From 5 March 2022 to 31 October 2022, 120 PGT couples who met the inclusion and exclusion criteria and sought treatment at our reproductive endocrinology department were selected. Subjects were assigned randomly to the control or intervention groups (n = 60 cases/group). This study was approved by the ethics committee of our hospital (IRB-20200292-R), with informed consent obtained from both patients and their families.

Inclusion criteria: (1) Female patients aged 20–45 years; (2) Patients with PGT indications [8], who underwent PGT treatment for the first time; (3) Proficient in using mobile phone software; (4) Education level of junior high school or above, with normal audiovisual reading and writing abilities; (5) Patients with clear consciousness, and no psychological or psychiatric disorders; and (6) Patients who voluntarily agree to participate in the study.

Exclusion criteria: Individuals for whom one or both spouses have severe physical illnesses.

Dropout criteria: (1) Patients who changed treatment plan midway. (2) Individuals who exhibit poor compliance during the intervention process. (3) Participants who did not complete the required four health education sessions.

Sample size calculation: According to the primary outcome measure, the Hamilton Anxiety Scale (HAMA), using the following formula, incorporating pre-experimental results.

$${\mathrm{n}}_1={\mathrm{n}}_2=2{\left[\frac{\left({\mu }_{\alpha }+{\mu }_{\beta }\right)}{\delta /\sigma }\right]}^2+\frac{1}{4}\mu _{\alpha }{}^2$$

In the formula, n₁ and n₂ are the sample sizes required for each group. The significance level is $\alpha$ = 0.050, $\beta$ = 0.100, $\delta$ is the difference between the two population means, $\delta$ = 2.290, and $\sigma$ is the overall standard deviation, $\sigma$ = 3.471. The table is µ_α = 1.960, µ_β = 1.282, and n₁ = n₂ $\approx$ 50 is calculated. Combined with the particularity of the PGT patient group, considering 10%–20% of the sample loss, the total number of samples in the two groups is determined to be 120 cases, 60 cases in the control group, and 60 cases in the observation group.

The numbers from 1 to 120 were written on uniform-sized paper, and 120 small paper strips were placed into a sealed opaque envelope, which was kept by the group members until the end of recruitment. Strips with single-digit numbers were assigned to the intervention group, while those with double-digit numbers were assigned to the control group.

Due to the nature of the intervention, neither the participants nor the researchers could be fully blinded to the study conditions. During the study, the grouping and data evaluation, and statistical analysis were carried out by different personnel. The grouping allocation of patients is only informed by the grouping personnel and the group health education personnel. The data evaluation and statistical analysis personnel were not informed of the grouping allocation, and the data evaluation was conducted designated evaluator in a private consultation room through one-on-one patient assessment, to avoid the interference of other personnel. If the evaluator became aware of the patient’s group assignments during the intervention phase, the patient was withdrawn from the study. Participants remained blinded to the research hypothesis and any additional interventions.

Two key evaluation points were chosen: the cycle entry day and the day before oocyte pickup. (1) Cycle entry day (before intervention): during this phase, general information about the patients was collected. Patients filled out the PGT knowledge questionnaire, HAMA, and SSRS. Patients in the intervention group scanned the QR code to join the WeChat group and were given an offline class attendance sheet. (2) Day before oocyte retrieval (after intervention): the PGT knowledge questionnaire, health education satisfaction rating scale, SSRS, and HAMA were completed to assess the impact of family-centered group health education on PGT patients’ cognition, social support, anxiety levels, and satisfaction with health education during the treatment cycle. Psychological counselors and trained nurses in assisted reproduction conducted the questionnaire. They explained the significance, purpose, content, and requirements of the study to the patients and their families, obtaining informed consent. A unified guidance language was used to assist patients in filling out the questionnaires. All questionnaires were collected on-site, and the investigator promptly verified their validity and completeness to address any missing items and rectify errors.

Statistical software SPSS 26.0 (IBM Corp., Chicago, IL, USA) was used for data analysis. Categorical data were expressed as counts and percentages [n (%)]. When the total number of cases (N) was $>$40 and the minimum theoretical number (T) was $>$5, the chi-square test was used for intergroup comparison; when N was $\ge$40 and 1 $\le$ T 5, the continuity correction test was used. The Kolmogorov-Smirnov test was used to assess data normality. Non-normally distributed continuous data were expressed as the median and interquartile range [M (P25, P75)] and compared using non-parametric tests. Normally distributed continuous data are expressed as the mean $\pm$ standard deviation (SD), with independent samples t-tests used for intergroup comparison and paired t-tests for pre- and post-intervention comparison. All tests were two-tailed, with a significance level of $\alpha$ = 0.05. p 0.05 was considered statistically significant.

