Effectiveness of a Combined Peer and Digital-led Intervention Program for College Students with High-Risk Sexual Behaviors: A Randomized Controlled Trial Based on the Behavior Change Wheel Model

Effectiveness of a Combined Peer and Digital-led Intervention Program for College Students with High-Risk Sexual Behaviors: A Randomized Controlled Trial Based on the Behavior Change Wheel Model | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effectiveness of a Combined Peer and Digital-led Intervention Program for College Students with High-Risk Sexual Behaviors: A Randomized Controlled Trial Based on the Behavior Change Wheel Model Rong Zhang, Xinya Xu, He Xu, Hongyan Zhang, Xiaohui Liang, Tao Peng, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8358162/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Background Risky sexual behavior (RSB) among college students is a major public health concern, leading to high rates of sexually transmitted infections (STIs) and adverse outcome. Traditional educational interventions often fail to translate knowledge into sustained behavioral change. The Behavior Change Wheel (BCW) theory provides a systematic framework for developing theory-informed interventions. This study aimed to develop and evaluate the effectiveness of a BCW-based intervention, combining peer and digital-lead intervention, to reduce RSB among Chinese college students. Methods A two-phase study was conducted. Phase 1 involved a qualitative study (n = 15) to identify barriers and facilitators to safer sex, a literature review, and a Delphi expert consultation (n = 13) to develop the intervention. Phase 2 was a randomized controlled trial to assess the effectiveness of the intervention. Seventy-six college students with a history of RSB were recruited and randomly assigned to the intervention group (n = 38) and control group (n = 38). The intervention group received a 6-week, peer and digital-lead ("SiLiang Health") intervention, while the control group received routine sexual health education. Primary outcomes were the frequency of RSB and risk perception. Secondary outcomes were psychosexual health and sense of shame related to sexuality. Assessments were conducted at baseline (T0), immediately post-intervention (T1), and one-month post-intervention (T2). Intention-to-treat (ITT) was used and data were analyzed using Generalized Estimating Equations (GEE). Results The analyses revealed significant group-by-time interaction effects on all outcome variables. For the primary outcome of RSB frequency, the intervention group showed a marked decrease from a baseline mean (SD) of 3.42 (1.00) to 2.51 (0.69) at T1 and 1.97 (0.71) at T2, with the reduction being significantly greater than that in the control group (p < 0.01; Cohen's d at T2 = 0.87). Risk perception scores increased significantly in the intervention group from 2.03 (1.37) at baseline to 4.54 (1.30) at T1 and 4.51 (1.44) at T2, with a significant group effect (p < 0.01) and a large effect size (Cohen's d at T1 = -2.20). It also confirmed significant improvements in psychosexual health in the intervention group, with lower scores on the sexual cognition and sexual attitude subscales (p < 0.01), and a pronounced reduction in the sense of shame (p < 0.01), all effect sizes ranging from medium to large. Conclusions BCW theory-based intervention, combining peer-led group sessions and digital support, is effective to reducing RSB and improving sexual health outcomes among college students. This intervention model offers a practical and engaging paradigm for healthcare professionals and educators working in adolescent and young adult health. Trial registration: Clinical registration number: NCT12345678(30/05/2024) . Risky Sexual Behavior College Students Behavior Change Wheel Peer-led Intervention Digital Health Randomized Controlled Trial Full Text Additional Declarations No competing interests reported. Table 1 to 3 are available in the Supplementary Files section. Supplementary Files Supplementtable.docx Tablesnew.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 15 Mar, 2026 Reviewers invited by journal 06 Mar, 2026 Editor invited by journal 10 Feb, 2026 Editor assigned by journal 30 Dec, 2025 Submission checks completed at journal 30 Dec, 2025 First submitted to journal 30 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8358162","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":603349699,"identity":"076f7034-9ae1-4cb3-8fdb-3b74a0d78918","order_by":0,"name":"Rong Zhang","email":"","orcid":"","institution":"Harbin Medical University","correspondingAuthor":false,"prefix":"","firstName":"Rong","middleName":"","lastName":"Zhang","suffix":""},{"id":603349700,"identity":"23245fd8-393f-48fe-bacd-07ad5af1da04","order_by":1,"name":"Xinya Xu","email":"","orcid":"","institution":"Harbin Medical 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High-Risk Sexual Behaviors: A Randomized Controlled Trial Based on the Behavior Change