Impact of Uncertainty on the Anxiety of Hospitalized Pregnant Women Diagnosed with Preterm Labor: Focusing on Mediating Effect of Uncertainty Appraisal and Coping Style

Eun Mi Kim; Sehoon Hong

doi:10.4040/jkan.2018.48.4.485

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Kim and Hong: Impact of Uncertainty on the Anxiety of Hospitalized Pregnant Women Diagnosed with Preterm Labor: Focusing on Mediating Effect of Uncertainty Appraisal and Coping Style

Original Article

J Korean Acad Nurs 2018;48(4):485-496.

Published online: 15 January 2018

DOI: https://doi.org/10.4040/jkan.2018.48.4.485

Impact of Uncertainty on the Anxiety of Hospitalized Pregnant Women Diagnosed with Preterm Labor: Focusing on Mediating Effect of Uncertainty Appraisal and Coping Style

Eun Mi Kim¹, Sehoon Hong^2,

¹CHA Bundang Women's Medical Delivery Care Center, Seongnam

²College of Nursing, CHA University, Pocheon, Korea

Address reprint requests to : Hong, Sehoon College of Nursing, CHA University, 120 Haeryoung-ro, Pocheon 11160, Korea Tel: +82-31-780-5290 Fax: +82-31-780-5069 E-mail: 38hooni@cha.ac.kr

Received 3 May 2018 Revised 20 August 2018 Accepted 20 August 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

This study aimed to test the mediating effect of uncertainty appraisal and coping style in the relation between uncertainty and anxiety in hospitalized pregnant women diagnosed with preterm labor.

Methods

The participants were 105 pregnant women diagnosed with preterm labor in hospitals in Korea. Data were collected from July to October 2017. The measurements included the Uncertainty in Illness Scale, Uncertainty Appraisal Scale, Coping Style Scale, and State Anxiety Inventory. Data were analyzed using descriptive statistics, an independent t-test, correlation, and multiple regression following the Baron and Kenny method and Sobel test for mediation.

Results

The mean score for anxiety was 2.29 out of 4.00 points and for uncertainty it was 2.46 out of 5.00 points. There were significant correlations among uncertainty, uncertainty danger appraisal, uncertainty opportunity appraisal, problem-focused coping, emotion-focused coping, and anxiety. Uncertainty danger appraisal (β=.64, p<.001) had a complete mediating effect in the relation between uncertainty and anxiety (Z=4.54, p<.001). Uncertainty opportunity appraisal (β=-.45, p<.001) had a complete mediating effect in the relation between uncertainty and anxiety (Z=3.28, p<.001). Emotion-focused coping (β=-.23, p=.021) had a partial mediating effect in the relation between uncertainty and anxiety (Z=2.02, p=.044).

Conclusion

Nursing intervention programs focusing on managing uncertainty appraisal and improving emotion-focused coping are highly recommended to decrease anxiety in hospitalized pregnant women diagnosed with preterm labor.

Keywords: Obstetric Labor, Premature, Uncertainty, Anxiety

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Table 1.

