Pilot Study of the Mastery Lifestyle Intervention

Abstract

Background Recognizing the effects of acculturation on quality of life and emotional health, especially during pregnancy, we developed an intervention that would target these factors in order to improve maternal well-being during the prenatal period and potentially improve infant outcomes, particularly preterm birth for Mexican-American women (Latinas). Objective The purpose of these pilot studies was to test the acceptability, feasibility, and preliminary efficacy of the mastery lifestyle intervention (MLI) to decrease depressive and anxiety symptoms and improve coping as implemented in prenatal clinics with culturally homogenous groups of Latinas. Methods The MLI was tested in three small pilot studies (n = 15), one in El Paso, Texas (an urban area), and two in Bastrop, Texas (a rural area outside Austin), for acceptability and feasibility. A pretest/posttest, quasi-experimental design was used with pregnant self-identified Mexican-American Latinas at 14–20 weeks' gestation. Measures of anxiety, depressive symptoms, and positive and negative coping were used. Results Feasibility was a success in terms of implementation of the MLI in an active prenatal clinic setting and the use of electronic tablets for data collection and entry of data into REDcap. Satisfaction was high, with the location of the MLI being at their primary OB/GYN clinic. Participants reported that six intervention sessions appear to be ideal as was the class length of 1.5 to 2 hours. On Cohen's d, there were medium to large effect size decreases in depressive and anxiety symptoms and small to medium effect size decreases in the use of negative coping strategies and small effect sizes for increases in positive coping strategies. Discussion Pilot testing of the MLI indicated that it was well accepted from the participants and feasible as a culturally tailored behavioral therapy administered in a group setting by nurse practitioners. Our initial pilot results also suggest preliminary efficacy as indicated by moderate to large Cohen's d effect sizes for depression and anxiety.

Pregnant Mexican American Biopsychosocial/Cultural risks for adverse infant outcomes

“…Future research could test predictability of such as system for identifying the most high‐risk patients. Development and testing of psychosocial interventions tailored to these results and targeted to Latinas (Ruiz et al., 2019) and to Mexican American Hispanics is vital to help prevent babies from being born too early and too small in this vulnerable population.…”

Psychological Interventions for Prenatal Anxiety in Latinas and Black Women: A Scoping Review and Recommendations

“…The second study authored by Ruiz et al ( 37 ) used a non-randomized pre-post intervention design ( n = 15) with a low-income Latina-only sample (31% were foreign born) enrolled during their first trimester of pregnancy. Authors reported that following the receipt of a six-session culturally-adapted combined Acceptance and Commitment Therapy (ACT) and Problem Solving Therapy (PST; delivered by nurse practitioners and midwives), women showed significant reductions in their prenatal anxiety symptoms from baseline to post-intervention.…”

The mastery lifestyle intervention to reduce biopsychosocial risks for pregnant Latinas and African Americans and their infants: protocol for a randomized controlled trial

“…We developed and pilot tested the novel Mastery Lifestyle Intervention (MLI), a culturally-relevant, manualized psychosocial group intervention that integrates two evidence-based CBT programs – Acceptance and Commitment Therapy (ACT) and Problem-Solving Therapy (PST) [ 12 ]. The intervention originally was targeted to address psychological risk factors demonstrated to be a factor in adverse pregnancy outcomes in Latinas [ 28 , 29 ].…”

“…Psychological factors appear to be important predictors [ 9 ] [ 1 , 10 , 11 ] that are potentially modifiable. Reducing psychological risks has had positive effects on some pregnant women [ 12 ]. Though there has been some concentration on reducing psychosocial risks in African American women, there has been minimal focus on decreasing psychosocial risks for Latina women.…”

“…To address gaps related to interventions for Latina and Black women, we developed, and pilot tested the novel Mastery Lifestyle Intervention (MLI). The MLI is a culturally-relevant, manualized psychosocial group intervention that integrates two evidence-based CBT programs -Acceptance and Commitment Therapy (ACT) and Problem-Solving Therapy (PST) [12]. The proposed study is unique in that the investigators are targeting psychological risk factors with the MLI as well as assessing the intervention's effect on associated neuroendocrine risk factors [20][21][22][23][24][25].…”