Protocol for a single-arm, prospective mixed-methods feasibility study of a culturally responsive maternal health promotion intervention

Background: Maternal mental health is a critical determinant of women's health and family functioning, yet mothers of children with Attention-Deficit/Hyperactivity Disorder (ADHD) experience elevated stress, stigma, and barriers to health-promoting behaviors. These challenges are intensified in culturally conservative communities, where gender-role expectations and limited access to culturally appropriate services restrict engagement with mainstream health care. Objective: This protocol outlines the implementation, and evaluation of a culturally responsive maternal health promotion intervention for Ultra-Orthodox Jewish (UOJ) mothers of children with ADHD. Earlier phases of the Intervention Mapping process, including needs assessment and intervention development, were completed prior to this protocol. The present study focuses on the final two steps of Intervention Mapping, implementation and evaluation, to support that the program is deliverable, acceptable, and sustainable in real-world practice. Methods: This protocol outlines a prospective, single-arm, mixed-methods feasibility study without a control group, to be conducted with UOJ mothers in telehealth-based groups. The six-session program integrates psychoeducation, peer discussion, and action planning, supported by culturally adapted materials and a moderated WhatsApp group. Implementation and acceptability will be evaluated through recruitment, retention, attendance, and structured feedback surveys, supplemented by qualitative focus groups. Intervention outcomes will include maternal stress, ADHD-related knowledge and beliefs, stigma, and engagement in health-promoting activities, assessed using validated instruments. Quantitative data will be analyzed using descriptive and repeated-measures statistics, and qualitative data will undergo thematic analysis. Conclusion: By integrating systematic planning with cultural tailoring, this protocol aims to contribute a model for developing and evaluating women's health interventions in underserved, culturally conservative populations. The study seeks to advance maternal health equity by demonstrating how culturally responsive approaches may reduce barriers, foster engagement, and promote sustainable health-promoting practices. Trial status: Recruitment commenced in November 2024 and remains ongoing at the time of manuscript submission. No interim analyses or outcome data analyses have been conducted at the time of manuscript submission.