Effect of Ear Massage on Stress, Anxiety, and Sleep Quality in Parents of Children With Type 1 Diabetes

NCT06829251 | Recruiting

• 1 other identifier: MersinU-SBE-EK-01
• Study Type: interventional
• Target: 62
• Locations: 1 country
• Sites: 1

Brief Summary

The purpose of this clinical trial is to determine the effect of self-administered ear massage on stress, anxiety levels, and sleep quality in parents of children diagnosed with Type 1 diabetes. Additionally, it aims to assess whether ear massage can prevent stress, anxiety, and poor sleep quality. The primary questions it seeks to answer are: H0: There is no significant difference in the mean stress scores between the intervention and control groups of parents. H0: There is no significant difference in the mean anxiety scores between the intervention and control groups of parents. H0: There is no significant difference in the mean Pittsburgh Sleep Quality Index (PSQI) scores between the intervention and control groups of parents. Researchers will compare the effects of ear massage on stress, anxiety levels, and sleep quality with a sham control. Participants: Intervention group: Self-administered effective ear massage twice daily for two weeks, with each session lasting three minutes, totaling 28 sessions. Control group: Self-administered sham ear massage twice daily for two weeks, with each session lasting one minute, totaling 28 sessions. Parents will be reached by sending an invitation letter to the groups they are in on WhatsApp (What's up Application) and Instagram.Volunteer parents will be evaluated for their eligibility criteria and assessed using the 'Depression, Anxiety, Stress Scale-21 (DASS-21)' form. Suitable parents will be sent the informed consent form, personal information form, and 'Pittsburgh Sleep Quality Index'. After the initial data collection, an online ear massage training will be provided. Both groups will receive a 20-minute individual online ear massage training. The Readiness Assessment Form will be used during the training. The application will start the next day. During the implementation process, brochures and video support will be provided by the researcher, and reminder messages will be sent at the times of application. Additionally, participants will be asked to set reminder alarms on their phones. Participants will complete the Ear Massage Tracking Form during the implementation process. At the end of the two-week period, the 'Depression, Anxiety, Stress Scale-21 (DASS-21)' form and the 'Pittsburgh Sleep Quality Index' will be filled out.

Conditions

Stress; Anxiety; Sleep Quality

Keywords

Ear Massage; Stress; Anxiety; Sleep Quality; Tip-1 Diabetes Mellitus; Parents

Outcome Measures

Primary Outcomes (3)

• Change in Stress Levels

  Changes in stress levels will be measured at two weeks using the Depression, Anxiety, Stress Scale-21 (DASS-21). Lovibond (1995) developed the original 42-item scale, and the same authors later created the 21-item short form, which was adapted to Turkish culture by Sarıçam (2018). The scale consists of seven items each for evaluating depression, anxiety, and stress. Responses are given on a 4-point Likert scale (0 = Never, 3 = Always). The Cronbach's Alpha coefficients of the scale are 0.87 for depression, 0.85 for anxiety, and 0.81 for stress. Depression is classified as follows: (0-4) Normal, (5-6) Mild, (7-10) Moderate, (11-13) Severe, (14+) Extremely Severe Depression. Anxiety is classified as: (0-3) Normal, (4-5) Mild, (6-7) Moderate, (8-9) Severe, (10+) Extremely Severe Anxiety. Stress is classified as: (0-7) Normal, (8-9) Mild, (10-12) Moderate, (13-16) Severe, (17+) Extremely Severe Stress.Only the stress and anxiety subscales will be assessed.

  2 weeks (after intervention)

• Change in Anxiety Levels

  Changes in anxiety levels will be measured at two weeks using the Depression, Anxiety, Stress Scale-21 (DASS-21). Lovibond (1995) developed the original 42-item scale, and the same authors later created the 21-item short form, which was adapted to Turkish culture by Sarıçam (2018). The scale consists of seven items each for evaluating depression, anxiety, and stress. Responses are given on a 4-point Likert scale (0 = Never, 3 = Always). The Cronbach's Alpha coefficients of the scale are 0.87 for depression, 0.85 for anxiety, and 0.81 for stress. Depression is classified as follows: (0-4) Normal, (5-6) Mild, (7-10) Moderate, (11-13) Severe, (14+) Extremely Severe Depression. Anxiety is classified as: (0-3) Normal, (4-5) Mild, (6-7) Moderate, (8-9) Severe, (10+) Extremely Severe Anxiety. Stress is classified as: (0-7) Normal, (8-9) Mild, (10-12) Moderate, (13-16) Severe, (17+) Extremely Severe Stress.Only the stress and anxiety subscales will be assessed.

