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The importance of information and communication technology in rural areas has gradually become prominent, and rural e-commerce has emerged as a crucial driver for promoting agricultural and rural development. This paper takes the comprehensive demonstration policy for e-commerce in rural areas as a quasi-natural experiment. It is based on five-period panel data from the China Family Panel Studies (CFPS) and employs the staggered difference-in-differences method to examine the impact of e-commerce on rural women entrepreneurship and its mechanisms. The research results indicate that the implementation of the comprehensive demonstration policy for e-commerce in rural areas significantly increases the probability of rural women engaging in entrepreneurship by 1.6 %. The entrepreneurial promotion effect of this demonstration policy is more pronounced for rural women in the central and western regions and those with lower educational levels, demonstrating the inclusiveness of e-commerce in rural development. Additionally, this promotion effect is also significantly influenced by marital heterogeneity. Mechanism analysis results suggest that the comprehensive demonstration policy for e-commerce in rural areas can stimulate the use of information and communication technology by rural women, leverage the crucial role of non-traditional education in skill development, alleviate financial and social capital constraints for rural women, and inspire a wave of rural women entrepreneurship. The paper argues that the construction of rural e-commerce has the potential to empower rural women entrepreneurship. [ABSTRACT FROM AUTHOR]

Abstract Background Several rural public health facilities in East Central Uganda have sub-optimal, below 50%, levels of uptake of cervical cancer screening services among women with HIV. This is attributed to low cervical cancer screening literacy: limited ability to access, understand, appraise, and apply cervical cancer screening information. This research identified multi-level (health facility, community, interpersonal and individual) barriers, and facilitators of accessing, understanding, and applying cervical cancer screening information among rural women with HIV attending rural public health facilities in East Central Uganda to inform interventions. Methods We conducted ten Focus Group Discussions with rural women aged 25–49 years with HIV attending four selected rural public health facilities: thirty women who had ever screened for cervical cancer and thirty women who had never screened for cervical cancer across different age categories. Data was collected using a guide based on the Integrated model of health literacy. Thematic analysis was used for analysis. Competences (accessing, understanding and applying cervical cancer screening information) and categories of factors (health system, community, interpersonal and individual factors) of the integrated model of health literacy were deductively derived whereas barriers and facilitators were deductively derived from women’s statements. Results Lack of communication materials and inability to access information were health facility and individual barriers of accessing cervical cancer screening information respectively. Facilitators of accessing information were access to information at health facility, community, and interpersonal levels and women’s ability to access information. Barriers and facilitators of understanding cervical cancer information were related to communication materials, provision of health education and women’s concentration during health education. Barriers and facilitators of applying cervical cancer screening information were related to communication and provision of cervical cancer screening services at health facility level, and interpersonal level from peers, partners and other family members as well as women’s ability to: understand information and access to cervical cancer screening services at individual level. Conclusions This study emphasizes the influence of multi-level factors on cervical cancer screening literacy among rural women with HIV attending rural public health facilities in East Central Uganda. Improving uptake of cervical cancer screening services among these women requires multi-level interventions.

Abstract This study endeavors to formulate a sustainable development-oriented model for home-based businesses catering to rural women in Guilan province. Employing a qualitative-quantitative research approach, the study is practical in its objectives and relies on survey methods for data collection. The research population encompasses two main groups: the first group involves academic professionals, scholars, and managers or experts from provincial organizations dedicated to employment and women’s issues, while the second group comprises 274 purposefully sampled individuals, including owners, managers, and women affiliated with micro-credit funds in Guilan province, selected through the snowball technique. Semi-structured interviews were conducted to gather data, and the Smart-PLS software package utilized the partial least squares (PLS) technique for advanced multivariate analysis in structural equation modeling. Evaluation of the home-based business development model for rural women, based on the coefficients of the direct path, reveals that educational (β = 0.112), social (β = 0.232), economic (β = 0.274), and policymaking (β = 0.381) variables significantly influence the sustainable development of home-based businesses (P

