A Quasi experimental study to assess the effectiveness of music therapy on stress and blood pressure among antenatal mothers with Pregnancy Induced Hypertension at selected hospitals of Punjab.

Meenakshi Sharma¹, Vibha^2*, Asha^3*

¹M.Sc. (Nursing), State Institute of Nursing and Paramedical Sciences, Badal, Sri Muktsar Sahib, Punjab

²Associate Professor, H.O.D. of OBG Department, SINPMS, Badal, Sri Muktsar Sahib, Punjab

³Assistant Professor, Department of OBG, SINPMS, Badal, Sri Muktsar Sahib, Punjab

*Corresponding Author’s Email: batra12345batra@yahoo.co.in, asha.kapoor1981@gmail.com

ABSTRACT:

Pregnancy is long and special journey for a woman but it places the health of the mother at risk. Pre-eclampsia is very serious and second leading cause of maternal morbidity. Stress can cause hypertension through repeated blood pressure elevations as well as by stimulation of the nervous system to produce large amount of vasoconstricting hormones. Among different complementary therapies, music therapy is found to be very effective in the recent years. In this study, A Quantitative Quasi Experimental Research Design and Approach was used. Sample was collected by using non-probability purposive sampling technique with sample size of 50. Study was conducted in Guru Gobind Singh Medical college and Hospital, Faridkot and Guru Nanak Dev Hospital, Amritsar. Music therapy was provided to experimental group for 20 minutes in morning and evening for 2 consecutive days to the antenatal mother with PIH. Structured interview has been used to assess the stress by Modified perceived stress scale. Sphygmomanometer and stethoscope used to measure the blood pressure. In experimental group, values of mean and SD during pre-interventional assessment are 6.04±2.05 and during post-interventional assessment are 3.8±1.38 respectively. In Control group, values of mean±SD during pre-interventional assessment are 5.4 and 1.8 and during post-interventional assessment are 5.12±1.81respectively. In a paired t-test, the experimental group showed significant decrease in level of stress and blood pressure at 0.05 level of significance after two days. According to value of chi square, blood pressure is significantly associated with demographic variable Education and Occupation at 0.05 level of significance.

KEYWORDS: Music therapy, Antenatal mothers with PIH, stress and blood pressure

INTRODUCTION:

Music is a very important part of our lives. Indian classical music has much impact on the individual mood and behaviour.¹

Music therapy has positive effect on pregnancy. Inclusion of music therapy as a nursing intervention in the current past-paced health care environment allows for an individualized approach to patients.² Pregnancy induced hypertension is defined as the hypertension that develops as a direct results of the gravid state. Gestational hypertension is sustained rise of blood pressure to 140/90 mm Hg or more on at least two occasions four or more hours apart after 20^th week of pregnancy without proteinuria and oedema for first time in pregnancy.³

Stress can cause hypertension through repeated blood pressure elevations as well as by stimulation of the nervous system to produce large amounts of vasoconstricting hormones. Association between stress and significant blood pressure elevations were documented in hypertensive pregnancies. Non pharmacological measures like progressive relaxation, acupressure, music therapy, etc are used to treat the mothers with PIH. Among these, music therapy is found to be very effective in the recent years.⁴ Listening to music can have a tremendously relaxing effect on our minds and bodies, especially slow, quiet classical music. This type of music can have a beneficial effect on our physiological functions, slowing the pulse and heart rate, lowering blood pressure, and decreasing the levels of stress hormones.⁵

NEED OF STUDY:

According to the American Music Therapy Association, Music Therapy is an established healthcare profession that uses music to address physical, emotional, cognitive, and social needs of individuals of all ages.⁵Pre-eclampsia is often silent, showing up unexpectedly during routine blood pressure check up. Gestational hypertension and preeclampsia are common disorders during pregnancy with the majority of cases developing at or near term.⁶ Ten million women develop preeclampsia each year around the world.³ Pre-eclampsia is of considerable public health threat particularly in developing countries. In India the incidence of pre-eclampsia is reported to be 8-10% of the pregnancies. The perinatal mortality in rural Punjab was estimated to be 34.57 per 1000 live births. Pre-eclampsia is very serious and second leading cause of maternal morbidity.⁷ Certain ragas of Indian classical music like raga Darbari, raga puriya kalian, raga bhairav and raga madhuvanti helps to reduce stress and blood pressure. Thus the use of listening to music is an economic, non-invasive and highly accepted interventional tool.⁸

OBJECTIVES:

1. To assess the pre-interventional level of stress and blood pressure among antenatal mothers with Pregnancy Induced Hypertension in experimental and control group.