  2 weeks (after intervention)

• Change in Sleep Quality

  Sleep quality will be assessed using the Pittsburgh Sleep Quality Index (PSQI). The PSQI is a 24-item questionnaire. The Pittsburgh Sleep Quality Index was developed by Buysse et al. in 1989 to assess sleep quality in psychiatric practice and clinical research. The PSQI evaluates sleep quality over the past month. The validity and reliability studies of this scale for the Turkish culture were conducted by Ağargün et al. in 1996, and the Cronbach's alpha reliability coefficient of the scale was found to be 0.80.Nineteen questions are self-reported, and the last 5 questions are answered by a spouse or roommate. Eighteen items are included in the scoring and are grouped into 7 component scores. Each item is rated on a scale of 0-3. The total score ranges from 0-21, with higher scores indicating poorer sleep quality.

  2 weeks (after intervention)

Secondary Outcomes (1)

• Change in Energy Levels

  Every day (for 2 weeks).

Study Arms (2)

Effective Ear Massage Group

EXPERIMENTAL

Parents in this group will receive a 20-minute individual instruction on ear massage via WhatsApp (What's up Application). They will be taught an effective ear massage technique targeting key stress, anxiety, and sleep points. The massage will be performed on the entire ear with varying pressure over a 3-minute period. During the sessions, parents will be assessed using the Readiness for Intervention Form . When the massage starts the day after the interview, parents will fill out the Ear Massage Follow-Up Form , and a reminder message will be sent by the researcher before the scheduled massage time, asking parents to set an alarm on their phones. Additionally, the Ear Massage Training Brochure will be provided. After two weeks, the Depression, Anxiety, Stress Scale-21 (DASS-21) and Pittsburgh Sleep Quality Index will be administered. At the end of the study, parents will be reminded to consider psychiatric clinic consultations.

Behavioral: Effective Ear Massage

Sham Ear Massage Group

SHAM COMPARATOR

Parents in this group will receive 20-minute individual instruction on ear massage via WhatsApp (What's up Application). They will perform a sham ear massage on the helix outer rim,helix crest and points 1, 2, and 3 without applying pressure. This 1-minute sham massage mimics the intervention but does not affect stress, anxiety, or sleep. Parents will be assessed using the Readiness for Intervention Form. The massage will start the day after the interview. Parents will fill out the Ear Massage Follow-Up Form . A reminder will be sent by the researcher before the massage time, asking them to set an alarm. Additionally, the Ear Massage Training Brochure will be provided. After two weeks, the Depression, Anxiety, Stress Scale-21 (DASS-21) and Pittsburgh Sleep Quality Index will be administered. The sham control group will later learn the effective ear massage technique. At the end, parents will be reminded to consider psychiatric consultations.

Behavioral: Sham Ear Massage

Interventions

Effective Ear Massage BEHAVIORAL

The intervention consists of a structured ear massage technique administered daily for 2 weeks. Parents will receive training on how to target specific pressure points on the ear to reduce stress and anxiety, and improve sleep quality. This training will be conducted via WhatsApp (What's up Application) for 20 minutes, followed by daily massage practice. The massage will be performed using varying pressure over a 3-minute period on the entire ear, focusing on stress and sleep points.

Effective Ear Massage Group

Sham Ear Massage BEHAVIORAL

The sham intervention involves a 1-minute ear massage on the outer helix rim, helix crest, and helix points 1, 2, and 3, without applying any pressure. The goal of the sham massage is to mimic the process of ear massage while ensuring no physiological effect on stress, anxiety, or sleep quality.

