Effect of a culturally adapted birth preparedness and complication readiness training intervention on knowledge among Hehe pregnant women in rural Iringa Tanzania: A controlled pretest-posttest quasi-experimental study

Abstract Background: Birth preparedness and complication readiness (BPCR) knowledge is important for recognizing maternal and newborn danger signs and preparing for timely care. However, conventional translation of BPCR educational materials may not adequately address local linguistic and cultural contexts. This study evaluated whether a culturally adapted Swahili BPCR training manual improved knowledge more than a standard translated Swahili BPCR training manual among Hehe pregnant women in rural Iringa, Tanzania. Methods: A controlled pretest-posttest quasi-experimental study was conducted among 176 pregnant women attending antenatal care in Mufindi and Kilolo districts. Eighty-eight women received the Culturally Adapted Swahili BPCR Training Manual and 88 received the Standard Translated Swahili BPCR Training Manual. Both groups received comparable BPCR education with standardized session duration, delivery format, language, and follow-up procedures. BPCR knowledge was assessed using a 64-item questionnaire at baseline and four weeks after the intervention. The primary analysis used Difference-in-Differences regression to compare changes in knowledge between groups. Multiple linear regression was used to assess the association between intervention-group assignment and post-intervention knowledge after adjustment for baseline knowledge and participant characteristics. Results: All 176 participants completed both assessments. Mean knowledge scores increased from 21.01 (SD 7.42) to 38.49 (SD 7.54) in the culturally adapted group and from 22.51 (SD 5.80) to 32.81 (SD 5.55) in the standard translated group. The culturally adapted group demonstrated a 7.18-point greater increase in knowledge than the standard translated group ({beta} = 7.18, 95% CI: 4.40-9.97; p < 0.001). After adjustment for baseline knowledge, age, education, gravidity, marital status, living arrangement, reading ability, and occupation, intervention-group assignment remained significantly associated with higher post-intervention knowledge ({beta} = 5.88, 95% CI: 3.84-7.92; p < 0.001). Conclusion: Culturally adapted BPCR education was associated with greater short-term improvement in knowledge than standard translated education among Hehe pregnant women. Integrating culturally and linguistically appropriate terminology, contextual explanations, and locally meaningful communication into BPCR education may strengthen knowledge outcomes. Multisite studies with stronger allocation procedures and longer follow-up are needed to confirm these findings.