Effect of a Culturally Adapted Birth Preparedness and Complication Readiness Training Intervention on Attitudes and Practices among Hehe Pregnant Women in Rural Iringa, Tanzania: A Controlled Pretest–Posttest Quasi-Experimental Study

Abstract Background Birth preparedness and complication readiness (BPCR) are important components of maternal health, yet educational interventions may be less effective when health messages are not culturally and linguistically relevant. This study evaluated the effect of a culturally adapted BPCR training intervention on attitudes and practices 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. Participants were allocated to a Culturally Adapted BPCR Training group (n = 88) or a Standard Translated BPCR Training group (n = 88). BPCR attitudes and practices were assessed before and four weeks after the intervention. Within-group changes were assessed using paired-samples t -tests, between-group differences using independent-samples t -tests, and intervention effects using Difference-in-Differences regression. Adjusted linear regression was also used to examine factors associated with post-test outcomes. Results The 176 participants had a mean age of 26.47 ± 6.13 years. At baseline, practice scores did not differ significantly between groups (7.41 ± 2.25 vs. 7.85 ± 1.78, p = 0.150), whereas attitude scores were lower in the intervention group (21.58 ± 3.47 vs. 24.69 ± 5.11, p < 0.001). At post-test, practice scores were higher in the intervention group (9.60 ± 1.40 vs. 9.03 ± 1.58, p = 0.012), while attitude scores were similar between groups (24.41 ± 4.31 vs. 24.86 ± 4.31, p = 0.482). The DiD analysis showed significantly greater improvements in attitudes (β = 2.55, 95% CI: 0.74–4.35, p = 0.006) and practices (β = 0.99, 95% CI: 0.24–1.74, p = 0.010) in the culturally adapted group. In adjusted regression, intervention assignment was associated with higher post-test practice scores (β = 0.658, 95% CI: 0.203–1.112, p = 0.005), but not with post-test attitude scores (β = −0.137, 95% CI: −1.509–1.235, p = 0.844). Conclusions Culturally Adapted BPCR education was associated with greater improvements in attitudes and practices than Standard Translated education among Hehe pregnant women in rural Tanzania. These findings support consideration of cultural and linguistic adaptation when developing BPCR education for culturally distinct populations. However, the findings should be interpreted in light of the quasi-experimental design, district-level allocation, baseline imbalance in attitudes, short follow-up, and the inability to directly assess mechanisms underlying the observed changes. Trial Registration Pan African Clinical Trials Registry PACTR202607626025411, registered retrospectively on 09 July 2026 https://pactr.samrc.ac.za