Health Behavior, Pregnancy
Conditions
Keywords
Pregnancy, Prenatal Education, Health Promotion, Health Promotion Behavior, Virtual Reality, Pender's Health Promotion Model
Brief summary
This randomized controlled, open-label trial evaluated the effects of education based on Pender's Health Promotion Model, delivered through virtual reality or printed educational booklets, on healthy lifestyle behaviors in pregnant women. The study was conducted at two family health centers in Istanbul, Turkey, between April 2025 and February 2026. A total of 102 primigravida pregnant women at 12-16 weeks of gestation were randomly assigned in equal numbers to a virtual reality education group, a booklet-based education group, or a routine-care control group. Both intervention groups received three weekly educational sessions followed by five monthly motivational interviewing telephone calls, while the control group received routine prenatal care. Healthy lifestyle behaviors and depression, anxiety, and stress symptoms were assessed at baseline and at 36-38 weeks of gestation. Ninety-five participants completed the study and were included in the analyses.
Detailed description
This randomized controlled, open-label study evaluated the effects of two delivery methods for education based on Pender's Health Promotion Model on healthy lifestyle behaviors in pregnant women. The study was conducted at two family health centers in Istanbul, Turkey, between April 2025 and February 2026. A total of 102 eligible primigravida pregnant women at 12-16 weeks of gestation were randomly assigned to three groups, with 34 participants in each group. The first experimental group received three weekly individual education sessions delivered through immersive 360-degree virtual reality videos. The second experimental group received the same educational content through printed booklets in three weekly individual face-to-face sessions. Following the educational sessions, both experimental groups received five monthly motivational interviewing telephone calls. The control group received routine prenatal care without additional education or motivational interviewing. The Healthy Lifestyle Behaviors in Pregnancy Scale and the Depression Anxiety Stress Scale-21 were administered face-to-face at baseline and by telephone at 36-38 weeks of gestation. The primary outcomes were changes in the total and subscale scores of the Healthy Lifestyle Behaviors in Pregnancy Scale. Changes in depression, anxiety, and stress subscale scores were evaluated as secondary outcomes. Ninety-five participants completed the study and were included in the analyses: 31 in the virtual reality education group, 32 in the booklet-based education group, and 32 in the control group.
Interventions
BEHAVIORALVirtual Reality-Based Prenatal Education
This behavioral intervention consisted of prenatal education based on Pender's Health Promotion Model delivered through immersive 360-degree virtual reality videos. The content focused on healthy lifestyle behaviors during pregnancy, including nutrition, physical activity, stress management, and health responsibility. Participants viewed the videos using virtual reality headsets in three weekly sessions. The video durations were approximately 25, 28, and 12 minutes. Following the educational sessions, participants received five monthly motivational interviewing telephone calls, each lasting approximately 20 minutes.
BEHAVIORALBooklet-Based Prenatal Education
This behavioral intervention consisted of prenatal education based on Pender's Health Promotion Model delivered through a printed booklet. The educational content was identical to that provided to the virtual reality group and focused on healthy lifestyle behaviors during pregnancy, including nutrition, physical activity, stress management, and health responsibility. The education was delivered in three weekly face-to-face sessions, each lasting approximately 15-30 minutes. Following the educational sessions, participants received five monthly motivational interviewing telephone calls, each lasting approximately 20 minutes.
Sponsors
Istanbul University - Cerrahpasa
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Intervention model description
This study uses a parallel assignment model in which participants are randomly assigned to one of three groups: (1) a virtual reality-based education group, (2) a booklet-based education group, or (3) a routine care control group. All interventions are delivered concurrently, and participants remain in their assigned group throughout the study period.
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 35 Years
Healthy volunteers
Yes
Inclusion criteria
* Pregnant women aged 18-35 years * Being at 12-16 weeks of gestation at enrollment * Being primigravida * Having no chronic disease or health condition affecting healthy lifestyle behaviors * Being able to communicate and provide informed consent
Exclusion criteria
* Having a high-risk pregnancy at enrollment, including gestational diabetes, preeclampsia, multiple pregnancy, or threatened preterm labor * Having a psychiatric disorder or communication impairment that could prevent participation * Having previously participated in a similar educational program
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Healthy Lifestyle Behaviors in Pregnancy Scale Total and Subscale Scores | From baseline (12-16 weeks of gestation) to the final assessment (36-38 weeks of gestation) | The Healthy Lifestyle Behaviors in Pregnancy Scale is a 29-item, 5-point Likert-type scale comprising six subscales: pregnancy responsibility (4-20 points), hygiene (4-20 points), nutrition (9-45 points), physical activity (3-15 points), travel (5-25 points), and acceptance of pregnancy (4-20 points). The total score ranges from 29 to 145. Higher total and subscale scores indicate healthier lifestyle behaviors during pregnancy. Change was evaluated by comparing baseline and final assessment scores. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Depression, Anxiety, and Stress Scale-21 Subscale Scores | From baseline (12-16 weeks of gestation) to the final assessment (36-38 weeks of gestation) | The Depression, Anxiety, and Stress Scale-21 is a 21-item self-report instrument comprising three subscales: depression, anxiety, and stress. Each subscale contains seven items rated on a 4-point scale from 0 to 3. Higher scores indicate greater levels of depression, anxiety, or stress symptoms. Change was evaluated by comparing baseline and final assessment scores. |
Countries
Turkey (Türkiye)
Outcome results
None listed