The effect of positive psychotherapy based group training midwives on work ability of midwifes: An RCT

Job ability in the midwifery profession is highly important due to the critical role played by midwives as one of the effectual components of the health system for providing midwifery services to two vulnerable groups in society, i.e., mothers and children. Job ability denotes the balance between a person’s ability to work and the occupational demands of the job in question. Job ability is defined in this model as the degree to which a person is physically or mentally able to adapt to the job requirements based on his/her health condition. The most significant factor considered in this model is individual health. In fact, in this model, health is one of the crucial components of job ability, not one of its determinants. In this case, job ability can be affected by various factors such as physical and psycho-social factors, occupational factors, physical and mental abilities, and lifestyle. The imbalance between these factors and one’s health can lead to reduced production, sick leave, and eventually work-related disabilities. Midwifery is one of the jobs where midwives are exposed to high stress daily, which can affect their job ability. In Iran, according to research findings, midwives’ job ability is on an average level. Therefore, it is necessary to take effective measures to improve midwives’ mental health and thus increase their job ability. One way that may prevent these disorders is to consider midwives’ well-being. The PERMA model is one of the positive psychological interventions recently developed by Seligman (2011) to help increase the well-being of individuals. The model consists of the five components of positive emotion (P), engagement (E), positive relationships (R), meaning (M) and accomplishment (A), where each component can independently enhance well-being, and the power of each component can help individuals find a happy, satisfying, meaningful life. Therefore, among interventions that are likely to affect midwives’ job ability are those based on positive psychology – an approach in psychotherapy associated with the creation of positive abilities and emotions. It aims to alleviate and tranquilize psychological trauma and to enhance happiness and well-being by increasing meaning to individuals’ lives. In recent years, the positivist approach in organizations has been considered as an optimal approach to influence different job outcomes, and some scholars have tried to translate its concepts into practical actions and interventions through which they can produce positive results. Accordingly, this study aimed to investigate the effect of positive psychotherapy-based group education on midwives’ job ability in Mashhad.

The present study was a randomized clinical trial with pretest-posttest design with control group that lasted from September 23, 2015 to March 20, 2016. The statistical population of the study included all midwives working in community health centers of Mashhad City, Iran. For sampling purposes, centers 1 and 3 were selected via cluster sampling method from among the five community health centers located in Mashhad city. Subsequently, all centers and subsidiaries affiliated with these centers were enlisted. Each of them was assigned a number from 0 to 113, and a small card with the corresponding number was issued. All the cards were put in a box. Each time, after shaking the box, one card was randomly taken out, and the number was recorded successively as either the intervention group or the control group. This process was reiterated until all the centers were allocated to the intervention or control groups. In this way, information dissemination between the two groups was prevented. Then, the researcher visited the intervention and control centers and invited all eligible midwives (who take care of mothers) to participate in the study. The sample size was obtained using the formula for comparing the means, and based on the results of the pilot study with 95% confidence and 80% power, the number of 17 subjects was obtained in each group, and taking into account the probability of drop of samples, sampling continued until the completion of each group as 30 subjects (total of 60 subjects). During the study, 13 midwives were excluded from the study in the intervention group due to irregular participation in the sessions. There was no drop of midwives in the control group. The most important criteria for selection of the respondents were at least an associate degree in midwifery and at least 1 year of work experience in community health centers, marriage, non-pregnancy, lack of referring to a psychiatrist during the past 6 months, or admission to a hospital due to mental illness, a history of using mentally affecting drugs, lack of a medical condition leading to a disability in performing occupational duties, and not receiving a severity score from the Anxiety, Stress, and Depression Scale (DASS 21). In addition, the most important exclusion criteria were the absence of more than one session in the training course, the occurrence of major stressful incidents during the study, and failure to do homework for three consecutive sessions. The data collection tool consisted of: Demographic information form of subjects (including three parts of the individual characteristics, occupational characteristics, and midwife’s lifestyle). The Persian versions of Ryffchr('39')s Scales Psychological Well-being (84 items) and The Persian versions of  Work Ability Index (WAI) was completed by midwives in the two intervention and control groups at pre-test and post-test stages. The educational interventions were conducted in groups based on Seligman’s 2011 PERMA model, along with homework assignments in eight 2-hour sessions held on a weekly basis. Each participant was required to complete the assignments between every two sessions and report back to the group at the next session. The control group received no intervention.After completing the intervention, the Ryff’s Psychological Well-Being scale and Work Ability Index (WAI)  was completed by midwives in the two intervention and control groups. In the present study, the statistical methods including independent t-test, paired t-test, Mann–Whitney test, Wilcoxon test, and the analysis of covariance were used to analyze the data using the SPSS software (version 19.0, SPSS Inc., Chicago, IL, USA). Moreover, p<0.05 was considered statistically significant.

According to the results, the mean ± standard deviation (SD) of age of the midwives in the intervention and control groups was 36.89±9.73 and 31.76±5.12 years, respectively, which were significantly different based on the independent t-test (p=0.010). Mean ± SDs of work experience in the two groups were 165.96±86.86 and 66.97±43.79, respectively, which had a significant difference based on the results of the Mann–Whitney test (p<0.001).Mean scores of midwives’ psychological well-being and job ability were not significantly different at baseline (p=0.381 and p=0.722, respectively). However, after the intervention, they were significantly higher in the intervention group than the control group (p<0.001 and p=0.004, respectively). Also, according to the Wilcoxon test, the mean score of midwives’ job ability in the intervention group was statistically different at the end of the study compared to baseline (p<0.001).

Findings showed that education based on positive psychotherapy could increase midwives’ job ability. Therefore, it is suggested that PERMA-based interventions be incorporated into in-service training courses of midwives in order to enhance their psychological well-being and thus improved job ability of midwives.(Clinical Trials Registry Number: IRCT20160102025813N3)