The Effectiveness of Mobile Phone–Based Microlearning Emotion-Focused Psychotherapy on Death Anxiety and Emotion Regulation among Patients Hospitalized in Cardiac Intensive Care Units
Determining the Effectiveness of Mobile Phone–Based Microlearning Emotion-Focused Psychotherapy on Death Anxiety and Emotion Regulation among Patients Hospitalized in Cardiac Intensive Care Units
Design
A single-blind, parallel-group, quasi-experimental study with a control group.
Settings and conduct
Cardiac Intensive Care Units (CCUs) of selected hospitals in Shiraz, Iran
Participants/Inclusion and exclusion criteria
Inclusion Criteria
Adults aged 40–70 years hospitalized in the CCU, who are clinically stable, able to read and communicate in Persian, have access to and can use a smartphone with internet, are willing to participate and provide written informed consent, and are not enrolled in similar educational programs.
Exclusion Criteria... Withdrawal from the study; occurrence of severe stressful events leading to PTSD; moderate-to-severe cognitive impairment (MMSE < 24), delirium, or other conditions preventing participation; significant visual or hearing impairment; clinical deterioration requiring rehospitalization; or failure to complete two consecutive educational sessions.
Intervention groups
Intervention group: Participants in the intervention group will receive an Emotion-Focused Therapy (EFT) program based on the protocols developed by Greenberg et al. (62) and Simmons et al. (63), delivered using a mobile phone–based microlearning approach. The intervention will last for three weeks and will consist of daily 10–20-minute educational video sessions. The standardized educational videos will be uploaded to a mobile application, allowing participants to access the microlearning content at their convenience.
Control group: Participants in the control group will receive no intervention during the study period.
Main outcome variables
Death Anxiety and Emotion Regulation
General information
Reason for update
Acronym
IRCT registration information
IRCT registration number:IRCT20251109067926N2
Registration date:2026-06-30, 1405/04/09
Registration timing:prospective
Last update:2026-06-30, 1405/04/09
Update count:0
Registration date
2026-06-30, 1405/04/09
Registrant information
Name
Mohammad Hadi Ayati
Name of organization / entity
Country
Iran (Islamic Republic of)
Phone
+98 71 3647 4254
Email address
mohammadh.ayt@sums.ac.ir
Recruitment status
Recruitment complete
Funding source
Expected recruitment start date
2026-08-06, 1405/05/15
Expected recruitment end date
2026-10-07, 1405/07/15
Actual recruitment start date
empty
Actual recruitment end date
empty
Trial completion date
empty
Scientific title
The Effectiveness of Mobile Phone–Based Microlearning Emotion-Focused Psychotherapy on Death Anxiety and Emotion Regulation among Patients Hospitalized in Cardiac Intensive Care Units
Public title
The Effectiveness of Emotion-Focused Psychotherapy in Patients with Cardiovascular Disease
Purpose
Supportive
Inclusion/Exclusion criteria
Inclusion criteria:
Ability to read and write at a basic level to comprehend the educational content
Ability to understand and communicate in Persian
Age between 40 and 70 years
Access to a smartphone with an active internet connection and the ability to use it
Not participating concurrently in any other similar educational programs
Willingness to participate in the study and provide written informed consent
Hospitalization in the Cardiac Intensive Care Unit (CCU)
Clinically stable condition allowing participation in brief educational activities
Exclusion criteria:
Withdrawal of consent or unwillingness to continue participation in the study at any point during the research.
Experience of a highly stressful life event, either recently or during the study period, resulting in Post-Traumatic Stress Disorder (e.g., the loss of a close family member), as determined by self-report, family report, or available health records.
Presence of moderate to severe dementia or a Mini-Mental State Examination (MMSE) score < 24 (or an equivalent validated cognitive assessment), as determined by self-report, family report, or available health records.
Presence of delirium or any medical condition that precludes participation in mobile-based educational interventions.
Visual or hearing impairment that prevents participation in the interactive educational activities.