Background: The multidimensional health poverty afflicting rural women of reproductive age bears profound implications for the sustainable development of families, societies, and healthy villages. Elucidating vulnerable groups at risk of multidimensional health poverty and delineating its determinants can inform refinements and implementation of health-poverty alleviation policies. Methods: Based on the 2022 "Health Status and Health Service Utilization" survey data in rural Ningxia, China, this study analyzes the dimension of health status, capacity for health service utilization, health expenditure and security using the A-F dual-threshold method, logit model, and probit model. It comprehensively evaluates multidimensional health poverty and analyzes its determining factors among rural women of childbearing age. Results: With k set at 0.3, the health multidimensional poverty index, incidence, and intensity among rural women of reproductive age were 0.021, 0.053, and 0.392, respectively. Chronic illness, capacity for free gynecological examination utilization, health examination utilization, and borrowing due to illness contributed significantly to multidimensional health poverty. Risk factors for multidimensional health poverty among rural women of childbearing age include age, unemployment, family size, and lack of sanitary toilets. Protective factors include being married, educational level, non-farm or student occupation, receiving government support, separate housing and kitchen, owning a television and computer. Conclusions: Even with the elimination of absolute poverty, the multidimensional health poverty situation among rural women remains important from a gender perspective. It is recommended to strengthen economic assistance and health service support for these groups, improve the level of rural health services from a gender perspective, and enhance housing structure and sanitation toilet usage in rural areas. Efforts should be made to narrow the digital divide in rural areas and promote digital health education. Pre-interventions on multidimensional health poverty can provide new pathways for the development, empowerment, and well-being of rural women of childbearing age. [ABSTRACT FROM AUTHOR]

Background of the study Child marriage is linked with multiple maternal and child health issues. However, there is insufficient information regarding the factors influencing child marriage among rural women. Objective To identify the determinants of child marriage among rural women of reproductive age women in the West Guji Zone, Southern Ethiopia, 2024. Methods A community-based cross-sectional study was conducted from April 1 to May 5, 2024. A multistage sampling procedure was used to select 711 participants. The SPSS version 25 was used for data analysis. A multivariable logistic regression model was fitted to determine the determinants of child marriage. Adjusted odd ratio with a 95% confidence interval was used to assess the strength of the associations, and statistical significance was declared at p < 0.05. Results The prevalence of child marriage was 49.6% (95% CI: 0.472-0.524). Being Muslim (AOR=2.104, 95% CI =1.176-3.764), nonformal fathers’ education (AOR=2.633, 95% CI=1.135-6.109), primary level of fathers’ education (AOR=3.326, 95% CI=1.421-7.787); not exposed to media (AOR=1.56, 95% CI=1.033-2.356); living with a relative (AOR=1.592, 95% CI=1.012-2.504); not knowing the legal age of marriage (AOR=2.528, 95% CI=1.593-4.010); marital decision making by girls (AOR=.666, 95% CI=.463-.959), and poor parental wealth status (AOR=4.464, 95% CI=2.795-7.129) were associated with child marriage. Conclusion Almost one in every two women married before 18 in the study area. The determinant factors include religion, fathers’ level of education, exposure to media, living arrangements; awareness of the legal marital age, marriage decision making, and parents’ wealth status. Thus, intervention efforts should focus on these factors to increase the marital age and improve women’s prospects.

Early screening for cervical cancer has substantially reduced the morbidity and mortality attributed to it. This study aimed to assess factors that affect the intention to undergo cervical cancer screening among rural women attending primary healthcare facilities in south-central Ethiopia. A health-facility-based, cross-sectional study design was employed for which the calculated required sample size was 427. An interviewer-administered structured questionnaire was adapted from previously published research and used to collect data. Statistical Package for Social Sciences (SPSS) version 27 was used for the statistical analysis. A logistic regression model was used to determine the factors that influenced the women’s intention to undergo cervical cancer screening. A total of 420 women participated in this study, with a response rate of 98%. The mean score from the questionnaire that was used to assess the women’s intention to undergo cervical cancer screening was 10.25 (SD ± 2.34; min 3, max 15). The absence of previous screening experience (AOR: 0.498; 95% CI 0.27–0.92) and high degree of perceived behavioural control (AOR, 0.823; 95% CI 0.728–0.930) were significantly negatively associated with women’s intention to undergo cervical cancer screening. Previous screening experience and perceived behavioural control significantly influenced the intention to undergo cervical cancer screening. Women in rural areas could, therefore, benefit from awareness-creation programmes that focus on these factors.

