Razi Journal of Medical Sciences

fa بررسی راهبردهای روان‌شناختی زنان نابارور با تحمل ابهام بالا در فرآیند درمان: یک مطالعه کیفی Examining the Psychological Strategies of Infertile Women with High Ambiguity Tolerance in the Treatment Process: A Qualitative Study توانبخشی روانی Psychiatric Rehabilitation پژوهشي Research <div style="text-align: justify;">زمینه و هدف: با توجه به اینکه ناباروری شدیداً افراد را از لحاظ روان‌شناختی تحت تاثیر قرار می‌دهد، پژوهش حاضر ‌‌‌‌‌‌‌‌‌‌‌‌‌‌‌با هدف واکاوی راهبردهای روانشناختی زنان نابارور با تحمل ابهام بالا صورت گرفته است. روش کار: ایـن مطالعـه بـا رویکـرد کیفـی و روش پدیدارشناسی انجـام شـد. ۱۲ نفـر از زنان نابارور که حداقل ۲ بار تحت درمان لقاح مصنوعی قرار گرفته بودند و در پرسش نامه تحمل ابهام مک لین نمره بالا به دست آوردند، در بیمارستان شهید اکبرآبادی در سـال ۱۴۰۲ بـر اسـاس نمونـهگیـری مبتنـی بـر هـدف انتخـاب و بـا اسـتفاده از مصاحبـههـای عمیـق نیمـه سـاختار یافتـه، مـورد مصاحبـه قـرار گرفتنـد. همـه مصاحبـههـا ضبـط و سـپس دسـت نویـس گردیـد و بـا اسـتفاده از روش هفت مرحلهایی کلایزی، مـورد تجزیـه و تحلیـل قـرار گرفت. یافته ها:‌‌‌ نتیجه حاصل از این پژوهش نشان داد که زنان نابارور با تحمل ابهام بالا راهبردهای روانشناختی خود را در چهار مرحله طی می کنند که این مراحل عبارتند از: الف. نگاه مثبت نسبت به درمان (تلاش‌های متعدد، خوش بینی و امیدواری، انتظار موفقیت، روبه رو شدن با چالش‌های حین درمان)، ب. واقع‌بینانه شدن و کاهش انتظارات (تردید و نگرانی، جستجوی اطلاعات، مشورت با متخصصان، کسب حمایت روانی بیرونی، تعصب نداشتن به گزینههای درمان، تغییر نگرش و تطبیق با واقعیت)، ج. تفویض به مشیت الهی (پذیرش و تسلیم، تقدیرگرایی، حفظ امید) و د. دگردیسی مرکزیت زندگی (جستجوی راهکارهای جایگزین، تصمیم‌گیری درباره مسیر درمانی، کسب حمایت خانواده و دوستان، بهبود روان‌شناختی، اقدام برای بازیابی کنترل زندگی). نتیجه‌گیری: با توجه به نتایج حاصل از یافتههای این پژوهش میتوان دریافت زنان ناباروری که نسبت به ابهام تحمل بالایی دارند، شروع به شناخت مثبت درمورد وضعیت مربوط به خود میکنند و این شناخت ها را به عنوان یک قطعیت در نظر نمی گیرند. آنها همچنان که با امیدواری به درمان ادامه میدهند، دیگر جنبه های زندگی خود را حذف نمیکنند و تلاش برای باردار شدن را در کنار مسائل دیگر زندگی دنبال میکنند.</div> <div style="text-align: justify;">Background & Aims: Fertility has become a growing problem for many couples who are trying to conceive(1). Although infertility is not a life-threatening issue, it can still be a stressful life experience for couples. The high stress of infertility can be attributed to the fact that having children is important in general society(6). People with infertility often face pressures and ambiguous situations in society due to the type of infertility. Different groups probably deal with infertility differently. In other words, not all infertile people experience infertility in the same way(10). Following a highly ambiguous pregnancy loss, bereaved couples struggle with distress due to various forms of ambiguity(11). Ambiguity tolerance refers to how an individual (or group) perceives and processes information about ambiguous situations or stimuli when faced with familiar, complex, or incongruous and unpredictable cues. A person with ambiguity tolerance experiences less stress reacts earlier and avoids ambiguous stimuli. However, people with high ambiguity tolerance find the situations of desirable stimuli challenging and interesting and do not reject or distort their incongruity complexity. Ambiguity-tolerant people tend to perceive ambiguous situations and ambiguous stimuli as desirable, challenging, and interesting. People with low ambiguity tolerance react prematurely, experience more anxiety and stress, and try to avoid ambiguous stimuli. They also tend to reach results as quickly as possible(12). Therefore, tolerance of ambiguity is one of the important factors in dealing with problems. In infertility, these patients are looking for a definite and clear medical diagnosis. One of the problems of infertile women is tolerating ambiguity. In the meantime, every person takes psychological strategies to face their problems. Although according to the researcher's reviews, no specific studies have been conducted regarding the psychological strategies of infertile women with high ambiguity tolerance, some studies have indirectly addressed the psychological strategies of these women. It is divided into self-focused strategies and other-focused strategies(17). Also, the results of another research have pointed to coping strategies focused on the individual, coping strategies focused on the family, and strategies focused on the community(18). The present study was conducted to analyze the psychological strategies of infertile women with high ambiguity tolerance. Methods: The study employed a qualitative approach and used the phenomenological method. The research was conducted with infertile women who were referred to the obstetrics and gynecology department of Shahid Akbar Abadi Hospital, an educational, research, and treatment center. The inclusion criteria involved being diagnosed with primary infertility by a gynecologist and obstetrician, aged between 20 and 45, having at least a high school diploma, experiencing infertility for at least 24 months after