How to cite:
Tiyara Safitri, Sri Sumarni, Aris Santjaka (2021). The Use of Misis-
Prety Application (Mindfulness Spiritual of Islam for Prenatal
Anxiety) Toward Childbirth Anxiety in Covid-19 Pandemic.
Journal Eduvest. 1(12): 1579-
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Eduvest – Journal of Universal Studies
Volume 1 Number 12, December 2021
p- ISSN 2775-3735 e-ISSN 2775-3727
THE USE OF MISIS-PRETY APPLICATION (MINDFULNESS
SPIRITUAL OF ISLAM FOR PRENATAL ANXIETY) TOWARD
CHILDBIRTH ANXIETY IN COVID-19 PANDEMIC
Tiyara Safitri, Sri Sumarni, Aris Santjaka
Health Polytechnic of the Ministry of Health Semarang, Indonesia
E-mail: [email protected], [email protected],
[email protected]
ARTICLE INFO ABSTRACT
Received:
November, 26
th
2021
Revised:
December, 17
th
2021
Approved:
December, 19
th
2021
Background: Reports show the prenatal anxiety of
Indonesia reaches a percentage of 28.7% of mothers
experience anxiety. The COVID-19 pandemic influences
pregnant mothers’ psychology, 76.2%. The physical,
psychological, and spiritual balance of pregnant mothers
should be healthily balanced. This healthy balance
includes the childbirth process to avoid psychological
interruption. The use of android application information
for obstetric service could improve maternal quality by
providing intervention autonomously. Method: This
Research & Development used True Experimental Pre and
Post-test with Control Group Design. The intervention was
with MiSIs-PreTy application to lose the anxiety of
primipara pregnant mothers with Trimester III status on
the experimental group for 7 days. Every day, the mothers
received 30 minutes of implementation. The positive
control group, on the other hand, received health
education about childbirth preparation. The researchers
took 30 respondents as the samples randomly. The data
analysis was tested with non-parametric Wilcoxon and
Mann Whitney tests. Results: The experts’ validation
about the developed application reliability obtained an
Tiyara Safitri, Sri Sumarni, Aris Santjaka
The Use of Misis-Prety Application (Mindfulness Spiritual of Islam for Prenatal Anxiety)
Toward Childbirth Anxiety in Covid-19 Pandemic 1580
average score of 92.80% from six aspects. They were
based on the ISO 9126 software’s quality, such as
usability, reliability, functionality, efficiency,
maintainability, and portability. The experiment used the
given intervention for both groups. It was effective to lose
the anxiety. The effectiveness for experimental group was
p < 0.001 while control group obtained p < 0.005.
However, the use of the developed application was more
effective to lose the anxiety with an average score of
11,8±5,414 for the experimental group than the positive
control group with 4,46±4,24. Conclusion: The developed
application, MiSIs-PreTy, was validated and revised to be
more effective to lose the anxiety of pregnant mothers.
Further researches could develop the findings by adding
some variables, such as childbirth self-efficacy as the valid
measuring tool to examine the pregnant mothers' belief
to give birth.
KEYWORDS
Mindfulness, Spiritual Mindfulness, Prenatal Anxiety,
Childbirth Anxiety, COVID-19
This work is licensed under a Creative Commons
Attribution-ShareAlike 4.0 International
INTRODUCTION
Pregnancy, childbirth, and postpartum are physiological and natural. Physical and
psychological changes make mothers feel uncomfortable. The changes also trigger mood
swings or mental imbalance. This imbalance triggers stress and anxiety during childbirth
(Harahap, 2018). Anxiety leads to unreadiness for mothers to deal with childbirth. This
situation influences the self-esteem of pregnant mothers to deliver their babies
(Munkhondya et al., 2020).
The anxiety may occur in both primipara and multipara mothers. Mothers with
the first pregnancy experience, primigravida, have strong anxiety than those multipara
mothers (Shodiqoh and Syahrul, 2014). The anxiety raises during the Trimester III of
pregnancy due to the childbirth process (Zengin et al., 2020).
The prevalence of psychological problems in developing countries with high risk
is 15.6% for pregnant mothers. Then, a percentage of 19.8% occurs on postpartum
mothers (Organization, 2014). The psychological problems also occur in various
advanced countries, such as France with a percentage of 7.9% primigravida mothers
suffering from anxiety, 11.8% of primigravida mothers suffering from depression, and
13.2% of primigravida mothers suffering both anxiety and depression (Ibanez et al.,
2015).
