<p>Integrated Behavioural Activation and physical activity interventions have the potential to tackle depression and diabetes multimorbidity. However, such interventions, developed in high-income countries, may need to be adapted and contextualized to be appropriate for use in low and middle-income countries. The objective of this study was to adapt an Integrated Behavioural Activation and physical activity intervention to tailor it for women with depression and type 2 diabetes mellitus living in Pakistan. Two co-design informed workshops with key stakeholders (people with depression and type 2 diabetes mellitus, carers, healthcare workers, and social workers) were conducted. The purpose of workshop 1 was to identify facilitators and barriers to the delivery of the original Integrated Behavioural Activation and physical activity intervention (BAcPAc) intervention as per the domains of the Bernal cultural adaptation framework (language, persons, metaphors, content, concepts, goals, methods, context). Based on the findings of workshop 1, changes were made to the original intervention. Stirman’s adaptation classification was used to map the changes. In workshop 2, participants’ feedback was used to refine the contents of the adapted intervention. A total of 21 participants attended workshop 1, while 16 participants attended workshop 2. Barriers and enablers were identified in all domains of the Bernal’s framework. Changes were made in the language, pictures/illustrations, intervention dose and delivery, training intensity, and evaluation measures. This study produced a theoretically informed, culturally adapted Integrated Behavioural Activation and physical activity intervention for women with depression and type 2 diabetes mellitus (BE-ACTIVE) living in Pakistan.</p>