Full Document 121

“A STUDY TO ASSESS THE EFFECTIVENESS OF PROGRESSIVE MUSCLE
RELAXATION THERAPY ON STRESS AMONG PREGNANT WOMEN IN SELECTED

HOSPITALS, BANGALORE.”
By
Mrs.ATHIRA CHANDRAN
Dissertation submitted to the

Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka.
In partial fulfillment of requirements for the degree of
MASTER OF SCIENCE IN NURSING
IN
OBSTETRICS AND GYNAECOLOGICAL NURSING
Under the Guidance of
Ms. LOGAMBAL K
Assistant Professor, Department Obstetrics and Gynaecological Nursing
THE OXFORD COLLEGE OF NURSING
BANGALORE
2018
I
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
DECLARATION BY THE CANDIDATE
I hereby declare that this dissertation entitled “A study to assess the effectiveness of
progressive muscle relaxation therapy on stress among pregnant women in selected
hospitals, Bangalore.” is a bonafide and genuine research work carried out by me under the
guidance of Assistant Professor Ms. Logambal K, Department of Obstetrics and Gynecological
Nursing, The Oxford College of Nursing, Bangalore.
Date: Signature of the Candidate

Place: Bangalore (Mrs. ATHIRA CHANDRAN)
II
CERTIFICATE BY THE GUIDE
This is to certify that this dissertation entitled “A study to assess the effectiveness
of progressive muscle relaxation therapy on stress among pregnant women in selected
hospitals, Bangalore.” is a bonafide research work done by Mrs. ATHIRA CHANDRAN, in
partial fulfillment of the requirement for the degree of Master of Science in Obstetrics and
Gynaecological Nursing.
Date: Signature of the Guide
Place: Bangalore Ms. Logambal K
Assistant Professor
Dept. of Obstetrics and Gynaecological Nursing
The Oxford College of Nursing
Bangalore.
III
ENDORSEMENT BY THE HOD/PRINCIPAL/HEAD OF THE INSTITUTION
This is to certify that this dissertation entitled “A study to assess the effectiveness
of progressive muscle relaxation therapy on stress among pregnant women in selected
hospitals, Bangalore.” is a bonafide research work done by Mrs. Athira Chandran under the
guidance of Ms. Logambal K, Assistant Professor in The Oxford College of Nursing, Bangalore.
Seal and Signature of the HOD Seal and Signature of the Principal
Ms. Karpagam S Mrs. Beena Chacko
Professor & HOD Principal
Dept. of Obstetrics and Gynaecological Nursing The Oxford College of Nursing
The Oxford College of Nursing Bangalore
Bangalore
Date: Date:
Place: Bangalore Place: Bangalore
IV
COPY RIGHT
DECLARATION BY THE CANDIDATE
I hereby declare that the Rajiv Gandhi University of Health Sciences, Bangalore,
Karnataka shall have the rights to preserve, use and disseminate this dissertation/ thesis in print
or electronic format for academic/ research purpose.
Place: Bangalore (Mrs. Athira Chandran)
© Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka
V
ACKNOWLEDGEMENTS
“The Lord is my strength and my shield; my heart leaps for joy and I will give thanks to him in
songs.” Psalms 28:7
In proffering my acknowledgements for the completion of my thesis “A study to assess the
effectiveness of progressive muscle relaxation therapy on stress among pregnant women in
selected hospitals, Bangalore” I express my thankfulness to the Almighty for His blessings and for
granting me wisdom, health and strength through the years.
I owe my deepest gratitude to my husband Mr. Adarsh S Kumar and Special thanks to my parents,
Mr. Ramachandran Nair, Mrs. Radha Ramachandran, Mr Sasi Kumar and Mrs.Rajeshwari
and my siblings, Arvind, Vishnupriya, Smitha Das for their love, support and sacrifice. They had
been a constant source of encouragement and guidance for me in life and in my studies.
My sincere thanks go to Late Sri. Narasaraju Garu, founder of The Oxford Group of educational
Institutions, Bangalore, Honourable chairman Sri. S.N.V.L. Narasimha Raju Garu, for giving
me all state of the art facilities, constant support, and encouragement for accomplishing my post-
graduation studies in this esteemed institution.
I am indebted to Mrs. Beena Chacko, Principal, The Oxford College of Nursing, for her
magnanimity of spirit, offering me valuable advice and encouragement. She has always been a
wonderful mentor and I have been greatly benefitted by her wisdom and immense knowledge. She
is indispensable not only to this esteemed institute but that the success of each and every student
may be attributed to her guidance, leadership and vision. It is a privilege to offer her my profound
thankfulness for this and much more.
I take great pleasure in expressing my deep sense of gratitude and sincere thanks to my guide
Assistant Professor Ms. Logambal K, Obstetrics and Gynaecological Nursing. She has been an
epitome of selflessness and provided me with valuable guidance, critical observations; prompt
advices that enable me to attain the fruitful completion of my study. Words cannot express my
deep appreciation to her. I thank God for giving her as my guide and pray that he shower his
blessings upon her for all times to come.
VI
I cherished the association I had with the faculty members of the Obstetrics and Gynaecological
Nursing Department- Ms. Karpagam S, Ms Purneshwari, Ms Aswini G for their unstinted
support to me in my study.
I would also like to thank Dr. J Balalakshmi HOD of Obstetrics and Gynaecology Nursing, Dr.
Bhavani B B, HOD of Child Health Nursing department and the rest of my Research Committee
Members, all HOD of various departments, Professors, associate professors and lecturers of The
Oxford College of Nursing, Bangalore for their support and valuable comments on my research.
I am indebted to Associate professor Mr. Surendra, professor Mr. Chinnadurai, statisticians
Bangalore, who on my request helped me in doing statistics analysis. My Heartfelt thanks to them
for their valuable support and also I thank Mr. Sunil for helping me in kannada translation.
My sincere thanks to all the Experts in the field of l Nursing Department-and clinical psychologist
for validating the contents of the tool and providing valuable suggestions. I express my deep sense
of gratitude to, Clinical Psychologist Ms. Jamuna Karkarla, M.Sc, M.Phil. Fortis Hospital,
Bangalore for training me in Progressive Muscle Relaxation Therapy and supporting me to
complete my study.
I gratefully acknowledge Dr. Gokula Krishna Ramadass, Medical Superintendent of The Oxford
Medical Hospital and Research Centre and Dr. Ramesh, HOD of Obstetrics and Gynaecology
of The Oxford Medical Hospital and Research Centre for their valuable suggestions, guidance
and giving me permission to conduct the study in their esteemed institution.
My warm gratitude goes to Mr. Nelson, Nursing Superintendent of The Oxford Medical
Hospital and Research Centre who had continually helped and supported me throughout my study
I cannot forget the motivation and guidance of the Assistant Nursing Superintendent, Nursing
supervisors, Ward incharges, Outpatient department of The Oxford Medical Hospital and
Research Centre throughout the period of completion of my dissertation
I offer my gratitude to Ms. Amrita Anil, Mr Nthin mathew, Ms.Geethu who accompanied me
throughout the course of my study and who had been a great help and support to me. I also express
VII
my sincere thanks to all the Pregnant women who participated in this study with full zeal and
formed the core and basis of this research study.
My heartfelt gratitude to my institution, The Oxford College of Nursing which provided me the
best platform to strengthen my potentials as a caregiver and to conduct this study proficiently,
sufficiently and with full enthusiasm.
My sincere and heartfelt thanks to all of my friends especially Helen Siby, Kamei Monica, L.
Benu and Diana S for their support and sincere concern throughout my study.
My special thanks to Manjunatha Enterprises who undertook the task of printing and binding this
thesis book.
Once again, my sincere thanks and gratitude to all those who directly and indirectly helped in the
successful completion of this dissertation.
Place: Bangalore (Mrs. Athira Chandran)
VIII
LIST OF ABBREVIATIONS
Abbreviation Expansion
PMRT Progressive muscle relaxation therapy
PSS Perceived Stress Scale
PHC Primary Health Centre
df Degree of freedom
f Frequency
n Sample size
r Correlation coefficient
r’ Estimated reliability of the entire test
SD Standard deviation
χ2 Chi-square
O1 Observation of stress in the pre-interventional test
O2 Observation of stress in the post-interventional test
X Treatment (intervention)
IX
`ABSTRACT
BACKGROUND AND PURPOSE: A relaxation technique is any method, process, procedure,
or activity that helps a person to relax; to attain a state of increased calmness; or otherwise reduce
levels of stress. Relaxation techniques are often employed as one element of a wider stress
management program and can decrease muscle tension, lower the blood pressure and slow heart
and breath rates, among other health benefits. There are different types of relaxation technique-
Progressive muscle relaxation technique is one of the types20. Since it is found to be effective in
managing stress as well as it is one of the easiest relaxation that can be followed without proper
training, the researcher has chosen this technique for the purpose of the study.
OBJECTIVES OF THE STUDY
1. To assess the level of stress among pregnant women before and after the intervention.
2.To find out the effectiveness of progressive muscle relaxation therapy on stress among pregnant
women.
3.To associate the pre-interventional stress scores with socio demographic variables of pregnant
women
4.To associate the pre-interventional stress scores with maternal variables of pregnant women
METHODOLOGY
Quasi experimental research design has been used to attain the objectives of the present
study. Sixty pregnant women were taken as samples, selected on the bases of non-probability
convenience sampling technique. Sociodemographic variables, Maternal variables and
Standardized Cohen Perceived Stress Scale was used to assess the level of stress in pregnant
women.
RESULTS: The findings of the present study show that in experimental group, the mean post-
interventional stress score (16±0.67) of the pregnant women score was lower than the pre-
interventional stress scores (25.23±3.63), the paired t value (13.60, p value <0.01) was significant
at 0.01 level. This indicates the progressive muscle relaxation therapy is effective in relieving
stress of pregnant women. It was found that there was a significant association between the pre-
X
interventional stress score and sociodemographic variable like age, education status, occupational
status and maternal variables like type of pregnancy at 0.05 level.
CONCLUSION: The present study concluded that the progressive muscle relaxation therapy was
effective on the level of stress among pregnant women.
KEYWORDS: Assess, Effectiveness, Progressive muscle relaxation therapy, Stress and Pregnant
women.
XI
TABLE OF CONTENTS
CHAPTERS CONTENTS PAGE NO.
I. INTRODUCTION 1-9
II. OBJECTIVES 10-14
III. REVIEW OF LITERATURE 15-28
IV. RESEARCH METHODOLOGY 30-41
V. RESULTS 43-73
VI. DISCUSSION 74-79
VII. CONCLUSION 80-82
VIII. SUMMARY 83-87
IX. BIBLIOGRAPHIC REFERENCES 88-97
X. ANNEXURES 98-130
XII
LIST OF TABLES
PAGE
SL.NO. TITLE
NO.
1. Frequency and percentage distribution of sociodemographic variables of 42
the pregnant women
2. Frequency and percentage distribution of maternal variables of the 51
pregnant women
3. Frequency and percentage distribution of pre-interventional level of 63
stress of pregnant women in experimental and control group
4. Frequency and percentage distribution of post-interventional level of 65
stress of pregnant women in experimental group and control group
5. Mean, SD and independent ‘t’ value of pre-intervention stress scores in 67
experimental and control group
6. Mean, SD and independent ‘t’ value of post-intervention stress scores in 68
7. Mean, SD and paired ‘t’ test value of stress scores of pregnant women 69
within experimental and control group
8. Association of the pre-interventional stress scores with socio 70
demographic variables of the pregnant women in experimental and
control group
9. Association of the pre-interventional stress scores with maternal 72
variables of the pregnant women in experimental and control group
XIII
LIST OF FIGURES
SL.NO. FIGURES PAGE NO.
1. Conceptual frame work on effective management of stress among 14
pregnant women based on Modified Wiedenbach’s The Helping
Art of Clinical Nursing Theory (1964)
2. Schematic representation of Research design 32
3. Distribution of pregnant women according to age group in 45
4. Distribution of pregnant women according to religion in 46
5. Distribution of pregnant women according to educational status in 47
6. Distribution of pregnant women according to occupational status 48
in experimental and control group
7. Distribution of pregnant women according to economic status in 49
8. Distribution of pregnant women according to place of living in 50
9. Distribution of pregnant women according to social support in 51
10. Distribution of pregnant women according to source of 52
information in experimental and control group
XIV
11. Distribution of pregnant women according to parity in 55
12. Distribution of pregnant women according to gestational weeks in 56
13 Distribution of pregnant women according to type of pregnancy 57
14 Distribution of pregnant women according to and birth spacing in 58
15. Distribution of pregnant women according to history of abortion 59
16. Distribution of pregnant women according to sex preference in 60
17. Distribution of pregnant women according to medications for 61
reducing stress in experimental and control group
18. Distribution of pregnant women according to practicing any kind 62
of exercise
19. Distribution of pregnant women according to Pre-interventional 64
level of Stress among Experimental and Control Group
20. Distribution of pregnant women according to Post-interventional 66
level of Stress among Experimental and Control Group
XV
LIST OF ANNEXURES
SL.NO. ANNEXURES PAGE NO.
I. Letter seeking expert guidance for content validity of the tool 101
II. List of experts consulted for content validity 102
III. Certificate of the content validity for tool 103
IV. Letter seeking consent from the participants 104
V. Tool for data collection 105
VI. Evaluation criteria checklist for validation of the tool 125
VII. Letter seeking permission to conduct pilot study 127
VIII. Letter granting permission to conduct study 129
IX. Certificate for Progressive Muscle Relaxation Therapy 131
X. List of statistical Formula used for the study 133
XVI
INTRODUCTION
XVII
Introduction
CHAPTER-I
INTRODUCTION
“Stress is nothing more than a socially acceptable form of mental illness.”
- Richard Carlson
Pregnancy is a unique, exciting and often joyous time in a woman's life, as it highlights the
woman's amazing creative and nurturing powers while providing a bridge to the future. Pregnancy
comes with some cost, however, for a pregnant woman needs also to be a responsible woman so
as to best support the health of her future child. The growing foetus (the term used to denote the
baby-to-be during early developmental stages) depends entirely on its mother's healthy body for
all needs. Consequently, pregnant women must take steps to remain as healthy and well-nourished
as they possibly can. Pregnant women should take into account the many health care and lifestyle
considerations. Everything feels rosy and she enjoys every bit of pampering that she gets from her
husband, in-laws, and parents. Being a woman is just a human but being a mother is divine. 1
Having a new-born is one of the most important events in a woman’s lifetime and, as well
as being a time of great joy. Having a child is a major life change, and mothers need support from
those around them, both during pregnancy and after the baby arrives. Child birth is considered a
multi-dimensional experience during the journey of pregnancy women undergo stress, fear, and
stress especially before delivery.
The word stress is derived from Latin word “stringi” which means “to be drawn tight”. Stress
is a physical or psychological stimulus that can produce mental tension or physiological reaction
that may lead to illness. Stress is a term that is commonly used today but has become increasingly
difficult to define. It shares, to some extent, common meanings in both the biological and
psychological sciences. Stress typically describes a negative concept that can have an impact on
one’s mental and physical well-being, but it is unclear what exactly defines stress and whether
stress is a cause, an effect, or the process connecting the two. With organisms as complex as
humans, stress can take on entirely concrete or abstract meanings with highly subjective qualities,
satisfying definitions of both cause and effect in ways that can be both tangible and intangible.2
1
Introduction
The incidence of stress during antenatal period is high; the incidence for occurring stress
is more in primigravida’s [51.6%] than multigravidas [30.8%]. Antenatal stress is prevalent and
serious problems in pregnancy that more than half of the pregnant women have stress antenatal
[and results of studies show that there is an association between mental health of women during
the prenatal period and the outcomes of pregnancy. The above percentage depends on the
gestational age, as in the second trimester and third trimester of pregnancy, the incidence was
reported as 35% in the first trimester and second trimester 32.4 %, respectively and also reported
the percentage in the third trimester as 50%.3
Feeling stressed is common during pregnancy. But too much stress can make
uncomfortable. Stress can make have trouble sleeping, have headaches, lose appetite or overeat.
High levels of stress that continue for a long time may cause health problems, like high blood
pressure and heart disease. In pregnancy, this type of stress can increase the chances of having a
premature baby (born before 37 weeks of pregnancy) or a low-birthweight baby (weighing less
than 5½ pounds). Babies born too soon or too small are at increased risk for health problems. The
common causes of maternal stress during pregnancy are; continuing present occupation, worry
about labor and baby, parenting ability and housekeeping before and after delivery. Now it is
proved that if under stress, hormone cortisol will be produced and if stress remains for a long
period of time it can cause high blood pressure to the mother and also to the fetus. 4
At one time or another, most people experience stress. The term stress has been used to
describe a variety of negative feelings and reactions that accompany threatening or challenging
situations. However, not all stress reactions are negative. A certain amount of stress is actually
necessary for survival. The stress reaction maximizes the expenditure of energy which helps
prepare the body to meet a threatening or challenging situation and the individual tends to mobilize
a great deal of effort in order to deal with the event. Both the sympathetic/adrenal and
pituitary/adrenal systems become activated in response to stress. 5
The sympathetic system is a fast-acting system that allows us to respond to the immediate
demands of the situation by activating and increasing arousal. The pituitary/adrenal system is
2
Introduction
slower-acting and prolongs the aroused state. However, while a certain amount of stress is
necessary for survival; prolonged stress can affect health adversely. 6
Homeostasis is a concept central to the idea of stress. In biology, most biochemical
processes strive to maintain equilibrium, a steady state that exists more as an ideal and less as an
achievable condition. Environmental factors, internal or external stimuli, continually disrupt
homeostasis; an organism’s present condition is a state in constant flux wavering about a
homeostatic point that is that organism’s optimal condition for living. Factors causing an
organism’s condition to waver away from homeostasis can be interpreted as stress. A life-
threatening situation such as a physical insult or prolonged starvation can greatly disrupt
homeostasis. On the other hand, an organism’s effortful attempt at restoring conditions back to or
near homeostasis, oftentimes consuming energy and natural resources, can also be interpreted as
stress. In such instances, an organism’s fight or flight response recruits the body’s energy stores
and focuses attention to overcome the challenge at hand. The ambiguity in defining this
phenomenon was first recognized by Hans Seyle in 1926 who loosely described stress as
something that ", in addition to being itself, was also the cause of itself, and the result of itself."
First to use the term in a biological context, Seyle continued to define stress as "the non-specific
response of the body to any demand placed upon it." Present-day neuroscientists believe that stress,
based on years of empirical research, "should be restricted to conditions where an environmental
demand exceeds the natural regulatory capacity of an organism." Despite the numerous definitions
given to stress, homeostasis appears to lie at its core.7
Biology has progressed in this field greatly, elucidating complex biochemical mechanisms
that appear to underlie diverse aspects of stress, shining a necessary light on its clinical relevance
and significance. Despite this, science still runs into the problem of not being able to settle or agree
on conceptual and operational definitions of stress. Because stress is ultimately perceived as a
subjective experience, it follows that its definition perhaps ought to remain fluid. For a concept so
ambiguous and difficult to define, stress nevertheless plays an obvious and predominant role in
the everyday lives of humans and nature alike.8
3
Introduction
There are various methods to reduce stress; such as meditation, yoga, hypnosis, imagery,
pharmaceutical method. Among this Progressive muscle relaxation therapy (PMRT) is an effective
and widely used strategy for stress relief. It is a therapy with tensing and relaxation of muscle
groups. The importance of muscle relaxation is to de-stress the body and mind. The advantages of
progressive muscle relaxation therapy include lowering of the blood pressure, lowering of the
muscle tension, the stress level, the level of fatigue and providing a sense of overall well-being.9
It was developed by Chicago physician Edmund Jacobson. He developed a lengthy and
meticulous technique, which focused on getting in touch with musculature and learning to control
the tension levels. Jacobson's method was designed so that the practitioner would eventually be
able to automatically and unconsciously monitor and release unwanted tension. He began to gather
empirical evidence of this interplay between the central nervous, mental processes and peripheral
muscle changes in a series of studies in 1920. Jacobsen investigated the startle reaction after a
sudden loud noise and ascertained that people who have learned to relax their muscles are not
startled. The level of muscle tension also affects the extent of the reflex. Jacobsen also ascertained
that mental visualisation, especially if associated with exercise, led to slight but measurable
muscular activity. For example, he showed that imagining specific arm movements was associated
with an increase in EMG activity of the biceps muscles. The process has since been adapted and
shortened by others, most notably Joseph Wolpe, and has become known as the abbreviated
progressive muscle relaxation training. Included in this adaptation is the tension–release cycle (e.g.
make a tight fist and then release) combined with a focus on breathing. 10
Freeman suggests that PMRT and other muscle-based relaxation variations convey health
benefits in three ways that is utilizing the effects of PMRT to manipulate autonomic responses,
Increases or activates the production of opiates, Promotes optimal immune function. Freeman
argues that PMR techniques blunt sympathetic arousal by training the individual to reduce oxygen
requirements, achieved by the repetitive release of muscle tension combined with slowing of
respirations. The importance of muscle relaxation is to de-stress the body and mind. The
advantages of progressive muscle relaxation include lowering of the blood pressure, lowering of
4
Introduction
the muscle tension, the level of stress, fatigue and providing a sense of overall wellbeing. Practice
of progressive muscle relaxation assist in relieving muscle tension, greatly improve overall feeling
of wellbeing and most importantly, reduce stress and stress during pregnancy and make the
pregnancy as joyous one. This makes it a useful therapeutic intervention for stress. Progressive
deep muscle relaxation is based on the premise that stress and relaxation are mutually exclusive;
stress can't be experienced when the muscles are relaxed. The procedure contrasts tension with
relaxation. A person first tenses a set of muscles to recognize the tense sensation. When he lets
those muscles relax, he's asked to become aware of the internal feeling and difference between
tension and relaxation. The focus of this exercise is gross muscle groups throughout the body,
including the forehead, eyes, nose, face, tongue, jaws, lips, neck, right arm, left arm, right leg, left
leg, upper back, chest, stomach, buttocks, and thighs.11
As a midwife the role of nurse in stress is provision of support in physical, emotional and
psychological problems by considering culture and beliefs of the clients. Provision of services to
the patient for the reduction of stress, helps the patient to cope with the stress and to alleviate the
stress. stress can affect maternal and foetal outcome and it can spoil the future of the child, and
same time it can cause danger effect in mother’s life also. this progressive muscle relaxation
therapy is easy to learn for antenatal mother, Muscle tension accompanies stress; one can reduce
stress by learning how to relax the muscular tension and there are no side effects.12
NEED FOR THE STUDY
The health and emotional well-being of a woman, both before and during her pregnancy,
can impact the future health of her child. "Stress is a silent disease," says Dr. Hobel, director of
maternal-fetal medicine at Cedars Sinai and a professor of obstetrics/gynecology and paediatrics.
Pregnant women need to be educated in recognizing when they have stress, the consequences and
some of the simple things they can do to make a difference. Experiencing stressful events or
environmental hardships, such as financial instability, the death of a loved one, or divorce, while
pregnancy can place an additional strain on a woman and increase her likelihood of adverse birth
5
Introduction
outcomes, including preterm birth and low birthweight. When the mother is stressed, several
biological changes occur, including elevation of stress hormones and increased likelihood of
intrauterine infection the fetus builds itself permanently to deal with this kind of high-stress
environment, and once it's born may be at greater risk for a whole bunch of stress-related
pathologies.13
Stress, in relation to pregnancy, has been measured in several ways: by counting the
frequency and rating the severity of daily hassles or significant life events during the course of
pregnancy, as a personality construct of trait stress, in terms of state stress, and as the extent of
fear associated with different aspects of the pregnancy (e.g. fear of giving birth). All these
dimensions of stress place a woman at risk to more complications during pregnancy. For example,
two independent studies have found that greater prenatal stress in the first trimester was related to
more complications during pregnancy (e.g. eclampsia), more labour difficulties (e.g. emergency
Caesarean section), and more negative infant outcomes (e.g. prematurity). 14
Stress as measured by state and trait levels of general stress or pregnancy specific stress,
or as measured by life events, has also predicted birth length and weight, with more stress
associated with decreased birthweight, including an increased likelihood of giving birth to infants
who weigh less than 2500 grams.
In globally, research suggests that about 14% to 23% of all pregnant women experience
stress during pregnancy. Stress causes a persistent feeling of sadness and loss of interest it is most
common in pregnancy. 15
In India, a study was conducted in primi antenatal mother’s reveals that 53 out of 160
(33.1%) antenatal women had moderate to severe stress. During antenatal period the behaviour of
the women often confronted with situations that demand adaptation. Maternal stress affects
maternal feelings, continuity of which may potentially lead to child development or subsequently
affect the maternal psychopathology, bolstering the idea of prenatal environmental transmission
of risk for later distress in life. 16
6
Introduction
In Karnataka, Quantitative approach was adopted for the study.30 primi antenatal women
who were on the first trimester of pregnancy and who met the inclusion criteria in selected
hospitals, Bangalore were selected through convenient sampling. 53% of the samples had Mild
fear of childbirth in first trimester and 20% had severe fear of childbirth in second trimester. But
in the third trimester majority of Primi antenatal women (i.e.) 73% had clinical fear of childbirth,
17% had severe fear of childbirth and 7% had moderate fear of childbirth. Throughout the course
of pregnancy, higher level of stress related to childbirth was reported during their third trimester
of pregnancy. Findings suggest the need of the training programme of mind body interventions as
an intervention for primi antenatal women to reduce the stress related to childbirth and prevent its
consequences.17
Prenatal maternal stress is associated with adverse birth outcomes. Relaxation techniques
might be effective in reducing stress during that period. The purpose of this study was to evaluate
the effects of applied relaxation in reducing stress in pregnant women in their second trimester, as
well as raising their sense of control. A randomized control trial with a prospective pre-test–post-
test experimental design was used. The results of the study demonstrated significant benefits from
the use of the techniques in the psychological state of the pregnant women. The systematic
implementation of the proposed relaxation techniques contributed in the reduction of perceived
stress (mean change −3.23, 95% CI: −4.29 to −0.29) and increased the sense of control (mean
change 1.99, 95% CI: 0.02–3.7).18
A randomized clinical trial was conducted on 66 primigravida women from April to
September (2014) in two health care centres covered the study results that stress but after the
intervention and stress (p<0.001) of the pregnant women was significantly lower in the progressive
muscle relaxation group than those of the control group. The study concludes that lack of side
effects and its easy applicability, this method can be recommended to use as an approach to reduce
stress in women during pregnancy. Here the statistical data revels that antenatal mothers are at
more risk of developing stress during pregnancy.19
7
Introduction
Progressive muscle relaxation involves tensing and relaxing a series of 16 muscle-groups to
achieve deep relaxation and has been used to reduce the stress. Though there are several muscle
relaxation and stress relieving techniques that are very useful, the Progressive Muscle Relaxation
is a fast and effective method that has a number of benefits.
Immediate Benefits of Progressive Muscle Relaxation Technique: Not only does progressive
muscle relaxation technique relax muscles and relieve off the stress, but it also yields several other
benefits. These include Better oxygen supply to the bloodstream, decreased heart beat level or
palpitation, Decreased and comfortable breathing rate, Lowered and comfortable level. Reduced
muscle tension throughout the body. Along with these immediate benefits of progressive muscle
relaxation technique, there are some long-term benefits as well that is A huge reduction in the
general level of stress across the body, Better concentration level, Better ability to stay focused,
Reduced frequency of stress, better general outlook towards life, a positive mood, Stronger
immune system, Enhanced general well-being, Increased energy levels, Better sleeping ability at
night or reduced insomnia level Progressive muscle relaxation technique has been proven to be a
very effective way in treating problems caused by stress.
Progressive muscle relaxation can be done lying down or sitting. It is very important to not
strain or overly tense the muscle. Just creating a little bit of tension is sufficient to cultivate greater
awareness of tension in the body and the relaxation that occurs when contracted muscles are
released. If any of the exercises cause discomfort or cramping, ease up, stop or skip this body part
entirely so as not to exacerbate any pre-existing injury or cause pain.
Though this technique is simple, it may take several sessions of practice before it is
completely mastered. Once this practice is learned, an abbreviated version can be practiced by
creating tension in certain muscle groups. For example, a shorthand method might include tensing
only hands and arms or just the forehead, eyes and jaw. It is possible to become so proficient at
PMR that it is only necessary to focus on one muscle group to produce these results. Tightening
and relaxing the first muscle group for each area of the body.19
8
Introduction
Therefore, the investigator felt the need of Progressive muscle relaxation therapy to reduce
the level of stress taking up the present study by which aims at reducing stress in pregnant women
by the use of progressive muscle relaxation therapy.
9
Objectives
CHAPTER-II
OBJECTIVES
This chapter deals with the statement of the problem, objectives of the study, operational
definition, hypothesis made in the study, limitations of the study and conceptual framework.
Objectives are the guiding forces for a researcher throughout the study.20 Explicit description of
the objectives is essential to come out with meaningful research. The statement of the problem and
the objectives for the current study are as follows:
STATEMENT OF THE PROBLEM
“A study to assess the effectiveness of progressive muscle relaxation therapy on stress among
pregnant women in selected hospitals, Bangalore”.
1. To assess the level of stress among pregnant women before and after the intervention
2.To find out the effectiveness of progressive muscle relaxation therapy on stress among pregnant
women.
3.To associate the pre-interventional stress scores with socio demographic variables of pregnant
women
HYPOTHESIS
H1: There will be significant difference in the pre-interventional and post-interventional stress
scores of pregnant women at the level of p>0.05
H2: There will be a significant association between the pre-interventional stress scores and socio
demographic variables of the pregnant women at the level of p>0.05
H3: There will be a significant association between the pre-interventional stress scores and
maternal variables of the pregnant women at the level of p>0.05
RESEARCH VARIABLES
 Independent variable: Progressive muscle relaxation therapy
 Dependent variable: Stress among pregnant women

