Effect of health education based on the Transtheoretical Model on pregnant women's knowledge, attitudes, and practices toward painless delivery: a quasi-experimental study.

BACKGROUND: Traditional methods have limited reach and sustainability and often fail to increase the actual uptake of epidural analgesia. This study explored the impact of health education grounded in the Transtheoretical Model (TTM) on primiparous women's knowledge, attitudes, and practices (KAP) regarding painless delivery, as well as associated delivery outcomes. MATERIALS AND METHODS: This quasi-experimental study was conducted at Wuhan Children's Hospital from December 2024 to April 2025. Eligible primiparous women planning vaginal delivery were assigned to the TTM-based intervention group or the routine education group according to enrollment sequence. All participants received epidural analgesia during labor. Baseline and post-intervention assessments measured KAP using a self-developed questionnaire, and childbirth experience using the Chinese version of the Childbirth Experience Questionnaire (CEQ-C). RESULTS: A total of 148 women were enrolled (TTM group: n = 77; routine education group: n = 71). All participants received epidural analgesia during labor as part of routine clinical practice. Post-intervention, the TTM group showed greater improvements in KAP scores (all p < 0.001) compared with the routine education group. At follow-up, KAP scores remained higher in the TTM group (all p < 0.001). CEQ-C scores did not differ significantly between groups (2.74 vs. 2.63, p = 0.062). Multivariable linear regression analysis indicated occupational role (β = -0.113, p = 0.014) and delivery satisfaction (p < 0.001) as independent predictors of CEQ-C scores. CONCLUSION: TTM-based individualized education significantly improves KAP levels in primiparous women. These findings suggest that implementing TTM interventions in clinical practice can optimize perinatal education.