Assessing Cultural Equivalence of a Translated Birth Preparedness and Complications Readiness Education Manual among Hehe Pregnant Women in Southern Tanzania

Background: Effective Birth Preparedness and Complications Readiness (BPC) communication depends on culturally and linguistically equivalent terminologies. In Tanzania, PPCR materials are often translated into Swahili without systematic assessment of cultural equivalence, which may prevent their cultural relevance and effectiveness. Guided by Cultural Equivalence Theory, aimed to explore locally appropriate language that accurately conveys the intended meaning of BPCR. Methods: A descriptive qualitative study design using focus group discussion in seven villages in two districts in Iringa, Southern Tanzania. Seven FGDs were conducted in Swahili using an interview guide developed from Swahili-translated BPCR content to explore pregnant women’s interpretations of Swahili BPCR concepts. It included 58 women purposively sampled until data saturation was achieved. Data were analyzed thematically to identify patterns of cultural equivalence in terminologies and concepts. Results: The mean age of the women was 28.4 years; they experienced two to three pregnancies and completed primary school. Five themes emerged: (1) cultural and linguistic adaptation enhances comprehension of BPCR concepts; (2) experiential and contextual re-expressing shapes understanding of danger signs; (3) sociolinguistic norms and modesty influenced health communication; (4) partial semantic equivalence and gaps in medical concepts: cord prolapse and neonatal cyanosis; (5) supplement explanatory strategies to bridge conceptual gaps. Conclusion: The findings show that effective BPCR education requires more than word-for-word translation; it must be adapted to the local culture by incorporating local language, real-life experiences, and social language norms and supplementing visual aids with contextual explanations to improve understanding and acceptance. Policymakers and program designers should prioritize culturally responsive revisions of BPCR materials to strengthen maternal and newborn health outcomes in rural and linguistically diverse settings.