10
Objectives
 Sociodemographic variables: Age, Religion, Educational status, Occupational status,
Economic status, Place of living, Social support, Source of information.
 Maternal variables: Parity, Gestational weeks, Type of pregnancy, Birth Spacing,
History of abortion, Sex preference, Medications for reducing stress, Practising any
kind of exercise.
OPERATIONAL DEFINTIONS
 Assess: It refers that the perceived stress among pregnant women measured by Cohen
perceived stress scale before and after the administration of the progressive muscle
relaxation therapy.
 Effectiveness: In this study it refers that the difference between pre-interventional and
post-interventional stress scores among pregnant women measured by Cohen perceived
stress scale.
 Progressive muscle relaxation therapy: It is a type of relaxation therapy used as a
nursing intervention for reducing or reliving stress during pregnancy. It includes the
sequence of contraction and relaxation of the individual muscle or muscle groups in a quiet
and calm environment by pregnant women and duration of the intervention is 20 minutes
administered for the period of 15 consecutive days.
 stress: It refers to the psychological and physiological reactions towards state of pregnancy
perceived by the women during pregnancy measured Cohen perceived stress scale.
 Pregnant women: It refers to the women who are in 3rd trimester of the pregnancy
ASSUMPTIONS
1. The women may be interested to do progressive muscle relaxation therapy
2. Administration of progressive muscle relaxation may improve birth outcome of the mother
3. Administration of progressive muscle relaxation therapy may improve the foetal outcome
4. Progressive muscle relaxation therapy help in reducing stress in pregnant women
11
Objectives
DELIMITATIONS OF THE STUDY
The study is delimited to 60 antenatal mothers who are in the third trimester of pregnancy in
selected hospitals, Bangalore.
CONCEPTUAL FRAMEWORK
A conceptual framework is a group of concept and a set of proportions that spells out the
relationships between them. Conceptual framework plays several interrelated rules in the progress
of science21.
A conceptual or theoretical framework in nursing research can help to provide a clear and concise
idea of the knowledge in the area.
The present study aims at assessing the effectiveness of progressive muscle relaxation therapy on
reducing stress among pregnant women. The conceptual framework selected for the study is based
on the Modified Wiedenbach’s The Helping Art of Clinical Nursing Theory. This theory
comprises of five elements which considered as the realities of nursing and they are agent,
recipient, goal, means framework given by wiedenbach.
Agent: The agent is the nurse who involves in giving care to the mother and who has the respect
for dignity, worth, autonomy and individuality of each human being and resolution to act
dynamically in relation to one’s belief. The agent in this study was the nurse investigator.
Recipient: It refers the pregnant women who are unable to cope up with stress.
Goal: The goal is to bring out or to achieve the desired outcome by the nurse. In this study it is the
reduction of stress.
Means: These are the actions taken by the nurse to achieve the goal. Here the nurse used
progressive muscle relaxation therapy.
Framework: It is the setting where the nursing actions was performed. The framework is
Antenatal Outpatient department, The Oxford Medical College Hospital and Research Centre,
Bangalore.
12
Objectives
STEP: 1- identification of a need for help
It involves identifying the pregnant women’s need for help. It is personal and unique to each
pregnant woman. Identification begins by getting information on her sociodemographic variables
and maternal variables.
STEP: 2- Ministering the needed help
It involves the help that is suitable, accessible and acceptable to the pregnant women. progressive
muscle relaxation therapy was given to pregnant women in the experimental group. No therapy is
given to control group.
STEP:3 – Validating that the needed help was met
Validating is the result that the pregnant women experience a reduction in the level of stress. Here
validation is the post-interventional done after progressive muscle relaxation therapy.
13
Objectives
EFFECTIVE MANAGEMENT OF STRESS AMONG PREGNANT WOMEN
NURSING PRACTICE VALIDATING THAT THE