unprotected sex, undergoing at least two unsuccessful artificial insemination attempts, not having a psychological disorder or receiving counseling or psychiatric services during the study, and being willing to participate. Exclusion criteria included unwillingness to participate, withholding information during the interview, and becoming pregnant during the study. The sample was selected based on the scores obtained from McLean's Ambiguity Tolerance Questionnaire(1993), given to 55 women who had undergone artificial insemination treatment at least twice. Those with high scores in the questionnaire were chosen for interviews. The number of participants was determined based on the study's nature and the quality of the collected information, until theoretical saturation was reached. The study utilized the seven-stage Collaizi's  analysis method. The first step involved carefully reading the participants' statements multiple times after conducting the interviews. Subsequently, in the second step, important sentences were extracted. In the third step, the researcher attempted to formulate the meanings of each important sentence. Following this, in the fourth step, the formulated meanings were classified into clusters of positions. In the fifth step, the researcher integrated all the ideas obtained into a detailed description of the field under study. Moving on to the sixth stage, the researcher condensed this detailed description of the studied phenomenon into a basic structure. Finally, in the last stage, the researcher referred back to the research participants and conducted a final interview to assess the validity of the results(19). Results: The study aimed to explore the psychological strategies of infertile women with high ambiguity tolerance who had undergone IVF treatment at least twice. Through interviews with 12 participants, 754 primary codes or conceptual propositions were identified and categorized into 18 sub-themes, with 4 main content areas identified. The study found that infertility treatment exerts both physical and psychological pressure on women, leading to uncertainty about the outcomes and making life more challenging. Importantly, the research highlighted the lack of direct investigation into the psychological strategies of infertile women with high ambiguity tolerance, emphasizing the significance of the current study. The research identified four stages in the psychological strategies of infertile women with high ambiguity tolerance during the treatment process: The positive outlook on life: This stage involves making multiple efforts, maintaining optimism and hope, expecting success, and facing challenges during treatment. Becoming realistic and reducing expectations: Women in this stage experience doubts and worries, seek information, consult with experts, obtain external psychological support, avoid bias towards treatment options, and adapt to reality. Surrendering to divine providence: This stage involves acceptance and surrender, fatalism, and maintaining hope. Transformation of the centrality of life: Women in this stage search for alternative solutions, decide on the course of treatment, obtain support from family and friends, experience psychological improvement, and take action to regain control of life. The study concluded that infertile women with high ambiguity tolerance maintain a positive outlook on their situation without considering it as a certainty. They continue to hope for treatment success while not neglecting other aspects of their lives, actively pursuing conception alongside other life issues. Conclusion: According to the results of the findings of this research, it can be concluded that infertile women who have a high tolerance for ambiguity, start to know positively about their respective situation and do not consider this knowledge as a certainty. As they continue to hope for treatment, they do not eliminate other aspects of their lives and pursue trying to conceive alongside other life issues. </div> تحمل ابهام, راهبردهای روانشناختی, زنان نابارور, مطالعه کیفی Psychological strategies, infertile women, ambiguity tolerance, qualitative study 1 14 http://rjms.iums.ac.ir/browse.php?a_code=A-10-7998-1&slc_lang=fa&sid=1 Niloufar Dirmanchi نیلوفر دیرمانچی 3900319475328460090285 3900319475328460090285 No PhD Student, Department of Education and Counseling, Central Tehran Branch, Islamic Azad University, Tehran, Iran دانشجوی دکتری مشاوره، گروه تربیت و مشاوره، واحد تهران مرکزی، دانشگاه آزاد اسلامی، تهران، ایران Somaye Kazemian سمیه کاظمیان s.kazemian@atu.ac.ir 3900319475328460090286 3900319475328460090286 Yes Associate Professor, Department of Counseling, Faculty of Psychology and Educational Sciences, Allameh Tabataba'i University, Tehran, Iran دانشیار، دانشکده علوم تربیتی و روانشناسی، دانشگاه علامه طباطبائی، تهران، ایران Ali Akbar Khosravi Babadi علی اکبر خسروی بابادی 3900319475328460090287 3900319475328460090287 No Associate Professor, Department of Education and Counseling, Central Tehran Branch, Islamic Azad University, Tehran, Iran دانشیار، گروه برنامه‌ریزی‌درسی واحد تهران مرکزی، دانشگاه آزاد اسلامی، تهران، ایران