University - Cerrahpasa
- Investigators
- Neriman Güdücü, Ph.D., Principal investigator, Istanbul University - Cerrahpasa
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07788508
- Sponsor's protocol ID
- E-10840098-202.3.02-7884
- Acronym
- MCR-Midwives
- Status last verified
- Aug 2026
- First submitted
- 23 Aug 2026
- Last updated
- 28 Aug 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No: Data are available from the corresponding author upon reasonable request
Study at a glance
From the registry record, last updated by the sponsor on 28 Aug 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Effect of Mandala Coloring on Psychological Resilience Among Midwives Working in Delivery Rooms: A Matched Cluster Randomized Controlled Trial
- ClinicalTrials.gov ID
- NCT07788508
- Acronym / sponsor ID
- MCR-Midwives / E-10840098-202.3.02-7884
- Keywords
- Psychological resilience, Mandala coloring, Midwives, Delivery room, depression, anxiety, stress
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 91 participants (actual)
- Lead sponsor
- Istanbul University - CerrahpasaUniversity, hospital or other
- Study start
- 1 Jan 2025 (actual)
- Primary completion
- 30 Aug 2025 (actual)
- Study completion
- 30 Aug 2025 (actual)
- First posted
- 26 Aug 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.
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.
Detailed description
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.
Study design
- Primary purpose
- Supportive care
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
- Model description
- Eight hospitals were matched into four pairs based on 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.
| Arm | Type | Receives |
|---|---|---|
| Mandala Coloring Group | Experimental | Behavioral: Mandala ColoringParticipants in this arm completed a six-week mandala coloring intervention. They were instructed to color a mandala twice per week for approximately 20-30 minutes per session, resulting in a total of 12 planned sessions. Participants selected a mandala design and colored it according to their own preferences. Adherence was monitored by asking participants to notify the researcher before each session and to send a photograph of the completed mandala after each session. Reminder messages were sent twice weekly. |
| Control Group | No intervention | –Participants in this arm continued their usual routines and did not receive the mandala coloring intervention during the six-week study period. They were contacted twice weekly to determine whether they had engaged in any relaxation or stress-reducing activities during the study period. After completion of the final assessment, participants were provided with information about mandala coloring and were offered the opportunity to engage in the activity. |
Who may qualify
- Sex
- Female only
- Healthy volunteers
- Accepted
- Age groups
- Child, Adult, Older adult
Key inclusion criteria (3 listed)
- Working as a midwife in the delivery room of one of the participating hospitals
- Voluntarily agreeing to participate in the study
- Providing informed consent
Key exclusion criteria (4 listed)
- 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
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 ColoringParticipants 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. | Behavioural | Mandala Coloring Group |
Primary outcome
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.
2 secondary outcomes
Depression Anxiety Stress Scale-21 (DASS-21)
Time frame: Baseline and immediately after the 6-week intervention
Psychological Well-Being Scale
Time frame: Baseline and immediately after the 6-week intervention
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 28 Aug 2026.
- Individual participant dataSharing planned: No. Data are available from the corresponding author upon reasonable request
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. This study is not recruiting at the moment.
Neriman Güdücü, Ph.D. principal investigator
Istanbul University - Cerrahpasa
8 sites 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 Psychological Resilience Among Midwives Working in Delivery Rooms, run by Istanbul University - Cerrahpasa at 8 sites 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 3 inclusion and 4 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: finished, as of the sponsor's last update on 28 Aug 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 8 sites 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?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Resilience Scale for Adults (RSA) (time frame: Baseline and immediately after the 6-week intervention). 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 28 Aug 2026.