The percentage of prenatal anxiety in Indonesia is reported with a percentage of
28.7% from 107.000.000 mothers suffering from anxiety. Other studies showed a
percentage of 53.3% of mothers suffering from childbirth anxiety (Heriani, 2016).
A percentage of 25-50% mortality rate of the fertile maternal period is caused due
to mortality rate and illness rate of maternal mothers (Prawirohardjo, 2008). Based on the
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Census Rate Survey in 2015, the mortality rate ratio of mothers in Indonesia is
305/100.000 live-born. The government struggles to lower the mortality rate into
232/100.000 live-born (Nurya Viandika, Kes, and Husada, 2020).
The unmanaged anxiety impact on pregnancy may cause complications, such as
premature birth, lower birth weight, and slower fetal development (Ciesielski, Marsit and
Williams, 2015); depression on postpartum mothers, and lower breast milk provision
(Becker et al., 2016). These impacts can be anticipated with the obstetric service model,
proposed by WHO. It is Midwife-Led Continuity of Care (MLCC). The service perceives
an obstetrician to support women during the antenatal, intrapartum, and postnatal periods
(Sandall et al., 2016).
The COVID-19 pandemic effect on maternity is 76.2% influencing the
psychological aspect of pregnant women. The significant statistical effect of the COVID-
19 pandemic on the anxiety and depression of pregnant women obtains a p-value of 0.001
(Durankuş and Aksu, 2020; Wu et al., 2020). Some efforts to lose the anxiety of pregnant
mothers are with mind-body intervention with autogenic training; biofeedback, imagery,
meditation, praying, autosuggestion, yoga, and hypnotherapy (Kuswandy, 2011).
Studies found the effectiveness of losing anxiety during childbirth, such as with
virtual reality (VR), Hypno pregnancy, gentle yoga, implementation of Al-Qur'an
Murotal, and therapeutic communication (Karyati, 2016; Ritsma Zunira Aryani, Rohmi
Handayani, 2018; Dian Puspitasari1, 2019; Riska, Purwara and Ganiem, 2020). Studies
about prenatal yoga found the influence of yoga on quick delivery speed. The study
showed increasing endorphin hormone (Kartikasari, Hadisaputro, and Sumarni, 2020).
Studies of the spiritual approach found the approach could facilitate individuals
to be successful. The spiritual approach, with a focus toward God, is something
originating from inner individuals (Faizah and Sudarmiati, 2017). This approach also
influences the childbirth process, including higher self-esteem of psychological problems
(Yuniarti et al., 2016). Mindfulness refers to an approach to holistic health intervention. It
could be applied based on cultural needs or community beliefs (Dwidiyanti et al., 2019).
The spiritual approach deals with the belief in God, the Almighty, and the Creator
(Parrott, 2017).
Mindfulness implementation of Islamic spiritual is an exercise to remember Allah
the Almighty as the Only God. Thus, the individuals always involve Him in every
process, especially dealing with pregnancy. This involvement will involve consciousness
to understand the condition that the experienced matter is not a coincidence but has been
planned by Allah the Almighty (Dwidiyanti, Pamungkas, and Ningsih, 2018). It
encourages self-acceptance practice, and conscious awareness and emotions (Putri and
Yuliandari Gunatirin, 2020).
A systematic review about effective mindfulness exercise toward the mental
health of maternal mothers, by Helen Hall, found that the exercise could develop the
childbirth capability of the mothers (Hall et al., 2015). Other research also found
mindfulness could solve anxiety problems during antenatal, empower the mothers, and
improve delivery satisfaction (Fisher et al., 2012).
Mental health, according to WHO, cited by Hawari (2011), deals with
psychological, biological, social, and spiritual health (Fitriyani et al., 2018). A study
about the effort to realize safe and comfortable childbirth found the level of stress could
be milder and lower after providing spiritual intervention (Nurrochmi, Nurlina, and
Padmawati, 2019). A study by Aslami et al (2016) found Islamic spiritual-based
mindfulness could lower anxiety and depression of pregnant mothers than cognitive-
based behavior (Aslami et al., 2017). Rita Jayanti (2016) also argue spiritual-based
Tiyara Safitri, Sri Sumarni, Aris Santjaka
The Use of Misis-Prety Application (Mindfulness Spiritual of Islam for Prenatal Anxiety)
Toward Childbirth Anxiety in Covid-19 Pandemic 1582
mindfulness was effective to improve psychological wellbeing than exercise for diabetes
mellitus type 2 sufferers (Jayanti, 2016).
