Effects of a psychological support and education program on perioperative anxiety in women undergoing hysterectomy: a pilot study in China

Qiaonan  Luo; Nichapatr Phutthikhamin

Authors

Qiaonan Luo Faculty of Nursing, Khon Kaen University
Nichapatr Phutthikhamin Faculty of Nursing, Khon Kaen University

Keywords:

hysterectomy, perioperative anxiety, transactional model of stress and coping, psychological support and education program

Abstract

Perioperative anxiety is a prevalent concern among women undergoing hysterectomy, often negatively impacting recovery and psychological well-being. This pilot study evaluated the preliminary efficacy of a psychological support and education program in reducing perioperative anxiety. A purposive sample of 10 women was recruited from two gynecology wards at central hospitals in Xiangyang, China. The intervention was delivered over four days and included (1) perioperative education, (2) individualized psychological support, (3) group discussions and reflective exercises, and (4) consolidation of coping strategies. Anxiety levels were assessed pre- and post-intervention using the Hamilton Anxiety Rating Scale (HAM-A). The program’s content validity was confirmed by five experts (CVI=.83), and the HAM-A showed acceptable internal consistency (cronbach’s α=.86). Data was analyzed using descriptive statistics and paired t-tests. Results demonstrated a significant reduction in anxiety following the intervention (t=10.543, 95% CI=6.68-10.32, p<.001), with scores decreasing from moderate to mild levels.

These findings suggest the potential value of brief, theory-informed moderate level to mild level psychosocial interventions in perioperative care. It is recommended that this program be integrated into standard gynecological nursing practices and ward protocols. Further research with larger samples and controlled designs is needed to validate the intervention and guide broader implementation.

References

Whiteman MK, Hillis SD, Jamieson DJ, Morrow B, Podgornik MN, Marchbanks PA. Inpatient hysterectomy surveillance in the United States, 2000–2019. Am J Obstet Gynecol. 2021;225(1):111.e1-9. doi:10.1016/j.ajog.2021.03.035.

National Center for Health Statistics. Hysterectomy among women aged 18 years and older: United States, 2021 [Internet]. Hyattsville (MD): Centers for Disease Control and Prevention; 2023 [cited 2025 Jun 7]. Available from: https://www.cdc.gov/nchs/products/databriefs/db494.htm

Oranratanaphan S, Teerapakpinyo C. Comparison of laparoscopic and abdominal hysterectomy: an experience from a university hospital in Thailand. Res Gynecol Obstet 2019;2(2):1–4.

Aust H, Eberhart L, Sturm T, Schuster M, Nestoriuc Y, Brehm F, et al. A cross-sectional study on preoperative anxiety in adults. J Psychosom Res 2018;111:133–9.

Caumo W, Schmidt AP, Schneider CN, Bergmann J, Iwamoto CW, Adamatti LC, et al. Risk factors for preoperative anxiety in adults. Acta Anaesthesiol Scand 2020;64(8):1121–9.

Guo P, East L, Arthur A. A preoperative education program to reduce anxiety and improve recovery among Chinese patients undergoing elective surgery: a randomized controlled trial. Int J Nurs Stud 2021;115:103863.

Zhang JE, Wong FKY, You LM, Zheng MC, Li Q, Zhang Y. Effects of a nurse-led preoperative education program on anxiety and depression in patients undergoing radical cystectomy: a randomized controlled trial. Eur J Oncol Nurs 2017;30:7–12.

Hart RI, Warren L. Empowerment in postoperative recovery: a concept analysis. J Adv Nurs 2019;75(6):1188–202.

Li Y, Wang S, Zhang H. Factors influencing postoperative anxiety in patients after gynecological surgery: a cross-sectional study. BMC Womens Health 2019;19:88.

Lazarus RS, Folkman S. Stress, appraisal, and coping. New York: Springer; 1984.

Guerra-Reyes L, Herron A, Sabo J. Psychosocial outcomes after hysterectomy: a systematic review. Womens Health Issues 2022;32(1):25–33.

1Anderson C, Pearson T, Zozula C. Emotional needs of women following gynecologic surgery: a qualitative study. J Obstet Gynecol Neonatal Nurs 2021;50(3):312–20.

Yilmaz E, Oz F. The effects of preoperative education and counselling on anxiety and satisfaction in women undergoing hysterectomy. J Clin Nurs 2019;28(5–6):931–41.

Chirico A, Lucidi F, De Laurentiis M, Milanese C, Napoli A, Giordano A. Virtual reality in health system: beyond entertainment. A mini review on the efficacy of VR during cancer treatment. J Cell Physiol 2016;231(2):275–87.

Happell B, Scott D, Platania-Phung C. Perceptions of barriers to physical health care for people with serious mental illness: a review of the international literature. Issues Ment Health Nurs 2012;33(11):752–61.

Dennis CL. Peer support within a health care context: a concept analysis. Int J Nurs Stud 2003;40(3):321–32.

Zuo H, Wang Q, Chen Y, Li Y. Peer support intervention to promote psychosocial adaptation and quality of life among patients undergoing major surgery: a systematic review. Patient Educ Couns 2022;105(9):2467–75.

Bandura A. Self-efficacy: the exercise of control. New York: W.H. Freeman; 1997.

Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol 1959;32(1):50-5.

Shanghai Mental Health Center. Reliability and validity of the Chinese version of the Hamilton Anxiety Rating Scale (HAMA) [Internet]. Shanghai: Shanghai Mental Health Center; [n.d.] [cited 2025 Jun 6]. Available from: https://www.xinlixue.cn

Jain S, Pansare S. Psychological impact of pre-operative education on post-operative health in patients undergoing elective hysterectomy. New Indian Journal of OBGYN 2021;8(1):33-8.

Hertzog MA. Considerations in determining sample size for pilot studies. Res Nurs Health 2008;31(2):180-91.

Razali NM, Wah YB. Power comparisons of Shapiro-Wilk, Kolmogorov-Smirnov, Lilliefors, and Anderson-Darling tests. J Stat Model Analytics 2011;2(1):21-33.

Goudarzi F, Khadivzadeh T, Ebadi A, Babazadeh R. Women's interdependence after hysterectomy: a qualitative study based on Roy adaptation model. BMC Womens Health 2022;22(1):40.

Roovers JP, van der Bom JG, van der Vaart CH, Heintz AP. Hysterectomy and sexual wellbeing: prospective observational study of vaginal hysterectomy, subtotal abdominal hysterectomy, and total abdominal hysterectomy. BMJ 2003;327(7418):774-8.