Table 1 Development steps for adaptation of DPP content to pGDM Latina women

Step 1: Characterizing the evidence-practice gap regarding diabetes prevention behaviors that are essential components of the DPP, for pGDM women and their families

Regional Consortium (RC) review of DPP curriculum and other intervention literature to identify: 1. diabetes prevention topics a most relevant to pGDM women and 2. potential health coaching delivery methods.

DPP curriculum selected targeting physical activity, stress relief, and healthy eating, with added emphasis on breastfeeding, infant care, mental health, family centered and peer-based social support, and health literacy skill building.

Message framing emphasizes emotional truths encountered for women, especially in the context of migration: e.g., the positive role of mothers as intergenerational custodians of family health, and the stress and sorrow of social isolation and challenges in reaching out to others for help.

Conduct of focus groups (FG) 1 and 2 to identify barriers and enablers among pGDM women about diabetes prevention activities in both rural and urban settings.

Step 2: Understanding barriers and enablers for diabetes prevention among postpartum women

RC review of FG data and pros and cons of different health IT technologies, such as ATSM, texting, or radionovellas.

ATSM-text blended model selected (vs text alone) with weekly format.

ATSM calls adapted in Spanish and English and calls dispatched at participant’s preferred times.

Step 3: Identifying which barriers and enablers need to be addressed

Analysis of FG data and mapping of theoretical constructs from TDF/COM-B relevant to identified barriers and enablers.

Added narratives addressing low risk perceptions, limited ability to leave house for exercise, tips for understanding nutrition and labels and on eliciting partner support in family health.

Prioritization of skill building around nutrition, and detailed examples of how women achieved successes for their family. Women’s preferences reflected 4–5 minute weekly calls with questions, narratives, and texting opt in tips.

Creation of recorded prototype behavioral questions, narratives, and texting examples to elicit reactions in FG 3–4 and identify additional content.

Step 4: Determining which intervention components, including behavior change techniques and modes of delivery, could overcome the modifiable barriers identified, and enhance the enablers

Final selection of content and frequency and duration of STAR MAMA based on barriers identified through FG 3–4 and enablers suggested by participants.

Delivery of behavior change support, diabetes prevention messages, and educational health coaching through the ATSM model.

Adaptations to narratives, queries and texts within the ATSM model to account for family values, key challenges (such as community influencers) and the desire to maintain cultural traditions while balancing a healthy lifestyle.

Step 5: Determining which policy categories could help encourage STAR MAMA content to be delivered in targeted settings

Creation of health coaching training materials to deliver to partner organizations involved in STAR MAMA, primarily WIC nutritionists who would be delivering health coaching call backs to STAR MAMA participants (service delivery).

For each of the weeks and for each of the queries and narratives included in STAR MAMA calls, there was a companion health coaching guide for use in call backs.

The RC reviewed these for acceptability to partners involved in STAR MAMA, primarily clinic staff at the primary care, high-risk obstetrics, and WIC programs that were involved in the pilot.