Differences in Variables by General and Obstetrical Characteristics (N=105

Characteristics	Categories	n (%)	Uncertai	nty		Uncertainty appraisal				Coping style			Anxiety
			Uncertai	nty	UDA	A	UOA		PFC		EFC		Anxiety
			M±SD	t or F (p)	M±SD	t or F (p)	M±SD	t or F (p)	M±SD	t or F (p)	M±SD	t or F (p)	M±SD	t or F (p
General characteristics
Age (yr)	〈35	53 (50.5)	2.47±0.37	1.64	2.17±0.93	1.77	2.47±0.84	-1.97	2.85±0.52	-2.25	2.84±0.51	-0.83	2.32±0.53	0.74
	≥35	52 (49.5)	2.35±0.34	(.105)	1.86±0.87	(.080)	2.82±0.96	(.051)	3.06±0.40	(.027)	2.91±0.34	(.409)	2.25±0.48	(.463)
Religion	Yes	55 (52.4)	2.31±0.36	-3.21	1.92±0.91	-1.12	2.74±1.01	1.11	3.05±0.45	-2.31	2.94±0.43	-1.75	2.26±0.50	-0.55
	No	50 (47.6)	2.53±0.33	(.002)	2.12±0.91	(.264)	2.54±0.79	(.271)	2.84±0.48	(.023)	2.79±0.42	(.084)	2.32±0.51	(.586)
Job	Yes	45 (42.9)	2.33±0.35	-1.98	2.03±0.80	0.10	2.67±0.88	0.28	3.00±0.43	0.90	2.91±0.45	0.83	2.34±0.51	0.86
	No	60 (57.1)	2.47±0.36	(.050)	2.01±0.99	(.924)	2.62±0.95	(.776)	2.92±0.50	(.371)	2.84±0.42	(.407)	2.25±0.50	(.392)
Economic status	High	2 (1.9)	2.27±0.26	0.69	2.06±0.09	0.55	1.93±0.91	1.22	3.00±0.18	0.15	2.60±0.14	0.41	2.33±0.11	0.01
	Middle	97 (92.4)	2.42±0.37	(.506)	1.99±0.92	(.580)	2.68±0.92	(.298)	2.96±0.49	(.863)	2.88±0.45	(.668)	2.29±0.52	(.994)
	Low	6 (5.7)	2.27±0.25		2.40±0.86		2.26±0.77		2.85±0.28		2.85±0.12		2.29±0.44
Marital satisfaction	Good	88 (83.8)	2.39±0.36	1.28	1.93±0.9	5.21	2.69±0.94	1.21	2.97±0.46	0.97	2.86±0.41	-0.49	2.28±0.51	0.08
	Fair	17 (16.2)	2.50±0.35	(.260)	2.47±0.87	(.025)	2.42±0.77	(.273)	2.85±0.53	(.336)	2.92±0.53	(.625)	2.32±0.51	(.784)
Level of education	High school	23 (21.9)	2.49±0.44	1.33	1.95±1.11	0.16	2.84±1.24	1.34	2.82±0.60	-1.28	2.86±0.45	-0.12	2.23±0.47	0.31
	≥College	82 (78.1)	2.39±0.33	(.251)	2.04±0.85	(.693)	2.59±0.80	(.249)	2.99±0.43	(.212)	2.87±0.43	(.905)	2.30±0.51	(.579)
Obstetric characteristics
Gestational age (wks)	〈28 wks	49 (46.7)	2.45±0.41	1.04	1.95±0.93	-0.70	2.70±0.78	0.57	2.91±0.40	-0.89	2.78±0.34	-2.09	2.26±0.39	-0.44
	≥28 wks	56 (53.3)	2.38±0.30	(.300)	2.08±0.90	(.488)	2.60±1.02	(.573)	2.99±0.53	(.375)	2.95±0.49	(.039)	2.31±0.59	(.665)
Hospitalization days	〈3	91 (86.7)	2.37±0.34	-2.89	1.97±0.89	-1.51	2.64±0.94	-0.09	2.94±0.46	-0.91	2.85±0.42	-1.34	2.24±0.49	-2.75
	≥3	14 (13.3)	2.66±0.38	(.005)	2.36±0.98	(.135)	2.66±0.80	(.931)	3.06±0.56	(.363)	3.01±0.50	(.183)	2.62±0.51	(.007)
Parity	Primi	68 (64.8)	2.39±0.32	-0.90	2.10±0.74	1.19	2.56±0.86	-1.32	2.92±0.49	-0.88	2.82±0.45	-1.52	2.36±0.45	1.93
	Multi	37 (35.2)	2.46±0.42	(.369)	1.88±1.16	(.238)	2.80±1.01	(.189)	2.82±0.45	(.380)	2.96±0.39	(.132)	2.16±0.58	(.056)
History of admission	Yes	27 (25.7)	2.41±0.38	0.01	2.32±0.80	2.06	2.31±0.77	-2.26	3.05±0.47	1.17	2.96±0.48	1.19	2.38±0.60	1.16
	No	78 (74.3)	2.41±0.35	(.992)	1.91±0.93	(.042)	2.76±0.94	(.026)	2.92±0.47	(.246)	2.84±0.42	(.237)	2.25±0.47	(.250)
History of administration	Yes	26 (24.8)	2.42±0.39	0.10	2.29±0.80	1.80	2.31±0.79	-2.20	3.06±0.48	1.28	2.97±0.48	1.40	2.39±0.61	1.17
	No	79 (75.2)	2.41±0.35	(.922)	1.93±0.93	(.075)	2.75±0.93	(.030)	2.92±0.47	(.203)	2.84±0.41	(.164)	2.25±0.46	(.246)
Planned pregnancy	Yes	69 (65.7)	2.43±0.29	0.83	2.00±0.82	-0.33	2.63±0.83	-0.28	2.96±0.42	0.21	2.81±0.37	-2.06	2.29±0.44	0.19
	No	36 (34.3)	2.37±0.47	(.409)	2.06±1.07	(.740)	2.68±1.08	(.778)	2.94±0.57	(.831)	2.99±0.52	(.042)	2.27±0.61	(.849)
Artificial insemination	Yes	30 (28.6)	2.39±0.34	-0.31	1.84±0.69	-1.26	2.84±1.00	1.38	2.98±0.54	0.28	2.83±0.47	-0.66	2.25±0.38	-0.45
	No	75 (71.4)	2.42±0.37	(.755)	2.09±0.98	(.212)	2.57±0.87	(.169)	2.95±0.45	(.783)	2.89±0.42	(.514)	2.30±0.55	(.655)
Regularly check-up	Yes	82 (78.1)	2.42±0.29	0.16	2.02±0.84	0.14	2.65±0.86	0.13	3.00±0.49	1.87	2.89±0.46	1.05	2.33±0.51	1.62
	No	23 (21.9)	2.40±0.55	(.874)	1.99±1.16	(.890)	2.62±1.10	(.895)	2.79±0.36	(.064)	2.79±0.32	(.297)	2.14±0.48	(.108)