Globally, rural women farmers benefited from only 5% of agricultural extension information, and also only 10% of the agricultural extension facilities, this affects their engagement in agricultural development resulting in an increased rate of poverty and lack of the necessary knowledge of agricultural practice. This study aimed to determine the internal and external factors influencing rural women farmers’ participation in agricultural activities in rural areas of Malaysia. The study was conducted in Ranau, Sabah, Malaysia. A sample size of 248 rural women farmers was selected using simple random sampling. A five-point Likert scale questionnaire was used for data collection. Collected data were subjected to descriptive and factor analysis using Statistical Packages for Social Science (SPSS) version 26. The findings indicated that the factors affecting rural women’s participation in agricultural activities in Ranau, Sabah, encompassed access to financial and agricultural inputs, social culture, land rights, access to land, technology adoption, participation in farm management decisions, limited scope of agricultural policy and access to resource and support for women in agriculture. The present study has provided insights into the factors contributing to women’s participation in agriculture activities. The study suggests that a theoretical model should be proposed to test the relationship between these factors and women’s participation in agriculture, along with research to identify solutions for reducing identified barriers.

Abstract Background Fear of childbirth (FOC) can influence both maternal and child health. Research on FOC in China is scarce, especially on rural women. This study aimed to assess pre- and postpartum FOC and its predictors among Chinese rural women. Methods This was a prospective correlation study. A total of 569 women completed the prenatal questionnaire in the third trimester, and 477 of them completed the postpartum questionnaire within three days after childbirth. Maternal socio-demographic information, clinical information, childbirth self-efficacy and prenatal and postpartum FOC were investigated. FOC was evaluated using the Wijma Childbirth Expectancy/ Experience Questionnaire (WDEQ). Descriptive, bivariate, multivariate linear regression analysis, univariate and multivariate logistic regression analyses were performed. Results The mean pre- and postpartum FOC scores were 64.5 (standard deviation: 25.1) and 64.3 (standard deviation: 23.9), respectively, with 20.8% of women reporting severe fear before childbirth and 18.2% after childbirth. Multivariate linear regression analysis revealed predictors for higher levels of prenatal FOC including higher education level, nullipara, higher monthly household income, lower family support, and lower childbirth self-efficacy (p

Abstract Introduction The health of women is of particular concern because they often have greater health needs than men and many women still lack access to quality healthcare services, preventing their ability to attain the best possible level of health. Hence, this study aimed to assess the accessibility and availability of health services among rural women. Methods A household survey was conducted by using a multi-stage sample with 407 married women aged 18–45 years, having at least one child and living in Tiruchirappalli District, Tamil Nadu were recruited for this study. A semi-structured questionnaire was used to collect data about the demographic status, and accessibility and availability of health services. Results Of the 407 respondents, 70% were aged between 26 and 40 years, 73% were working as farmers and labourers and 77% were living in nuclear families. 71% of them had enjoyed hospital facilities near their residence and 83% of the hospitals were run by the government. In village health nurse service (VHN), 34% of the respondents had received all services from VHN and 86% did not face any kind of gender inequality and almost all of them were satisfied with the service provided by the VHN. Almost all the respondents (98%) were satisfied with the availability of health services and 92% of them benefited from the government scheme related to childbirth. Conclusion This study showed that overall, the women were satisfied with the availability of healthcare services and reproductive health services. Moreover, almost all of them benefited from the government scheme related to childbirth.

AbstractIn recent years, some localities in Tunisia that are among the most amenable to agritourism have focused on the development of agritourism houses with a focus on rural women through agritourism entrepreneurial training. In this regard, the current study examines the influential determinants of entrepreneurial behavior using an agritourism method with rural Tunisian women. 167 of the study’s 235 rural Tunisian women participants were chosen using the Cochran algorithm. The findings suggest that rural women will have a strong desire to establish agritourism residence through a gradual process of changing norms towards the acceptance of rural women entrepreneurs as well as the acceptance of agritourism culture through the establishment of local and regional institutions and organizations in a context of family support with strong bonds of commitment, solidarity, environmental, and infrastructural foundations.