Sham Ear Massage Group

Eligibility Criteria

• Age: 21 Years - 60 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Between February 2025 and July 2025, parents of children diagnosed with Type 1 diabetes, who are registered in the Mersin Diabetics group on WhatsApp (What's up Application), the Type 1 Diabetics association on Instagram, and the community forums and groups of diabetes education nurses and dietitians, will be eligible to participate in the study.
• Those who are willing to participate in the study and have signed the informed consent form
• Those who score medium or higher \[stress (10 points or more) or anxiety (8 points or more)\] on the Depression, Anxiety, Stress Scale-21 (DASS-21) and prefer to perform ear massage first over immediately receiving psychiatric support
• Those who have the facilities to participate in online training (internet, phone/tablet/computer, etc.) will be included in the sample.

You may not qualify if:

• Between February 2025 and July 2025, parents of children diagnosed with Type 1 diabetes, who are registered in the Mersin Diabetics group on WhatsApp (What's up Application), the Type 1 Diabetics association on Instagram, and the community forums and groups of diabetes education nurses and dietitians, will be eligible to participate in the study.
• Those who are not willing to participate in the study
• Those with a psychiatric diagnosis made by a doctor
• Those who score medium or higher \[stress (10 points or more) or anxiety (8 points or more)\] on the DASS-21 scale, but prefer to receive psychiatric support first over ear massage after immediately receiving psychiatric support
• Those receiving regular professional psychological support
• Those taking antidepressants, anticonvulsants, or sleeping pills
• Pregnant women or those suspected of being pregnant
• Those with auricular aplasia or hypoplasia
• Those with active infection or disruption of skin integrity in the ear area (ulcer, eczema, urticaria, surgical incision, etc.)
• Those with visual, hearing, or speech impairments
• Those receiving regular complementary or alternative treatments for stress, anxiety, and sleep (acupuncture, facial massage, phytotherapy, meditation, breathing exercises, etc.) will not be included in the sample.

Sponsors & Collaborators

• Mersin University: lead

Study Sites (1)

Mersin University Health Sciences Institute Nursing Department Çiftlikköy Campus Yenişehir / MERSİN TURKEY

Mersin, 33343, Turkey (Türkiye)

RECRUITING

Related Publications (13)

• Wang Y, Zhang J, Jin Y, Zhang Q. Auricular Acupressure Therapy for Patients with Cancer with Sleep Disturbance: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med. 2021 Oct 14;2021:3996101. doi: 10.1155/2021/3996101. eCollection 2021.

  PMID: 34691214 BACKGROUND

• Chen SR, Hou WH, Lai JN, Kwong JSW, Lin PC. Effects of Acupressure on Anxiety: A Systematic Review and Meta-Analysis. J Integr Complement Med. 2022 Jan;28(1):25-35. doi: 10.1089/jicm.2020.0256.

  PMID: 35085025 BACKGROUND

• Park S, Park H, Bang YY. The Effects of Auricular Acupressure on Physiological Index, Depression, Anxiety, and Stress for Elders With Hypertension. Holist Nurs Pract. 2023 Jan-Feb 01;37(1):24-33. doi: 10.1097/HNP.0000000000000558.

  PMID: 36378089 BACKGROUND

• Tseng YT, Chen IH, Lee PH, Lin PC. Effects of auricular acupressure on depression and anxiety in older adult residents of long-term care institutions: A randomized clinical trial. Geriatr Nurs. 2021 Jan-Feb;42(1):205-212. doi: 10.1016/j.gerinurse.2020.08.003. Epub 2020 Sep 11.

  PMID: 32921508 BACKGROUND

• Cha NH, Park YK, Sok SR. Effects of Auricular Acupressure Therapy on Stress and Sleep Disturbance of Middle-Aged Women in South Korea. Holist Nurs Pract. 2017 Mar/Apr;31(2):102-109. doi: 10.1097/HNP.0000000000000197.

  PMID: 28181975 BACKGROUND

• Kuo SY, Tsai SH, Chen SL, Tzeng YL. Auricular acupressure relieves anxiety and fatigue, and reduces cortisol levels in post-caesarean section women: A single-blind, randomised controlled study. Int J Nurs Stud. 2016 Jan;53:17-26. doi: 10.1016/j.ijnurstu.2015.10.006. Epub 2015 Oct 22.

