Efficacy of an e-education program based on the Health Belief Model on exercise management in women with gestational hypertension: A randomized controlled clinical trial

This study aimed to evaluate the effectiveness of a Health Belief Model (HBM)–based electronic education program combined with individualized supervised exercise in improving exercise adherence and pregnancy outcomes among women with gestational hypertension. A randomized controlled trial was conducted from June 2024 to February 2025 at a tertiary hospital in Shenzhen, China. A total of 142 pregnant women diagnosed with gestational hypertension were randomly assigned to either an experimental group or a control group. The experimental group received routine antenatal care plus a 6-week HBM-based e-education intervention delivered via a mobile application and SMS reminders, complemented by individualized in-person exercise guidance. The control group received routine antenatal care only. After the 6-week intervention, outcomes were assessed using the 6-minute walk test, a disease knowledge and attitudes questionnaire, and the Pregnancy Exercise Self-Efficacy Scale. Primary outcomes included exercise adherence, blood pressure control, incidence of preeclampsia, and other pregnancy-related outcomes. At 6 weeks post-intervention, the experimental group demonstrated significantly greater improvements than the control group in exercise adherence, blood pressure control, preeclampsia incidence, disease-related knowledge and attitudes, and exercise self-efficacy (all P < 0.05). Specifically, participants in the experimental group engaged in more frequent and longer-duration exercise sessions ( P < 0.05). Their blood pressure was maintained within a more stable and clinically optimal range (systolic: 135.2 ± 4.7 mmHg; diastolic: 85.4 ± 4.5 mmHg), which was significantly better than that of the control group (systolic: 138.4 ± 10.4 mmHg; diastolic: 90.9 ± 6.9 mmHg; P < 0.05). The incidence of preeclampsia was also significantly lower in the experimental group ( P < 0.05). Additionally, scores for disease knowledge, attitudes, and exercise self-efficacy were higher in the experimental group ( P < 0.05). Within-group comparisons revealed that the experimental group showed significant improvements from baseline in exercise frequency, duration, total physical activity, and knowledge/attitude scores ( P < 0.05), whereas the control group showed no significant changes ( P = 0.232). By embedding video-based education, real-time monitoring, and personalized support into routine prenatal care, this intervention facilitated positive behavioral changes in physical activity among pregnant women. The approach offers a scalable model for clinical nurses to delivering tailored remote exercise support for women with other pregnancy-related complications.