NEEDED HELP WAS MET
IDENTIFYING THE NEED FOR  Post assessment of
HELP MINISTERING THE stress among
pregnant women
 Collection of socio NEED HELP
demographic and maternal
Experimenta
REALITIES
variables from the l group –
Progressive Positive
experimental group and muscle outcome –
relaxation Reduced
control group stress level.
Agent – Nurse therapy
 Assessment of the stress Recipient –Pregnant women
level by standardized Cohen Goal – To reduce stress
level
perceives stress scale. Means –Progressive muscle
therapy Control group Negative
Framework – Antenatal Routine outcome –
OPD Antenatal care No
reduction in
stress level
Not included in the study

Notn
Figure 1. Conceptual framework on effective management of stress among pregnant women based on Modified Wiedenbach’s Helping Art of
Clinical Nursing Theory (196
14
REVIEW OF
LITERATURE
Review of the literature
CHAPTER-III
REVIEW OF THE LITERATURE
A literature review is a written summary of the state of existing knowledge on research
problem. The task of reviewing research literature involves the identification, selection of critical
analysis and written description of existing information on a topic.22
The literature relevant to this study was reviewed and organized in the following headings:
1. Literature related to stress during the pregnancy
2. Literature related to effect of progressive muscle relaxation therapy on stress during
pregnancy
3. Literature related to ill effect of stress during pregnancy in maternal and neonatal
outcome
4. Literature related to effect of relaxation therapies on stress during pregnancy
1. Literature related to stress during the pregnancy
A cross sectional study was conducted from an ongoing registry. Study participants
were 1522 women receiving prenatal care at a university obstetric clinic. Multiple logistic
regression identified factors associated with high stress as measured by the Prenatal Psychosocial
Profile stress scale. The study reveals that the majority of participants reported antenatal
psychosocial stress high were significantly associated with high psychosocial stress. this study was
concluded that Antenatal psychosocial stress is common, and high levels are associated with
maternal factors known to contribute to poor pregnancy outcomes. 23
A randomised-controlled trial study was conducted on the association between antenatal
depression, stress, and stress, and preterm birth published. The study reveals that There is strong
evidence that antenatal distress during the pregnancy increases the likelihood of preterm birth. The
study concluded that the effects of pregnancy distress were associated but not with medically
indicated preterm birth.24
15
A cohort study was conducted to 65,212 children who underwent health examinations from 7
to 13 years of age in public or private schools. We identified 459 children as exposed to prenatal
stress, defined by being born to mothers who were bereaved by death of a close family member
from one year before pregnancy until birth of the child. Body mass index values and prevalence
of overweight were higher in the exposed children, but not significantly so until from 10 years of
age and onwards, as compared with the unexposed children. The study concluded that results
suggest that severe pre-pregnancy stress is associated with an increased risk of overweight in the
offspring in later childhood.25
A cross sectional study was conducted in pregnant women to total of 19,282 singleton
pregnancies in women with valid information about psychological stress during pregnancy. The
study results that There were 66 stillbirths in the population studied. Compared with women with
an intermediate level of psychological stress during pregnancy, women with a high level of stress
had 80% increased risk of stillbirth. The study was concluding that Psychological stress during
pregnancy was associated with an increased risk of stillbirth.26
Chronic stress is one of many causes of human preterm birth, but no direct evidence has yet
been provided. Pregnant dams of the parental generation were exposed to stress from gestational
days 12 to 18. Their pregnant daughters (F1) and grand-daughters (F2) either were stressed or
remained as non-stressed controls. The study results that Progressively up to the F2
generation, stress gradually reduced gestational length, maternal weight gain and behavioral
activity, and increased blood glucose levels.27
A descriptive survey study was conducted to investigate the role of quality of life in
pregnancy stress rates. The second aim was to explore the relationship between maternal stress
rate and the four domains of quality of life namely physical health, psychological status, social
relationships and environmental conditions.29
A quantitative study was conducted to investigate the role of quality of life in pregnancy
stress rates quantitative cross-sectional research. It was conducted for pregnant women in all
16
trimesters of pregnancy the collected data was analyzed by SPSS version 22 using one-way
ANOVA. The study reveals that in the current study, we hypothesized that quality of life may
influence the perceived stress during pregnancy. The mean age of the women surveyed was
estimated 27±4.8 years. The ultimate result showed that there is a significant relationship between
quality of life and pregnancy stress level.29
A descriptive survey was conducted to identify the stress and its associated factors among
(160) antenatal women aged 20-45 years. The study Results that the present study reveals no or
mild stress level among antenatal women 107(66.9) and moderate to severe stress in 53(33.3%) of
them. A statistically significant association was observed for gravida, education and monthly
family income of antenatal women. The study Concludes that Stress during antenatal period was
observed among more than half the women. Stress was significantly associated with gravida,
educational status and monthly family income.30
A cross-sectional prospective observational study was conducted among the pregnant
women attending Antenatal Check-up at the general Antenatal Clinic of Department of Obstetrics
and Gynecology. Data was collected by using self-structured questionnaire using General Health
Questionnaire (GHQ-12) and 21 item modified life events inventory during the late first trimester
and early third trimester. The study reveals that Most of the respondents were among the age group
of 20-29 years with mean age of 25 years. The study Concludes that There was high prevalence of
stress among the women. The prevalence of stress in the rural areas might be even more than this
number.31
A case–control study was conducted that included 340 women; in which 168 women who
gave birth preterm and 172 women who gave birth at term. The study reveals that Maternal stress
during pregnancy was more common among women who gave birth preterm compared to women
who gave birth at term. Among the women who experienced stress during pregnancy 54 % gave
birth preterm with stress as an attributable risk factor. Among all of the women the percentage was
23 %. The Study Concludes that Stress seems to increase the risk of preterm birth. It is of great
17
importance to identify and possibly alleviate the exposure to stress during pregnancy and by doing
so try to decrease the preterm birth rate.32
A comparative study was conducted to seek for magnitude of stress conditions among
pregnant women, the clinical profile of stressed pregnant women and the potential of stress on
adverse maternal and perinatal outcomes. The study reveals that concerned 1082 women whose
qualified as the stressed. Instruction level (the educated more frequent among the stressed),
socioeconomic status (the elevated more frequent among the stressed) and religion status (both the
traditional and new charismatic more frequent among the stressed). The 3 most prominent stress
factors were parent’s death (p 0.000), tension in family (p 0.000) and tension in couple (p 0.003).
In offspring too, risk of outcomes’ occurrence was enhanced by stress, except for macrosomia and
neonatal distress.33
A cross sectional study was conducted in which 48 case-control pairs, matched for known
predictors of miscarriage risk, using the Life Events and Difficulties Schedule. The study
results that The miscarriage group were more likely to have experienced a "severe life event" in
the three months preceding miscarriage more likely to have been experiencing a "major social
difficulty" and more likely to have experienced "life events of severe short-term threat" in the
fortnight immediately beforehand Fifty-four per cent of the miscarriage group had experienced at
least one of the above indicators of psychosocial stress before miscarrying, compared with 15% of
controls Alternatively, there may be a common determinant predisposing to both stress and
miscarriage.34
A cross-sectional study was conducted by standardized self-reported questionnaires in 934
mothers of singletons following delivery, Maternal hair cortisol concentrations at childbirth and
the cumulative incidences of parent-reported child AD symptoms, parent-, and pediatrician-
reported AD diagnoses were assessed until age 2 years (n = 787). Overall, 205 dermatologic
examinations were performed in 167 children showing AD symptoms. The study results that
Maternal stress and stress were associated with child AD symptoms by trend (RR and aRR: 1.5
18
(1.0,2.3) for the highest vs. the lowest quarter of chronic stress, the study concludes that
Stress measurements or related constructs are linked to AD symptoms.35
This is a cross-sectional study involving 296 women, in which 146 pregnant women
without any medical problem were compared with 150 non-pregnant women. The study results
that There was no statistical difference between pregnant and non-pregnant women [56.8%
(83/146) vs. 48.6% (73/150), odds ratio (OR) 1.39 95% confidence interval (CI) 0.88-2.19]
regarding the level of stress. Pregnant women had a higher level of stress compared with the non-
pregnant (15.7% vs. 2.6%, P = 0.0002) and ultrasound examination decreased the stress level. The
study concludes that Pregnant women are more stress, and after the ultrasound examination, the
level of stress decreased.36
2.Literature related to effect of progressive muscle relaxation therapy on stress among
pregnant women
A comparative study was conducted to evaluate the effects of applied progressive
muscle relaxation in reducing stress in pregnant women in their second trimester. A randomized
control trial with a prospective pre-test-post-test experimental design was used. Methods are 60
primigravida women in their second trimester were assigned randomly to receive a 6-
week stress management programmed. The results of this study support the claim that training in
the proposed progressive muscle relaxation techniques may constitute an ideal, non-
pharmaceutical, intervention that can promote well-being, at least during pregnancy. longer studies
will be necessary in the future, in order to examine the long-term effects of relaxation techniques.37
A randomized study was conducted about the effects of relaxation on psychosocial
wellbeing during pregnancy. The sample consists of 39 samples [n=39] and research design was
experimental. Participants were assigned to one or two active relaxation techniques which
progressive muscle relaxation therapy is used. The tool used was visual analogue scale, and
participants were asked to report the relaxation self. The result of the study was there is relaxation
of 45.5 percent on various psychological and biological stress systems. Through the finding of the
19
study concludes that those who were receiving muscle relaxation technique were able to control
their stress levels.38
A cross sectional study was conducted to assess the effects of applied progressive muscle
relaxation training on perceived stress in pregnant women on 110 primigravida’s [n=110] with a
mean age of 23yrs with a mean gestational age of 17weeks. The samples were drawn by random
sampling technique assigned into experimental and control group. The tool used to measure the
stress is Cohen perceived stress scale. In this study the experimental group received muscle
relaxation therapy along with routine antenatal care, and control group received only routine
antenatal care. The result of the study was that, there was a significant reduction in stress for
experimental group 77 percent as compared to control group 19.6 percent. It concludes that the
beneficial effects of muscle relaxation on reducing stress among primigravidas.39
A cross sectional study was conducted for effects of progressive muscular relaxation and
on stress during pregnancy. This three-group clinical trial was conducted in health centres and
governmental hospitals. Sixty pregnant (after 20 weeks of gestational age) women with were
assigned to two groups. The study reveals that After 4 weeks of intervention, stress were
significantly decreased in progressive muscle relaxation and breathing experimental groups. The
study concludes that interventions were effective in experimental group.40
A randomized study was conducted on 66 primigravid women from April to September
in two health care centers. Subjects were randomly divided into two groups. The study reveals that
mean age of subjects in this study was 25.5±4.3 years. the study concludes that due to the
progressive muscle relaxation therapy effect on reducing stress, and lack of side effects and its
easy applicability, this method can be recommended to use as an approach to reduce depression,
and stress in women during pregnancy.41
A randomized study was conducted for Eighty-four stressed pregnant women were recruited
during the second trimester of pregnancy and randomly assigned a progressive muscle relaxation
group or a control group that received standard prenatal care alone. The relaxation group provided
20
themselves with progressive muscle relaxation sessions on the same time schedule. Immediately
after the relaxation therapy sessions on the first and last days of the 16-week period the women
reported lower levels of stress. The result of the study was relaxation group had higher dopamine
and serotonin levels and lower levels of cortisol and norepinephrine. The study concludes that that
stressed pregnant women and their offspring can benefit from relaxation therapy. 42
A quasi-experimental study was conducted on progressive muscle relaxation therapy for
preventing and treating preterm labour. The Randomized controlled trials with a total of 833
women were included. The benefits of relaxation were found in one study for maternal stress at 26
to 29 weeks’ gestational age, baby birth weight and type of delivery; when applying relaxation
therapy together with standard treatment. For women in preterm labour the results for the main
outcome of preterm birth in the intervention and control groups from a single study were not
different. According to the results of this review, there is some evidence that relaxation during
pregnancy reduces stress.43
A randomized study was conducted to determine the effect of progressive muscle
relaxation on pregnant women's health. In this clinical trial, 60 primigravida women admitted to
the prenatal clinic. Using purposive sampling method, Study Results that Total mean score of
health of the experimental group and the control group before the intervention was 35.83 (6.92)
and 29.46 (8.3), respectively, and after the intervention, the respective scores were 20.2 (5.61) and
27.85 (8.24). The study concludes that Given that the results showed the effectiveness of
progressive muscle relaxation on pregnant women's health, the prenatal clinics can include a
training program for progressive muscle relaxation in the routine training programs for pregnant
women.44
A randomized study was conducted to measure the effects of progressive muscle
relaxation training on stress and health-related quality of life of patients with ectopic pregnancy
receiving methotrexate treatment. Ninety inpatients receiving this treatment were randomly
assigned to a progressive muscle relaxation group (n = 45) or a control group (n = 45). The control
21
group received standard single-dose methotrexate treatment, and the experimental group received
methotrexate and additional muscle relaxation training until hospital discharge. The study
conclude that muscle relaxation training can effectively improve the stress and health-related
quality of life of patients with ectopic pregnancy receiving methotrexate treatment in an inpatient
setting.45
A cross sectional study was conducted of 64 pregnant women with bronchial asthma from
the local population in an 8-week randomized, prospective, controlled trial. Thirty-two were
selected for PMR, and 32 received a placebo intervention. The systolic blood pressure forced
expiratory volume in the first second, the study results that According to the intend-to-treat
principle, a significant reduction in systolic blood pressure and a significant increase in both forced
expiratory volumes in the first second and peak expiratory flow were observed after PMR. The
study concludes that progressive muscle relaxation appears to be an effective method to improve
blood pressure decrease stress levels, thus enhancing health-related quality of life in pregnant
women with bronchial asthma.46
3.Literature related to ill effect of stress during pregnancy in maternal and neonatal outcome
A cross sectional study was conducted to examine the psychosocial profile of 25
women with gestational diabetes mellitus and compared them to 25 non-diabetic pregnant women.
Measures administered included the Pregnancy Experiences Scale the Problem Areas in Diabetes
Scale, and the Perceived Social Support Scale. Elevated levels of diabetes-related distress were
found in 40% of women with GDM. In addition, the GDM group reported less social support from
outside the family. Our preliminary study indicates that the experience of GDM appears to be
associated with increased psychological distress in comparison to the experience of non-diabetic
pregnant women. This may indicate the need for psychological screening in GDM and the
provision of psychological support in some cases.47
A quasi experimental study was conducted in pregnant women, 4314 women who delivered
a singleton live birth at the Boston Medical October. CH is defined as hypertension diagnosed
22
before pregnancy. Information regarding LS and SP was collected by questionnaire. Preeclampsia
was diagnosed by clinical criteria. The study results that LS, SP and CH were each associated with
an increased risk of preeclampsia. Compared with normotensive pregnancy with low LS, both
normotensive pregnancy with high LS and pregnancy with CH and low LS (10.6(7.5–15.1))
showed an increased risk of preeclampsia, while pregnancy with high LS and CH yielded the
highest risk of preeclampsia. This study concludes that high psychosocial stress and CH can act in
combination to increase the risk of preeclampsia up to 20-fold. This finding underscores the
importance of efforts to prevent, screen and manage CH, along with reducing psychosocial stress,
particularly among women with CH.48
A case-control study was conducted to measure the quantified stress induced,
cytoprotective proteins, determined protein modifications as markers for oxidation and glycation,
Moreover, measured expression levels of enzymes involved in antioxidant defense in the first
trimester (week 7-9) placenta of normal and T1DM women by immunoblot and real-time qPCR.
were analyzed the study results that HSP70 (+19.9± 10.1%) and HO-1 (+63.5± 14.5%) were
elevated (p < 0.05) in first trimester placenta of T1DM women when compared to normal women.
However, levels of HNE or CML modified proteins were unchanged. Elevated stress in early
placenta of T1DM women may contribute to disturbances in placental development.49
A case-control study was performed to study oxidative stress markers in the serum of
pregnant women with or without OSA. Patients with OSA were identified between
Contemporaneous controls were pregnant subjects without apnea, gasping, or snoring around the
time of delivery. The study results that Serum samples from 23 OSA cases and 41 controls were
identified. Total antioxidant capacity was higher in women with OSA in comparison to controls
(p value <0.0001). The study concludes that Contrary to our hypothesis, the results of this study
suggest that pregnant women with OSA have higher antioxidant capacity and lower oxidative and
carbonyl stress markers compared to controls, suggesting a possible protective effect of
intermittent hypoxia.50
23
A cross sectional study was conducted in to enroll a longitudinal cohort of 155 women,
followed during pregnancy (6-9 months), early (0-6 weeks), and later (4-6 months) postpartum,
and 2 cross-sectional cohorts (60 early and 56 later postpartum). Household and social factors;
obstetric history; nutritional, infectious, and psychosocial stressors; and infant characteristics were
explored. The study reveals that Diet diversity (3.4 ± 1.3) and adult food security (38%) were low.
The study concludes that the variability in sociodemographic, nutritional, and psychosocial
variables, will allow exploration of factors that promote resilience or increase vulnerability of the
mother-infant dyad.51
A quasi experimental study was conducted during normal gestations, oxidant molecules
have many physiological functions, which are summarized in controlling cellular fate and
signalling, thus playing a crucial role in pregnancy development. Oxidative stress (OS) arises when
the production of reactive oxygen species (ROS) overwhelms the intrinsic antioxidant defences.
Hyperglycaemia leads to an increased production of ROS through different metabolic pathways.
Moreover, TFs may also induce proinflammatory cytokine expression, such as interleukin-6,
tumour necrosis factor-α, and monocyte chemoattractant protein-1, which are able to cause insulin
resistance directly or indirectly. The management of OS, along with tight glycaemic control, could
be beneficial, both preconception ally and during pregnancy, in women with GDM. However,
whether an antioxidant supplementation or a diet rich in antioxidants can prevent the consequences
of OS in the offspring or not is yet to be elucidated.52
A cohort study was conducted, children of these participants, 73,708 (2.8%) had a CVD
event during follow-up (up to 40 years). A total of 50,940 (2.0%) subjects born to mothers who
lost a relative during pregnancy or the year before were categorized as exposed. Cox Proportional
Hazards models were used to analyze the data. The overall hazard ratio (HR) (95% confidence
interval) of having a CVD was 1.13 (1.06–1.20); the estimate was 1.24 (1.11–1.38) for heart
disease and 1.27 (1.01–1.60) for hypertension. Additional sibling-matched analyses showed an
overall attenuated association (1.08 (0.94–1.24)). The study Concludes that results suggested a
24
modest association between prenatal stress and CVD, both in childhood and early adulthood,
which could be of importance, especially at an older age when the individuals are followed over a
long period.53
A cohort study was conducted in live singletons born. The children were assigned to the
bereaved group if their mothers lost a child, partner, spouse, parent or sibling during pregnancy or
up to 12 months before pregnancy. Follow –up started at the date of birth and ended at the date of
first hospital treatment for psoriasis or a prescription redeemed for topical vitamin D derivatives,
emigration, death the study results that during 28 million persons – years of follow up. 7956
children were hospitalized or prescribed medications for psoriasis. Overall prenatal exposure to
maternal bereaved was not associated with risk of psoriasis in general, however children born to
mothers who lost a partner, or an older child had increased risk of psoriasis. The study concludes
prenatal exposure to the most stressful life event may contribute to the developmental and /or
exacerbation of psoriasis.54
4. Literature related to effect of relaxation therapies on stress during pregnancy

