Feasibility, acceptability and preliminary outcomes of the Parents Under Pressure program: a Canadian pilot study

• This is the first feasibility, acceptability study of the Parents Under Pressure Program in Canada with a perinatal sample. • The program was acceptable to both providers and mothers; however, feasibility indicators were not met. • Several barriers to program delivery were identified which will help inform potential future evaluations and implementation of the program within community organizations The perinatal period is crucial for mothers and their offspring with various determinants of health that may influence experiences and susceptibility to negative outcomes. Programs, like Parents under Pressure (PuP) have been designed to reach at-risk mothers and improve well-being among mothers and their children, specifically during the first two years of life. This study primarily examined the feasibility and acceptability of the PuP program among at-risk women in Canada during their perinatal period. Secondary objectives included assessing changes in key functioning domains over time. A mixed methods study was conducted in Ontario and Quebec, Canada from January 2021-March 2023. Mothers were recruited from five community agencies. Quantitative data were collected from mothers over four study visits. Qualitative interviews were conducted with a subset of mothers and PuP service providers. Data on the program’s feasibility and acceptability, domains of functioning including mental health, substance use, and parenting were analyzed. Fifty-five mothers consented to participating in the PuP program, with 51 completing the baseline assessment. The study met the research retention threshold, with 83 % of mothers completing the final research study (post-5 month) visit. However, only 64 % (n = 34) met the clinical retention threshold for the PuP program (6 + modules or provider completed the closure module). Reasons for incompletion including life changes and loss of interest in the program. Qualitative interviews indicated the program was acceptable to both mothers and providers and identified barriers to implementation. While the PuP program was well-received by both mothers and providers, its feasibility in this context was limited, potentially due to the high-risk characteristics of the sample or external factors such as staff turnover. Future studies may consider adapting the program to include group-based or online components to better meet mothers’ needs.