2. To provide music therapy to antenatal mothers with Pregnancy Induced Hypertension in experimental group.

3. To assess the post-interventional level of stress and blood pressure among antenatal mothers with Pregnancy Induced Hypertension in experimental and control group.

4. To compare the pre-interventional and post-interventional level of stress and blood pressure among antenatal mothers with Pregnancy Induced Hypertension in experimental and control group.

5. To find out association of level of stress and blood pressure among antenatal mothers with Pregnancy Induced Hypertension with selected demographic variables.

OPERATIONAL DEFINITIONS:

1. Effectiveness: It refers to the extent to which music therapy will achieve the desired result in reducing the level of stress and blood pressure among the antenatal mothers with Pregnancy Induced Hypertension measured on modified perceived stress scale and sphygmomanometer.

2. Music therapy: It refers to listening to the selected Indian classical instrumental music by antenatal mothers with Pregnancy Induced Hypertension two times a day for 20 minutes for 2 consecutive days with the help of earphones.

3. Stress: It refers to the extent of feeling perceived and expressed by antenatal mothers with Pregnancy Induced Hypertension measured on modified perceived stress scale ranging from low to high perceived stress.

4. Blood Pressure: It refers to the rise of blood pressure in which systolic blood pressure is more than 140 mm Hg and diastolic blood pressure is more than 90 mm Hg as measured by sphygmomanometer and stethoscope.

5. Antenatal Mothers: It refers to a pregnant women with Pregnancy Induced     Hypertension after 20 weeks of gestation who are admitted in the maternity units of selected hospitals of Punjab.

6. Pregnancy induced Hypertension: It refers to an antenatal mother with pre-eclampsia or Gestational Hypertension.

HYPOTHESIS:

H₁: There will be significant difference between the mean pre-interventional and post-interventional level of stress among antenatal mothers with Pregnancy Induced Hypertension exposed to music therapy at 0.05 level of significance.

H₂: There will be significant difference between the mean pre-interventional and post-interventional blood pressure among antenatal mothers with Pregnancy Induced Hypertension exposed to music therapy at 0.05 level of significance.

MATERIAL AND METHODS:

Research Approach and Research Design:

A Quantitative Quasi Experimental Non Randomized Control Group Research Approach and Design was used to conduct the study to assess the effectiveness of music therapy on level of stress and blood pressure among antenatal mothers with Pregnancy Induced Hypertension.

Research Settings:

The study was conducted in the Guru Gobind Singh Medical College and Hospital, Faridkot and Guru Nanak Dev Hospital, Amritsar.

Target Population:

The population of the study was 50 antenatal mothers with Pregnancy Induced Hypertension admitted in hospitals which was taken as research setting.

Sampling Technique and sample size:

Non-Probability Purposive Sampling technique was used to select the sample. Sample size of study was 50 antenatal mothers with Pregnancy Induced Hypertension i.e. 25 in experimental group and 25 in control group admitted in hospitals which was taken as research setting.

Selection and Development of tool(s):

Section I- It consist of selected demographic variables among antenatal mothers with Pregnancy Induced Hypertension which are Age in years, Gravida, Education, Pre-conceptional education, Occupation, Previous use of any type of music therapy and Previous family history of PIH.

Section II-

Modified Perceived stress scale to assess the level of stress among antenatal mothers with Pregnancy Induced Hypertension.

Section III-

To assess blood pressure by sphygmomanometer or stethoscope and record the blood pressure on recording sheet among antenatal mothers with Pregnancy Induced Hypertension.

Intervention:

Provision of music therapy among antenatal mothers with Pregnancy Induced Hypertension.