A Randomized study was conducted in comparing relaxation techniques with usual care, no
treatment or sham interventions to prevent or treat PTL. Mean difference (MD) and its 95%
confidence intervals (CI) were calculated for continuous outcomes and risk ratio (RR) and 95%
CI for dichotomous data. The included studies were different in terms of intervention, practice,
and time, and there were no clear coherent hypotheses. For women not in PTL, the benefits
of relaxation were found in one study for maternal stress at 26 to 29 weeks’ gestational age (mean
difference (MD) -7.04; 95% confidence interval (CI) -13.91 to -0.17). The study concludes that
According to the results of this review, there is some evidence that relaxation during pregnancy
reduces stress.55
A quasi experimental study was conducted to highlight the importance of identifying pregnant
women who experience severe stress and the need for interventions that commence early
in pregnancy. The aim of this study was to review studies that investigated the effects
25
of relaxation techniques during pregnancy, including maternal, fetal, and neonatal outcomes.
Relaxation during pregnancy is associated with autogenic effects that include regulation of
emotional states and physiology. Relaxation is also associated with positive effects both on fetal
behavior and on obstetric and neonatal outcomes.56
A randomized study was conducted 371 nulliparous women out of 4575 indicating severe
fear of childbirth. These women were randomized to psycho educative group intervention with
relaxation (n = 131; six sessions during pregnancy by community nurses (referral if necessary).
The study results that Postnatal maternal adjustment and childbirth experience were better in the
intervention group compared with controls. The study concludes that in nulliparous women with
severe fear of childbirth, participation in a targeted psycho educative group resulted in better
maternal adjustment, a less fearful childbirth experience and fewer postnatal depressive symptoms,
compared with conventional care.57
A randomized study was conducted in the experimental group received routine prenatal
care along with 7-week applied progressive muscle relaxation training sessions, while the control
group received only routine prenatal care. The study results that significant reductions in low birth
weight, caesarean section, and/or instrumental extraction were found in the experimental group
compared with the control group. The study concludes that the findings suggest beneficial effects
of nurse-led relaxation education sessions during the prenatal period. This intervention could serve
as a resource for improving pregnancy outcomes in women with high stress.58
A randomized study was conducted to Pregnant women awaiting amniocentesis, were
randomly assigned in the morning and the afternoon to three groups for 30 min: listening to
relaxing music, sitting and reading magazines, and sitting in the waiting-room. The study results
that Maternal cortisol and state stress were correlated in the afternoon, but not in the morning. The
larger decreases in cortisol occurred in the music group. The study concludes that A relaxing
intervention as short as 30 min, especially listening to music, decreases plasma cortisol and self-
26
reported state stress score. Pregnant women might benefit from the routine practice of relaxation in
the imminence of clinical stressful events.59
A study was conducted to analyse the Effectiveness of progressive muscle relaxation therapy
on the level of stress and physiological parameters among the antenatal mothers. Quasi
experimental approach was adopted; one group pre-test post-test research design was selected for
the study. Studies have demonstrated that for reducing the stress among the Antenatal mother.60
A cross sectional study was conducted to the participants were 55 pregnant women with
preterm labour who hospitalized from, participants were assigned to experimental group and the
other 26 participants to control group. The Progressive muscle relaxation therapy was applied to
the experimental group for 5 days. The study Results that the state stress score and the preterm
labour stress score of experimental group were statistically significant lower than those of control
group. In addition, the systolic and diastolic blood pressure, pulse rate of experimental group was
statistically lower than those of control group. The skin temperature of experimental group was
higher than that of control group.61
A quasi experimental study with pre and post-test without control group design was
undertaken on 50 antenatal mothers attending outpatient department and the sample were selected
by purposive sampling technique. Data were collected by the use of Modified pregnant women’s
specific stress scale and analysed by using descriptive and inferential statistics. Highly significant
difference was found out between pre and post-test stress score. No significant association was
found between post-test knowledge with demographic variables. Statistical analysis of data
revealed that video assisted teaching module on Benson relaxation therapy was effective for
reducing the stress among the Antenatal mother.62
The randomized study was conducted to assess the behaviour of 33 foetuses was analysed
during laboratory relaxation/quiet rest and controlled for baseline fetal behaviour. The result of the
intervention (progressive muscle relaxation, PMR, and guided imagery, GI) showed changes in
fetal behaviour. this study concludes that indicates that the foetus might participate in
27
maternal relaxation and suggests This could especially be true for women who tend to direct their
attention to body sensations such as abdominal activity.63
A quasi-experimental study was conducted with women who experienced preterm labour
randomly assigned to a control or experimental group. The experimental group was to do a daily
relaxation exercise. Total sample was comprised of 107 women with singleton gestations. The
study results that the outcome variables were analysed using analysis of covariance, with the
preterm labour risk score entered as a covariate to compensate statistically for group differences.
The study concludes that Relaxation therapy made a difference in preterm labour outcome.64
A cross sectional study conducted in Relaxation exercises have become a standard
intervention for individuals with stress disorders, but little is known about their potential for stress
relief during pregnancy. Thirty-nine third-trimester high and low stress pregnant women
performed active or passive relaxation while levels of stress, hypothalamic-pituitary-adrenal axis
and sympathetic-adrenal-medullary system activity were assessed before and after the relaxation
period. pregnant women with high levels of trait stress benefited less than women with low levels
from a single standardized relaxation period.65
A randomized controlled trial was conducted in 84 pregnant women were randomly
divided into two groups of teaching PMRT and control group. In the intervention group, 60-90-
minute classes were held every week lasting for 4 weeks. Besides, home practice charts were given
to the mothers and researchers controlled the home practices by phone calls every week. The
control group received routine prenatal care. The study concludes that PMRT could improve the
NST results, reduce the basal fetal heart rate, and increase the number of fetal heart accelerations.
Therefore, relaxation therapies are recommended during pregnancy.66
A prospective randomized controlled study was designed to examine the effects of progressive
muscle relaxation therapy accompanied by music on pregnant women with stress. In total, 66
pregnant women were assigned randomly to a progressive muscle relaxation group or a control
group (33 women in each). The study concludes that progressive muscle relaxation accompanied
28
by music may be an effective therapy for reducing stress in pregnant women. Large randomized
studies are recommended to confirm these results.67
A randomized study was conducted on effect of progressive muscle relaxation therapy on
maternal stress. 80 pregnant women were assigned to experimental group and control group. The
Progressive muscle relaxation therapy was applied to the experimental group for 5 days. The
findings of this review indicate that there is strong evidence that progressive muscle relaxation
therapy is an effective in the reduction of stress levels during pregnancy.68
29
RESEARCH
METHODOLOGY
Research methodology
CHAPTER-IV
RESEARCH METHODOLOGY
Research methodology is a way to systematically solve the research problem. It may be
understood as a science of studying how research is done scientifically. It includes the various
steps that are generally adopted by an investigator in studying the research problem along with the
logic behind them. Research methodology not only includes the research methods but also
considers the logic behind the methods used in the context of the research study and explains why
a particular method or technique is used. So that research results are capable of being evaluated
either by the investigator or by others.69
This chapter deals with methodology adopted for the present study such as research
approach, setting, population, sampling technique, sample selection, inclusion and exclusion
criteria, development of the tool, collection of data, pilot study, procedure of data collection and
plan for data analysis. The present study is aimed to assess the effectiveness of progressive muscle
relaxation therapy on stress among pregnant women in selected hospitals, Bangalore.
RESEARCH APPROACH
Research approach is the basic procedure for conducting the research inquiry. It is an
umbrella that covers the basic procedure for conducting research. In the present study, Quantitative
research approach was used as the investigator aimed at evaluating the effectiveness of progressive
muscle relaxation therapy on stress among pregnant women in selected hospitals, Bangalore.
RESEARCH DESIGN
The research design refers to the investigator’s overall plan for obtaining answers to the
research questions and it spells out strategies that the investigator adopted to develop information
that is accurate, objective and interpretable.
30
Quasi experimental research design will be for this study
Post-
Non -Probability sampling Pre-interventional
Intervention interventional
technique-Convenience sampling test
test
Experimental group O1 X O2
Control group O1 - O2
1. O1 = assessment of pre-interventional stress among pregnant women in the experimental
and control group.
2. O2 = assessment of post-interventional stress among pregnant women in the
experimental and control group.
3. X = administration of the progressive muscle relaxation therapy to pregnant women after
the measurement of the pre-interventional stress in the experimental group.
31
RESEARCH APPROACH: Quantitative research approach
HHH
RESEARCH DESIGN: Quasi experimental research design
SETTING: The Oxford Medical College Hospital and Research Centre

