Virtual Reality-Based Health Promotion Education and Healthy Living Behaviors in Pregnant Women

Pregnancy is a critical period that significantly alters a woman's lifestyle and necessitates the adoption of healthy behaviors. During pregnancy, engaging in healthy lifestyle behaviors such as attending regular prenatal checkups, avoiding harmful habits, maintaining a balanced diet, performing regular physical activity, and managing stress effectively is of great importance. Neglecting these behaviors can result in serious complications such as preterm birth, low birth weight, and the need for intensive care unit admission.

To support behavioral changes during this period, various behavior change theories are utilized. Among these, Pender's Health Promotion Model (HPM) evaluates cognitive, emotional, and environmental factors collectively to facilitate the development of health-promoting behaviors. The model explains the formation of health behaviors by considering individuals' previous experiences, perceived benefits and barriers, self-efficacy, and interpersonal influences.

The American College of Obstetricians and Gynecologists (ACOG) recommends the adequate intake of nutrients such as folic acid, iron, calcium, and vitamin D during pregnancy, along with increased water consumption and regular exercise. Exercise has been shown to reduce postpartum depression and accelerate recovery. Furthermore, ACOG emphasizes the importance of stress management and social support and recommends providing women with counseling services both during pregnancy and the postpartum period.

Nutrition education based on Pender's model has been shown to significantly improve diet quality in intervention groups. Similarly, interactive training materials such as role-play, simulations, and games have demonstrated a positive impact on pregnant women's health knowledge and behaviors.

This study will utilize two types of educational materials: virtual reality (VR) and printed educational booklets. VR provides individuals with a three-dimensional, interactive, and realistic learning environment, enhancing the effectiveness of health education. Studies have shown that VR reduces labor pain and anxiety and improves metabolic parameters in pregnant women with gestational diabetes.

There is a lack of comprehensive, theory-based, and technology-assisted interventions targeting behavioral change in pregnant women. Therefore, this study aims to evaluate the effectiveness of education delivered via VR and booklets-both based on Pender's model-on healthy lifestyle behaviors during pregnancy.

A total of 96 pregnant women will be randomly assigned to three groups:

Experimental Group 1: Three-session model-based education delivered via virtual reality headset.

Experimental Group 2: Three-session model-based face-to-face education using printed booklets.

Control Group: Routine prenatal care only. Data will be collected using the Healthy Lifestyle Behaviors in Pregnancy Scale (HLBPS), the Depression Anxiety Stress Scale (DASS-21), follow-up forms, and postpartum evaluation forms. After the intervention, motivational follow-up phone calls will be conducted. This study is expected to demonstrate the impact of a VR-based, evidence-informed educational program tailored to pregnant women on the adoption and sustainability of health-promoting behaviors.

Inclusion criteria

• Pregnant women between 12-16 weeks of gestation
• Primigravida (first pregnancy)
• No chronic disease or health condition affecting lifestyle behaviors
• Able to communicate and give informed consent

Exclusion criteria

• High-risk pregnancies (e.g., gestational diabetes, preeclampsia, multiple pregnancy, threatened preterm labor)
• Existing psychiatric or communication impairments (e.g., language barrier)
• Having previously participated in similar educational programs