Effect of hand massage on anxiety levels before contraceptive device installation in prospective IUD and implant users

Authors

  • Masruroh Masruroh Universitas Respati Yogyakarta. Indonesia
  • Istri Yuliani Universitas Respati Yogyakarta. Indonesia
  • Eko Mindarsih Universitas Respati Yogyakarta. Indonesia
  • B Verawati Universitas Respati Yogyakarta. Indonesia

DOI:

https://doi.org/10.21927/jnki.2026.14(2).302-313

Keywords:

Anxiety, Hand massage, Contraceptive device, IUD, Implant

Abstract

Background: Anxiety prior to contraceptive insertion is commonly experienced by prospective family planning acceptors. Psychological discomfort during the procedure may reduce client comfort, influence decision-making, and potentially affect the continuity and effectiveness of contraceptive use. In many clinical settings, anxiety management is often limited to verbal reassurance, while simple non-pharmacological approaches are rarely implemented. One technique that has received increasing attention is hand massage, which may promote relaxation through stimulation of peripheral nerves and improved blood circulation. This intervention is simple, inexpensive, and easy to apply in routine healthcare services.

Objectives: This study aimed to examine the effect of hand massage on reducing anxiety levels among prospective intrauterine device (IUD) and implant acceptors at the Independent Midwife Practice of Istri Yuliani, Sleman.

Methods: This research employed a quasi-experimental design with a one-group pre-test and post-test approach to examine changes before and after the intervention. This research employed a quasi-experimental design with a one-group pre-test and post-test approach to examine changes before and after the intervention A total of 56 prospective contraceptive acceptors participated in the study. Anxiety levels were measured using the Hamilton Rating Scale for Anxiety (HRS-A) before and after the hand massage intervention. The massage was administered prior to contraceptive insertion as a relaxation technique. Data analysis was performed using descriptive statistics to describe the distribution of anxiety levels and paired t-test to examine the significance of anxiety reduction following the intervention.

Results: Before the intervention, 75% of respondents experienced mild anxiety, while only 3.6% reported no anxiety symptoms. After receiving hand massage, the proportion of respondents without anxiety symptoms increased substantially to 80.4%, whereas mild anxiety decreased to 19.6%. The paired t-test indicated a statistically significant reduction in anxiety scores (p = 0.001).

Conclusions: Hand massage is associated with a reduction in anxiety prior to contraceptive insertion. This technique may serve as a supportive non-pharmacological intervention to enhance client comfort and improve the overall experience of family planning services.

References

Rasyid PS. The Effect Of Providing Information On Implant Installation Procedures To The Anxiety Level Of The Implant Acceptor Candidate In Gorontalo City (2019) J Nas Ilmu Kesehat. 2019;1(3):15–27.

Estevez E, Hem-Lee-Forsyth S, Viechweg N, John S, Menor SP. Advancing Pain Management Protocols for Intrauterine Device Insertion: Integrating Evidence-Based Strategies Into Clinical Practice. Cureus. 2024.

Envall N, Elgemark K, Kopp Kallner H. Mepivacaine instillation for pain reduction during intrauterine device placement in nulliparous women: a double-blinded randomized trial. Am J Obstet Gynecol. 2024.

Qu J-H, Shou C-C, Xin He QW, Fang Y-X. Analysis of acupoint massage combined with touch on relieving anxiety and pain in patients with oral implant surgery. World J Psychiatry. 2024;3206(4):533–40.

Bürger Z, Müllerschön C, Kübbeler J, Comasco E, Henes M, Kogler L, et al. Association of hormonal contraception with stress reactivity in women. Psychoneuroendocrinology. 2024;160:106833.

Eriç J, Purut YE, Harmancl H. The Effect of Video Assisted Information on Anxiety and Pain Associated with Intrauterine Device Insertion. Gynecol Obstet Invest. 2020;85(1):82–7.

Nguyen L, Lamarche L, Lennox R, Ramdyal A, Patel T, Black M, et al. Strategies to Mitigate Anxiety and Pain in Intrauterine Device Insertion: A Systematic Review. J Obstet Gynaecol Canada. 2020;42(9):1138-1146.e2.

Wessels J, Klinger R, Benson S, Brenner T, Zöllner C, Elsenbruch S, et al. Preoperative Anxiolysis and Treatment Expectation (PATE Trial): open-label placebo treatment to reduce preoperative anxiety in female patients undergoing gynecological laparoscopic surgery – study protocol for a bicentric, prospective, randomized-controlled trial. Front Psychiatry. 2024;15.

Masruroh M, Yuliani I, Mindarsih E, Verawati B, Rahmawati I. Anxiety Of Mothers Before IUD And Implant Insertion. Nurse Heal J Keperawatan. 2024;13(2):409–14.

Mamlukah. A comparative analysis of the use of back massage and Murattal AI-Qur’an on dysmenorrhea pain and anxiety levels. Int J Res Med Sci. 2024;12(7):2252–7.

Mckenzie N, Barnhart K. An innovative and non-invasive method of reducing pain utilizing vibration during iud insertion: patient reactions and one provider’s approach. J Sex Med. 2024;21(Supplement_5).

ElShora SAE, Elsayed H, El-Feshawy N, Abd Elaziz Hassen H. The Effect of Benson’s Relaxation Therapy on Pre-Cesarean Section Fear and Anxiety among Nulliparous Women. Assiut Sci Nurs J. 2024;12(41):75–83.

