In the present study, we investigated the effect of telephone counseling on COVID-19-related health anxiety in pregnant women referring to health centers in Saveh city. Based on the results of the present study, possible factors thought to affect health anxiety, including age, education level, occupation, the number of previous pregnancies, history of abortion, the presence of underlying diseases, and monthly income, were comparable between the intervention and control groups, with no statistically significant differences.
The results of this study showed that the telephone counseling intervention could reduce health anxiety in pregnant women. In the intervention group, there was a statistically significant difference in the mean score of health anxiety before and after counseling (P < 0.001) so that the mean score of health anxiety remarkably declined after the intervention, indicating the positive impact of telephone counseling on health anxiety in pregnant mothers. Consistently, Asadzadeh et al. [17], in a study on the women who experienced traumatic childbirth, investigated the effectiveness of a short counseling period (in-person or via telephone) led by midwives in alleviating post-traumatic stress disorder, depression, and anxiety symptoms. The recent study showed that the intervention group had significant improvements in post-traumatic stress disorder and depression and anxiety symptoms six weeks after the counseling period compared to the control group (P = 0.001). Also, in line with the findings of the present study, Khakbazan et al [18] investigated the effect of telephone counseling on the quality of life of women during the postpartum period (42 days after delivery). In the psychological and physical dimensions, the average scores in the intervention group were higher than in the control group (77.70 vs. 62.3), indicating a significant difference between the two groups in terms of the physical and psychological dimensions of quality of life (P < 0.001). In a study by Fathizadeh et al [19], the results showed that pregnancy classes reduced anxiety in various dimensions (fear of childbirth, fear of mood swings, fear of changing of marital relationships) in pregnant mothers.
According to the results of the present study, the mean score of maternal health anxiety before the study was higher than the standard threshold of health anxiety in both the intervention and control groups, suggesting that the pregnant mothers participating in this study had high health anxiety levels at the baseline. The COVID-19 pandemic has increased anxiety among pregnant women. In fact, women express worries over the health of their children, as well as the health of the unborn child. More than half of the women participating in this study had considerably high levels of health anxiety. Social distancing instructions can also cause additional concerns and anxiety in pregnant women, adversely affecting their physical and mental health. So, it is essential to recognize this condition and support patients by providing accurate and up-to-date information [7].
Mizrak et al, in a study in Turkey, reported that fear of the unknown and disruption of routine pregnancy care and social life (due to quarantine instructions) could exaggerate pregnant women’s concerns during the COVID-19 epidemic[20].Another study by Kahyaoglu et al. in Turkey showed that the prevalence of anxiety and depression in pregnant women during the COVID-19 pandemic were 64.5% and 56.3%, respectively[21].
A study by Corbett et al. showed that most pregnant women (83.1%) were not worried about their health before the COVID-19 pandemic while 50.7% of mothers were concerned about their health most of the time during the pandemic [22]. These concerns could have been related to the lack of communication with relatives (especially when there was a need for help), social distancing regulations, and lack of familial and social support [23]. The implementation of social distancing, commuting, and quarantine restriction has been noted among the reasons for elevated anxiety and worry among most pregnant women during the COVID-19 outbreak [24].
This situation is a serious issue taking into mind that anxiety and health concerns may cause mothers to refuse prenatal care, which may lead to adverse perinatal consequences. The mothers’ lack of referring to health care centers would direct them towards alternative information sources to find answers to their questions. Therefore, due to the different answers provided by different sources, they may become confused when deciding on the validity and legitimacy of the source. So, sometimes they may have to over-search for finding answers to their questions, which can trigger or exaggerate their health anxiety [4].
This study had some limitations. First, it is impossible to control all the confounding variables affecting health anxiety. We examined and compared some demographic variables that may affect health anxiety in the intervention and control groups and there was no significant difference between the two groups in terms of these variables. Second, control group samples may have received similar counseling through audio-visual media during the intervention. This case was asked after the study from the samples of the control group and samples with similar experience were excluded from the study. Third, due to limited access to research samples in COVID conditions, post-test questionnaires for all samples were completed by telephone. In order to increase the accuracy of the respondents, sufficient response time was given to the samples.
Based on the results of the present study, it is necessary for health care providers to deliver proper prenatal care and counseling to pregnant mothers. Today, telephone counseling is particularly popular during pregnancy. However, not all studies support this issue, and two studies did not recognize counseling as the best intervention to provide health services to pregnant women [25, 26].
According to the findings of the present research, during the COVID-19 pandemic, telemedicine tools and strategies, including telephone counseling, can be effective in reducing the negative consequences of the pandemic on the quality of health care services before, during, and after delivery.