The aim of this study was to determine the role of rural women in production and marketing of agricultural products in Zalm village, and identify the differences in production and marketing of agricultural products of rural women’s role according to some variables (Age, Level of Education, Marital status, number of family, Standard of Living, Profession and Women’s income). The research population involved all women in zalm village included (50) women. The data was collected through personal interviews; questionnaire was prepared for this purpose, to confirm the validity the questionnaire was reviewed by some experts. The results showed that the Role of rural women’s in Agricultural production was medium tend to low, while the Role of rural women’s in marketing of agricultural products was low tend to medium. The results indicated significant differences in women’s role of agricultural production according to (Level of Education, Standard of Living, and profession), while no-significant differences according to (age, Marital status, number of family, Women’s income), also The results appeared significant differences in women’s role of agricultural marketing according (Level of Education, and profession), while no significant differences according (age, Marital status, number of family, Standard of Living, Women’s income). Depending on the results we conclude that the work in the agricultural sector has changed due to the lack of government support for farmers in terms of providing agriculture Requirements for production or marketing of their products. The result shows that the level of education affects the role of women in production and marketing, as well as educational levels leads to an increase in their awareness and culture, and the expanding their knowledge of the importance of the agricultural sector. The Researcher recommended encouraging and supporting rural women to engage in agricultural work by the responsible authorities, and increasing their awareness of the importance of working in this field through the use of various extension methods, as well as working to provide agricultural production and marketing requirements so that their potential is properly exploited for the development of the agricultural sector.

Objectives: Social media-based interventions have the potential to endure improvements in the health-seeking behaviors of the users. The upswing rate of social media usage among rural women of Bihar (India) allows for improving their knowledge, attitude, and practice toward breast cancer which is a big concern in resource-limited countries. This study attempted to evaluate the impact of video-based intervention in advancing knowledge of breast cancer risk factors, symptoms and attitude, and and practice to conduct breast cancer screening. Methods: A quasi-experimental design study was conducted among rural women in Bihar, India using pretest-posttest method. Validated YouTube Hindi videos were shared in a series as an intervention for the participants. The impact of the intervention videos was assessed by analyzing the 267 fully filled up questionnaires. Additionally, demographic characteristics were calculated and their relationship with knowledge, attitude, and practices was evaluated. Results: After three months of the intervention there was a statistically significant (

This study examines the transformative role of self-help groups (SHGs) in the socioeconomic development of rural women in Cooch Behar District, India, and their contribution toward achieving Sustainable Development Goals (SDGs) of the United Nations. In this study, we explored the effect of SHGs on rural women by specifically addressing SDGs, such as no poverty (SDG 1), zero hunger (SDG 2), good health and well-being (SDG 3), quality education (SDG 4), and gender equality (SDG 5). Given this issue, a cross-sectional survey and comparison analyses are needed to assess the socioeconomic development of rural women and their awareness level before and after the participation of rural women in SHGs. The survey conducted as part of this study was divided into three sections, namely, demographic characteristics, socioeconomic development, and awareness level, with each focusing on different aspects. A group of 400 individuals who were part of SHGs completed the questionnaire survey form. The results showed that the participation of rural women in SHGs significantly improved their socioeconomic development and awareness level, as supported by both mean values and t test results. Memberships in SHGs and microcredit programs were the major elements that boosted the socioeconomic development of rural women, which also achieves SDGs 1, 2, 3, 4, and 5. This study revealed that participation in SHGs and related financial services significantly aided rural women in economically disadvantaged communities in accumulating savings and initiating entrepreneurial ventures. Moreover, participation in SHGs was instrumental in enhancing the self-confidence, self-efficacy, and overall self-esteem of rural women. Finally, doing so enabled them to move more freely for work and other activities and to make family and common decisions.

