Neuman Systems Model-Based Yoga Therapy for Test Anxiety in Secondary School Students

Overview

This cluster randomized controlled trial evaluates the effects of a yoga therapy program grounded in the Neuman Systems Model on test anxiety, quality of life, and mindfulness among eighth-grade students aged 13-14 years in Denizli, Türkiye. The study was conducted with students preparing for the national High School Entrance System (LGS) examination. A total of 166 eighth-grade students were allocated to intervention and control groups at the school level. The intervention consisted of a structured yoga therapy program delivered once weekly for four weeks. Outcomes were assessed using standardized measures of test anxiety, quality of life, and mindfulness at baseline, mid-intervention, and post-intervention. The study received ethics committee approval, institutional permissions, and written informed consent from parents or legal guardians.

This cluster randomized controlled trial was designed to evaluate the effects of a yoga therapy program grounded in Neuman Systems Model on test anxiety, quality of life, and mindfulness levels among 13-14-year-old middle school students. The target population consisted of eighth-grade students attending schools in the central districts of Denizli province, Türkiye. In Türkiye, eighth-grade students prepare for the nationwide High School Entrance System (LGS) examination and may experience high academic pressure and test anxiety. Therefore, the study was conducted with eighth-grade students. The inclusion criteria were defined as being an eighth-grade student, having no physical or mental disability, agreeing to participate voluntarily in the study, and providing parental consent. Students with prior regular yoga experience were excluded to minimize potential confounding factors that could influence the effects of the intervention. Among 68 public middle schools in the central districts of Denizli, 27 schools that agreed to participate constituted the study pool. From this pool, two schools meeting the eligibility criteria were selected using simple random sampling. Each school was considered a cluster. The selected schools were then allocated to intervention and control groups by an independent researcher using a simple randomization method. Following randomization, two classes were randomly selected from seven eighth-grade classes in the intervention school, and two classes were randomly selected from nine eighth-grade classes in the control school. Cluster randomization at the school level was employed to minimize contamination due to potential information exchange between intervention and control groups. The sample size was calculated using G\*Power version 3.1.9.4. The calculation was based on a study design involving two groups and three measurement time points. A repeated-measures analysis of variance (ANOVA) was used with a medium effect size (f = 0.25), a significance level of 0.05, and a statistical power of 0.95. The minimum required sample size was determined to be 142 students. Considering potential attrition, it was planned to include 80 students in each group, for a total of 160 students. Ultimately, the study sample consisted of 166 students, with 81 in the intervention group and 85 in the control group. The yoga therapy program was developed in collaboration with the researcher, who is certified in children's yoga, and two certified yoga experts with experience in adult yoga, children's yoga, and mindfulness-based practices. The intervention was delivered jointly by the researcher and one of the certified yoga instructors. The program was conducted over four weeks, with one 40-minute session per week. Each session consisted of breathing awareness and intention setting (5 minutes), warm-up exercises (5 minutes), yoga postures aimed at improving attention, balance, strength, and self-confidence (15 minutes), pranayama practices designed to reduce anxiety and enhance focus (5 minutes), and relaxation with mindfulness-based meditation (10 minutes). Outcome variables were assessed using the Westside Test Anxiety Scale for test anxiety, the Quality of Life Scale for Children and Adolescents (13-18 years version) for quality of life, the BAU Mindfulness Scale for Children for mindfulness levels, and a researcher-developed Student Information Form for demographic characteristics. Data were collected at three time points: baseline assessment before the first intervention session, mid-assessment after the second session, and post-assessment after the fourth session. The study was approved by the Non-Interventional Clinical Research Ethics Committee of Pamukkale University and conducted with the necessary institutional permissions from the Ministry of National Education. Participation was voluntary, and written informed consent was obtained from parents or legal guardians of all participating students.