Take-up of community-based perinatal mental health peer support from trained volunteers: a realist-informed study

To explore mechanisms that lead mothers with perinatal mental health difficulties to take up an offer of face-to-face peer support from trained volunteers, and contextual factors triggering those mechanisms.

Realist evaluation methods were used to identify context-mechanism-outcome configurations for take-up in a community-based, third sector programme offering one-to-one and group peer support in the UK. Data were from semi-structured interviews with mothers (n = 20), peer support volunteers (n = 27), and staff (n = 9), and baseline quantitative and open-text data about mothers at referral (n = 260).

182/260 mothers (70%) took up peer support, varying between sites with different populations. Twenty context-mechanism-outcome configurations explained take-up, which depended on complex contextual factors. Mechanisms clustered around mothers' expectations of psychological safety; desire for a meaningful reference group for social comparison; beliefs about what they may gain; expectations about how it might compare to professional mental health support; and practical issues such as mode of delivery. The purpose of peer support can be misunderstood. Not all communities see value in talking about emotional distress with peers, and not all mothers trust peers to be non-judgemental. One-to-one and group support may feel safe to different mothers.

Programmes should work with mothers, third sector organisations, and community leaders, to identify how perinatal mental health peer support can be locally offered most appealingly. Accessibility may be increased by offering a choice of group or one-to-one support, and a blend of face-to-face, telephone, and video-conferencing. Publicity material should clearly explain what peer support is and how it can help.