  PMID: 26525188 BACKGROUND

• Xin D, Cui L, Wang L, Zhang Q, Chen X, Shi Y, Zhu W, Xu N, Li W, Wang Y. Effect of auricular acupressure on sleep quality in breast cancer patients: A systematic review and meta-analysis of randomized controlled trials. Complement Ther Clin Pract. 2024 Nov;57:101876. doi: 10.1016/j.ctcp.2024.101876. Epub 2024 Jun 9.

  PMID: 38925078 BACKGROUND

• Rechenberg K, Grey M, Sadler L. Stress and Posttraumatic Stress in Mothers of Children With Type 1 Diabetes. J Fam Nurs. 2017 May;23(2):201-225. doi: 10.1177/1074840716687543. Epub 2017 Jan 10.

  PMID: 28795899 BACKGROUND

• Morrow T, Bhatia SH, Parmar AM, Baker L, Abadula F, Williamson D, Choudhary A, Jaser SS. Sleep Habits of Early School-Aged Children with Type 1 Diabetes and Their Parents: Family Characteristics and Diabetes Management. Behav Sleep Med. 2022 Sep-Oct;20(5):649-658. doi: 10.1080/15402002.2021.1977305. Epub 2021 Sep 24.

  PMID: 34559603 BACKGROUND

• Bassi G, Mancinelli E, Di Riso D, Salcuni S. Parental Stress, Anxiety and Depression Symptoms Associated with Self-Efficacy in Paediatric Type 1 Diabetes: A Literature Review. Int J Environ Res Public Health. 2020 Dec 28;18(1):152. doi: 10.3390/ijerph18010152.

  PMID: 33379307 BACKGROUND

• Horsch A, McManus F, Kennedy P, Edge J. Anxiety, depressive, and posttraumatic stress symptoms in mothers of children with type 1 diabetes. J Trauma Stress. 2007 Oct;20(5):881-91. doi: 10.1002/jts.20247.

  PMID: 17955536 BACKGROUND

• Whittemore R, Jaser S, Chao A, Jang M, Grey M. Psychological experience of parents of children with type 1 diabetes: a systematic mixed-studies review. Diabetes Educ. 2012 Jul-Aug;38(4):562-79. doi: 10.1177/0145721712445216. Epub 2012 May 11.

  PMID: 22581804 BACKGROUND

• Azimi T, Johnson J, Campbell SM, Montesanti S. Caregiver burden among parents of children with type 1 diabetes: A qualitative scoping review. Heliyon. 2024 Mar 12;10(6):e27539. doi: 10.1016/j.heliyon.2024.e27539. eCollection 2024 Mar 30.

  PMID: 38524615 BACKGROUND

Related Links

• A comprehensive study explaining the pathophysiology, diagnosis, and management of type-1 diabetes.
• Link to the Official Gazette Containing Regulations in the Regulation of the Ministry of Health of the Republic of Turkey

MeSH Terms

Conditions

Anxiety Disorders; Sleep Initiation and Maintenance Disorders

Condition Hierarchy (Ancestors)

Mental Disorders; Sleep Disorders, Intrinsic; Dyssomnias; Sleep Wake Disorders; Nervous System Diseases

Central Study Contacts

Ebru Koç, Master's Nursing

CONTACT

+90 534 820 01 62; ebru33koc@gmail.com

Sümbüle Köksoy Vayısoğlu, Advisor

CONTACT

03243610001/14218; sumbule@mersin.edu.tr

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Masking Details: The parents participating in the study will not know which group they are in. During the statistical analysis of the study, group codes will be created as A and B, and which codes represent which groups will be kept in a sealed envelope by a researcher who is not involved in the analysis phase. The group codes will be revealed after all analyses are completed.
• Purpose: SUPPORTIVE CARE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Master of Science in Public Health Nursing student

Model Details: The study is designed as a single-blind, randomized, sham-controlled, interventional research to determine the effect of self-administered effective ear massage on stress, anxiety levels, and sleep quality in parents of children diagnosed with Type 1 diabetes. Participants in the intervention group will perform effective ear massage, while participants in the control group will receive sham ear massage that mimics the intervention but does not stimulate pressure points.

Study Record Dates

• First Submitted: February 11, 2025
• First Posted: February 17, 2025
• Study Start: February 15, 2025
• Primary Completion: July 15, 2025
• Study Completion: February 15, 2026
• Last Updated: May 18, 2025

Record last verified: 2025-05

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)