Clinical deterioration during the intervention requiring rehospitalization.
Failure to view two consecutive educational sessions provided during the intervention.
Age
From 40 years old to 70 years old
Gender
Both
Phase
N/A
Groups that have been masked
Outcome assessor
Sample size
Target sample size:
84
Randomization (investigator's opinion)
Not randomized
Randomization description
Blinding (investigator's opinion)
Single blinded
Blinding description
In this study, blinding will be implemented such that the research assistant responsible for data collection and the statistician responsible for data analysis will remain blinded to group allocation until the completion of the study.
Placebo
Not used
Assignment
Parallel
Other design features
This study is designed as a single-blind, parallel-group, quasi-experimental study with a control group.
Secondary Ids
empty
Ethics committees
1
Ethics committee
Name of ethics committee
Research Ethics Committee of the Schools of Nursing and Midwifery and Health Management and Medical
Street address
Vice Chancellor for Research, 7th Floor, Central Building of Shiraz University of Medical Sciences, Adjacent to the Red Crescent Society, Zand Boulevard, Shiraz, Iran.
City
Shiraz
Province
Fars
Postal code
71348-14336
Approval date
2026-05-23, 1405/03/02
Ethics committee reference number
IR.SUMS.NUMIMG.REC.1405.018
Health conditions studied
1
Description of health condition studied
Cardiovascular diseases
ICD-10 code
I51
ICD-10 code description
Complications and ill-defined descriptions of heart disease
Primary outcomes
1
Description
Death Anxiety
Timepoint
At baseline (before the intervention), immediately after the intervention, and one month after the intervention.
Method of measurement
Templer Death Anxiety Scale - DAS
2
Description
Emotion Regulation
Timepoint
At baseline (before the intervention), immediately after the intervention, and one month after the intervention.
Method of measurement
Emotion Regulation Questionnaire - ERQ
Secondary outcomes
empty
Intervention groups
1
Description
Intervention group: Participants allocated to the intervention group will receive an **Emotion-Focused Therapy (EFT)** program based on the protocols developed by Greenberg et al. (62) and Simmons et al. (63), delivered using a **mobile phone–based microlearning approach**. The intervention will be administered over **three weeks** and will consist of **daily 10–20-minute educational video sessions**.The educational content will be developed based on the EFT protocol and reviewed by two faculty members with doctoral degrees in nursing and expertise in psychiatric and mental health nursing. The electronic learning materials will be prepared according to the standards of the Virtual School and E-Learning Center of Excellence of Shiraz University of Medical Sciences and will undergo instructional design, quality assurance, and technical review before implementation. The videos will be narrated and edited using Camtasia software and uploaded to a dedicated mobile application in MP4 format.Before the intervention begins, participants will receive a brief individual orientation session on using the application and accessing the microlearning content. Technical support contact information will also be provided. The application will be designed to allow sequential access to the educational sessions, بحيث participants can view each session only after completing the previous one. The application will also record participants' viewing statistics and, following completion of each video, present two short questions to assess comprehension of the session content. To minimize contamination, downloading or sharing of the educational videos will not be permitted, and the materials will be accessible only within the application.Consistent with the theoretical framework proposed by Greenberg et al., the intervention is designed to facilitate the identification, processing, expression, and regulation of emotions. To reinforce learning, each session will begin with a brief review of the previous session. Participants will be able to submit questions, share their experiences, and communicate with the research team through the application's discussion platform. In addition, brief telephone follow-up calls (1–2 minutes) will be conducted at predetermined intervals throughout the intervention period to promote adherence and reduce attrition.Outcome measures will be assessed at **baseline, immediately after completion of the intervention, and one month after the intervention** in both the intervention and control groups. The collected data will be entered into **SPSS** software for statistical analysis.**Control group:** Participants in the control group will receive **routine care only** and will not receive any components of the EFT microlearning intervention during the study period.
