Effect of happiness pregnancy application-based health education on anxiety, treatment compliance, and satisfaction in women undergoing IVF-ET: a quasi-experimental study

In vitro fertilization–embryo transfer (IVF-ET) involves a prolonged treatment cycle with multiple stages. Women undergoing IVF-ET often experience anxiety related to inadequate treatment-related knowledge, potentially affecting treatment compliance and patient experience. This study evaluated the associations between health education delivered via the Happiness Pregnancy Application and anxiety, knowledge, satisfaction, treatment compliance, and outpatient waiting time. A quasi-experimental study was conducted at a large reproductive medicine center in southern China between December 2023 and January 2026. Of 510 women screened, 487 met the inclusion criteria and consented. Allocation was based on admission time. The control group received routine health education ( n = 247); the intervention group additionally received the Happiness Pregnancy Application ( n = 240). After 14 participants withdrew, 473 women completed follow-up. 1:1 propensity score matching yielded 229 matched pairs ( N = 458). The primary outcome was the Self-Rating Anxiety Scale (SAS) score. Secondary outcomes were IVF-ET knowledge, satisfaction, treatment compliance, and outpatient waiting time. Between-group comparisons used paired Wilcoxon signed-rank and McNemar tests. Adjusted estimates were obtained using multivariable linear regression, ordinal logistic regression, or a linear mixed-effects model. Bonferroni correction was applied for the secondary outcomes (α′ = 0.0125). The continuous SAS score did not differ between groups (paired Wilcoxon Z = − 0.444, P = 0.657; adjusted β = 0.59, P = 0.518). SAS clinical grades shifted toward lower severity in the intervention group ( Z = − 2.943, P = 0.003; adjusted OR = 0.607, 95% CI: 0.418 to 0.880, P = 0.009), with moderate anxiety decreasing from 9.6% to 1.3%. Satisfaction, knowledge, and treatment compliance scores were higher in the intervention group (all P < 0.001, r = 0.21 to 0.39). Outpatient waiting time was 15.60 min shorter (95% CI: −22.35 to − 8.85, P < 0.001). Happiness Pregnancy Application-based health education was associated with a more favorable anxiety severity distribution, although no significant difference was observed in continuous anxiety scores. It was also associated with greater IVF-ET knowledge, higher patient satisfaction, better treatment compliance, and shorter outpatient waiting time. The study protocol was registered at ClinicalTrials.gov (ChiCTR2500113755) on December 2, 2025.