The pocketbook for pregnant mothers and newborn babies, by the Minister of
Health of Republic Indonesia in 2020, explains that in this COVID-19 pandemic,
Antenatal Care visits (ANC) and maternity class visits should be postponed (Dirjen
Kesmas, 2020). This limitation lowers ANC comprehension. Thus, it is important to use
service of the online method to ensure the service is comprehensive without a face-to-face
meeting.
The vast technological development allows obstetric service to occur via
Android-based smartphone utilization. In this world, a percentage of 90% of adults have a
smartphone (PERRIN, 2015). In this research, the researchers used information
technology utilization with a smartphone as the gap to fill. Thus, the researchers
conducted a study to develop MiSIs-PreTy application as the alternative to lower the
anxiety of pregnant mothers to face the childbirth process during the COVID-19
pandemic. The intervention model was realized into recorded audio. These audios could
be listed daily. The audio is 30 minutes long and was played for 7 days autonomously.
This procedure aimed to support the psychological and spiritual needs of pregnant
mothers.
RESEARCH METHOD
Research type and design
This Research & Development aimed to develop the MiSIs-PreTy application.
The name stands for Mindfulness Spiritual Islam for Prenatal Anxiety. It provides
mindfulness spiritual Islam directly for pregnant women in Trimester III via online media
by using android-based application media. This application can be downloaded and is the
research's product.
Research & Development is a method to find, develop, improve, and produce
products. Then, the results are examined to create standardized products (Sugiyono,
2014). Based on the Research & Development by Borgh & Gall, modified by Sugiyono,
R&D describes the stages or procedural plots descriptively to produce a product or
develop the existing product. The development also aims to improve effectiveness and
efficiency. The products could be modules, books, applications, training videos, and
learning videos.
The research used true experimental with pre-test and post-test with control
group design. This research consisted of two groups. The first group, the experimental
group, received intervention with the MiSIs-PreTy application.
In this research, the researchers used the probability sampling technique. It was
random sampling in which the sampling technique was done with the lottery. The
researchers took the sample by screening the initial anxiety of the pregnant mothers.
Then, they selected the sample by putting 30 numbers written on rolled papers. The first
stage was determining the experimental respondent with lottery numbers.
Population and sample
The population in this research consisted of all primipara pregnant mothers in
Trimester III listed in Cohort of Maternal Mother Cohort of Health Agency, Bintan
Regency, from March until April 2021. There were 64 respondents. Based on the
calculation of the minimum sample size, the researchers used fifteen respondents. Thus,
the researchers took both group samples, 30 respondents.
The sample of this research consisted of some primipara mothers in Trimester III.
They were considered to represent the population and meet the inclusion and exclusion
skills.
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RESULT AND DISCUSSION
Table 1. Expert Validation Test Result
Table 1 shows the validity test result of MiSIs-PreTy concerning the Mindfulness
Spiritual Islam is 94.40%. Then, the information and technology media experts scored the
Mindfulness Spiritual Islam with a percentage of 96.80%. Then, the psychological
experts of Maternal Mental Health scored with a percentage of 87.20%. The reliability
test average score of the MiSIs-PreTy application is 92.80%, categorized high. It
indicates the developed application was readable to test in a trial run with a limited
population. Thus, the effectiveness of MiSIs-PreTy to lose the anxiety could be measured.
After being validated and receiving the recommendation for the application
design, the researchers revised the product. The initial revision was done by revising the
materials input in the application.
Then, the revision was done based on the expert of Maternal Mental Health
dealing with the colors, texts, and icons that influenced the psychology of the mothers.
Figure 1. Exercise for revising text about mindfulness spiritual: left (before) and
after (right)
Table 2. The Normality test of Anxiety Score of Experimental Group and Control
Group
Groups
Variables
Anxiety Score
p-value*
Experiment
Pretest
Post-test
0,633
0,003
Control
Pretest
Post-test
0,023
0,450
Validators/Experts
N
V
alidation
score
Percent
age
M
ean
Dr. Meidiana Dwidiyanti, S.Kp.,
M.Sc
2
5
1
18
94,40%
92,80%
Muhammad Irfan, ST
2
5
1
21
96,80%
Nuzulia Rahma, S.Psi., Psi
2
5
1
09
87,20%
Tiyara Safitri, Sri Sumarni, Aris Santjaka
The Use of Misis-Prety Application (Mindfulness Spiritual of Islam for Prenatal Anxiety)
Toward Childbirth Anxiety in Covid-19 Pandemic 1584
Table 2 shows the data are not normally distributed with a p-value < 0.05 on the
control group's pretest. The obtained p-value is 0.023. Then, the posttest data of the
experimental group obtain a p-value of 0.003. The pretest of the experimental group has
normal data distribution with a p-value of 0.633 for the experimental group and a p-value
of 0.450 for the control group. The scores indicated the data distribution is not normal.
