Development and evaluation of a culturally adapted birth preparedness and complication readiness training among Hehe pregnant women in rural Tanzania: exploratory sequential mixed-methods study

Background: Birth preparedness and complication readiness (BPCR) education promotes childbirth preparation, recognition of danger signs, and timely care-seeking. However, translation alone may not ensure that BPCR messages are culturally and conceptually meaningful. The objective of the study is to develop and evaluate culturally adapted BPCR training guided by Cultural Equivalence Theory among Hehe pregnant women in rural Iringa, Tanzania, and assess its effects on knowledge, attitudes, and practices compared with standard Kiswahili-translated training. Methods: An exploratory sequential mixed-methods design will be used. The qualitative phase will explore women’s understanding of BPCR concepts and identify culturally meaningful terminology and explanations. Findings will inform manual adaptation through translation, expert review, community input, cognitive review, and pilot testing. The quantitative phase will use a controlled pretest–posttest quasi-experimental design in two rural districts. BPCR knowledge, attitudes, and practices will be assessed at baseline and approximately four weeks after training. Qualitative data will undergo thematic analysis, while quantitative data will be analyzed using mixed-effects regression and Difference-in-Differences analysis. Conclusions: The study will assess whether culturally adapted BPCR training provides additional benefits over standard translated training and inform culturally responsive maternal health education in rural Tanzania. Trial Registration: Pan African Clinical Trials Registry: PACTR202607626025411.