Abstract Background The multidimensional health poverty afflicting rural women of reproductive age bears profound implications for the sustainable development of families, societies, and healthy villages. Elucidating vulnerable groups at risk of multidimensional health poverty and delineating its determinants can inform refinements and implementation of health-poverty alleviation policies. Methods Based on the 2022 "Health Status and Health Service Utilization" survey data in rural Ningxia, China, this study analyzes the dimension of health status, capacity for health service utilization, health expenditure and security using the A-F dual-threshold method, logit model, and probit model. It comprehensively evaluates multidimensional health poverty and analyzes its determining factors among rural women of childbearing age. Results With k set at 0.3, the health multidimensional poverty index, incidence, and intensity among rural women of reproductive age were 0.021, 0.053, and 0.392, respectively. Chronic illness, capacity for free gynecological examination utilization, health examination utilization, and borrowing due to illness contributed significantly to multidimensional health poverty. Risk factors for multidimensional health poverty among rural women of childbearing age include age, unemployment, family size, and lack of sanitary toilets. Protective factors include being married, educational level, non-farm or student occupation, receiving government support, separate housing and kitchen, owning a television and computer. Conclusions Even with the elimination of absolute poverty, the multidimensional health poverty situation among rural women remains important from a gender perspective. It is recommended to strengthen economic assistance and health service support for these groups, improve the level of rural health services from a gender perspective, and enhance housing structure and sanitation toilet usage in rural areas. Efforts should be made to narrow the digital divide in rural areas and promote digital health education. Pre-interventions on multidimensional health poverty can provide new pathways for the development, empowerment, and well-being of rural women of childbearing age.

Abstract Background Worldwide exclusive breastfeeding is still recommended as a successful strategy even during the COVID -19 pandemic to lower infant morbidity and mortality. This study aimed to assess the knowledge and practices of exclusive breastfeeding among rural women during the COVID-19 pandemic. Methods A descriptive cross-sectional study was conducted at EL-Morabeen Family Medicine Center in rural Damietta, Egypt among 178 lactating women who were chosen by using the purposive sampling technique. A developed structured questionnaire consisting of four parts was used to gather data from March to May 2022. Univariate analysis for descriptive data and bivariate analysis through the chi-square test were performed. Results The current study revealed that 73% of the studied rural women did not receive any breastfeeding counseling during antenatal visits and 61.2% of them believed that coronavirus was transmitted through breastmilk. Only 15.2% of them breastfed their infant exclusively for 6 months, 88.2% of mothers delayed breastfeeding initiation after delivery and 48.3% administered the prelacteal feeds. A total of 98.3% of rural women had never made skin-to-skin contact, and 79.2% of them had not been vaccinated against COVID-19. Additionally, a statistically significant association between good knowledge and practice with highly educated women aged 26–30 years, with a monthly income of 4000–6000 L.E was found. Furthermore, only 26.4% and 26.1% of rural women had good knowledge and practice scores respectively. Conclusion Suboptimal breastfeeding practices, such as delayed onset of breastfeeding, low percentages of exclusivity, early weaning, prelacteal feeding administration, and lack of skin-to-skin contact during the COVID -19 pandemic were prevalent among the studied rural mothers. Breastfeeding counseling for all pregnant women and implementation of evidence-based practices in the health care system, such as the early initiation of breastfeeding and skin-to-skin contact, are recommended.

Rural women's employment can be one of the ways to generate income, reduce the pressure on resources, and as a result, rural development. Meanwhile, the cooperative sector can play a significant role in the employment of rural women. But a vital issue that is important in this regard is the factors that influence the decision and intention of rural women who are members of local micro funds to start investing and working in cooperatives. In this regard, this research was designed to investigate factors affecting the behavioral intention of rural women members of Lorestan Province Micro Credit Funds towards self-employment in Cooperatives. The statistical population consisted of all rural women members of Lorestan Province Micro Credit Funds (N= 1087) who sampling of multistage quota proportional to the sample size through Krejcie and Morgan sampling table resulted in to select of 307 samples. Data collection in this study was conducted using a researcher-made questionnaire. After preparing the questionnaire and confirming its validity by the experts panel, its reliability was confirmed through a pilot study by calculating Cronbach's alpha values for the variables investigated. Structural equation modeling was used to determine factors influencing rural women's intention to self-employment in cooperatives through AMOS24. The results revealed that the interests variable has the highest direct impact on rural women's intention to self-employment in cooperatives and self-efficacy has the highest indirect influence on rural women's intention to self-employment in cooperatives.

