{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T18:08:05Z","timestamp":1789150085830,"version":"build-2803163510"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Diabetes in pregnancy requires sustained self-care and clear guidance across hospital, home, and primary care settings. Conventional educational materials may be less accessible to women facing social vulnerability or limited health literacy. Culturally grounded communication may improve the understandability and relevance of discharge guidance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a methodological study in two public tertiary maternity hospitals in Fortaleza, Brazil, to develop and content-validate an educational\n                      <jats:italic>cordel<\/jats:italic>\n                      , a traditional Brazilian form of rhymed popular literature. The material was developed through a structured evidence search, collaboration with health researchers and\n                      <jats:italic>cordelistas<\/jats:italic>\n                      , and pilot testing. It was evaluated by 22 hospitalized pregnant women with gestational diabetes mellitus or pre-existing type 2 diabetes and by 40 expert judges. Item-level Content Validity Indices (I-CVIs), scale-level CVI by averaging item values (S-CVI\/Ave), Cronbach\u2019s alpha, and Kendall\u2019s coefficient of concordance were calculated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All target-population items achieved an I-CVI of 1.00, and the S-CVI\/Ave was 1.00. The evaluation responses showed modest internal consistency (raw alpha\u2009=\u20090.67; standardized alpha\u2009=\u20090.66). Among expert judges, I-CVIs ranged from 0.95 to 1.00 and the S-CVI\/Ave was 0.99. Internal consistency of expert responses was high (raw alpha\u2009=\u20090.96; standardized alpha\u2009=\u20090.97), whereas Kendall\u2019s W was 0.039, indicating weak concordance in the relative ranking of items despite high absolute favorable agreement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      The educational\n                      <jats:italic>cordel<\/jats:italic>\n                      showed strong preliminary evidence of content validity, cultural relevance, and acceptability for hospitalized pregnant women with diabetes. The findings support further testing in larger and more diverse samples, using standardized measures of understandability and actionability and designs that evaluate effects on knowledge, self-care, continuity of care, and clinical outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0357959","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T17:26:18Z","timestamp":1789147578000},"page":"e0357959","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Culturally grounded health communication to support self-care among pregnant women with diabetes: Development and content validation of an educational cordel in Brazil"],"prefix":"10.1371","volume":"21","author":[{"given":"Francisca \u00c9dla Santos Leite","family":"Gurgel","sequence":"first","affiliation":[{"name":"University of Fortaleza. Avenida Washington Soares, Edson Queiroz","place":["Fortaleza, Cear\u00e1, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raimunda Magalh\u00e3es","family":"da Silva","sequence":"additional","affiliation":[{"name":"University of Fortaleza. Avenida Washington Soares, Edson Queiroz","place":["Fortaleza, Cear\u00e1, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1015-9173","authenticated-orcid":true,"given":"Jonas Loiola","family":"Gon\u00e7alves","sequence":"additional","affiliation":[{"name":"University of S\u00e3o Paulo","place":["S\u00e3o Paulo, Brazil"],"department":["School of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cidianna Emanuelly Melo","family":"do Nascimento","sequence":"additional","affiliation":[{"name":"University of Fortaleza. Avenida Washington Soares, Edson Queiroz","place":["Fortaleza, Cear\u00e1, Brazil"]},{"name":"State University of Cear\u00e1","place":["Fortaleza, Cear\u00e1, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita Neuma Dantas Cavalcante","family":"de Abreu","sequence":"additional","affiliation":[{"name":"University of Fortaleza. Avenida Washington Soares, Edson Queiroz","place":["Fortaleza, Cear\u00e1, Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Helena de Carvalho Valente","family":"Presado","sequence":"additional","affiliation":[{"name":"Lisbon School of Nursing","place":["Lisbon, Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suely Kazue Nagahashi","family":"Marie","sequence":"additional","affiliation":[{"name":"University of S\u00e3o Paulo","place":["S\u00e3o Paulo, Brazil"],"department":["School of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,11]]},"reference":[{"issue":"1","key":"pone.0357959.ref001","doi-asserted-by":"crossref","DOI":"10.1590\/s0104-12902024220633pt","article-title":"Entre a busca por assist\u00eancia e sua efetiva\u00e7\u00e3o: peregrina\u00e7\u00e3o de gestantes e pu\u00e9rperas com quadro de near miss materno","volume":"33","author":"A Brilhante","year":"2024","journal-title":"Sa\u00fade e Sociedade"},{"key":"pone.0357959.ref002","article-title":"A percep\u00e7\u00e3o da gravidez de risco e suas implica\u00e7\u00f5es no contexto vivido","volume":"45","author":"FVV Feitosa","year":"2025","journal-title":"Psicol Cienc Prof"},{"issue":"12","key":"pone.0357959.ref003","doi-asserted-by":"crossref","first-page":"4633","DOI":"10.1590\/1413-812320182412.31422017","article-title":"Risco gestacional e desigualdades sociais: uma rela\u00e7\u00e3o poss\u00edvel?","volume":"24","author":"\u00c9M Garcia","year":"2019","journal-title":"Cien Saude Colet"},{"key":"pone.0357959.ref004","doi-asserted-by":"crossref","DOI":"10.19175\/recom.v10i0.3625","article-title":"Representa\u00e7\u00f5es sociais de gestantes que frequentam servi\u00e7o especializado em gesta\u00e7\u00f5es de alto risco","volume":"10","author":"SN Ferreira","year":"2020","journal-title":"Revista de Enfermagem do Centro-Oeste Mineiro"},{"key":"pone.0357959.ref005","article-title":"Grupo de gestantes de alto-risco como estrat\u00e9gia de educa\u00e7\u00e3o em sa\u00fade","volume":"40","author":"FLC Alves","year":"2019","journal-title":"Rev Gaucha Enferm"},{"issue":"1","key":"pone.0357959.ref006","doi-asserted-by":"crossref","DOI":"10.1590\/2177-9465-ean-2020-0098","article-title":"Orienta\u00e7\u00f5es \u00e0s gestantes no pr\u00e9-natal: a import\u00e2ncia do cuidado compartilhado na aten\u00e7\u00e3o prim\u00e1ria em sa\u00fade","volume":"25","author":"BL Marques","year":"2021","journal-title":"Esc Anna Nery"},{"issue":"10","key":"pone.0357959.ref007","doi-asserted-by":"crossref","first-page":"4397","DOI":"10.1590\/1413-812320212610.10752021","article-title":"O Brasil cumprir\u00e1 o ODS 3.1 da Agenda 2030? 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