# Culturally Adapted Lifestyle and Mental Health Intervention for Low-Income Pregnant Women: A Feasibility Study

## TL;DR

A culturally adapted program for low-income pregnant women in Portugal improved lifestyle and mental health, with better results in in-person sessions.

## Contribution

A culturally adapted lifestyle and mental health intervention for low-income pregnant women in Portugal, with a comparison of in-person and online delivery.

## Key findings

- The COPE program showed high acceptability and feasibility with 65.2% recruitment and 68.9% retention.
- Anxiety and depressive symptoms significantly decreased post-intervention, with sustained anxiety reduction postpartum.
- In-person sessions showed better postpartum depression outcomes compared to online sessions.

## Abstract

Low-income pregnant women face challenges in maintaining a healthy lifestyle during pregnancy and protecting their mental health, increasing their risk of adverse perinatal outcomes. The Creating Opportunities for Personal Empowerment (COPE) program, culturally adapted for the Portuguese context, aims to promotes a healthy lifestyle and mental health.

We aimed to assess the feasibility, acceptability, and preliminary effects of the culturally adapted intervention among low-income pregnant women, comparing in-person and online modalities.

This mixed-methods study followed the Medical Research Council framework. Phase I involved cultural and linguistic adaptation of COPE using the ADAPT model. Phase II was a pre-post feasibility study with 45 low-income pregnant women attending in-person or online sessions. Feasibility was assessed through recruitment and retention. Acceptability was evaluated via engagement in skill-building activities, session rescheduling, and qualitative feedback. Preliminary effects were measured at T0 (baseline), T1 (post-intervention), and T2 (4-6 weeks postpartum).

Recruitment was 65.2%, with 68.9% retention, higher in the online group. On average, participants completed 3 skill-building activities and rescheduled 2.3 sessions. Qualitative feedback supported the intervention’s acceptability. Anxiety and depressive symptoms significantly decreased from T0 to T1, with anxiety reduction sustained at T2. Postpartum depression declined in the in-person group but increased online. Perceived stress remained unchanged, while healthy lifestyle beliefs and behaviors improved significantly.

The COPE intervention was feasible and acceptable, demonstrating improvements in lifestyle behaviors and mental health. Its cultural adaptation supports applicability in the Portuguese context and highlights potential for broader international transfer.

Open Science Framework (https://doi.org/10.17605/OSF.IO/SQ5GK).