This study was aimed at assessing the indigenous knowledge of rural women in forest resources conservation in Agoi-ekpo and Agoi-ibami in Yakurr Local Government Area of Cross River State, Nigeria. The objective of the study is: To examine the extent to which indigenous knowledge of rural women have influenced forest resources utilization and conservation. The sampling techniques used for the study are purposive and systematic in the selection of settlements. Purposive sampling was adopted because it was the researcher’s deliberate intention to choose the rural communities in Yakurr L.G.A. that have direct interface with the Forest Reserves and are involved in the use and management of forest resources. While the systematic sampling was used to select rural women households at fixed intervals. The research findings revealed that a significant percent (71.2%) of the rural women were involved in the harvesting of forest resources. The study also showed that different quantities of edible leaves, fruits, snails, and medicinal herbs were collected by rural women for varying purposes. It further showed that these forest resources were harvested at varying frequencies and that they generate income to the rural women. The main forest resources conserved as revealed by the study included afang, atama, editan, bush mango, and hot leaf because of the high exploitation. Restrictions on the felling and uprooting of plants as well as ban on exploitation were the two prominent ways of forest resources conservation. Pearson’s correlation result indicated a positive and significant association between indigenous practices of rural women and forest resources utilization and conservation. It also showed that problems encountered in the collection of forest resources did not vary by the ages of rural women. In order to control unwanted exploitation of forest resources as well ensure the availability for the future, local communities should set-up forest guards or vigilante to control the quantity of edible forest resources that will be harvested from the forest.

Abstract Fars province, as one of the most susceptible ecotourism regions of Iran, has paid attention to the establishment of ecotourism residences with the priority of rural women through ecotourism entrepreneurial training in recent years. In this regard, the present study investigates the effective factors on entrepreneurial behavior with Fars rural women ecotourism approach in Iran. The participants of the study were 431 of rural women in Fars and 205 were decided by Cochran formula. It is inferred from the results that step-by-step procedure of changing norms towards the acceptance of rural women entrepreneurs as well as the acceptance of ecotourism culture through the establishment of local and regional institutions and organizations in a context of family support with strong bonds of commitment, solidarity, environmental and infrastructural foundations will lead to a strong desire to constitute ecotourism residence by rural women.

The goal of empowerment programs is to promote initiatives aimed at uplifting society's impoverished and disenfranchised citizens, who are typically women and youth. This paper, therefore, examined the socioeconomic features influencing rural women accessibility to empowerment programs in Kogi state, Nigeria. The research is specifically looking at socioeconomic characteristics of respondents, ascertaining the level of effectiveness of empowerment programs on agricultural activities, describe the level of accessibility to empowerment programs and identifying the constraints of empowerment programs. Random and snow ball sampling methods have been combined to gather information from 125 respondents. Descriptive statistics and multiple linear regression were used to analyze data. Average farm size was 2.82 ha, with annual income of 466,000 NGN. Empowerment programs such as Kogi APPEAL and Farmer moni were mostly accessible among women farmers. Marital status, household size, education were significant factors in accessing empowerment programs among women in Kogi state. Therefore, it is recommended that policies and programs that address women farmers' access to empowerment programs assets should be more inclusive.

Women entrepreneurs use virtual social networks in their professional relationships. These relationships with higher quality leads to better performance in their businesses. The present study aimed to analyze the effects of virtual social networks on improving rural women’s entrepreneurship. The statistical population of the study included all members of the Agricultural Development Specialized Holding Companies in Fars province in Iran. The study was conducted using survey and stratified random sampling methods with 269 individuals participated via questionnaires. The results indicated that virtual social networks had a favorable effect on rural women’s businesses. There was a significant difference between women in the different studied counties regarding the effects of virtual social networks on business. In addition, a significant difference was observed between women in various groups regarding the effect of virtual social networks on business. In addition, greater effect of virtual social networks on women’s businesses led to higher business resilience among the women entrepreneur and their businesses, which resulted in increasing the women’s information about business activities and their entrepreneurial activities in their businesses. Further, more use of social networks by the women led to more use of marketing methods and strategies. Therefore, it is suggested that Agricultural Development Specialized Holding Companies use the functions of virtual social networks in order to information transfer, networking and online training for members when necessary. Also provide the necessary training in the application of appropriate marketing methods and strategies to rural women entrepreneurs using these networks.