Attibele, Bangalore
POPULATION: Pregnant women in 3rd trimester
SAMPLE SIZE: 60 (30 In experimental Group & 30 In Control Group)
SAMPLING TECHNIQUE –Non-probability Convenience Sampling
DATA COLLECTION
Tool I: Part A- Sociodemographic variables
Part B- Maternal variables
Tool II: Standardized Cohen Perceived Stress Scale
Tool III: Intervention protocol (PMRT)
 PRE-INTERVENTION TEST: Assessing the level of stress by
using standardized Cohen perceived stress scale (Experimental
group and Control group)
 Progressive muscle relaxation therapy (Experimental group)
 POST-INTERVENTION TEST: Reassessment of the level of stress by
using standardized Cohen perceived stress scale (Experimental group
and Control group)
ANALYSIS: Descriptive & Inferential Statistics
Figure 2: Schematic representation of research design
32
SETTING OF THE STUDY
Setting refers to the area where the study is conducted. It is the physical location and
condition in which the data collection takes place in a study. Based on the geographical proximity,
feasibility and familiarity with the setting, the investigator selected The Oxford Medical College
Hospital and Research Centre, Bangalore, which is a 600 bedded hospital, to carry out the present
study.
VARIABLES
Variables are concepts at various levels of abstraction that are measured, manipulated or
controlled in the study.70 It is also an attribute of a person or object that varies when taken on
different values. The categories of variables discussed in the present study are:
Independent variable
It is a stimulus or activity that is manipulated or varied by the investigator to create the
effects on dependent variable. In the present study independent variable refers to progressive
muscle relaxation therapy.
Dependent variable
It is the outcome or response due to the effect of the independent variable, which
investigator wants to predict or explain. In the present study the dependent variable is the level of
stress among pregnant women.
Sociodemographic variables
In the present study the sociodemographic variables include age, religion, educational status,
occupational status, place of living, economic status, social support, source of information.
Maternal variables
It includes, parity, gestational weeks, type of pregnancy, birth spacing, history of abortion,
sex preference, medication for reducing stress, practicing any kind of exercises.
30
POPULATION
The population represents the entire group or all the elements like individual or objects that meet
certain criteria for inclusion in the study. The population of the present study comprise of pregnant
women who are in the 3rd trimester in selected hospitals at Bangalore.
SAMPLE AND SAMPLING TECHNIQUE
Sample
Sample refers to a subject of the population that is selected to participate in a particular
study. Sample of the present study were pregnant women in the 3 rd trimester attending antenatal
Outpatient department in The Oxford Medical College Hospital and Research Centre, Bangalore.
Sample size
Sample size of the present study consist of 60 pregnant women in 3rd trimester attending
antenatal Outpatient department in The Oxford Medical College Hospital and Research Centre,
Bangalore.
Sampling technique:
Sampling technique is defined as the process of selecting a group of people or other
elements with which to conduct a study. Non-probability convenience sampling technique was
adopted to select the sample for the present study
SAMPLING CRITERIA
The sample was selected with the following predetermined set of criteria.
Inclusion criteria
The study includes the pregnant women in trimester
1. who can read, speak kannada and English
2. who are willing to participate in the study
3. who are available during data collection period
Exclusion criteria
The study excludes the pregnant women
31
1.who are undergoing any other methods of stress management strategies
2.who are having medical and obstetrical complications
SELECTION AND DEVELOPMENT OF THE TOOL
Tool selected in the research study should be vehicle as far as possible that would provide data for
drawing conclusion pertinent to the study, at the same time add to the body of knowledge in the
discipline. Based on the research problem and the objectives of the study, the following steps were
undertaken to select and the development of data collection tool.
Tool - 1
PART- A: Socio demographic variables
It is a structured self – administered questionnaire developed by investigator to gather data
regarding socio demographic variables like age, religion, educational status, economic status,
occupational status, place of living, social support, source of information.
PART B: Maternal variables
It is a structured self – administered questionnaire developed by investigator to gather data
regarding maternal variables like parity, gestational weeks, type of pregnancy, birth spacing,
history of abortion, sex preference, medications for reducing stress, practicing any kind of
exercises.
Tool 2: Cohen Perceived Stress Scale
The Cohen Perceived Stress Scale (PSS) is a classic stress assessment instrument. The tool, while
originally developed in 1983, by Sheldon Cohen. The Perceived Stress Scale (PSS) standardized
tool is widely used psychological instrument for measuring the perception of stress. The scale also
includes a number of direct queries about current levels of experienced stress. The items are easy
to understand, and the response alternatives are simple to grasp. Individual scores on the PSS can
range from 0 to 40 with higher scores indicating higher perceived stress, Scores ranging from 0-13
32
would be considered low stress, 14-26 would be considered moderate stress, 27-40 would be
considered high perceived stress. Moreover, the questions are of a general nature and hence are
relatively free of content specific to any subpopulation group. Permission for use of scale is allowed
for academic research or educational purposes. The tool was chosen after an extensive review of
literature, discussion with the guide and various experts in field of nursing.
CONTENT VALIDITY
Validity refers as an extent to which an instrument accurately reflects the abstract construct (or
concept) being examined. The socio demographic variables, maternal variables and Cohen
perceived stress scale were submitted to 7 nursing experts in the field of Obstetrics and
Gynecological Nursing and 1 Clinical Psychologist along with the problem statement, objectives,
hypotheses, operational definitions, intervention protocol and criteria checklist for evaluation. The
experts were requested to give their opinion and suggestions regarding the relevance of the tool to
improve the clarity and contents of the items. As per the suggestion from experts, in demographic
variables modification was done, social support, economic status was rearranged. The final tool
was incorporated with the expert suggestions and opinion. The final draft of the tool consisted of
8 items in the socio demographic data and 8 items in Maternal variables.
Training of the investigator: The investigator had undergone 1 week of training programme in
progressive muscle relaxation therapy.
PRETESTING OF THE TOOL
Pretesting of the tool with the final draft was carried out in 20 pregnant women in the third trimester
selected by non-probability convenience sampling technique from Begur PHC, Bangalore. The
tool was found to be feasible.
33
Reliability of the tool
Reliability is the degree of consistency or dependability with which an instrument measures the
attribute it is designed to measure. It is concerned with consistency, accuracy, precision, stability,
equivalence and homogeneity. Cohen perceived stress scale is developed by Sheldon Cohen it
measures degree to which situations in one’s life are appraised as stressful. Permission for use of
scale is allowed for academic research or educational purposes71. The reliability of the tool was
established by using split half method. The co-relation between the split half was obtained r = 0.85.
The estimated reliability of the tool by applying the Spearman’s Brown prophecy r’=0.9199. So,
the tool used for assessing stress in pregnant women was found to be definitely reliable.
PILOT STUDY
A pilot study is a smaller version of a proposed study conducted to develop and refine the
methodology. The functions of the pilot study are to obtain information for improving the project
or processing its feasibility.72 After obtaining formal written permission from Medical officer in
Begur PHC Bangalore, Pilot study was conducted from 12/2/2018 to 26/2/2018 among 20 pregnant
women selected by Non-probability convenience sampling technique.
On the 1st day (i.e., 12/02/2018) first the investigator introduced self, explained about the purpose
of the study to pregnant women. The pregnant women were assured anonymity and confidentiality
of the information provided by them and written consent was obtained from the pregnant women.
The pre-interventional test was conducted on 12-02-18 by using Cohen perceived stress scale.
After pre-interventional test the investigator demonstrated the progressive muscle relaxation
therapy for 20 minutes and the pregnant women were asked to do return demonstration under the
verbal instruction and supervision of the investigator. Progressive muscle relaxation therapy was
given for 15 days continuously for the pregnant women under the verbal instruction and
supervision of investigator. On the 18th day post-interventional test was conducted using the same
Cohen perceived stress scale i.e. on 1-03-18 The pilot study findings revealed that the overall post-
34
interventional stress scores were lower than the pre-interventional stress scores in the experimental
group and the progressive muscle relaxation therapy was effective in reducing the stress of
pregnant women.
PILOT STUDY FINDINGS:
In sociodemographic variables, Majority of the pregnant women in experimental group 90%
were in the age group of 22 – 26 years, 80% were Muslim, 50% had primary education, 70% were
house wives, 90% had Rs.20001 – 30000 income, 100% had support from their husbands,100%
of them belongs to rural area and 100% had not received any source of information, Majority of
the pregnant women in control group 90% were in the age group of 22 – 26 years, 60% were
Hindu, 70% had secondary education, 80% were daily wages, 100% had 20001 – 30000 income,
100% had support from their husband, 100% of them belongs to rural area and 100% had not
received any source of information.
Maternal variables, Majority of pregnant women in experimental group 90% were primi, 90%
were in 28-33 gestational weeks, 90% had planned pregnancy, 90% had birth spacing, 100% had
no history of abortion, 100% had no sex preference, 100% had not taken medication for reducing
stress, and 100% were not practicing any kind of exercise for reducing stress.
Majority of pregnant women in control group 90% were to primi, 100% had 28-33 gestational
weeks, 90% had planned pregnancy, 90% had birth spacing, 100% had no history of abortion,
100% had no sex preference, 100% had not taken medication for reducing stress, and 100% were
not practicing any kind of exercise for reducing stress.
There was no significant difference between mean pre-interventional stress scores of pregnant
women in the experimental group was (28.0±4.03) and control group (26.0 ±2.16), (t=0.69,
p=0.926) There is a significant different between mean post-interventional stress score of the
pregnant women was (18.40 ± 0.97) in the experimental group and control group (25.80 ±2.10),
(t=16.11, p=<0.001 at 0.001 level. So, the null hypothesis is rejected, research hypothesis is
35
accepted. Thus, it indicates that progressive muscle relaxation therapy was effective in reducing
the stress of pregnant in experimental group.
In experiment group, the mean post-interventional stress score (18.40 ± 0.97) of the pregnant
women score was lower than the pre-interventional stress scores (28.0±4.03), (paired t value 0.69,
p value <0.001) was significant at 0.01 level. There was no significant difference pre-
interventional (26.0 ±2.16), stress scores and post-interventional stress scores in control group
(26.0 ±2.16), (t=0.69, p=0.926). So, the null hypothesis is rejected, research hypothesis accepted.
Thus, it indicates that progressive muscle relaxation therapy was effective in reducing stress of
pregnant women in experimental group.
There was no significant association found between pre-interventional stress scores of the
pregnant women with selected sociodemographic variables such as, age, religion, education,
occupation, social support and place of living. There was no significant association found between
pre-interventional stress scores of the pregnant women with maternal variables such as parity,
gestational weeks, type of pregnancy, birth spacing, history abortions, sex preference, medications
for reducing stress, practicing any kind of exercises.
PROCEDURE OF DATA COLLECTION
Data collection was done during the month of March – April 2018. After obtaining prior
permission from the Medical Superintendent and Ethical committee of The Oxford Medical
College Hospital and Research Centre, using non-probability convenience sampling technique the
samples were selected.
Step1: Gathered all the selected pregnant women in antenatal outpatient department. Informed
consent was taken from all the pregnant women.
Step 2: The pregnant women were divided in to 2 groups (i.e. is experimental group and control
group) and each group consist of 30 samples and all the pregnant women were made comfortably
to sit in chair. Those pregnant women not able to participate in the therapy were selected as control
group.
36
Step 3: Day first, administered questionnaires that related to socio-demographic variables,
maternal variables and Cohen perceived Stress Scale as pre-interventional test for the both the
groups and average time taken to complete by each pregnant woman was 20 minutes.
Step 5: The pregnant women in the experimental group were asked to observe the Progressive
Muscle Relaxation therapy demonstrated by the investigator through the verbal instruction. The
therapy was also taught with the help of video display and intervention protocol (PMRT) was
given to the pregnant women. The pregnant women in the control group were instructed to come
on 18th day for the post-interventional test.
Step 6: All the pregnant women were asked to lie down and do return demonstration of the
Progressive muscle relaxation therapy as per the verbal instruction and supervision of the
Investigator. The total time duration of the procedure was 20 minutes.
Step 7: All the pregnant women were made to do all steps of progressive muscle relaxation therapy
under the verbal instruction and supervision of the Investigator for a period 15 day once in a day.
Those who were not able to attend particular day, the investigator instructed to perform the
progressive muscle relaxation therapy through the telephone.
Step 8: The therapy was also taught with the help of video display and intervention protocol was
given to the pregnant women.
Step 9: Post- interventional test was done using same Cohen perceived Stress Scale on the next
month for both experimental and control group.
Step 10: Therapy has been explained to the control group by giving Interventional protocol of
Progressive muscle relaxation therapy, discussed about effect of that.
DATA ANALYSIS
The data analysis was done by descriptive and inferential statistics.
37
Descriptive statistics-
 Frequency, percentage, mean and standard deviation were used to compute the socio
demographic variables, pre-interventional and post-interventional level of stress among
pregnant women.
Inferential statistics
 Parametric test
- Paired t-test was used to find the effectiveness of progressive muscle relaxation therapy
on stress of pregnant women.
- Independent t-test, used to determine whether there is a statistically significant difference
between the means in two unrelated groups.
 Non-parametric test – chi square test was used to find out the association between the
pre- interventional stress scores & socio demographic variables among pregnant women.
SUMMARY
This chapter dealt with the description of research approach, research design, settings, variables,
population, sample and sampling technique, development and description of the tool, validity and
reliability of the tool, pilot study, procedure for data collection and the plan for data analysis.
38
RESULTS
Result
CHAPTER-V
RESULTS
Analysis is the detailed examination of the elements or structure of something. In research analysis,
analysis means commutation of certain measures along with searching for problems of relationship
that exist among data group69.
This chapter deals with the analysis and interpretation of data obtained from 60 pregnant women
with the help of standardized Cohen perceived stress scale developed by Sheldon, to assess the
effectiveness of progressive muscle relaxation therapy on the level of stress among pregnant
women.
1. To assess the level of stress among pregnant women before and after the intervention
3. To find out the effectiveness of progressive muscle relaxation therapy on stress among pregnant
women.
4. To associate the pre-interventional stress scores with socio demographic variables of pregnant
women
HYPOTHESIS
H1: There will be significant difference in the pre-interventional and post-interventional stress
scores of pregnant women at the level of p > 0.05
H2: There will be a significant association between the pre-interventional stress score and socio
demographic variables of the pregnant women at the level of p > 0.05
maternal variables of the pregnant women at the level of p > 0.05.
ORGANISATION OF THE FINDINGS
The obtained data was entered for tabulation and statistical processing. The data collected from
pregnant women were grouped and analyzed with help of descriptive and inferential statistics of
data was organized and presented under the following sections:

42
Result
SECTION I: Description of sociodemographic variables of pregnant women in experimental and
control group.
SECTION II: Description of maternal variables of pregnant women in experimental and control
group.
SECTION III: Level of the pre and post-interventional stress scores in experimental and control
group.
SECTION IV: (A) Effectiveness of progressive muscle therapy between the groups.
(B) Effectiveness of progressive muscle therapy within the groups
SECTION V: Association of the pre-interventional stress scores with socio demographic variables
of pregnant women.
SECTION VI: Association of the pre-interventional stress scores with maternal variables of
pregnant women.
43
Result
SECTION-I
DESCRIPTION OF SOCIODEMOGRAPHIC VARIABLES OF PREGNANT
WOMEN IN EXPERIMENTAL AND CONTROL GROUP
TABLE 1: Frequency and percentage distribution of sociodemographic variables of the
pregnant women
n=60
Sl. Experimental group Control group

Sociodemographic
No. (n=30) (n=30) p value
variables
f % f %
1. Age in years
a) 17-21 30 100 1 3.3
b) 22-26 - - 29 96.7 <0.001*
2. Religion
a) Hindu 13 43.3 17 56.7
b) Muslim 14 46.7 13 43.3
c) Christian 3 10 - - 0.168
3. Educational Status
a) Primary
26 86.7 20 66.7
education
b) Secondary
4 13.3 10 33.3 0.067
education
4. Occupational
Status
a) Housewife 17 56.7 13 43.3
b) Daily wage 2 6.7 16 53.4
c) Self-employed 11 36.6 1 3.3 0.001**
43
Result
5. Economic Status
a) 20001-30001 30 10 30 100
b) 10001-20000 - - - - 1.000
6. Place Living
a) Urban - - 9 30
b) Rural 30 100 21 70 0.01*
7. Social Support
a) Husband 30 100 30 100
b) Parents - - - - 1.000
8. Source
Information
a) None 30 100 30 100
b) Media - - - - 1.000
The table- 1 reveals that Most of the pregnant women in experimental group 30 (100%) were in
the age group of 17 – 21 years, were as 29 (96.7%) were in the age of 22-26 years in control group.
Most of the pregnant women in experimental group 14 (46.7%) were Muslim, were as 17 (56.7%)
were Hindus in control group. Most of the pregnant women in experimental group 26 (86.7%) had
primary education, were as 20 (66.7%) had primary education in control group. Maximum number
of the pregnant women in experimental group about 17 (56.7%) were house wives, about13
(43.3%) were house wives in control group. Maximum number of the pregnant women in
experimental group 30(10%) had Rs. 20001 – 30000 income, were as30 (10%) had Rs20001 –
30000 incomes in control group. All the pregnant women in experimental group 30(100%)
belonged to rural area, were as 21(70%) belonged to rural area in control group. Most of the
pregnant women 30 (100%) in experimental group and control group had husband’s support. Most
of the pregnant women in experimental group and control group 30(100%) had not received any
source of information.
44
Result
100 % 96.7%
100
90
80
Percentage of pregnant women
70
60
50
40
30
20 3.3% 0%
10
0
17 - 21 Yrs 22 - 26 Yrs
Age in years Experimental Group

Control Group
Figure.1: Distribution of pregnant women according to Age group in Experimental and Control
group
45
Result
100
90
80
70
56.7 %
60
43.3 % 46.7 %
50 43.3 %
40
30
20
10 % 0%
10
0
Hindu Muslim Christian
Experimental Group
Religion
Control Group
Figure.2: Distribution of pregnant women according to Religion in Experimental and Control

group
46
Result
100
90
86.7 %
80
70
66.7 %
60
50
40
30 33.3 %
20
13.3 %
10
0
Primary Education Secondary Education
Experimental Group
Educational status Control Group
Figure.3: Distribution of pregnant women according to Educational Status in Experimental and

Control group
47
Result
100
90
80
70
56.7 %
60 53.4 %
50 43.3 %
36.6 %
40
30
20
6.7 %
10 3.3 %
0
House Wife Daily Wages Self Employed
Experimental Group
Occupational status
Control Group
Figure.4: Distribution of pregnant women according to Occupational status in Experimental and

Control group
48
Result
100 %
100
90
80
70
60
50
40
30
20 10 %
10 0% 0%
0
20001-30001 10001-20000
Economic status Experimental Group

Control Group
Figure. 5: Distribution of pregnant women according to Economic Status in Experimental and

Control group
49
Result
100 %
100
90
80 70 %
70
60
50 30 %
40
30
20
10 0%
0
Urban Rural
Experimental Group
Place of living
Control Group
Figure.6: Distribution of pregnant women according to Place of living in Experimental and Control
group
50
Result
100
100 %
90 100 %
80
70
60
50
40
30
20
10 0% 0%
0
Husband Parents
Experimental Group
Social Support
Control Group
Figure.7: Distribution of pregnant women according to Social support in Experimental and Control
group
51
Result
100 % 100 %
100
90
80
70
60
50
40
30
20
10 0% 0%
0
None Media
Experimental Group
Source Information
Control Group
Figure.8: Distribution of pregnant women according to Source Information in Experimental and

Control group
52
Result
SECTION-II
DESCRIPTION OF MATERNAL VARIABLES OF PREGNANT WOMENIN
EXPERIMENTAL AND CONTROL GROUP
TABLE 2: Frequency and percentage distribution of maternal variables of the pregnant
women
n=60
Experimental group Control group

Sl.
Maternal variables (n=30) (n=30) p value
No.
f % f %
1. Parity
a) Primi 27 90 29 96.7
b) Multi 3 10 1 3.3 0.301
2. Gestational weeks
a) 28-33 weeks 29 96.7 30 100
b) 34-39 weeks 1 3.3 - - 0.476
3. Type of pregnancy
a) Planned 25 83.3 29 96.7
b) Unplanned 5 16.7 1 3.3 0.085
4. Birth spacing
a) Nil 27 90 29 96.7
b) Less than 3
years 3 10 1 3.3 0.301
5. History of abortion
a) No 30 100 30 100 1.000
b) Yes - - - -
53
Result
6. Sex preference
a) No 30 100 30 100 1.000
b) Yes - - - -
7 Medication for
reducing stress
a) No 30 100 30 100 1.000
b) Yes - - - -
8 Practicing any
kind of exercise
a) No 30 100 30 100 1.000
b) Yes - - - -
The table- 2 reveals that Most of the pregnant women in experimental group 27 (90%) were
belonged to primi, were as 29 (96.7%) belonged to primi in the control group. Maximum number
of the pregnant women in experimental group29(96.7%) belonged to 28-33 weeks, were as 30
(100%) belong to 28-33 of gestational weeks in control group. Maximum number of the pregnant
women in experimental group 25 (83.3%) belong to planned pregnancy, were as 29 (96.7%) belong
to planned pregnancy in control group. Most of the pregnant women in experimental group 27
(90%) had primi birth spacing, were as on 29 (96.7%) had primi birth spacing in control group.
Most of the pregnant women in experimental group 30 (100%) had no history of abortion, were as
30 (100%) had no history of abortion in control group. Most of the pregnant women in
experimental group 30 (100%) had no sex preference, were as 30 (100%) had no sex preference in
control group. Most of the pregnant women in experimental group 30 (100%) had not taken any
medication for reducing stress, were as 30 (100%) had not taken medication for reducing stress in
control group. Most of the pregnant women in experimental group 30 (100%) were not practicing
any kind of exercise for reducing stress, were as 30 (100%) were practicing any kind of exercise
for reducing stress in control group.
54
Result
96.7 %
100 90 %
90
80
70
60
50
40
30
20 10% 3.3 %
10
0
Primi Multi
Experimental Group
Parity Control Group
Figure.9: Distribution of pregnant women according to Parity in Experimental and Control group
55
Result
100 %
100 96.7 %
90
80
70
60
50
40
30
20
10 3.3% 0%
0
28-33 34-39
Experimental Group
Gestational Weeks Control Group
Figure.10: Distribution of pregnant women according to Gestational Weeks in Experimental and