A total of 120 PGT patients were enrolled, of whom two changed their treatment plan halfway through, and five patients failed to follow up. Ultimately, 113 PGT patients completed the intervention, including 58 patients in the intervention group and 55 in the control group (Fig. 1), which is within the expected sample size range and meets the sample size requirement. No statistically significant differences were found between the two groups regarding age, education level, family income, occupation, and reasons for undergoing PGT (p $>$ 0.05) (Table 1).

Fig. 1.

Flow chart. The flowchart illustrates the step-by-step process of this study. PGT, preimplantation genetic testing; n, number of samples.

At baseline assessment, the intervention group (n = 58) exhibited 17 cases (29.3%) of probable anxiety and 8 cases (13.8%) of definite anxiety, while the control group (n = 55) showed 20 cases (36.4%) of probable anxiety, 3 cases (5.5%) of definite anxiety, and 2 cases (3.6%) of significant anxiety. Following the intervention, the anxiety profile demonstrated notable changes: in the intervention group, probable anxiety cases decreased to 16 (27.6%) with only 2 cases (3.4%) of definite anxiety remaining; conversely, the control group displayed an increase to 24 cases (43.6%) of probable anxiety along with 5 cases (9.1%) of definite anxiety and persistent 2 cases (3.6%) of significant anxiety. No statistically significant differences in the total HAMA and dimension scores were found between the intervention and control groups pre-intervention (p $>$ 0.05). Total HAMA and dimension scores were lower in the intervention group than in the control group post-intervention, with statistically significant differences (p 0.05). No statistically significant differences were found in HAMA and dimension scores within the control groups when comparing post-intervention and pre-intervention values (p $>$ 0.05). Post-intervention, the intervention group demonstrated significantly lower HAMA and dimension scores compared to the pre-intervention values (p 0.05) (Table 2).

No statistically significant difference was found between the intervention and control groups in the total social support score and dimension scores pre-intervention (p $>$ 0.05). However, total social support, objective support scores and support utilization subscales were higher in the intervention group than in the control group post-intervention, with statistically significant differences (p 0.05). Although the intervention group demonstrated numerically higher scores for subjective support, the difference did not reach statistical significance (both p $>$ 0.05). No significant differences were observed in the scores of SSRS total score and dimension scores (subjective support and support utilization) in the control group pre- and post-intervention (p $>$ 0.05). However, the objective support score significantly increased following the intervention (p 0.05), indicating a statistically meaningful improvement. Post-intervention, the intervention group demonstrated significantly higher social support and dimension scores compared to the pre-intervention values (p 0.05) (Table 3).

No statistically significant difference in PGT knowledge questionnaire scores was found between the two groups pre-intervention (p $>$ 0.05). PGT knowledge questionnaire scores were higher in the intervention group than in the control group post-intervention, with a statistically significant difference (p 0.05). PGT knowledge questionnaire scores of both the control and the intervention group were higher post- than pre-intervention, with statistically significant differences (p 0.05) (Table 4).

The health education satisfaction score of the intervention group was higher than that of the control group post-intervention, and the difference was statistically significant (p 0.05) (Table 5).

Anxiety is a common manifestation of various mental disorders, characterized by intense, overwhelming, and persistent feelings of worry and fear that can escalate within minutes, often accompanied by physiological symptoms. Patients undergoing ART for pregnancy frequently experience adverse emotions, including anxiety and apprehension, because of the intricate nature of the process, high costs, and unpredictable treatment outcomes [12, 13]. Furthermore, many patients’ spouses are who are unable to accompany them during treatment, resulting in a lack of psychological and social support, which exacerbates their negative emotions. In this study, the HAMA was employed to provide more objective assessments, minimizing patient subjectivity. However, administering the HAMA requires trained professionals with specialized expertise for proper evaluation. A study has reported [14] that a considerable proportion of IVF patients still have substantial emotional problems from before treatment and up to six months after treatment. In the six months following unsuccessful treatment, $>$20% of the women showed subclinical forms of anxiety and/or depression. Our findings revealed the intervention group (n = 58) exhibited 17 cases (29.3%) of probable anxiety and 8 cases (13.8%) of definite anxiety, while the control group (n = 55) showed 20 cases (36.4%) of probable anxiety, 3 cases (5.5%) of definite anxiety, and 2 cases (3.6%) of significant anxiety. Goldman et al. [15] argues that patients undergoing PGT not only endure stress from IVF-ET but also from genetic testing of embryos. Chronic negative emotions can disrupt the female endocrine function, affect the hypothalamic-pituitary-ovarian (HPO) axis, and lower pregnancy success rates [16]. In the present study, PGT-assisted pregnancy patients were grouped with their family members during the family-centered group health education process. This not only enhanced patient-to-patient communication but also improved the interaction between patients and their families. It enabled patients to adopt a more positive attitude toward their condition, confront their disease more positively, and facilitate improved communication with healthcare providers. Grouping patients and families increased psychological and social support. The results revealed that post-intervention, patients in the observation group experienced significantly lower anxiety levels compared to those in the control group. Following the intervention, the anxiety profile demonstrated notable changes: in the intervention group, probable anxiety cases decreased to 16 (27.6%), with only 2 cases (3.4%) of definite anxiety remaining. This suggests that the family-centered group health education model effectively reduces anxiety among patients undergoing PGT, aligning with previous research findings [17].