Data Collection Procedure:

After obtaining permission from Medical Superintendent of hospitals and college ethical committee, the study was conducted in the maternity units of selected hospitals of Punjab. Music was prepared under the guidance of music expert and validated by him. The data collection was conducted in month of January, 2015. Before giving the intervention, written consent taken from antenatal mothers with Pregnancy Induced Hypertension. Firstly, Pre-interventional Assessment of level of stress and blood pressure was done. Provide music therapy for 20 minutes to the antenatal mother without disturbing. This music contains specific ragas played with the help of classical instruments (raga Darbari playaed on flute, raga Alhaiya Bilawal played on sarod, raga bilaskhani todi played on sitar, raga bhairavi played on santoor and raga Puriya Kalyan played on sarangi). Post-interventional assessment of Blood pressure was done immediately after giving music therapy. The blood pressure was recorded every time before and after giving the music therapy for 2 consecutive days in morning and evening time of day. The stress was checked by structured interview after last session of music therapy at the evening time of second day. Only routine care was provided to control group. There was no other alternative and complementary therapy intervened to control group and experimental group.

Plan for Data Analysis:

Analysis and interpretation of data based on objectives and calculated by using descriptive, inferential statistics and required advance statistics formulas.

Analysis and Interpretation:

· Demographic characteristics of antenatal mothers with PIH

· Pre-interventional level of stress

· Post- interventional level of stress

· Comparison of effect of Music therapy

· Association of level of stress and blood pressure with selected demographic variables

Demographic characteristics of antenatal mothers with PIH:

Table–1. Frequency and percentage distribution of antenatal mothers with PIH according to their demographic variables N=50

S. No.	Characteristics	Experimental Group (n=25) Frequency(n) %age		Control Group (n=25) Frequency(n) %age		Chi square Value df
1.)	Age (In Years) a.) 19-24 b.) 25-30 c.) More than 30	17	68	15	60	0.34^NSdf=1
		8	32	10	40
		0.00	0.00	0.00	0.00
2.)	Gravida a.) Primi b.) Multi	18	72	17	68	0.09^NSdf=1
		7	28	8	32
3.)	Education a.) Illiterate b.) Middle c.) Senior Secondary d.) Graduation	14 7 3 1	56 28 12 4	13 8 2 2	52 32 8 8	0.63^NSdf=3
4.)	Pre-conceptional Education a.) Yes b.) No	7 18	28 72	5 20	20 80	0.43^NSdf=1
5.)	Occupation a.) Working b.) Non-working	5	20	3	12	0.59^NSdf=1
		20	80	22	88
6.)	Previous use of any type of Music therapy a.) Yes b.) No If yes specify----	0.00	0.00	0.00	0.00	Chi square cannot be computed
		25	100	25	100
7.)	Previous family history of PIH a.) Yes b.) No	9 16	36 64	12 13	48 52	0.73^NSdf=1

NS- Non-significant

Result show that according to chi square test, the values are statistically non-significant at 0.05 level of significance which means experimental and control groups are homogenous in nature.

Pre-interventional level of stress:

Table-2. Frequency & percentage distribution of the pre-interventional level of stress among antenatal mothers with Pregnancy Induced Hypertension in experimental and control group. N=50

Level of stress	Pre-interventional level of stress
	Experimental group (n=25) Frequency (n) %age		Control group (n=25) Frequency (n) %age
Low stress (0-4)	8	32	7	28
Average stress (5-8)	15	60	17	68
High stress(9-12)	2	8	1	4

Maximum Score=12

Minimum Score=0

It concluded that the highest number of antenatal mothers with PIH had average stress in both experimental and control group.

Post-interventional level of stress:

Table–3. Frequency & percentage distribution of the post-interventional level of stress among antenatal mothers with Pregnancy Induced Hypertension in experimental and control group. N=50

Level of stress	Post-interventional level of stress
	Experimental group(n=25)		Control group (n=25)
	Frequency (n)	%age	Frequency (n)	%age
Low stress(0-4)	20	80	11	44
Average stress(5-8)	5	20	14	56
High stress(9-12)	0	0	0	0

Maximum score=12

Minimum score=0

It concluded that the highest number of antenatal mothers with PIH had low stress in experimental group and average stress in control group.

