Gamified Healthy Lifestyle Training in Women Undergoing Assisted Reproductive Treatment

The Effect of Gamified Healthy Lifestyle Behavior Training on Healthy Lifestyle and Self-Efficacy in Women Undergoing Assisted Reproductive Treatment

Objective: A prospective randomized controlled trial with a pretest-posttest design was planned to evaluate the effects of a gamified healthy lifestyle behaviors training intervention using the D6 model, to be administered to women undergoing assisted reproductive treatment (ART), on healthy lifestyle behaviors and infertility self-efficacy.

Aim: Reproductive health and Assisted Reproductive Technologies (ART) have undergone rapid technological and clinical development in recent years, offering a variety of treatment options to couples struggling with infertility. Methods such as Intrauterine Insemination (IUI), In Vitro Fertilization (IVF), and Intracytoplasmic Sperm Injection (ICSI) are the most common practices aimed at increasing pregnancy rates. However, these treatments are complex processes affected by high stress levels, emotional burden, and lifestyle factors. Strengthening individuals' sense of self-efficacy strengthens their motivation to adapt to treatment and achieve health-related goals. In this intense and complex treatment process, it is essential to strengthen the self-efficacy perceptions of infertile couples, as this can enhance their motivation to achieve health-related goals by improving their adaptation to the treatment process. Although the literature reveals findings indicating that the development of healthy lifestyle behaviors positively influences the treatment outcomes of individuals undergoing infertility treatment, it is an undeniable fact that developing and sustaining such behaviors is often challenging-even for healthy individuals. For those experiencing infertility, which represents a complex life crisis both psychologically and physiologically, this process can become even more difficult. In this context, gamification is intended to be utilized as an innovative approach by integrating it into the process of promoting healthy lifestyle behaviors among infertile women.

Method: This study will be a prospective randomized controlled trial with a pretest-posttest model. The study population will consist of women undergoing assisted reproductive treatment who presented to the In Vitro Fertilization Unit in the Infertility and Reproductive Endocrinology Department at Istanbul University, Istanbul Faculty of Medicine Service Building, between October 2025 and October 2026. The sample will consist of 105 infertile women who met the study criteria based on a power analysis and agreed to participate in the study. After obtaining informed consent from infertile women who meet the study criteria and agree to participate, the women will be randomly assigned to three groups based on age, type of ART (IUI, IVF, ICSI), and number of treatments to ensure equality between the groups. These groups will be divided into three groups: a group receiving gamified healthy lifestyle behaviors education and a booklet during the ART process, a group receiving only the booklet, and a group receiving standard ART clinic training. All study groups will complete an Introductory Information Form, the Healthy Lifestyle Behavior Follow-up Form for Infertile Women, the Healthy Lifestyle Behavior Scale II (HLBS II), and the Infertility Self-Efficacy Scale Short Form (SES). One group will receive the gamified healthy lifestyle behaviors education program and a booklet, while the second group will receive the healthy lifestyle behaviors education booklet. The third group will receive standard ART clinic training. Post-tests (Healthy Lifestyle Behaviors for Infertile Women Follow-up Form, Healthy Lifestyle Behaviors Scale II, Infertility Self-Efficacy Scale Short Form) and "Gamified Healthy Lifestyle Behaviors Training Program Evaluation Form" was given to the group receiving gamified healthy lifestyle behaviors training will be administered to all groups at the end of Month 1. Repeat tests (Healthy Lifestyle Behaviors for Infertile Women Follow-up Form, Healthy Lifestyle Behaviors Scale II, Infertility Self-Efficacy Scale Short Form, and Gamified Healthy Lifestyle Behaviors Education Program Evaluation Form) will be administered at Month 3.

As part of the study, the effects of gamified healthy lifestyle behaviors and self-efficacy on the healthy lifestyle behaviors and self-efficacy of infertile women who received gamified healthy lifestyle behaviors education and an educational booklet during the ART process will be compared with those of infertile women who received only the educational booklet, compared to those who received standard ART clinic training. This will scientifically demonstrate the contribution of the gamification approach to the behavioral change processes of infertile women.

Inclusion Criteria:

• Women aged 18-49 years
• Diagnosed with primary infertility
• Currently undergoing assisted reproductive treatment (IUI, IVF, or ICSI)
• Able to read, understand, and communicate in Turkish
• Have access to a digital device (mobile phone, tablet, or computer) and internet connection
• Provide voluntary written informed consent

Exclusion Criteria:

• Diagnosed psychiatric disorder that may interfere with participation
• Presence of a severe medical condition (e.g., active cancer or other serious systemic disease) that may affect treatment outcomes
• Medical complications requiring hospitalization during the study period
• Communication barriers preventing completion of study procedures
• Withdrawal of consent at any time during the study