Control group
56
Result
96.7 %
100 83.3 %
90
80
70
60
50
40
30 16.7 %
20 3.3 %
10
0
Planned Unplanned
Experimental Group
Type of pregnancy Control Group
Figure.11: Distribution of pregnant women according to Type of pregnancy in Experimental and

Control group
57
Result
90 % 96.7 %
100
80
60
40
20 10%
3.3 %
0
Nil Less than 3 years
Experimental Group
Birth Spacing Control Group
Figure.12: Distribution of pregnant women according to Birth spacing in Experimental and Control
group
58
Result
100 % 100 %
100
80
60
40
20
0%
0%
0
No Yes
Experimental Group
History of Abortion Control Group
Figure.13: Distribution of pregnant women according to History of Abortion in Experimental and

Control group
59
Result
100 % 100 %
100
80
60
40
20
0% 0%
0
No Yes Experimental Group
Sex Preference Control Group
Figure.14: Distribution of pregnant women according to Sex Preference in Experimental and

Control group
60
Result
100 % 100 %
100
90
80
70
60
50
40
30
20
10 0% 0%
0
No Yes
Experimental Group
Medication for reducing stress
Control Group
Figure.15: Distribution of pregnant women according to Medication for reducing stress in

Experimental and Control group
61
Result
100 % 100 %
100
90
80
70
60
50
40
30
20
10 0% 0%
0
No Yes
Experimental Group
Practicing any kind of exercise Control Group
Figure.16: Distribution of pregnant women according to practicing any kind of Exercise in

Experimental and Control group
62
Result
SECTON-III
LEVEL OF PRE AND POST INTERVENTIONAL STRESS SCORE OF
PREGNANT WOMEN IN EXPERIMENTAL AND CONTROL GROUP
TABLE3: Frequency and percentage distribution of pre-interventional level of stress of
pregnant women in experimental group and control group
n=60
Level of stress (n=30) (n=30)
f % f %
Low (0-20) - - - -
Moderate (21-30) 23 76.7 24 80
High (31-40) 7 23.3 6 20
Table 3 shows that,
in experimental group majority 23(76.7%) of pregnant women had moderate stress, 7(23.3%) had
high stress. In control group majority 24(80%) of pregnant women had moderate stress and 6(20%)
had high stress.
63
Result
100
90
80 %
80 76.7 %
70
60
50
40
30
23.3 %
20 %
20
10 0% 0%
0
Low Moderate High
Experimental Group
Level of Stress
Control Group
Figure.17: Distribution of pregnant women according to Pre-interventional level of Stress

among Experimental and Control Group
64
Result
TABLE 4: Frequency and percentage distribution of post-interventional level of stress of
pregnant women in experimental group and control group
n=60
Experimental group Control
Level of stress (n=30) (n=30)
f % f %
Low (0-20) 30 100 - -
Moderate (21-30) - - 24 80
High (31-40) - - 6 20
Table 4 shows that,
In experimental group majority 30(100%) of pregnant women had low stress. In control group
majority 24(80%) of pregnant women had moderate stress and 6(20%) had high stress.
65
Result
100%
100
90 80%
80
70
60
50
40
30 20%
20
10 0%
0% 0%
0
Low Moderate High
Experimental group
Level of stress
Control group
Figure.18: Distribution of pregnant women according to Post-interventional level of Stress among

Experimental and Control Group
66
Result
SECTION-IV
A. EFFECTIVENESS OF PROGRESSIVE MUSCLE RELAXATION THERAPY
BETWEEN THE GROUPS
TABLE:5 Mean, SD and independent ‘t’ value of pre-interventional stress scores in
n=60

t p
Stress score (n=30) (n=30)
value value
Mean SD Mean SD
Pre-interventional
25.3 3.63 25.8 2.78 0.67 0.926
score
Table 5 shows that,
There was no significant difference between mean pre-interventional stress scores of pregnant
women in the experimental group (25.3±3.63) and control group (25.80±2.78), (t=0.67, p =0.926)
at 0.05 level. This indicates that both the groups were homogenous in terms of pre-interventional
mean stress score.
67
Result
TABLE 6: Mean, SD and independent ‘t’ value of post-interventional stress scores in