Category
Behavior
2
Description
Control group: Participants in the control group will receive routine hospital care and will not receive any components of the study intervention during the trial. However, in accordance with ethical principles, the complete educational materials will be made available to participants in the control group after completion of the study and analysis of the study results
Category
Behavior
Recruitment centers
1
Recruitment center
Name of recruitment center
Cardiac Care Units (CCUs) of selected hospitals affiliated with Shiraz University of Medical Science
Full name of responsible person
Sorur Javanmardifard
Street address
School of Nursing and Midwifery, Namazi Square, Zand Boulevard, Shiraz, Iran
City
Shiraz
Province
Fars
Postal code
7193613119
Phone
+98 71 3647 4258
Email
soror.javanmardi@yahoo.com
Sponsors / Funding sources
1
Sponsor
Name of organization / entity
Shiraz University of Medical Sciences
Full name of responsible person
Hamid Mohammadi
Street address
7th Floor, Central Administration Building, Shiraz University of Medical Sciences, Adjacent to the Red Crescent Society, Zand Boulevard, Shiraz, Iran
City
Shiraz
Province
Fars
Postal code
7193613119
Phone
+98 71 3235 7282
Email
vcrdep@sums.ac.ir
Grant name
Grant code / Reference number
Is the source of funding the same sponsor organization/entity?
Yes
Title of funding source
Shiraz University of Medical Sciences
Proportion provided by this source
100
Public or private sector
Public
Domestic or foreign origin
Domestic
Category of foreign source of funding
empty
Country of origin
Type of organization providing the funding
Academic
Person responsible for general inquiries
Contact
Name of organization / entity
Shiraz University of Medical Sciences
Full name of responsible person
Sorur Javanmardifard
Position
Assistant Professor
Latest degree
Ph.D.
Other areas of specialty/work
Nursery
Street address
School of Nursing and Midwifery, Namazi Square, Zand Boulevard, Shiraz, Iran
City
Shiraz
Province
Fars
Postal code
71936–13119
Phone
+98 71 3677 4254
Email
soror.javanmardi@yahoo.com
Person responsible for scientific inquiries
Contact
Name of organization / entity
Shiraz University of Medical Sciences
Full name of responsible person
Sorur Javanmardifard
Position
Assistant Professor
Latest degree
Ph.D.
Other areas of specialty/work
Nursery
Street address
School of Nursing and Midwifery, Namazi Square, Zand Boulevard, Shiraz, Iran
City
Shiraz
Province
Fars
Postal code
7193613119
Phone
+98 71 3647 4258
Email
soror.javanmardi@yahoo.com
Person responsible for updating data
Contact
Name of organization / entity
Shiraz University of Medical Sciences
Full name of responsible person
Sorur Javanmardifard
Position
Assistant Professor
Latest degree
Ph.D.
Other areas of specialty/work
Nursery
Street address
School of Nursing and Midwifery, Namazi Square, Zand Boulevard, Shiraz, Iran
City
Shiraz
Province
Fars
Postal code
7193613119
Phone
+98 71 3647 4258
Email
soror.javanmardi@yahoo.com
Sharing plan
Deidentified Individual Participant Data Set (IPD)
Yes - There is a plan to make this available
Study Protocol
Yes - There is a plan to make this available
Statistical Analysis Plan
Yes - There is a plan to make this available
Informed Consent Form
Yes - There is a plan to make this available
Clinical Study Report
Yes - There is a plan to make this available
Analytic Code
Yes - There is a plan to make this available
Data Dictionary
Yes - There is a plan to make this available
Title and more details about the data/document
The primary study outcomes will be made publicly available.
When the data will become available and for how long
Access will begin 6 months after publication of the study results.
To whom data/document is available
Researchers and individuals affiliated with academic institutions
Under which criteria data/document could be used
The data will be provided for informational purposes only.
From where data/document is obtainable
The data are available upon request via email at soror.javanmardi@yahoo.com
What processes are involved for a request to access data/document
The data are available upon request via email at soror.javanmardi@yahoo.com