M±SD=Mean standard deviation; UDA=Uncertainty danger appraisal; UOA=Uncertainty opportunity appraisal; PFC=Problem-focused coping EFC=Emotion-focused coping.

Table 2.

Level of Uncertainty, Uncertainty Appraisal, Coping Style and Anxiety (N=105)

Variables	Scale			Item
Variables	Possible range	Actual range	M±SD	Possible range	Actual range	M±SD
Uncertainty	32~160	51~110	79.61±11.87	1.00~5.00	1.52~3.24	2.46±0.36
Ambiguity	13~65	19~46	34.10±6.90	1.00~5.00	1.00~3.56	2.37±0.61
Complexity	7~35	9~22	14.47±2.95	1.00~5.00	1.33~3.17	2.03±0.45
Inconsistency	7~35	7~22	14.09±2.84	1.00~5.00	1.00~4.00	2.12±0.68
Unpredictability	5~25	10~19	14.73±2.34	1.00~5.00	2.00~4.50	3.29±0.57
Uncertainty appraisal
UDA	0~40	0~34	16.14±7.29	0.00~5.00	0.00~4.25	2.02±0.91
UOA	0~35	5~34	18.50±6.40	0.00~5.00	0.71~4.86	2.64±0.91
Coping style	18~72	37~71	52.34±7.72	1.00~4.00	2.06~3.94	2.91±0.43
PFC	8~32	17~32	23.64±3.79	1.00~4.00	2.13~4.00	2.95±0.47
EFC	10~40	19~40	28.70±4.32	1.00~4.00	1.90~4.00	2.87±0.43
Anxiety	20~80	22~69	45.73±10.09	1.00~4.00	1.10~3.45	2.29±0.50

M±SD=Mean standard deviation; UDA=Uncertainty danger appraisal; UOA=Uncertainty opportunity appraisal; PFC=Problem-focused coping; EFC=Emotion-focused coping.