t p
Stress (n=30) (n=30)
value value
Mean SD Mean SD
Post-interventional
16 0.67 25.73 2.83 17.11 <0.001
score
**Significant at 0.001 level
Table 6 shows that there is a significant difference between mean post-interventional stress score
of pregnant women (16±0.67) in the experimental group, and control group (25.73±2.83),
(t=17.11), p=<0.001 at 0.001 level. So, the null hypothesis is rejected, research hypothesis is
accepted. Thus, it indicates that progressive muscle relaxation therapy was effective in reducing
the stress of pregnant women in experimental group.
68
Result
B. EFFECTIVENESS OF PROGRESSIVE MUSCLE RELAXATION THERAPY
WITHIN GROUPS
TABLE 7: Mean, SD, and paired ‘t’ test value of stress scores of pregnant women within
(n=30) (n=30)
Stress
t p t p
Mean SD Mean SD
value value value value
Pre-interventional
25.23 3.63 25.8 2.78
score
13.6 0.00 1.83 0.960
Post-interventional
16 0.67 25.73 2.83
score
*Significant at 0.01 level
Table 7 shows that, in experimental group, the mean post-interventional stress score (16±0.67) of
the pregnant women score was lower than the pre-interventional stress scores (25.23±3.63), (paired
t value 13.60, p value <0.01) was significant at 0.01level.
There was no significant difference between pre-interventional (25.80±2.78) stress scores and
post-interventional stress scores in control group (25.27±2.83), (the paired t-value =1.83, p value
= 0.960). So, the null hypothesis is rejected, research hypothesis is accepted. Thus, it indicates that
progressive muscle relaxation therapy was effective in reducing the stress of pregnant women in
experimental group.
69
Result
SECTION-V
ASSOCIATION OF THE PRE-INTERVENTION STRESS SCORES WITH SOCIO
DEMOGRAPHIC VARIABLES OF PREGNANT WOMEN
TABLE:8 Association of the pre-intervention stress scores with socio demographic variables
of the pregnant womenin experimental and control group
n=60
Stress level
Sociodemographic χ2 p
Moderate High
variables value value
n % n %
Age in years
a) 17-21 21 67.7 10 32.3 4.24 0.040*
b) 22-26 26 89.7 3 10.3 df=1
Religion
a) Hindu 23 76.7 7 23.3
b) Muslim 22 81.5 5 18.5 0.45 0.06
c) Christian 2 66.7 1 33.3 df=2
Educational Status
a) Primary education 39 84.8 7 15.2 4.83
b) Secondary
8 57.1 6 42.9 df=1 0.028*
education
Occupational Status
a) Housewife 26 86.7 4 13.3
b) Daily wages 15 83.3 3 16.7 7.17
c) Self-employed 6 50 6 50 df=2 0.028*
70
Result
Economic Status
a) 20001-30001 47 78.3 13 21.7 0 1.000
b) 10001-20000 - - - - df=1
Place Living
a) Urban 4 44.4 5 55.6 7.17 1.000
b) Rural 43 84.3 8 15.7 df=2
Social Support
a) Husband 23 76.7 7 23.3 0 1.000
b) Media - - - - df=1
**highly significant at 0.05 level
The table- 8 reveals that there was a significant association between the pre-interventional score
and sociodemographic variables such as, age in years (χ2= 4.24, p = 0.040), educational status
(χ2= 4.83, p = 0.028), occupational status (χ2 = 7.17, p = 0.028)at 0.05 level of significant, hence
the hypothesis stating that there is a significant association between the selected demographic
variables and pre-interventional stress score was accepted for the variables. There was no
significant association between pre-interventional test score and other sociodemographic variables
such as religion (χ2 = 0.45, p = 0.060), place living (χ2 = 7.17, p = 0.007), economic status (χ2 =
0.00, p = 1.000), social support (χ2 = 0.00, p = 1.000).
71
Result
SECTION-VI
ASSOCIATION OF THE PRE-INTERVENTION STRESS SCORES WITH
MATERNAL VARIABLE OF PREGNANT WOMEN
TABLE: 9 Association of the pre-interventional stress scores with maternal variables of the
pregnant womenin experimental and control group
n=60
Stress level
χ2 p
Maternal variables Moderate High
value value
n % n %
Parity
a) Primi 43 76.8 13 23.2 1.19
b) Multi 4 100 - - df=1 0.08
Gestational weeks
a) 28-33 weeks 46 78 13 22 0.28
b) 34-39 weeks 1 100 - - df=1 0.08
Type of pregnancy
a) Planned 45 83.3 9 16.7 7.95
b) Unplanned 2 33.3 4 66.7 df=2 0.0085*
Birth spacing
a) Less than 3
4 100 - - 1.19
years
df=1
b) Primi 43 76.8 13 23.2 0.08
History of abortion
a) No 47 78.3 13 21.7 0
b) Yes - - - - df=2 1.000
72
Result
Sex preference
a) No 47 78.3 13 21.7 0
b) Yes - - - - df=1 1.000
Medication for
reducing stress
a) No 47 78.3 13 21.7 0
b) Yes - - - - df=2 1.000
Practicing any kind
of exercise
a) No 47 78.3 13 21.7 0
b) Yes - - - - df=1 1.000
**Significant at 0.05level
The table- 9 reveals that There was a significant association between the pre-interventional stress
score and maternal variables such as type of pregnancy (χ2 = 7.95, p = 0.0085) at 0.05 level of
significant. There was no statically significant association between pre-interventional score and
other maternal variables such as, parity(χ2 = 1.19, p = 0.080),gestational weeks(χ2 = 0.28, p =
0.080),social support (χ2 = 0.00, p = 1.000), birth spacing (χ2 = 1.19, p = 0.080), history of
abortion(χ2 = 0.00, p = 1.000),sex preference(χ2 = 0.00, p = 1.000),medication for reducing stress
(χ2 = 0.00, p = 1.000),practicing any kind of exercise (χ2 = 0.00,p = 1.000).
73
DISCUSSION
Discussion
CHAPTER-VI
DISCUSSION
This chapter discusses the major findings of the study and reviews them in relation to findings
from the results of the previous studies. The present study was attempted to assess the effectiveness
of progressive muscle relaxation therapy on stress among pregnant women in selected hospitals,
Bangalore.
1.To assess the level of stress among pregnant women before and after the intervention.
women.
women
4. To associate the pre-interventional stress scores with maternal variables of pregnant women
HYPOTHESIS
H1: There will be significant difference in the pre-interventional and post-interventional of stress
scores of pregnant women at the level of p>0.05
The findings of the study are discussed under the following headings:
SECTION I: Description of sociodemographic variables of pregnant women in experimental and
control group.
SECTION II: Description of maternal variables of pregnant women in experimental
and control group.
74
Discussion
SECTION III: Level of the pre and post-interventional stress scores in experimental and control
group.
SECTION V: Association of the pre-interventional stress scores with socio demographic
variables of pregnant women.
pregnant women.
SECTION I: Description of sociodemographic variables of pregnant women in experimental
and control group.
In the present study of the pregnant women in experimental group 100% in the age group of 17 –
21 years, and 96.7% in the age of 22-26 years in control group, were 46.7% were muslim in
experimental group, 56.7% Hindus in control group, were 86.7% had primary education in
experimental group and 66.7% had primary education in control group, were 56.7% belong to
house wives experimental group and 43.3% belong to house wives in control group, were 10%
had Rs. 20001 – 30000 income in experimental group and 10% had Rs 20001 – 30000 income in
control group, were 100% belong to rural area experimental group and 70% belong to rural in
control group, were 100% in experimental group and control group had husband’s support, were
in experimental group and control group 100% had not received any source of information.
This is supported by cross sectional study conducted to find out Effect of Relaxation Therapy on
Pregnancy Induced Stress in selected territory hospital, among the subjects, majority were in the
age group 18 to 26 years, majority had the income of 4501 to 6000, majority were Hindus,
housewives, subjects from rural background, with high school education. 50% of subjects were
vegetarians and 50% were mixed groups.73
75
Discussion
SECTION II: Description of maternal variables of pregnant women in experimental and
control group.
The present study shows that majority of pregnant women in experimental group 90% were belong
to primi and 96.7% belong to primi in the control group, in experimental group 96.7% belong to
28-33 gestational weeks and 100% belong to 28-33 of gestational weeks in control group, in
experimental group 83.3% belong to planned pregnancy and 96.7% belong to planned pregnancy
in control group, 90% had primi birth spacing in experimental group and 96.7% had primi birth
spacing in control group, 100% had no history of abortion in experimental group and 100% had
no history of abortion in control group, 100% had no sex preference in experimental group and
100% had no sex preference in control group, 100% had not taken any medication for reducing
stress in experimental group and 100% had not taken medication for reducing stress in control
group, 100% were not practicing any kind of exercise for reducing stress in experimental group
100% were practicing any kind of exercise for reducing stress in control group.
These findings were similar to a study conducted to find out the effects of progressive muscular
relaxation and breathing control technique on stress during pregnancy, which shows that three
groups were matched and showed no significant difference in terms of jobs, socioeconomic class,
body mass index, age, gestational age at their entry into the study, intended or unintended
pregnancy, the number of deliveries.74
SECTION III: Level of the pre and post-interventional stress scores in experimental and
control group.
In pre-interventional stress scores majority 76.7% of pregnant women had moderate stress in
experimental group, 23.3% had high stress and 80 % of pregnant women had moderate stress, 20
% had high stress in control group.
These findings were similar to a study conducted to find out the effect of progressive muscle
relaxation and guided imagery on stress of pregnant women referred to health centers shows that
scores of stress in pregnant women before and after the intervention in the relaxation group had a
76
Discussion
statistically significant difference. Means of scores for stress, anxiety, and depression after
relaxation exercises for pregnant women showed a significant decline.75
In post-interventional stress scores majority 100% of pregnant women had low stress in
experimental group, 80% of pregnant women had moderate stress and 20% had high stress in
control group.
These findings were similar to a study conducted to find out the effects of progressive muscle
relaxation on the level of stress experienced by the primigravid women in the third trimester. The
results of post-intervention test, 3.1% respondents had severe level of stress; 28.1% had moderate
level of stress; and 68.8% experienced mild level. In short, most of the primigravid women in the
third trimester experienced moderate level of stress. It showed that the stress level decreased after
the treatment.76
A. The present study shows that there was no significant difference between mean pre-
interventional stress scores of pregnant women in the experimental group (25.3±3.63) and control
group (25.80±2.78), (p=0.67, p=0.926) at 0.05 level. This indicates that both the groups were
homogenous in terms of pre-interventional mean stress score.
These findings were similar to a study conducted to evaluate effects of progressive muscle
relaxation therapy on antenatal stress among primigravida women, which shows that the overall
stress among primigravidae in the study and the control groups during pre-test and post-test
revealed that in the pre-test, 38 (30.4%) in the study group and 44 (35.2%) in the control group
had mild stress. 87 (69.6%) in the study group and 81 (64.8) in the control group had moderate
stress. No significant difference was found between groups on overall stress.77
The present study shows that there is a significant difference between mean post-
interventional stress score of pregnant women (16±0.67) in the experimental group, and control
group (25.73±2.83), (t=17.11), p=<0.001 at 0.001 level. So, the null hypothesis is rejected,
77
Discussion
research hypothesis is accepted. Thus, it indicates that progressive muscle relaxation therapy was
effective in reducing the stress of pregnant women in experimental group.
These findings were like a study conducted to find out Effects of Progressive Muscle Relaxation
Exercises for reducing stress and Quality of Life During Pregnancy. The results that, there was a
statistically significant difference between the 2 groups in the change in stress scores experienced
over the 8 weeks (f = 94.873; df = 2; P .001). The 33 participants in the Progressive muscle
relaxation group reported a significant reduction in stress scores at week 8 (P <005). In contrast,
those in the control group exhibited increased stress scores at week 8; the increases reached
statistical significance.78
B. The present study shows that in experimental group, the mean post-interventional stress score
(16±0.67) of the pregnant women score was lower than the pre-interventional stress scores
(25.23±3.63), (paired t value 13.60, p value <0.01) was significant at 0.01level. There was no
significant difference between pre-interventional (25.80±2.78) stress scores and post-
interventional stress scores in control group (25.27±2.83), (the paired t-value =1.83, p value =
0.960). So, the null hypothesis is rejected, research hypothesis is accepted. Thus, it indicates that
progressive muscle relaxation therapy was effective in reducing the stress of pregnant women in
experimental group.
These findings were similar to a study conducted to find out the effect of progressive muscle
relaxation on pregnant women's general health. The results show that, comparison of the mean
difference in the subscales of physical symptoms, maternal stress and depression by paired t-test showed a
significant difference (P < 0.001) before and after intervention in the experimental group, but in the control
group, this difference was not significant. Also, the mean difference of general health in the
experimental group before and after intervention was obtained as 15.63 (5.73), whereas it was 4.77
(1.96) in the control group, and paired t-test showed a significant difference on comparing this
mean difference (P < 0.001).79
SECTION V: Association of the pre-interventional stress scores with socio demographic
variables of pregnant women.
78
Discussion
The present study shows that, there was a significant association between the level of stress and
sociodemographic variables such as, age in years (χ2= 4.24, p = 0.040*), educational status (χ2 =
4.83, p = 0.028*), occupational status (χ2 = 7.17, p = 0.028*) at 0.05 level of significant, hence the
hypothesis stating that there is a significant association between the selected demographic
variables and pre-interventional score was accepted for the variables. There was no significant
association between pre-interventional score and other sociodemographic variables such as
religion (χ2 = 0.45, p = 0.060), place living (χ2 = 7.17, p = 0.007), economic status (χ2 = 0.00, p =
1.000), social support (χ2 = 0.00, p = 1.000).
These findings were similar to a study conducted to find out The Effectiveness of Muscle
Relaxation Therapy in Reduction of Maternal Stress Among Primigravida’s at selected areas of
gottigere phc, Bangalore. There is significant association between maternal stress and selected
demographic variables.80
pregnant women.
The present study shows that, there was a significant association between the pre-intervention
stress score and maternal variables such as type of pregnancy (χ2 = 7.95, p= 0.0085*) at 0.05 level
of significant. There was no statically significant association between pre-intervention score and
other maternal variables such as, parity (χ2 = 1.19, P = 0.080), gestational weeks (χ2 = 0.28, p =
0.080), social support (χ2 = 0.00, p = 1.000), birth spacing (χ2 = 1.19, p = 0.080), history of
abortion (χ2 = 0.00, p = 1.000), sex preference(χ2 = 0.00, p = 1.000), medication for reducing
stress (χ2 = 0.00, p = 1.000), practicing any kind of exercise (χ2 = 0.00,p = 1.000).
These findings were similar to a study conducted to find out Effect of Relaxation Therapy on
stress. The result shows that, therefore was interpreted that there was no significant association
between pre-therapy scores of level of stress and selected variables. The study findings revealed
that, there was no significant correlation (r <0.3) between pre-therapy scores of physiological
parameters and pre-relaxation scores.81
79
CONCLUSION
Conclusion
CHAPTER- VII
CONCLUSION
Relaxation therapies are most commonly tried in medical circumstances in which stress is
believed to play a particularly large role. These include insomnia, surgery, chronic pain, and cancer
treatment support. The benefits of relaxation are more simply a refreshed mind and rejuvenated
spirit. The relaxation response is proposed to involve decreased arousal of the autonomic nervous
system and central nervous system as well as increased parasympathetic activity characterized by
lowered musculoskeletal and cardiovascular tone and altered neuro-endocrine function. Reducing
stress, reducing or eliminating insomnia can decrease the chances of developing certain health
conditions, such as heart disease and cancer.69
This chapter presents the conclusion drawn, implications, limitations, recommendations and
suggestions. The focus of this study was to assess the effectiveness of progressive muscle
relaxation therapy in relieving stress among pregnant women in selected Hospitals, Bangalore.
Quasi experimental research design and Quantitative research approach was used in the study. The
data collected was subjected to analysis using descriptive statistics and inferential statistics.
IMPLICATIONS OF THE STUDY
The findings of the study can be used in the following areas of nursing practice:
CLINICAL NURSING
 Nursing professionals working in the hospital as well as in the community can understand the
importance of progressive muscle relaxation therapy and its various benefits.
 Nurses working in different unit can adopt the practice of progressive muscle relaxation therapy
among themselves, caregivers and patients.
 Nurses can help in building awareness regarding progressive muscle relaxation therapy and its
positive aspects towards health in the community.
 The nurse can educate the patients and their family members to perform progressive muscle
relaxation therapy daily as it is found to relieve stress, anxiety and tension.
80
Conclusion
NURSING EDUCATION
 Short term in-service training programmes can be organized among staff nurses and peripheral
health workers related to progressive muscle relaxation therapy.
 Nurse educators should educate the patients as well as caregivers about coping with stressful life
situations through progressive muscle relaxation therapy.
 Nurse educator can introduce progressive muscle relaxation therapy to student nurses and its
positive effect on relieving stress related to their studies.
NURSING ADMINISTRATION
 The nurse administrators can take part in developing protocols on progressive muscle relaxation
therapy.
 Planning and organization of health programmes requires efficient team work in planning for man
power, money, material and methods to conduct successful health programme both at the hospital
and in the PHC’s. He/she must also encourage and depute nurses to participate in such programmes
conducted by other health organizations.
 The nurse administrators can mobilize the available resources and personnel towards the health
awareness on benefits of progressive muscle relaxation therapy in relieving anxiety and stress
levels.
 The nurse administrator can make provisions for student nurses to learn about progressive muscle
relaxation therapy and put it into practice.
NURSING RESEARCH
 This study can help to develop further research ideas using progressive muscle relaxation therapy
among various other groups.
 This study may motivate the beginning researchers to conduct same study with different variables
on a large scale. The public and private agencies should also encourage research in this field
through materials and funds.
81
Conclusion
 Nurses being the target groups in the health care delivery system and counselling being an
expanded role, they should take initiative to conduct further research regarding effectiveness of
progressive muscle relaxation therapy on various ways in coping with stress.
LIMITATIONS OF THE STUDY
 The study has included only few pregnant women in the selected hospital.
 The study is conducted in one hospital, which restricts the generalization.
RECOMMENDATIONS
On the basis of the findings of the study following recommendations have been made:
 A similar study can be replicated on a large sample to generalise the findings
 Comparative study can be done on rural and urban population
SUGGESTIONS
 Nursing Educational institutions can motivate students to actively participate in progressive muscle
relaxation therapy sessions.
 Make sure all pregnant should know about the benefit relaxation techniques
 Related to clinical field the administration should conducted progressive muscle relaxation therapy
classes for the caregivers as well as the patient. Physician should be able to be diagnosed symptoms
of stress and refer immediately for progressive muscle relaxation therapy.
 Every health professional should be able to perform progressive muscle relaxation therapy as it is
very easy to practice, and no formal training is needed for this therapy.
SUMMARY
This chapter deals with the findings and conclusion of the study. It gives the implications for the
nursing practice, nursing education, nursing administration and nursing research. It clarifies the
limitations of the study and gives recommendations and suggestions for future research
82
SUMMARY
Summary
CHAPTER-VIII
SUMMARY
This study was intended to This chapter discusses the major findings of the study and reviews them
in relation to findings from the results of the previous studies. The present study was attempted to
assess the effectiveness of progressive muscle relaxation therapy on stress among pregnant women
in selected hospitals, Bangalore.
1.To assess the level of stress among pregnant women before and after the intervention.
women.
women
4. To associate the pre-interventional stress scores with maternal variables of pregnant women
HYPOTHESIS
H1: There will be significant difference in the pre and post-interventional stress scores of pregnant
women at the level of p>0.05
METHODOLOGY
for this study conceptual framework based on Modified Wiedenbach’s the Helping Art of Clinical
Nursing model (1964) was adopted. This study is based on a quantitative research approach. The
independent variable of the study was progressive muscle relaxation therapy and dependent
variable was level of stress among pregnant women. quasi experimental research design was
adopted. Non-probability convenience sampling technique was adopted to select the samples. Tool
I consisted Part A and Part B. Part A consist of self- administered socio demographic variables
83
Summary
developed by the investigator and Part B consisted of the self – administered maternal variables
developed by investigator. Tool II and consisted of the standardized Cohen Perceived Stress Scale
by Sheldon Cohen. The scale also includes a number of direct queries about current levels of
experienced stress. The items are easy to understand, and the response alternatives are simple to
grasp. Individual scores on the PSS can range from 0 to 40 with higher scores indicating higher
perceived stress, Scores ranging from 0-13 would be considered low stress, 14-26 would be
considered moderate stress, 27-40 would be considered high perceived stress. Tool III consist of
interventional protocol (PMRT).
A pilot study was to find the feasibility of the study from 12/2/2018 to 26/2/2018
among 20 pregnant women at in Begur PHC Bangalore. The main study was conducted from 12-
03- 2018 to 2- 04 -2018 among 60 pregnant women at The Oxford Medical College Hospital and
Research Centre. The data was collected, and the result were described and analyzed using
descriptive and inferential statistics.
MAJOR FINDINGS OF THE STUDY
In the present study
SECTION I: Description of sociodemographic variables of pregnant women in experimental
and control group.
In the experimental group 100% in the age group of 17 – 21 years, and 96.7% in the age of
22-26 years in control group, were 46.7% were muslim in experimental group, 56.7% Hindus in
control group, were 86.7% had primary education in experimental group and 66.7% had primary
education in control group, were 56.7% were to house wives experimental group and 43.3% were
to house wives in control group, were 10% had Rs. 20001 – 30000 incomes in experimental group
and 10% had Rs 20001 – 30000 incomes in control group, were 100% belong to rural area in
experimental group and 70% belong to rural in control group, were 100% in experimental group
and control group had husband’s support, were in experimental group and control group 100% had
not received any source of information.
84
Summary
SECTION II: Description of maternal variables of pregnant women in experimental and
control group.
The study shows that majority of pregnant women in experimental group 90% were belong
to primi and 96.7% belong to primi in the control group, in experimental group 96.7% belong to
28-33 gestational weeks and 100% belong to 28-33 gestational weeks in control group, in
experimental group 83.3% belong to planned pregnancy and 96.7% belong to planned pregnancy
in control group, 90% had primi birth spacing in experimental group and 96.7% had primi birth
spacing in control group, 100% had no history of abortion in experimental group and 100% had
no history of abortion in control group, 100% had no sex preference in experimental group and
100% had no sex preference in control group, 100% had not taken any medication for reducing
stress in experimental group and 100% had not taken medication for reducing stress in control
group, 100% were not practicing any kind of exercise for reducing stress in experimental group
100% were practicing any kind of exercise for reducing stress in control group.
SECTION III: Level of the pre and post-interventional stress scores in experimental and
control group.
 In pre-interventional stress scores majority 76.7% of pregnant women had moderate
stress in experimental group, 23.3% had high stress and 80 % of pregnant women
had moderate stress, 20 % had high stress in control group.
 In post-interventional stress scores majority 100% of pregnant women had low
stress in experimental group, 80% of pregnant women had moderate stress and 20%
had high stress in control group.
SECTION-IV A) Effectiveness of progressive muscle relaxation therapy between the groups
 There was no significant difference between mean pre-interventional stress scores
of pregnant women in the experimental group (25.3±3.63) and control group
(25.80±2.78), (p=0.67, p=0.926) at 0.05 level. This indicates that both the groups
were homogenous in terms of pre-interventional stress score.
85
Summary
 There is a significant difference between mean post-interventional stress score of
pregnant women (16±0.67) in the experimental group, and control group
(25.73±2.83),
(t=17.11, p=0.001) at 0.001 level. So, the null hypothesis is rejected, research
hypothesis is accepted. Thus, it indicates that progressive muscle relaxation therapy
was effective in reducing the stress of pregnant women in experimental group.
B) Effectiveness of progressive muscle relaxation therapy within groups
In experimental group, the mean post-interventional stress score (16±0.67) of the pregnant
women score was lower than the pre-interventional stress scores (25.23±3.63), the paired t value
(13.60, p value <0.01) was significant at 0. 01level.There was no significant difference between
pre-interventional (25.80±2.78) stress score in control group (25.27±2.83), (the paired t value
=1.83 p value =0.960). So, the null hypothesis is rejected, research hypothesis is accepted. Thus,
it indicates that progressive muscle relaxation therapy was effective in reducing stress of pregnant
women in experimental group.
SECTION-V Association of the pre-interventional stress scores with socio demographic
variables of pregnant women
There was a significant association between the level of stress and sociodemographic
variables such as, age in years (2 =4.24, p=0.040), educational status (2 =4.83, p=0.028)
Occupational Status (χ2 = 9.49, p = 0.034) at 0.05 level of significant, hence the hypothesis stating
that there is a significant association between the selected demographic variables and pretest score
was accepted for the variables. There was no significant association between pretest score and
other sociodemographic variables such as religion (χ2 = 0.31, p = 0.580), place living (χ2 = 4.80, p
= 0.028)., economic Status (χ2 = 0.00, p = 1.000), social support (χ2 = 0.00, p = 1.000).
SECTION: VI Association of the pre-interventional stress scores with maternal variable of
pregnant women
There was a significant association between the pre-interventional stress score and
maternal variables such as type of pregnancy (χ2 = 7.95, p = 0.0085) at 0.05 level of significant.
86
Summary
There was no statically significant association between pre-interventional score and other maternal
variables such as, parity (χ2 = 1.19, p = 0.080), gestational weeks (χ2 = 0.28, p = 0.080), social
support (χ2 = 0.00, p = 1.000), birth spacing (χ2 = 1.19, p = 0.080), history of abortion (χ2 = 0.00,
p = 1.000), sex preference(χ2 = 0.00, p = 1.000), medication for reducing stress (χ2 = 0.00, p =
1.000), practicing any kind of exercise (χ2 = 0.00,p = 1.000).
87
BIBLIOGRAPHY
Bibliographic reference
CHAPTER-IX
BIBLIOGRAPHIC REFERENCE
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ANNUEXURES
Annexures
CHAPTER-X
ANNEXURE-I
LETTER SEEKING EXPERT GUIDANCE FOR CONTENT VALIDITY OF THE TOOL
From
Mrs. Athira Chandran
II-year M.Sc. Nursing student,
Obstetrical and Gynaecological Nursing
To
....................................................................
Forwarded Through,
The Principal
Subject: seeking permission for content validation of the research tool
Respected sir/ madam,
Sub: requesting the opinion and suggestions of experts for establishing content validity of
the tool
I, Mrs. Athira Chandran, II-year M.Sc. Nursing (Obstetrical and Gynaecological Nursing
student of The Oxford College of nursing, request your good self, if you would kindly accept to
validate my tool on “A STUDY TO ASSESS THE EFFECTIVENESS OF PROGRESSIVE
MUSCLE RELAXATION THERAPY ON STRESS AMONG PREGNANT WOMEN IN
SELECTED HOSPITALS, BANGALORE.” I would be obliged if you kindly affirm your
Acceptance to undersigned with your valuable suggestion on the topic. I have attached the details
of my study along with the research tool.
Thanking you in anticipation