Abidah SN, Novianti H, Masruroh N. Effectiveness of combination of benson relaxation and lavender aromatherapy relaxation towards changes in anxiety in the third trimester pregnant woman. Bali Med J. 2023;12(3):3382–6.

Li Z, Bauer B, Aaberg M, Pool S, Van Rooy K, Schroeder D, et al. Benefits of hand massage on anxiety in preoperative outpatient: A quasi-experimental study with pre- and post-tests. Explore. 2021;17(5):410–6.

Anggri Yanti D, Sumiati Silaban L, Purba S, Mariati Simarmata J, Kesehatan Medistra Lubuk Pakam Jl Sudirman No I, Pakam Kab Deli Serdang L. Pengaruh hand massage terhadap penurunan tingkat kecemasan klien pre operasi di rumah sakit patar asih lubuk pakam tahun 2021. J Keperawatan dan Fisioter. 2021 ;3(2):171–9.

Nasihin N. The Effect of Hand Massage on Reducing the Anxiety Level of Pre-Surgery Clients in Tangerang City Regional Public Hospital. Poltekita J Ilmu Kesehat. 2023;17(1):1–7.

Risbud N, Daukia K, Ghanekar K. Knowledge attitude and practice of contraception in women of rural population following delivery in a tertiary care hospital. INDIAN J Appl Res. 2024;60–1.

Ardanti NKJ, Dewi NLMA. Gambaran tingkat pengetahuan pasangan usia subur tentang penggunaan alat kontrasepsi iud. Coping Community Publ Nurs. 2023;11(5):490.

Konsam M, Praharaj SK, Shetty J, Panda S, Lakshmi R V, Kamath A, et al. Effectiveness of Comprehensive Health-literacy And Relaxing Music (CHARM) intervention on pregnancy-related anxiety among low-risk primigravid women: A randomized controlled trial. Psychol Music. 2024;

Hosaini S, Yazdkhasti M, Ghafari FM, Mohamadi F, Rad SHRK, Mahmoodi Z. The relationships of spiritual health, pregnancy worries and stress and perceived social support with childbirth fear and experience: A path analysis. PLoS One. 2023;18(12).

Kazemi SN, Vaziri-harami R, Vaziri-harami S, Mousavian FS. Anxiety Disorders in Pregnant Women and its Effects on Choosing the Delivery Method. Rev Colomb Psiquiatr. 2023.

Zeng G, Niu J, Zhu K, Li F, Liu L, Gao K, et al. Effects of Non-Pharmacological Interventions on Depression and Anxiety in Pregnant Women: A Systematic Review and Network Meta-Analysis. Lancet. 2024.

Bukuluki P, Kisaakye P, Houinato M, Ndieli A, Letiyo E, Bazira D. Social norms, attitudes and access to modern contraception for adolescent girls in six districts in Uganda. BMC Health Serv Res. 2021;21(1):1–14.

Idris IB, Syed Soffian SS, Baharom M, Baharuddin UM, Hashim S, Nawi AM. Influence of sociocultural beliefs and practices on contraception: a systematic review. Women Health. 2022;62(8):688–99.

Adewale Ogundiran T, Mohammadnezhad M, Ibrahim Ogundiran A, Mohammed H. Role of sociocultural beliefs/norms on level of access and uptake of contraceptives among unmarried adolescent girls in Nigeria: A systematic review study. MOJ Public Heal. 2024;13(1):73–9.

Sarnak DO, Wood SN, Zimmerman LA, Karp C, Makumbi F, Kibira SPS, et al. The role of partner influence in contraceptive adoption, discontinuation, and switching in a nationally representative cohort of Ugandan women. PLoS One. 2021;16(1).

Agha S, Morgan B, Archer H, Paul S, Babigumira JB, Guthrie BL. Understanding how social norms affect modern contraceptive use. BMC Public Health. 2021;21(1):1061–1061.

Minkanic M, Tran E. Socioeconomic and Cultural Factors Influencing Type of Hormonal Contraceptive Use in Women in Developed vs Under-Developed Geographic Areas. Clin Exp Investig. 2024;4(1):2–9.

Li Z, Bauer B, Aaberg M, Pool S, Van Rooy K, Schroeder D, et al. Benefits of hand massage on anxiety in preoperative outpatient: A quasi-experimental study with pre- and post-tests. Explore (NY). 2021;17(5):410–6.

Hamdani SU, Zill-e-Huma, Zafar SW, Suleman N, Um-ul-Baneen, Waqas A, et al. Effectiveness of relaxation techniques ‘as an active ingredient of psychological interventions’ to reduce distress, anxiety and depression in adolescents: a systematic review and meta-analysis. Int J Ment Health Syst. 2022;16(1):31.

Nasihin N. The Effect of Hand Massage on Reducing the Anxiety Level of Pre-Surgery Clients in Tangerang City Regional Public Hospital. Poltekita J Ilmu Kesehat. 2023;17(1):1–7.

Nabighadim M, Mirghafourvand M, Maghalian M. Nonâ€Pharmacological Interventions Before Cataract Surgery for Preoperative Anxiety: A Systematic Review and Metaâ€Analysis. Nurs open, 2025;12(1).

Downloads

Published

2026-06-30

Issue

Section

Articles