Coping Styles and General Self-Efficacy Among Pregnant Women: Evidence from a Multicenter Study in Tunisia

Background: Coping styles and general self-efficacy (GSE) are central to managing pregnancy challenges, yet evidence from lower-middle-income countries remains limited. This study aimed to identify coping styles during pregnancy and to assess their associations with GSE, social determinants, and pregnancy-related factors. Methods: A multicenter cross-sectional study was conducted among pregnant women aged 18-45 years attending antenatal clinics in Sousse, Tunisia, between July 2024 and March 2025. A multistage random sampling strategy recruited participants. Data was collected using validated Arabic versions of the Brief COPE Inventory and the General Self-Efficacy Scale (GSES). Results: Among 417 respondents, emotion-focused coping was the most frequently used coping strategy (mean = 31.83 ± 6.85). Mean GSE was 28.15 ± 6.01, with 12.2% reporting low GSE. There is a significant difference between GSE and problem-focused and emotion-focused coping styles (p = 0.011; p = 0.019, respectively). Unemployment was negatively associated with problem-focused coping (p = 0.012), while rural residence and divorce were negatively associated with emotion-focused coping (p = 0.037; p = 0.004, respectively). Avoidant coping style was determined by unemployment and multiparity (p =0.043; p = 0.049, respectively). Conclusions: These findings highlighted the need for comprehensive perinatal care strategies that incorporate psychosocial factors and address contextual vulnerabilities, particularly among rural, unemployed, and divorced pregnant women.