Co-designing a community-led digitally system for cardiovascular disease prevention in the Caribbean

Abstract

Adverse pregnancy outcomes, including hypertensive disorders of pregnancy and gestational diabetes, are early indicators of future cardiometabolic risk. Yet the post-partum period remains an underused opportunity for cardiovascular disease prevention, particularly where postnatal care ends at six weeks and is weakly connected to primary care, community follow-up and family-based prevention. In the Caribbean, these missed opportunities are shaped by health-system capacity, gendered care pathways, family roles and the practical realities of community life. This presentation discusses SMARThealth Caribbean, a community-led, digitally aided support system for cardiovascular disease prevention among post-partum women with adverse pregnancy outcomes and adult household members in Jamaica, Guyana, Dominica, and St. Vincent and the Grenadines. The project uses participatory co-design to culturally co-adapt the SMARThealth platform to local care pathways, community priorities and health-system readiness. While digital platforms are often positioned as enabling ‘leapfrogging’ in LMICs, they can also reproduce or deepen existing inequities in access, literacy and decision-making. The presentation will discuss how participatory co-adaptation of SMARThealth with multisectoral stakeholders is used not only to improve usability but to actively identify and mitigate forms of digital exclusion related to gender norms, shared device access, connectivity and health-system fragmentation. It will highlight how digital co-adaptation can both enable and constrain equitable access, showing the tension between digital leapfrogging and digital injustice in community-based cardiovascular prevention.