Yours sincerely
Enclosures
1. Problem Statement and the objectives of the study Mrs. Athira Chandran
2. Hypothesis and operational definitions
3. Demographic data and maternal variables
4. Cohen perceived stress scale
5. Evaluation criteria check list
6. Content validity certificate
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Annexures
ANNEXURE – II
LIST OF EXPERTS CONSULTED FOR CONTENT VALIDITY
1. Dr. Pushpaveni N.P.
Professor, Obstetrics & Gynaecological Nursing
Government College of Nursing.
2. Mrs. Reddamma G.G.
M.Sc.(N), Obstetrics & Gynaecological Nursing
Government College of Nursing.
3. Mrs. S. Madhusheela
Asso. Professor, Obstetrics & Gynaecological Nursing
Narayana Hrudalaya College of Nursing.
4. Dr. J. kamala
Kims College of Nursing.
5. Mrs. Swathi
Asso. Professor, Obstetrics & Gynaecological Nursing
T. John College of Nursing
6. Mrs. Sheela J
Asst. Professor, Obstetrics & Gynaecological Nursing
R.V. College of Nursing
7. M. S. Karpagam
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ANNEXURE-III
CERTIFICATE OF CONTENT VALIDITY FOR TOOL
This is to certify that the tool of Mrs. Athira Chandran, II-year M.Sc. Nursing student of The
Oxford College of Nursing Bangalore (Affiliated to Rajiv Gandhi University Of Health Sciences)
has been validated by undersigned and can proceed with this tool and conduct the main study for
dissertation entitled “A study to assess the effectiveness of progressive muscle relaxation
therapy on stress among pregnant women in selected hospitals, Bangalore.”
Place: Signature and seal of experts
Date:
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Annexures
ANNEXURE-IV
LETTER SEEKING CONSENT OF THE SUBJECTS TO PARTICIPATE
Dear participant, study
I Mrs. Athira Chandran, M.Sc. Nursing student at The Oxford College Of Nursing,
Bangalore is conducting a study to assess the “Effectiveness of progressive muscle relaxation
therapy on stress among pregnant women in selected hospitals at Bangalore”.
I request you to answer all the given questions with the most appropriate responses with
regards to your situation. Kindly don’t have any question unattended. All the information provided
will be strictly confidential. Kindly sign the consent form given below.
Thanking You
Yours faithfully
(ATHIRA CHANDRAN)
CONSENT FORM
I ___________________________hereby consent for the above said study knowing that all the
information provided by me would be treated with almost confidentiality.
Date: Signature of participant
Place: Bangalore
(Name and Address)
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Annexures
Tool - I
PART I- SOCIO DEMOGRAPHIC VARIABLES
Instructions: here by you are requested to provide certain information concerning yourself.
Please answer to the questions asked.be sure to answer every item, the answer will be kept
strictly confidential
1. Age in years
a) 17- 21 ( )
b) 22- 26 ( )
c) 27- 31 ( )
d) 32 -36 ( )
e) 37 – 40 ( )
f) 41 and above ( )
2. Religion
a) Hindu ( )
b) Muslim ( )
c) Christian ( )
d) Others ( )
3. Educational status
a) No formal education ( )
b) Primary education ( )
c) Secondary education ( )
d) Graduate and above ( )
4. Occupational status
a) Housewife ( )
b) Daily wage ( )
c) Self-employed ( )
d) Professional ( )
e) Government employee ( )
5. Place of living
a) Urban ( )
b) Rural ( )
6. Social support
a) Husband ( )
b) Parents ( )
c) In laws ( )
d) Neighbours ( )
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e) No social support ( )
7. Economic status
a) Above 30,001 ( )
b) 20,001- 30,001 ( )
c) 10001-20,000 ( )
d) Less than 10,000 ( )
8. source of information about stress adaptation during pregnancy

a) mass media ( )
b) family ( )
c) friends ( )
d) Health personnel ( )
e) None ( )
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TOOL -I
PART –II (MATERNAL VARIABLES)
Instructions: here by you are requested to provide certain information concerning yourself.
Please answer to the questions asked.be sure to answer every item, the answer will be kept
strictly confidential.
1.Parity
a) primi ( )
b) multi ( )
2. Gestational weeks
a) 28 -33 weeks ( )
b) 34-39 weeks ( )
c) 40 weeks ( )
3. Type of pregnancy
a) planned ( )
b) unplanned ( )
4. Birth spacing
a) less than 3 years ( )
b) 3- 5 years ( )
c) more than 5 years ( )
5.Have you undergone any previous abortion
a) Yes: if please specify ( )

b) No ( )
6. Do you have any sex preference for baby
a) Yes, if please specify ( )
b) No ( )
7. Are you taking any medicines for reducing stress
b) No ( )
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8. Are you following any kind of exercise
b) No ( )
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TOOL -II
PERCEIVED STRESS SCALE
by Sheldon Cohen
The Perceived Stress Scale (PSS) is the most widely used psychological instrument for measuring
the perception of stress. The scale also includes a number of direct queries about current levels of
experienced stress. The items are easy to understand, and the response alternatives are simple to
grasp. Moreover, the questions are of a general nature and hence are relatively free of content
specific to any subpopulation group.
Name: Date ___/___/_____
Age:______
0 = Never 1 = Almost Never 2 = Sometimes 3 = Fairly Often 4 = Very Often
1. In the last month, how often have you been upset because of something that happened
unexpectedly? 0 1 2 3 4
2. In the last month, how often have you felt that you were unable to control the important
things in your life? 0 1 2 3 4
3. In the last month, how often have you felt nervous and “stressed”?
0 1 2 3 4
4. In the last month, how often have you felt confident about your ability to handle your
personal problems? 4 3 2 1 0
5. In the last month, how often have you felt that things were going
your way? 4 3 2 1
6. In the last month, how often have you found that you could not cope with all the things
that you had to do? 0 1 2 3 4
7. In the last month, how often have you been able to control irritations
in your life? 4 3 2 1 0
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8. In the last month, how often have you felt you were on top
of things? 4 3 2 1 0
9. In the last month, how often have you been angered because of things that were outside
of your control? 0 1 2 3 4
10. In the last month, how often have you felt difficulties were piling up so high that you
could not overcome them? 0 1 2 3 4
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TOOL -III
PROGRESSIVE MUSCLE RELAXATION THERAPY
INTERVENTION PROTOCOL
The intervention - progressive muscle relaxation therapy (It is a sequence of contraction &
relaxation of the specific muscle groups in a quiet & calm environment, from head to foot, with
attention paid to the contrast between tension and relaxation. because of the feeling of warmth and
heaviness are felt in the relaxed muscle after it is tensed, a mental relaxation is felt as a result),
will be taught by investigator herself.
STEPS:
By sitting in a chair in calm and quiet environment with closed eyes the procedure has to be done.
Deep breath (3 minutes)
Take deep breaths without making noise and concentrate on your deep breathing for three
minutes. Do not strain yourself to take too much air and let it not be very fast. Take relaxing deep
breaths. Check whether your stomach bulges out when you breathe in and shrinks inside when you
breathe out.
1. Fist
Keep the hand on the arm rest of the chair and make a fist (a person’s hand when the fingers
are bent in towards the palm and held there tightly, typically in order to strike a blow or grasp
something) and tense the hand muscles for 8 seconds. Then slowly release the tension for 16
seconds by saying “relax... relax… relax….” by yourself and feel the warmth developed in that
particular muscle group. Take a deep breath for 30 seconds. Each step has to be performed for 2
times. So repeat the step again
2. Hands on the shoulder
Keep the palm over the shoulders and pull the shoulder down for 8 seconds to tense the
shoulder muscles. Then slowly release the tension for 16 seconds by saying “relax... relax…
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relax….” by yourself and feel the warmth developed in that particular muscle group. Take a deep
breath for 30 seconds. Then repeat the step for one more time.
3. Stretch hands downward
Keep the hands straight and stretch it towards downwards for 8 seconds to tense the hands
and sides of your back muscles. Then slowly release the tension for 16 seconds by saying “relax...
relax… relax….” by yourself and feel the warmth developed in that particular muscle group. Take
a deep breath for 30 seconds. Then repeat the step for one more time.
4. Eyes
Clench the eyelids tightly shut for 8 seconds to tense the eye muscles. Then slowly
release the tension for 16 seconds by saying “relax... relax… relax…” by yourself and feel the
warmth developed in that particular muscle group. Take a deep breath for 30 seconds. Then repeat
the step for one more time.
5. Jaws
Close the lips and tilt the head and make a smile for 8 second to tense the jaw muscles. Then
slowly release the tension for 16 seconds by saying “relax... relax… relax….” by yourself and feel
the warmth developed in that particular muscle group. Take a deep breath for 30 seconds. Then
repeat the step for one more time.
6. Head
Press the head back on the crest rail of the chair for 8 seconds to tense the head muscles.
Then slowly release the tension for 16 seconds by saying “relax... relax… relax….” by yourself
and feel the warmth developed in that particular muscle group. Take a deep breath for 30 seconds.
Then repeat the step for one more time.
7. Chest
Take a deep breath and hold the breath for 8 seconds to tense the chest muscles. Then slowly
release the tension by exhaling for 16 seconds by saying “relax... relax… relax….” by yourself
115
Annexures
8. Stomach
Suck the stomach inside and hold for 8 seconds to tense the abdominal muscles. Then slowly
release the tension for 16 seconds by saying “relax... relax… relax….” by yourself and feel the
warmth developed in that particular muscle group. Take a deep breath for 30 seconds. Then repeat
the step for one more time.
9. Legs
Keep the feet flat on the floor and press the floor for 8 seconds to tense the leg muscles.
Then slowly release the tension for 16 seconds by saying “relax... relax… relax….” by yourself
10. All the steps together
Tense hand, eye, jaw, chest, abdomen, and leg muscle together for 8 seconds. Then slowly
release the tension in all area together for 16 seconds by saying “relax... relax… relax….” by
yourself and feel the warmth developed in that particular muscle group. Take a deep breath for 30
seconds. Then repeat the step for one more time.
Complete relaxation for 3 minutes.
Finally, be in a relaxed state for 3 minutes without shaking your body parts and enjoy the
relaxation. Keep your focus on your relaxed body. If you are distracted, take a deep relaxing breath
and start focusing on your relaxed body. Once 3 minutes of deep relaxation gets over, move your
body parts slowly and gently and then slowly get up.
This intervention will be practiced by the pregnant women for the duration of 20 minutes once in
a day for a period of 15 days.
116
Annexures
117
Annexures
118
Annexures
120
Annexures
ANNEXURE-V
EVALUATION CRITERIA CHECKLIST FOR VALIDATION OF THE TOOL
Respected sir / madam
Kindly go through the content and put (tick) against the following column ranging from very
relevant to not relevant, when found to be not relevant and needs modification kindly give your
opinion in the remarks column.
TOOL-I
PART - A
Areas Item no very relevant need not remarks
relevant modification relevant
Part I 1
demographic 2
data 3
PART- B
Areas Item no very relevant need not remarks
relevant modification relevant
Maternal 1
variables 2
121
Annexures
7
10
TOOL –II
Cohen 2
perceived 3
stress scale 4
10
SUGGESTIONS
Signature of the expert
122
Annexures
ANNEXURE-VI
LETTER SEEKING PERMISSION TO CONDUCT PILOT STUDY
From,
Athira Chandran
II year M.Sc Nursing
The Oxford College Of Nursing
Bangalore
Through
The Principal
Bangalore
To
The Medical Superintendent
Begur PHC
Bangalore
Respected Sir/Madam
Sub: Seeking permission to conduct pilot study.
I, Athira Chandran, II year M.Sc Nursing student of The Oxford College Of Nursing, Bangalore
has selected the following topic of research to be submitted to Rajiv Gandhi University Of Health
Sciences, Bangalore, Karnataka in partial fulfilment of requirement for the degree of Master Of
Science in Obstetrical and Gynaecological Nursing.
Title of the study: “A study to assess the effectiveness of progressive muscle relaxation
therapy on stress among pregnant women in selected hospital at Bangalore”.
In this regard there is need of your esteemed help and cooperation as I would like to conduct the
study in your institution. I request you to kindly permit me to conduct the proposed study and
provide the necessary support. I shall furnish further details of the study.
Please do the needful.
Thanking you
Place: Bangalore Yours sincerely
Date: Athira Chandran
120
Annexures
ANNEXURE-VII
121
Annexures
ANNEXURE-VIII
LETTER SEEKING PERMISSION TO CONDUCT STUDY
From,
Athira Chandran
II year M.Sc Nursing
Bangalore
Through
The Principal
Bangalore
To,
The Medical Superintendent
The Oxford Medical College, Hospital and Research Centre
Attibele, Bangalore
Respected Sir/Madam
Sub: Seeking permission to conduct study.
I, Athira Chandran , II year M.Sc Nursing student of The Oxford College Of Nursing, Bangalore
has selected the following topic of research to be submitted to Rajiv Gandhi University Of Health
Sciences, Bangalore, Karnataka in partial fulfilment of requirement for the degree of Master Of
Science in Obstetrical and Gynaecological Nursing.
Title of the study: “A study to assess the effectiveness of progressive muscle relaxation
therapy on stress among pregnant women in selected hospital at Bangalore”.
In this regard there is need of your esteemed help and cooperation as I would like to conduct the
study in your institution. I request you to kindly permit me to conduct the proposed study and
provide the necessary support. I shall furnish further details of the study.
Please do the needful.
Thanking you
Place: Bangalore Yours sincerely

Date: Athira Chandran
125
Annexures
ANNEXURE-IX
126
Annexures
ANNEXURE-X
CERTIFICATE FOR PROGRESSIVE MUSCLE RELAXATION THERAPY
To whomsoever it may concern
This is to certify that Mrs. Athira Chandran, 2nd year M.Sc.(Nursing) student from The Oxford
College of Nursing, Bangalore, has undergone training in Jacobson Progressive Muscle Relaxation
(JPMR) under our psychology division. I am pleased to state that she can perform JPMR therapy
and she has been able to perform a good picture of the concerned training.
She is eligible to teach and demonstrate JPMR for her research purpose.
Thanking you
Sincerely
127
Annexures
ANNEXURE-XI
128
Annexures
LIST OF STATISTICAL FORMULAS USED FOR STUDY
1. Reliability of PSS
Spearman’s Brown prophecy formula for reliability;
2r
Spearman Brown prophecy formula = r’ =
1+r
r = correlation coefficient calculated on the test retest
Where method
r’ = estimated reliability of the entire test
For comparing the coefficient of correlation, the formulas used was;
𝑵∑𝒙𝒚−∑𝒙∑𝒚
Pearson correlation coefficient r=
√𝑵∑𝒙𝟐 −(∑𝒙)𝟐 √𝑵∑𝒚𝟐 −(∑𝒚)𝟐
2. Descriptive Statistics
∑𝑥
Mean =
𝑛
Where x is
is sum of the values
n = number of values
Standard deviation, SD =
∑𝑑
𝑛
3. Inferential statistics:
Parametric test - paired ‘t’ test
𝑑̅
t= 2
√𝑠
𝑛
Where; d̅ = is the mean difference, s 2 = sample varience, n = sample size
df=(n-1) Where; df = degree of freedom
129
Annexures
Independent ‘t’ test

̅̅̅̅
𝑋1−𝑋2̅̅̅̅
t= = t (n1+n2-2) df
√ ( S12 /n1 + S22 /n2)
Where; ̅̅
X1̅̅ = Mean of first group
̅X2
̅̅̅= Mean of second group
S12 = Variance of the first group

S 2=
2 Variance of the second group
n
1= Sample size of first group
n2= Sample size of second groups
Non-parametric test - Chi-square
χ2 = 𝑂−𝐸 ; Where, O = observed frequency

𝐸
E = Expected frequency
df = (r-1) (c-1); Where; df = degree of freedom
r = number of rows
c = number of columns
130

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“A STUDY TO ASSESS THE EFFECTIVENESS OF PROGRESSIVE MUSCLE

RELAXATION THERAPY ON STRESS AMONG PREGNANT WOMEN IN SELECTED

Dissertation submitted to the

In partial fulfillment of requirements for the degree of

MASTER OF SCIENCE IN NURSING

OBSTETRICS AND GYNAECOLOGICAL NURSING

Under the Guidance of

Assistant Professor, Department Obstetrics and Gynaecological Nursing

THE OXFORD COLLEGE OF NURSING

DECLARATION BY THE CANDIDATE

progressive muscle relaxation therapy on stress among pregnant women in selected

guidance of Assistant Professor Ms. Logambal K, Department of Obstetrics and Gynecological

Nursing, The Oxford College of Nursing, Bangalore.

Date: Signature of the Candidate

CERTIFICATE BY THE GUIDE

of progressive muscle relaxation therapy on stress among pregnant women in selected

hospitals, Bangalore.” is a bonafide research work done by Mrs. ATHIRA CHANDRAN, in

Date: Signature of the Guide

Place: Bangalore Ms. Logambal K

Dept. of Obstetrics and Gynaecological Nursing

The Oxford College of Nursing

ENDORSEMENT BY THE HOD/PRINCIPAL/HEAD OF THE INSTITUTION

of progressive muscle relaxation therapy on stress among pregnant women in selected

Ms. Karpagam S Mrs. Beena Chacko

Professor & HOD Principal

Dept. of Obstetrics and Gynaecological Nursing The Oxford College of Nursing

The Oxford College of Nursing Bangalore

Place: Bangalore Place: Bangalore

DECLARATION BY THE CANDIDATE

or electronic format for academic/ research purpose.

Date: Signature of the Candidate

Place: Bangalore (Mrs. Athira Chandran)

© Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka

songs.” Psalms 28:7

In proffering my acknowledgements for the completion of my thesis “A study to assess the

effectiveness of progressive muscle relaxation therapy on stress among pregnant women in

granting me wisdom, health and strength through the years.

graduation studies in this esteemed institution.

thankfulness for this and much more.

blessings upon her for all times to come.

Nursing Department- Ms. Karpagam S, Ms Purneshwari, Ms Aswini G for their unstinted

I am indebted to Associate professor Mr. Surendra, professor Mr. Chinnadurai, statisticians

Bangalore for training me in Progressive Muscle Relaxation Therapy and supporting me to

and giving me permission to conduct the study in their esteemed institution.

Research Centre throughout the period of completion of my dissertation

formed the core and basis of this research study.

sufficiently and with full enthusiasm.

successful completion of this dissertation.

Date: Signature of the Candidate

Place: Bangalore (Mrs. Athira Chandran)

PMRT Progressive muscle relaxation therapy

PSS Perceived Stress Scale

PHC Primary Health Centre

r’ Estimated reliability of the entire test

O1 Observation of stress in the pre-interventional test

O2 Observation of stress in the post-interventional test

BACKGROUND AND PURPOSE: A relaxation technique is any method, process, procedure,

OBJECTIVES OF THE STUDY

convenience sampling technique. Sociodemographic variables, Maternal variables and

status and maternal variables like type of pregnancy at 0.05 level.