A theory-based educational intervention to change intention of fetal protection among women with unplanned pregnancies: study protocol of a cluster randomized controlled trial

BACKGROUND: Unplanned pregnancies are a significant global public health concern, associated with elevated risks of adverse maternal and fetal outcomes, including unsafe abortion, inadequate prenatal care, and psychological distress. Fetal protection, which encompasses proactive health behaviors and safeguards, is a critical but complex goal within this population. Theory-based educational interventions are needed to effectively promote the necessary behavioral intentions. OBJECTIVE: The main objective of the study is to evaluate the effectiveness of an educational intervention in enhancing fetal protection intentions among women experiencing unplanned pregnancies, utilizing an extended Protection Motivation Theory (PMT) model as its framework. METHODS: This study employs a two-arm, parallel-group randomized controlled trial (RCT) design involving 40 women with unplanned pregnancy. The intervention consists of a structured four-session educational program, explicitly mapped onto an extended Protection Motivation Theory (PMT) framework that integrates threat appraisal (perceived susceptibility, severity), coping appraisal (self-efficacy, response efficacy, response costs), and the added constructs of awareness and subjective norms. Data will be collected at three time points: baseline (S0), immediately post-intervention (S1), and 12 weeks' post-intervention (S2), using a demographic questionnaire, the London Measure of Unplanned Pregnancy (LMUP) at S0, and a researcher-developed PMT-based fetal protection intention questionnaire administered at all three time points. CONCLUSION: This protocol outlines a novel, theory-driven approach to addressing fetal protection in unplanned pregnancies. By targeting the psychological mechanisms of behavior change, the intervention aims to empower women to adopt protective health behaviors. The findings from the subsequent trial will contribute to the evidence based on effective strategies for improving maternal and fetal health outcomes in this vulnerable population.