Implementing a Community-Centered Approach to Gestational Diabetes Screening in Rural Guatemala: A Process Report

Introduction: Gestational diabetes (GD) screening remains limited in many low- and middle-income countries (LMICs) due to resource constraints, limited training, and low community awareness. Although community-centered approaches may improve access to screening in rural and Indigenous settings, the implementation processes through which such approaches are designed and operationalized are rarely documented. Methods: This study presents a community-based implementation process report describing the development, adaptation, and early implementation of a GD screening program in rural Guatemala, guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) implementation science framework. Using a participatory approach, international screening guidelines were systematically adapted to the local context through iterative protocol refinement, structured stakeholder engagement, and ongoing feedback from community health educators and partner institutions. Aggregate program data were used descriptively to characterize early screening uptake and feasibility. Results: Key implementation challenges included patient no-shows, community skepticism, and difficulties among health educators in interpreting screening procedures. Iterative adaptations were introduced to simplify protocols, reduce loss to follow-up, and strengthen community engagement. Over time, the program expanded from point-of-care screening to more comprehensive prenatal services and increased collaboration with the Ministry of Health and local community outlets. A total of 103 Indigenous Mayan Tz'utujil women were screened (mean age: 26.9 years; range: 15-46), of whom, 12 were diagnosed with GD. Conclusions: This implementation process report demonstrates the scientific value of systematically documenting real-world adaptation, feasibility, and stakeholder engagement when introducing GD screening in rural Indigenous LMIC settings. The implementation lessons described may inform similar maternal health initiatives in comparable contexts.