Abstract Background Strong Hearts, Healthy Communities 2.0 (SHHC-2.0) was a 24-week cardiovascular disease prevention program that was effective in improving physical activity and nutrition behaviors and clinical outcomes among women in 11 rural New York, USA towns. This study evaluated the delivery of SHHC-2.0 to prepare the intervention for further dissemination. Methods This process evaluation was guided by the Medical Research Council recommendations and engaged program leaders and participants (i.e., women over age 40) using quantitative and qualitative methods. The quantitative evaluation included examination of enrollment and retention data, a participant survey, and a fidelity checklist completed after classes. Descriptive and comparative statistics were used to assess implementation measures: program reach, participant attendance, dose delivered, program length, perceived effectiveness, fidelity, and participant satisfaction. The qualitative evaluation included focus groups (n = 13) and interviews (n = 4) using semi-structured guides; audio was recorded and transcripts were deductively coded and analyzed using directed content analysis and iterative categorization approaches. Comparisons across towns and between intervention and waitlist control groups were explored. Results Average reach within towns was 7.5% of the eligible population (range 0.7-15.7%). Average attendance was 59.8% of sessions (range 42.0-77.4%). Average dose delivered by leaders was 86.4% of curriculum components (range 73.5-95.2%). Average session length was 51.8 ± 4.8 min across 48 sessions. Leaders’ perceived effectiveness rating averaged 4.1 ± 0.3 out of 5. Fidelity to curricular components was 81.8% (range 67.4-93.2%). Participants reported being “more than satisfied” with the overall program (88.8%) and the health benefits they obtained (72.9%). Qualitative analysis revealed that participants: (1) gained new knowledge and enjoyable experiences; (2) perceived improvements in their physical activity, nutrition, and/or health; (3) continued to face some barriers to physical activity and healthy eating, with those relating to social support being reduced; and (4) rated leaders and the group structure highly, with mixed opinions on the research elements. Conclusions SHHC-2.0 had broad reach, was largely delivered as intended, and participants expressed high levels of satisfaction with the program and its health benefits. Our findings expand on best practices for implementing cardiovascular disease prevention programs in rural communities. Clinical trials Registration www.clinicaltrials.gov #NCT03059472.

Abstract Background Intensive lifestyle interventions were effective to reduce the risk of type 2 diabetes mellitus (T2DM) for women with gestational diabetes mellitus (GDM) history. However, reaching these mothers and maintaining participation in lifestyle interventions is suboptimal in real-world settings. Effective, feasible and sustainable new lifestyle interventions are needed. The objectives of this three-arm trial are to (1) compare diabetes risk outcomes of an evidence-based intensive lifestyle modification (ILSM) intervention, a camp-style lifestyle modification program (CAMP) intervention, and usual care among women with GDM history; and (2) evaluate the comparative efficacy of the CAMP versus ILSM intervention on implementation outcomes. Methods A three-arm cluster randomized clinical trial (RCT) using a hybrid type 2 implementation design will be conducted in two counties in Hunan province in China. Six towns from each county will be randomly selected and assigned to CAMP, ILSM, and the usual care group (25 women from each of 12 towns, 100 women in each arm). The ILSM includes six biweekly in-person sessions and 3-month telephone health consultations, while the CAMP consists of a 2-day camp-based session and 3-month health consultations via a popular social media platform. Both interventions share the same session content, including six lifestyle skills. Efficacy (T2DM risk score and behavioral, anthropometric, psychosocial, and glycemic variables) and implementation outcomes (recruitment, acceptability, feasibility, fidelity, and cost-effectiveness) will be collected at baseline, 6-month, and 12-month. Pre-planned ANOVA F-test and generalized estimating equations will be included to test time-by-arm interactions. Discussion The CAMP intervention is expected to have better reach, better attendance, and comparable effectiveness in reducing the risk of T2DM, thus improving postpartum care for GDM in China. The delivery of a concentrated format supplemented with technology-based support may provide an efficient and effective delivery model for implementing maternal health promotion programs in primary care settings. Trial registration Registered in the Chinese Clinical Trial Registry (ChiCTR2200058150) on 31st March 2022.