Reducing maternal, perinatal, and non-communicable disease risks in pregnant women in Brazil: Cross-cultural validation of the SMARThealth Pregnancy intervention with a Pilot Study

Abstract

BACKGROUND: Prenatal and postpartum care stands out as a facilitator of access to health services for women, allowing the identification and treatment of non-communicable diseases such as gestational diabetes mellitus (GDM), hypertensive disorders (HDP) and anaemia and interrupting transgenerational cycles of morbidity and mortality.JUSTIFICATION: Considering the territorial dimension and the heterogeneity of socioeconomic scenarios in Brazil, it is justifiable and urgent to implement public policies integrated with innovative strategies that offer clinical decision support systems based on clinical risk factors and current guidelines for early diagnosis and timely interventions in primary care, such as SMARThealth Pregnancy (SHP). OBJECTIVES: The general aim is to achieve cross-cultural adaptation and evaluate the feasibility and acceptability of the SHP for preventing non-communicable chronic diseases (GDM, HDP, and anemia) in pregnant women in Brazil. The specific objectives are: (1) To incorporate Brazilian guidelines into the SHP clinical decision support algorithm, translation into Portuguese, transcultural adaptation and validation of the SHP for the Brazilian public health care scenario; (2) Assess the feasibility and acceptability of implementing an international collaboration program (SHP) for the prevention of non-communicable diseases during pregnancy and after birth.CASUISTIC AND METHODS: The phase of incorporation of Brazilian clinical guidelines, cross-cultural adaptation and validation of the SHP for the Brazilian public assistance scenario will be a cross-sectional study using a descriptive model with mixed methods. The pilot phase assessing the feasibility and acceptability of the SHP-Brazil for the prevention of chronic non-communicable diseases in Brazil will be an open, cluster-randomized clinical trial conducted at primary health care centres in Ribeirão Preto-SP/Brazil, including health professionals and 200 pregnant women undergoing prenatal care. The primary health centres will be cluster-randomized into two groups: control group (routine prenatal and postpartum care) and intervention group (prenatal and postpartum care guided by the SHP-Brazil). The SHP intervention includes three components: (1) an educational component aimed at primary care healthcare professionals, (2) the mHealth platform that provides clinical decision support, and (3) an AI chatbot to support and provide lifestyle guidance for women and their families involved. EXPECTED RESULTS: The cross-cultural validation process for the Brazilian scenario and assessment of feasibility and acceptability will ensure that it is culturally sensitive and linguistically accurate. The pilot study will be carried out in primary care, seeking to evaluate the acceptability and implementation capacity of the program in the Brazilian reality. With the results of this project, it will be possible to propose testing the SHP strategy in a large-scale randomized clinical trial in the country, evaluating its effectiveness in meeting the specific needs of Brazilian pregnant women, optimizing its potential positive impact on maternal health and that of their descendants in the short term, and long term across the country.