Table 3.

Correlational Relationships among the Variables (N=105)

Variables		Uncertainty	Uncertainty appraisal		Coping style
		Uncertainty	UDA	UOA	PFC	EFC
		r (p)	r (p)	r (p)	r (p)	r (p)
Uncertainty	UDA	.50 (<.001)	1
appraisal	UOA	-.41 (<.001)	-.63 (<.001)	1
Coping style	PFC	-.39 (<.001)	-.28 (.004)	.49 (<.001)	1
	EFC	-.32 (<.001)	-.34 (<.001)	.45 (<.001)	.81 (<.001)	1
Anxiety		.28 (.005)	.62 (<.001)	-.48 (<.001)	-.23 (.019)	-.29 (.002)

UDA=Uncertainty danger appraisal; UOA=Uncertainty opportunity appraisal; PFC=Problem-focused coping; EFC=Emotion-focused coping.

Table 4.

Mediating Effect of Uncertainty Appraisal in the Relationship between Uncertainty and Anxiety (N=105)

Variables		B	β	t	p	Adj. R²	F	p
Uncertainty appraisal
UDA	1. Uncertainty → UDA	1.28	.50	5.91	<.001	.25	34.89	<.001
	2. Uncertainty → Anxiety	0.39	.28	2.90	.005	.07	8.43	.005
	3. Uncertainty, UDA → Anxiety					.37	31.94	<.001
	1) Uncertainty → Anxiety	-0.07	-.05	-0.54	.589
	2) UDA → Anxiety	0.36	.64	7.16	<.001
				Sobel test: Z=4.54, p
UOA	1. Uncertainty → UOA	-1.04	-.41	-4.55	<.001	.16	20.68	<.001
	2. Uncertainty → Anxiety	0.39	.28	2.90	.005	.07	8.43	.005
	3. Uncertainty, UOA → Anxiety					.23	16.25	<.001
	1) Uncertainty → Anxiety	0.13	.09	0.98	.330
	2) UOA → Anxiety	-0.25	-.45	-4.72	<.001
				Sobel test: Z=3.28, p<.001

Adj.=Adjusted; UDA=Uncertainty danger appraisal; UOA=Uncertainty opportunity appraisal.

Table 5.

Mediating Effect of Coping Style in the Relationship between Uncertainty and Anxiety (N=105)

Variables		B	β	t	p	Adj. R²	F	p
Coping style
PFC	1. Uncertainty → PFC	-0.52	-.39	-4.36	<.001	.15	18.93	<.001
	2. Uncertainty → Anxiety	0.39	.28	2.90	.005	.07	8.43	.005
	3. Uncertainty, PFC → Anxiety					.08	5.20	.007
	1) Uncertainty → Anxiety	0.31	.22	2.14	.035
	2) PFC → Anxiety	-0.15	-.14	-1.38	.172
				Sobel test: Z=1.30, p=.193
EFC	1. Uncertainty → EFC	-0.39	-.32	-3.44	.001	.09	11.81	.001
	2. Uncertainty → Anxiety	0.39	.28	2.90	.005	.07	8.43	.005
	3. Uncertainty, EFC → Anxiety					.11	7.13	.001
	1) Uncertainty → Anxiety	0.28	.20	2.06	.042
	2) EFC → Anxiety	-0.27	-.23	-2.34	.021
				Sobel test: Z=2.02, p=.044

Adj.=Adjusted; PFC=Problem-focused coping; UOA=Uncertainty opportunity appraisal; EFC=Emotion-focused coping; UDA=Uncertainty danger appraisal.

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