Comparison of effect of music therapy on stress:

Table-4. Comparison of pre-interventional and post-interventional level of stress among antenatal mothers with PIH in experimental and control group N=50

Group	Level of stress				df	‘t’ value
	Pre-interventional		Post-interventional
	Mean	SD	Mean	SD
Experimental group (n=25)	6.04	2.05	3.8	1.38	24	8.04*
Control group ( n=25)	5.4	1.8	5.12	1.81	24	1.42^NS
	df =48 ‘t’ 1.82^NSdf =48 ‘t’ 1.42*

Max. Score= 12 NS- Non-significant

Minimum score=0 *Significant p< 0.05

The t value of post-interventional level of stress between experimental and control group was 1.42 which is statistically significant at 0.05 level of significance. It concluded that there is significant difference in pre-interventional and post-interventional level of stress in experimental group which shows that music therapy is effective

Comparison of effect of music therapy on Blood Pressure:

Table 5. Comparison of pre-interventional and post-interventional blood pressure among antenatal mothers with Pregnancy Induced Hypertension between experimental and control group. N=50

S. no.	Days	Time	BP	Pre interventional				Un Paired t test	Post-interventional				Unpaired t test
				Experimental group		Control group			Experimental group		Control group
				Mean	SD	Mean	SD		Mean	SD	Mean	SD
I	Day I	Morning	SBP	147.04	7.30	147.8	7.80	0.346^NS	141.92	6.50	147.7	7.7	2.70*
			DBP	98.4	9.20	97.68	7.71	0.26^NS	94.64	8.47	97.6	7.70	1.19 ^NS
		Evening	SBP	142.24	6.71	146.4	7.61	2.05*	139.60	6.50	146.32	7.47	3.2*
			DBP	95.76	7.88	96.24	6.88	0.21^NS	93.36	7.80	96.16	6.87	0.56 ^NS
II	Day II	Morning	SBP	139.2	6.05	144.4	8.08	2.41*	136.8	6.05	144.4	8.08	3.53*
			DBP	93.12	8.50	94.48	7.28	0.56^NS	90.56	8.09	94.40	7.21	1.6 ^NS
		Evening	SBP	139.2	6.05	143.28	7.50	2.98*	134.96	6.16	143.36	7.45	4.13*
			DBP	90.88	7.76	93.60	6.60	1.24^NS	88.56	7.17	93.52	6.69	2.33*

NS- Non-significant

*Significant at p< 0.05

df=48

It concluded that there is significant difference in systolic blood pressure readings of morning and evening timings of day I and day II between experimental and control group during pre-interventional and post-interventional assessment.

Association of level of stress and blood pressure with selected demographic variables:

Table 6. Association of blood pressure of day II evening among antenatal mothers with Pregnancy Induced Hypertension with selected demographic variables in Experimental group. n=25

S. No.	Characteristics	n	Level of blood pressure				Chi square value
			< Median 134		≥ Median 134
			F12	%	F 13	%
1.	Education Illiterate Middle Senior Secondary Graduation	14	3	21.43	11	78.57	12.12* df=3
		7	6	85.71	1	14.29
		3	3	100.00	0	0.00
		1	0	0.00	1	100.00

NS- Non-significant

*Significant at p < 0.05

The table 6(c) depict that the chi square test was used to assess association and there was significant association of Educational status of mother with blood pressure.

Table 7. Association of systolic blood pressure of day II evening among antenatal mothers with Pregnancy Induced Hypertension with selected demographic variables in Control group. n=25

S. No.	Characteristics	n	Level of blood pressure				Chi square value
			< Median 142		≥ Median 6
			F(10)	%	F(15)	%
1.	Occupation Working Non-working	3	3	100.00	0	0.00	5.11* df=1
		22	7	31.82	15	68.18
		13	5	38.46	8	61.54

NS= Non-significant

*Significant at p< 0.05

The table 7 depict that there was significant association of Occupation of mother with blood pressure at 0.05 level of significance.

RECOMMENDATIONS:

· Study can be replicated on larger sample.

· Music therapy should be given to all kind of patients like cancer patients, cardiac patients etc.

· Further research is required to clarify the differential effects of researcher-selected versus patient-selected music.

CONCLUSION:

The research study concluded that the music therapy was effective in reducing level of stress and blood pressure among antenatal mothers with PIH. The study provided benefit to samples from the music therapy. Hence, music therapy was effective.

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Received on 16.07.2016 Modified on 23.08.2016

Accepted on 29.08.2016 © A&V Publications all right reserved

Int. J. Adv. Nur. Management. 2016; 4(4): 355-360.

DOI: 10.5958/2454-2652.2016.00079.2