Common mental health conditions during pregnancy include depression and anxiety. Having
an immigrant status and belonging to an ethnic minority group is linked to an increased
likelihood of perinatal mental health problems. The lack of culturally tailored and
innovative intervention is a predominant factor affecting mental health outcomes for
immigrant women. Psychological and psychosocial interventions have been reported to
significantly improve non-migrant women's mental health. The Thinking Healthy Program
(THP), a low-intensity, low-cost, psychosocial intervention ("talking therapies") based
on cognitive behavioural therapy, is comprised of 12, 1-hour sessions with content
organized in modules (e.g., preparing for the baby, baby's arrival) that have associated
activities (e.g., mood chart). In China, the THP has been culturally and linguistically
adapted using rigorous processes and delivered to support women in the management of
perinatal depression. To improve access and ensure a more impactful outcome to the
culturally adapted THP, a mobile App was created in China with a brief Chinese version of
the culturally adapted THP.
The primary objective of this study is to (1) assess the feasibility (acceptability and
usability) of the linguistically and culturally adapted THP delivered through a mobile
App to Chinese immigrant pregnant women residing in Canada; and (2) examine the process
of recruitment, retention, and adherence to intervention to inform a future trial. The
secondary objective is to produce preliminary evidence on the effectiveness of the brief
Chinese version of THP on immigrant women's mental well-being, specifically depression.
A sequential explanatory mixed-method feasibility study involving a pre-post design in
which a single group will be assembled and assessed quantitatively at baseline, 3-4 weeks
post completion of brief Chinese version of the THP intervention and again at 6-8 weeks
following the birth of their baby. A subset of participants that have engaged with the
intervention (n=up to 15) will be invited to individual semi-structured telephone
interview to share their experience with the intervention.
A convenience sample of 50 participants will be recruited for the intervention, with a
subset of 15 participants to be individually interviewed via the telephone.
Participants will be recruited through social media (WeChat and Xiaohongshu), research
team members' University mailing list, dissemination to professional colleagues (e.g.,
Obstetrics and Gynecologists), and collaboration with social and health-based
organizations that serve the East Asian community in Canada.
At baseline, the sociodemographic characteristics, immigrant characteristics,
health/obstetric history, and history of psychological well-being will be assessed.
Potential covariates that will be assessed once include acculturation (baseline;
Vancouver Index of Acculturation) and preterm birth (at 6 to 8 weeks postpartum) while
all others including pregnancy-related anxiety (Pregnancy-Related Anxiety Scale), somatic
symptoms (Patient Health Questionnaire-15), psychological stress (Perceived Stress
Scale-10), resilience (Connor-Davidson Resilience Scale-10), social support
(Multidimensional Scale of Perceived Social Support), mother-infant relationship
(prenatal section of the Pre- and Postnatal Bonding Scale), and patient activation
(Behavioural Activation for Depression Scale) will be assessed at baseline and follow-up
(after intervention and/or 6 to 8 weeks postpartum), using the scales and instruments
listed above.