Therefore, the researchers used a non-parametric test, the Wilcoxon test, to pair the data.
The researchers also used Mann Whitney test for unpaired data to see the effectiveness
differences from both groups.
Table 3. The Effectiveness Test Score of Primipara Mothers’ Anxiety on TM III
for Experimental and Control Groups
Table 3 shows the conditions before and after the intervention. The minimum and
maximum scores of the mothers’ anxiety for both groups are lower. The results of the
paired variable test for primipara mothers' anxiety obtain a p-value of 0.001 for the
experimental group and a p-value of 0.005 for the control group. Both groups obtain p-
value < 0.05. It means the use of MiSIs-PreTy was effective to lose childbirth anxiety by
providing health education and effective childbirth preparation. Here are the comparative
test results or the anxiety score changes for each variable.
Table 4. The Anxiety Score Changes of Primipara Mothers with TM III for
Experimental and Control Groups
Groups
Mean±SD
p-value*
ΔMean±SD
pre-post
p-value*
P
retest
P
osttest
Experi
ment
26,67 ±
5,960
14,87 ±
5,041
0,000
11,8 ± 5,414
0,001
Control
28,8 ±
4,784
24,33 ±
4,169
0,009
4,46 ± 4,24
Table 4 shows p-value of experimental group is 0.000, p-value < 0.05. On the
other hand, the p-value of the control group is 0.009, p-value < 0.05. It means there are
significant differences between the anxiety scores for both groups, before and after the
intervention. The anxiety average score pretest of the experimental group is 26.67. Then,
after the intervention, the score lowers to 14.87. It has an 11.8 decrease. On the other
hand, the average pretest score of anxiety is 28.8. Then, after being intervened, the score
lowered to 24.33. The low score was not significant as the experimental group was, 4.46.
Thus, the decreasing score of anxiety was greatly found in the experimental group than
the positive control group.
The unpaired data test analysis with p-value delta (Δ) mean is 0.001 (p-value <
0.05). It means the use of MiSIs-PreTy application for the experimental group was
effective to lose the anxiety score than the control group treated with health education
about childbirth to decrease the childbirth anxiety. The evidence is the delta score with
the average score of decreasing rate for the control group is 4.46 (14%) while the
experimental group is 11.8 (44%).
Groups
Mean±SD
Min-Max
p-value*
Experiment
Pretest
Post-test
26,67 ± 5,960
14,87 ± 5,041
16-35
10-25
0,001
Control
Pretest
Post test
28,8 ± 4,784
24,33 ± 4,169
19-34
18-32
0,005
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After obtaining the anxiety scores from the pre-test and post-test of the trial run,
the researchers evaluated and distributed the questionnaire to judge the developed
application online for the respondents.
The researchers found, during the limited test, that MiSIs-PreTy was effective to
lower the childbirth anxiety for primipara mothers during the COVID-19 pandemic. The
evidence was the research data analysis. It obtained a p-value < 0.05 with a degree of
freedom (CI) of 95%. From the data, the researchers revised the application greatly. The
researchers also used audio to promote mindfulness with tender sound. This matter was
suggested by a psychologist to make the mothers feel comfortable while listening and
doing the stage. The other consideration was - changing the application algorithm. The
respondents had to fill the pretest of anxiety before accessing the existing information to
avoid research biases
CONCLUSION
From the research, the researchers concluded that the development and
researching process about the use of MiSIs-PreTy, Mindfulness Spiritual Islam for
Prenatal Anxiety, toward childbirth anxiety during the COVID-19 pandemic lasted with
seven procedural stages of R&D. The product obtained an average score of 92.80% from
experts based on six aspects of software quality, ISO 9126. They were usability,
reliability, functionality, efficiency, maintainability, and portability. The use of MiSIs-
PreTy was effective to lose the anxiety of childbirth in the COVID-19 pandemic with a p-
value of 0.001. There were significant differences in MiSIs-PreTy application uses with
an anxiety score 200% higher than the provision of health education about childbirth
preparation.
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