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A randomized controlled trial of a Transtheoretical Model-based intervention to promote healthcare-seeking behavior for menstrual abnormalities among female university students
https://doi.org/10.24552/0002000290
https://doi.org/10.24552/0002000290d5ec6392-a622-4829-b4c1-2d45ef35fc06
| 名前 / ファイル | ライセンス | アクション |
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A76.pdf (8.3 MB)
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| アイテムタイプ | デフォルトアイテムタイプ（フル）(1) | |||||||||||
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| 公開日 | 2026-06-03 | |||||||||||
| タイトル | ||||||||||||
| タイトル | A randomized controlled trial of a Transtheoretical Model-based intervention to promote healthcare-seeking behavior for menstrual abnormalities among female university students | |||||||||||
| 言語 | en | |||||||||||
| 作成者 |
外, 千夏
× 外, 千夏
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| アクセス権 | ||||||||||||
| アクセス権 | open access | |||||||||||
| アクセス権URI | http://purl.org/coar/access_right/c_abf2 | |||||||||||
| 内容記述 | ||||||||||||
| 内容記述タイプ | Abstract | |||||||||||
| 内容記述 | [Objective] Seeking medical care for menstrual abnormalities and receiving treatment such as oral contraceptives (OC) or low-dose estrogen–progestin (LEP) therapy are important behaviors for maintaining reproductive health among female university students. However, healthcare-seeking rates among young women remain low, and treatment dropout has been identified as a significant challenge (Hoka et al., 2019). Therefore, behavioral change approaches that promote timely healthcare utilization and sustained treatment adherence are needed. Interventions based on the Transtheoretical Model (TTM) provide stage-matched, personalized support and have demonstrated effectiveness across various health behaviors. However, no intervention studies have applied the TTM to promote healthcare-seeking behavior for menstrual abnormalities among female university students. The purpose of this study was to examine the effectiveness of personaalized TTM-based messages in promoting healthcare-seeking behavior. This study aims to contribute to improving reproductive health among young women. [Materials and Methods] This study employed a randomized controlled trial (RCT) design. Participants were individually randomized using a computer-based allocation system. Data were collected from June 2024 to May 2025. Participants were 461 first-year female students aged 18–19 years enrolled in universities and junior colleges in Prefecture A. Participants accessed the study website via a URL or QR code and registered with a research LINE application. The intervention group received personalized, computer-tailored messages immediately after allocation and again at 3 months. These messages combined 5 symptom types and 3 stage types based on the TTM framework. The control group received a standardized digital leaflet containing general information. The primary outcome was change in stage of healthcare-seeking behavior based on the TTM: precontemplation, contemplation, preparation, action, and maintenance. Secondary outcomes included menstrual knowledge, general self-efficacy (GSES), processes of change, and decisional balance. User feasibility was assessed by usability, comprehension, and frequency of material access. Participants who completed baseline assessment were included in the modified intention-to-treat (mITT) analysis. An exploratory analysis focused on participants with symptoms interfering with daily life. Per-protocol analysis was conducted as sensitivity analysis. Stage scores were coded from 1 to 5. Changes between groups were compared using the Mann–Whitney U test, and effect sizes were calculated. Participants were categorized into regression, stagnation, or progression groups, and changes in GSES were analyzed using the Kruskal–Wallis test. User feasibility variables were analyzed using chi-square or Fisher’s exact tests. Statistical significance was set at P<0.05. [Results] The mITT population included 231 participants (intervention: 119; control: 112). The per-protocol population included 115 participants (completion rate 45.6%). No statistically significant differences in stage change were observed between groups at any time point. Similar findings were obtained in exploratory and per-protocol analyses. Regarding secondary outcomes, menstrual knowledge significantly improved in the intervention group compared with the control group from baseline to 3 months in the per-protocol analysis (r= 0.19, P=0.016). Improvement in GSES was significantly greater in the progression group than in the stagnation group at 9 months and between 3 and 9 months. Similar trends were observed in per-protocol analysis. More than 70% of respondents reported that the website and LINE application were easy to use. Comprehension of materials was high in both groups. However, engagement was limited; the median number of times materials were viewed was approximately once, and 35.0–49.0% accessed reference URLs. [Conclusion] Although this TTM-based, computer-tailored intervention combined symptom-specific and stage-specific messages, it did not produce significant differences in stage progression. Possible explanations include limited intervention intensity, low engagement, and insufficient emphasis on concrete action planning. The categorical nature of the stage outcome may also have reduced sensitivity to detect change. Additionally, students’ hesitation toward medical consultation or OC/LEP use may have attenuated the intervention effect. However, improved self-efficacy among participants whose stages progressed suggests the importance of psychological factors in menstrual health-related behaviors. This study extends previous research by evaluating actual healthcare-seeking and treatment-related behaviors within an RCT framework. Limitations include potential contamination, incentive effects, limited outcome sensitivity, and restricted generalizability. |
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| 言語 | en | |||||||||||
| 言語 | ||||||||||||
| 言語 | eng | |||||||||||
| 資源タイプ | ||||||||||||
| 資源タイプ識別子 | http://purl.org/coar/resource_type/c_db06 | |||||||||||
| 資源タイプ | doctoral thesis | |||||||||||
| ID登録 | ||||||||||||
| ID登録 | 10.24552/0002000290 | |||||||||||
| ID登録タイプ | JaLC | |||||||||||
| 学位授与番号 | ||||||||||||
| 学位授与番号 | 甲第76号 | |||||||||||
| 学位名 | ||||||||||||
| 学位名 | 博士(健康科学) | |||||||||||
| 言語 | ja | |||||||||||
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| 学位名 | Doctor of Philosophy in Health Sciences | |||||||||||
| 言語 | en | |||||||||||
| 学位授与年月日 | ||||||||||||
| 学位授与年月日 | 2026-03-10 | |||||||||||
| 学位授与機関 | ||||||||||||
| 学位授与機関識別子Scheme | kakenhi | |||||||||||
| 学位授与機関識別子 | 21102 | |||||||||||
| 学位授与機関名 | 青森県立保健大学 | |||||||||||
| 言語 | ja | |||||||||||
| 学位授与機関名 | Aomori University of Health and Welfare | |||||||||||
| 言語 | en | |||||||||||
| リンク |
A randomized controlled trial of a Transtheoretical Model-based intervention to promote healthcare-seeking behavior for menstrual abnormalities among female university students [論文及び審査結果の要旨]
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