Development, Implementation and Evaluation of Anxiety Management Program for Women Under Gynecological Surgery With Spinal Anesthesia: A Participatory Action Research Based on the Parihs Framework Publisher Pubmed



Modanloo M ; Halakou S ; Khoddam H ; Nikpeyma N ; Rajablou K ; Gholizadeh S ; Sadeghloo A ; Mirsadeghi M
Source: BMC Psychology Published:2026

Abstract

Background: Anxiety reduction is an objective that should be part of each patient’s care plan. The aim of this study was to develop, implement, and evaluate an anxiety management program for women under gynecological surgery with spinal anesthesia based on the participatory action research using PARIHS framework. Methods: This participatory action research was conducted from 2020 to 2023 in a referral gynecological surgery center in northeastern Iran and followed four phases: (1) problem identification using interviews, observations, literature review, and Numeric Visual Analog Anxiety Scale (NVASA); (2) planning through 16 expert panel and stakeholder sessions to design feasible evidence-based actions; (3) action, implemented in three cycles targeting healthcare providers, the environment, and patients; and (4) evaluation, was conducted by using NVASA measurements across cycles and assessments of communication skills and stress among healthcare providers. Data were analyzed using conventional content analysis for qualitative findings and paired statistical tests for quantitative outcomes. Results: Data analysis from interviews and observations in the first phase of the research process, led to the emergence of 20 subcategories and 6 main categories. A comprehensive literature review further delineated three intervention categories: healthcare provider, patient, and environmental interventions, along with 13 subcategories. In the main evaluation of the effectiveness of the cycles of action phase, mean anxiety score of patients before the interventions were 6.1 ± 1.9, and after the interventions of the health care providers, environment, and patient was 4.66 ± 2.17, 2.86 ± 1.79, and 2.64 ± 1.2, respectively, which had a statistically significant difference (p < 0.001). Conclusions: Anxiety management program based on action research steps has reduced anxiety in patients of study, the application of the anxiety management program with the participation of patients and healthcare providers in the context with a combination of extracted evidence led to the change in the attitude of the stakeholders. © The Author(s) 2026.