Wheel Model","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Risky Sexual Behavior, College Students, Behavior Change Wheel, Peer-led Intervention, Digital Health, Randomized Controlled Trial","lastPublishedDoi":"10.21203/rs.3.rs-8358162/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8358162/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eRisky sexual behavior (RSB) among college students is a major public health concern, leading to high rates of sexually transmitted infections (STIs) and adverse outcome. Traditional educational interventions often fail to translate knowledge into sustained behavioral change. The Behavior Change Wheel (BCW) theory provides a systematic framework for developing theory-informed interventions. This study aimed to develop and evaluate the effectiveness of a BCW-based intervention, combining peer and digital-lead intervention, to reduce RSB among Chinese college students.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA two-phase study was conducted. Phase 1 involved a qualitative study (n\u0026thinsp;=\u0026thinsp;15) to identify barriers and facilitators to safer sex, a literature review, and a Delphi expert consultation (n\u0026thinsp;=\u0026thinsp;13) to develop the intervention. Phase 2 was a randomized controlled trial to assess the effectiveness of the intervention. Seventy-six college students with a history of RSB were recruited and randomly assigned to the intervention group (n\u0026thinsp;=\u0026thinsp;38) and control group (n\u0026thinsp;=\u0026thinsp;38). The intervention group received a 6-week, peer and digital-lead (\"SiLiang Health\") intervention, while the control group received routine sexual health education. Primary outcomes were the frequency of RSB and risk perception. Secondary outcomes were psychosexual health and sense of shame related to sexuality. Assessments were conducted at baseline (T0), immediately post-intervention (T1), and one-month post-intervention (T2). Intention-to-treat (ITT) was used and data were analyzed using Generalized Estimating Equations (GEE).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe analyses revealed significant group-by-time interaction effects on all outcome variables. For the primary outcome of RSB frequency, the intervention group showed a marked decrease from a baseline mean (SD) of 3.42 (1.00) to 2.51 (0.69) at T1 and 1.97 (0.71) at T2, with the reduction being significantly greater than that in the control group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01; Cohen's d at T2\u0026thinsp;=\u0026thinsp;0.87). Risk perception scores increased significantly in the intervention group from 2.03 (1.37) at baseline to 4.54 (1.30) at T1 and 4.51 (1.44) at T2, with a significant group effect (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and a large effect size (Cohen's d at T1 = -2.20). It also confirmed significant improvements in psychosexual health in the intervention group, with lower scores on the sexual cognition and sexual attitude subscales (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), and a pronounced reduction in the sense of shame (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), all effect sizes ranging from medium to large.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eBCW theory-based intervention, combining peer-led group sessions and digital support, is effective to reducing RSB and improving sexual health outcomes among college students. This intervention model offers a practical and engaging paradigm for healthcare professionals and educators working in adolescent and young adult health.\u003c/p\u003e\u003ch2\u003eTrial registration:\u003c/h2\u003e \u003cp\u003eClinical registration number: NCT12345678(30/05/2024) .\u003c/p\u003e","manuscriptTitle":"Effectiveness of a Combined Peer and Digital-led Intervention Program for College Students with High-Risk Sexual Behaviors: A Randomized Controlled Trial Based on the Behavior Change Wheel Model","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-11 07:32:13","doi":"10.21203/rs.3.rs-8358162/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"224624191508186426076449912768309300668","date":"2026-03-15T13:12:15+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-06T11:58:19+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-10T09:24:09+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-31T04:01:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-30T13:10:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-12-30T13:01:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"521b9402-5988-4762-aec9-afd2a4f46f98","owner":[],"postedDate":"March 11th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-11T07:32:13+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-11 07:32:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8358162","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8358162","identity":"rs-8358162","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}