Digital Health-Based Peer Support Ecosystem for Gestational Diabetes Mellitus in Vietnam (VALID II Study):...

Gestational diabetes mellitus (GDM) is associated with fetal overgrowth, increased risks of perinatal morbidity and mortality, and long-term complications for mother and child, including cardiovascular disease and type 2 diabetes. Innovative, peer-based digital health interventions are emerging globally as a potential approach to assist and empower women in effective self-care and well-being during pregnancy. However, there remains substantial potential to develop and evaluate culturally sensitive digital health interventions for pregnant women with GDM, especially in low- and middle-income countries.

This study aimed to bridge the gap between the World Health Organization (WHO) self-care framework and local practice by designing and piloting the "Healthy Pregnancy" intervention, a multiplatform digital ecosystem for women with GDM in northern Vietnam, through a staged cocreation and pilot refinement process.

Between December 2022 and February 2024, drawing on the WHO's conceptual framework for self-care and cocreation approach, we iteratively developed "Healthy Pregnancy," a digital health intervention, in 4 stages: (1) formative studies and self-care construct prioritization, (2) cocreation processes with key stakeholders, (3) development and design translation, and (4) pilot testing and final refinement.

In stage 1, we identified gaps in current digital health interventions in low- and middle-income countries, explored the sociocultural realities of women with GDM in Vietnam, and prioritized 7 self-care constructs. In stage 2, we conducted a cocreation workshop to enable key stakeholders to co-design the foundational infrastructure for the potential intervention. In stage 3, we established a multicomponent digital intervention ecosystem with explicitly defined operating workflows. Finally, in stage 4, we gathered suggestions for a digital health intervention from a pilot test group of pregnant women with GDM, to refine and optimize the system schematic and information flow before moving to the real intervention.

By applying a cocreation approach across all stages of development of the "Healthy Pregnancy" digital health intervention, from problem identification to solution development and evaluation, we developed a locally tailored GDM self-care model. This process not only addressed gaps in standard care but also empowered pregnant women through a supportive, multiple-stakeholder environment. This study demonstrates a rigorous cocreation pathway for systematically translating WHO self-care constructs into a feasible, culturally adapted digital ecosystem for GDM in Vietnam and offers a transferable, people-centered design process alongside a practical blueprint for integration into routine maternal care.