Aim

The overall aim of this 1-year project is to gain a deeper understanding of the unique acculturation challenges faced by PSAIs in Ontario, Canada, and to refine current programs and services to better serve PSAIs. The overarching research question is: How do PSAIs in Ontario experience acculturative stress, and what coping mechanisms do they employ during their transition to a new cultural environment? This project has two key objectives:

1. To explore PSAIs experiences of acculturative stress and coping mechanisms in Ontario, Canada with a focus on cultural, social, and structural factors that intensify stress during pregnancy.
2. To develop actionable recommendations for adapting existing programs and services to better support PSAIs’ reproductive well-being and integration.

Theoretical underpinning

This project is rooted in an equity-oriented approach, which focuses on identifying and addressing systemic and structural inequities that affect health and social outcomes. Within this equity lens, we will examine the cultural, social, and structural factors that influence PSAIs’ access to health and social services for addressing their reproductive well-being needs. This includes uncovering the structural and systemic marginalization that PSAIs face as they navigate the challenges of immigrating to a new country. Our overarching aim is to advocate for the development of equitable, culturally safe support services that enhance the well-being of PSAIs in Ontario, empowering them to cope and thrive in their new cultural environment.

The theoretical perspective guiding this work is Berry’s Acculturation Model (1980) [30] (Fig 1), which proposes a two-dimensional framework for understanding acculturation. The first dimension concerns the retention or rejection of an individual’s native culture, while the second addresses the adoption or rejection of the host culture. From these dimensions, four acculturation strategies emerge: 1) Assimilation, occurs when individuals adopt the cultural norms of a dominant or host culture, over their original culture; 2) Separation, occurs when individuals reject the dominant or host culture in favor of preserving their culture of origin; 3) Integration, occurs when individuals are able to adopt the cultural norms of the dominant or host culture while maintaining their culture of origin.; and 4) Marginalization, occurs when individuals reject both their culture of origin and the dominant host culture. This model also emphasizes the concept of acculturative stress [30], which arises from navigating the challenges posed by these cultural intersections. This model will serve as an analytical framework for exploring the experiences of acculturative stress and coping mechanisms among PSAIs in Ontario, Canada. Through this framework, the study aims to uncover how cultural, social, and structural factors, such as cultural differences, language barriers, loss of social support networks, and ethnic discrimination intensify acculturative stress and influence the coping mechanisms employed by this population [21,31].

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Fig 1. Berry’s Model of Acculturation.

https://doi.org/10.1371/journal.pone.0345952.g001

In the context of SA immigrant communities in Canada, Berry’s four acculturation strategies provide a useful conceptual lens for anticipating how acculturation may shape stress experiences. Assimilation pressures, for example, may arise as PSAIs navigate expectations to adopt Western norms surrounding autonomy, gender roles, or parenting practices, which can contrast with collectivist values and extended family-based support systems common in SA households. Conversely, separation may occur when individuals strongly maintain heritage cultural practices, potentially leading to tension when these practices are misunderstood or not accommodated within Canadian social and health systems. Integration, often considered an adaptive strategy, may require structural and social supports that enable PSAIs to balance cultural continuity with participation in the host society, particularly during pregnancy and early postpartum when formal and informal support networks are critical. Marginalization may emerge in contexts where individuals experience both weakened ties to their heritage culture and barriers to engaging with the host culture, such as discrimination, language challenges, or unfamiliarity with health and social services. These anticipated dynamics illustrate how Berry’s model will guide our analytic approach and help identify cultural, social, and structural factors that may influence acculturative stress and coping among PSAIs in Ontario.

The community partner organization

This project was developed in response to a request from a community organization, Council of Agencies Serving South Asians (CASSA), driven by their recognition of the unique acculturation challenges faced by PSAIs and their families as they adapt to a new cultural environment in Ontario. CASSA identified this critical need through its extensive work with PSAIs and their families, particularly in relation to the immigration and settlement process. CASSA serves as a social justice umbrella organization that supports Ontario’s SA communities in addressing a wide range of social, political, economic, and cultural barriers. CASSA operates across Ontario, Alberta, and British Columbia, leading projects and advocating for policies focused on racialized health and well-being, systemic racism, racial equity in education, gender-based violence, and hate eradication. Its mission is to advance social justice and equity for SA communities across Canada. Through its various programs, CASSA engages a diverse array of communities, policymakers, experts, advocates, and academics via advisory tables, steering committees, public forums, consultations, galas, fundraisers, awareness campaigns, and social media. CASSA has played a central role in shaping the project and conceptualizing it alongside the research team, ensuring that it aligns with their strategic priorities, particularly around immigration and settlement support. CASSA will play a key role in the project’s activities, including facilitating the recruitment of PSAIs through its extensive network of SA agencies, contributing to the development of interview guides, participating in interviews, and attending analysis meetings to ensure that the evolving analysis remains relevant and useful. They will also help in co-creating knowledge products and disseminating knowledge mobilization (KMob) products across their network of 120 agencies and 12 individual leaders. Throughout the project, CASSA will continue to provide valuable intellectual leadership and engage in shared decision-making.

Study design

This project will employ a constructivist qualitative design, using Braun & Clarke’s reflexive thematic analysis [32]. This approach is appropriate because it emphasizes that themes are actively constructed through researcher engagement with the data, rather than passively “discovered,” allowing for a nuanced understanding of participants’ lived experiences. Reflexivity will be central, as researchers will reflect on their perspectives, assumptions, and experiences throughout the study. Previous research on the phenomenon, acculturative stress among PSAIs [11,20–22], provides a valuable basis for shaping the project’s design and setting clear boundaries for investigation. The findings emerging from this approach will accomplish the project’s first objective, which is to collect and analyze the experiences of acculturative stress and coping mechanisms among PSAIs in Ontario.