Social support involves individuals assisting vulnerable groups through supportive actions, helping them manage challenges effectively. It is divided into objective support, subjective support, and utilization of support [18]. PGT patients often have a history of abnormal fertility, recurrent miscarriages, chromosomal abnormalities, or carry abnormal genes [19]. Patients, influenced by the traditional Chinese culture, might experience guilt toward their families and concerns about how friends and relatives perceive them. This can result in an avoidance of treatment, reluctance to confront the support and concern from loved ones, and a decline in interpersonal communication and social engagement. Furthermore, the patient’s husband may not be frequently present during treatment, leading to a lack of social support for the patient. Matsubayashi et al. [20] suggest that adverse emotions in patients undergoing ART-assisted pregnancies largely stem from insufficient family support and care, underscoring the crucial role of family involvement and companionship throughout the treatment process. Research shows that greater social support correlates with more spiritual and material aid, improved disease knowledge, better marital quality, and reduced anxiety levels [21, 22]. This study adopted a family-centered group health education approach, allowing patients and family members to participate together, thereby strengthening their communication and enhancing the patient’s psychological and social support. To assess the influence of family-centered education on patients’ social support, the SSRS was selected for its efficiency and strong practicality compared to alternative assessment tools. Our findings showed that the total social support, objective support scores and support utilization of the intervention group were higher than those of the conventional control group. However, there were no statistically significant differences observed in the dimensions of patients’ subjective support may be attributed to several potential factors, including insufficient intervention frequency, limited intervention methods and formats, and possibly inadequate sample size. These aspects will be systematically improved in future studies.

Routine health education for ART patients primarily involves verbal explanations from medical staff, where patients typically receive information about the disease and treatment plans in a passive manner. However, this approach has several drawbacks, including unilateral one-sided information delivery and a lack of engagement due to repetitive formats [23]. Moreover, different medical professionals manage various stages of treatment, leading to inconsistencies in health education. As a result, there is often low cooperation between doctors and patients, which can hinder treatment. The management structure implemented in our research integrates professionals from reproductive medicine, laboratory embryology, and nursing specialties. The intervention team develops the curriculum, encompassing face-to-face instruction and online Q&A sessions that systematically, comprehensively, and continuously address every stage of PGT treatment. Integrating images, videos, live demonstrations, and various teaching techniques creates an educational experience that engages both visual and auditory senses. This approach not only makes health education more appealing but also sidesteps the downsides of conventional rote learning. The results show that the disease knowledge questionnaire scores of the patients in the intervention group were significantly higher than those in the control group. This indicates that the family-centered group health education model is more effective in addressing the disease and treatment needs of patients and their spouses, consistent with the research findings of Yang et al. [24].

The family-centered group health education model employs a group teaching format that incorporates various methods, including video and audio playback, live explanations, and visual displays. These approaches offer a broader range and deeper content. It also meets patients’ disease knowledge needs and ensures timely access to disease and treatment knowledge through online science articles, videos, and WeChat Q&A. A thorough understanding of the treatment process helps patients make informed decisions, thereby enhancing their overall medical experience. Compared to conventional health education, the family-centered group health education model transforms patients from passive recipients to active participants. This shift not only promotes a mutually trusting relationship between nurses and patients [25] but also more effectively addresses patients’ concerns. This model reduces feelings of loneliness by fostering support from medical staff, family members, and peers. Moreover, the communication platform it establishes enables patients to connect with others who share similar experiences, facilitating mutual support and promoting navigation of the treatment process. A survey on health education satisfaction was also conducted post-intervention. It was found that the health education satisfaction scores of the intervention group were significantly higher than those of the control group, indicating that the family-centered group health education model can effectively improve patient satisfaction.

This study aimed at the unique population of PGT patients, which enhanced the specificity of the study. At present, there are few reports on health education for PGT patients, and the application of the group management model in this population is particularly scarce. Therefore, this study has certain innovations. However, due to the limitations in time, manpower, resources, and funding, this study was conducted at a single reproductive center. As a result, the representativeness of the study population may be limited, which restricts the generalizability of findings to some extent. This study focuses on investigating HAMA and social support and analyzes and discusses them. Because the PGT knowledge questionnaire and the health education satisfaction questionnaire are self-made and lack universality, the investigation and discussion are insufficient. The intervention time was relatively short, and there was no long-term follow-up of patients; therefore, the sustained impact of the intervention could not be assessed. These limitations will be addressed and improved upon in future research.