Study participants and setting

We plan to purposively recruit first-generation PSAIs who self-identify as SA, currently reside in Ontario, and immigrated to Canada within the past five years, as this period represents a critical window in the acculturation process when individuals may experience heightened stress and adaptation challenges [31]. Eligible participants must have experienced at least one pregnancy, whether first or subsequent, after migrating to Canada within the past five years. Participants do not need to be currently pregnant. To explore diverse experiences, we will use a maximum variation sampling strategy. This will include participants across different stages of pregnancy post-immigration (immediately upon arrival, one to two years, and three to five years after migration), various immigration statuses (Canadian citizens, permanent residents, temporary residents, asylum seekers, and individuals with precarious or undocumented status), employment statuses, countries of origin (Pakistan, India, Bangladesh, and Sri Lanka), and languages spoken (English, Urdu, Punjabi, Hindi, and Bangla). Study participants recruitment will be facilitated by CASSA. If needed, PSAI will also be recruited through other sources such as healthcare providers and social media platforms that cater to SA populations.

Data collection

We will conduct semi-structured in-depth individual interviews with PSAI to explore their perceptions and experiences related to cultural adaptation, language barriers, cultural differences, social support, sources of stress, and coping mechanisms. Participants will be invited to take part in virtual interviews via a separate project email. Each interview will follow a semi-structured guide [33] (See Appendix A in S1 File) that includes open-ended questions. The guide has been developed iteratively based on a review of the literature on acculturative stress and perinatal experiences among SA immigrant populations, and informed by Berry’s acculturation framework (1980). The guide has been reviewed by the study team and will be pilot tested with 2–3 individuals to assess clarity, cultural relevance, and interview flow. Revisions from the pilot testing will be incorporated, and the final interview guide will be included in the subsequent manuscript reporting the study findings. The interviews will be conducted by the Principal Investigator (PI) and Graduate Research Assistant (GRA) via Zoom (Zoom Video Communications, Inc.). The decision to conduct interviews via Zoom was guided by considerations of accessibility, flexibility, and participant comfort. Given that participants may have caregiving responsibilities, transportation barriers, or geographic dispersion, virtual interviews reduce logistical burden and may facilitate participation, particularly among immigrant populations. Interviews will be conducted in the participants’ preferred language—Hindi, Urdu, English, Punjabi, or Bangla. The PI is proficient in English, Hindi, and Urdu, and we will hire a GRA with proficiency in at least one SA language, preferably Bangla or Punjabi. If necessary, we will engage a professional interpreter for Punjabi and Bangla interviews. We plan to conduct approximately 25–30 semi-structured interviews, with each lasting between 40 and 60 minutes. The final number of interviews will be guided by the concept of information power [34] that is, the more relevant and rich the information provided by participants in relation to the study aim, the fewer participants are required. We will also prioritize depth and richness to capture diverse experiences based on immigration status, pregnancy timeframe post-arrival, language spoken, and country of origin. Interviews will be simultaneously transcribed and then translated into English for analysis. Participants will receive an honorarium (20 CAD per hour) recognizing the value of their time.

Data analysis

Data will be analyzed using Braun and Clarke’s reflexive thematic analysis [32], which emphasizes the active role of the researcher in constructing themes. Anonymized interview transcripts will be imported into NVivo (version 12 Plus; QSR International) [35]. The PI and GRA will engage in an iterative, inductive process, beginning with data familiarization, generating initial codes, identifying themes, and refining these themes through ongoing analytic reflection. Coding will be reflexive and interpretive. The PI and GRA will actively reflect on their perspectives, assumptions, and experiences, acknowledging how these shape the construction of themes. Reflexive journaling and regular analytic discussions will support transparency, consider alternative interpretations, and enhance analytic rigor. Themes will be constructed to capture both explicit and latent meanings in participants’ accounts, with particular attention to experiences of acculturative stress, integration, and assimilation, interpreted through Berry’s (1980) framework [30]. The analysis will identify patterns, similarities, and differences in reproductive well-being needs, barriers to adapting to a new cultural environment during pregnancy, navigation of social services, and coping strategies.

Study timeline

Participant recruitment is currently ongoing and commenced in November 2025. Recruitment is expected to continue until June 2026. Data collection will occur concurrently with recruitment and is anticipated to be completed by July–August 2026. Data analysis will begin in August–September 2026, with completion of analysis and reporting of results expected by December 2026.

Ethics

Ethical approval for this project has been obtained from the Western University Health Sciences Research Ethics Board (HSREB) in June 2025 (Protocol # 127113). All eligible participants will receive detailed information about the study, including its objectives, potential risks and benefits, procedures, the nature of their involvement, and their rights such as the ability to withdraw at any time without consequence. Only authorized members of the research team will have access to study data. All study data will be securely stored for up to seven years following the completion of the study, in accordance with institutional policies.

Limitations

As this manuscript describes a study protocol, findings are not yet available. Potential limitations include the possibility of recruitment challenges due to language diversity and varying immigration statuses, which may affect the representativeness of the sample. The study is also limited to PSAIs residing in Ontario, which may reduce generalizability to other provinces or South Asian immigrant populations in Canada. Additionally, as interviews will be conducted virtually, we acknowledge potential limitations, including challenges in establishing rapport, reduced capacity to observe non-verbal communication, technological barriers (e.g., limited internet access or digital literacy), and privacy concerns within shared living environments. To address these limitations, we will provide technical assistance as needed and facilitate referrals to organizations that offer access to digital devices and internet connectivity, including libraries and community partners (CASSA). Despite these limitations, the study’s purposive and maximum variation sampling approach is designed to capture diverse perspectives to ensure rich and meaningful insights.