Community-based perinatal mental health peer support: a realist review
Abstract Background Peer support has been suggested as an alternative or complement to professional support for mothers with perinatal mental health difficulties. The aim of this realist review was to synthesise the evidence on perinatal mental health peer support programmes outside mental health se...
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| Format: | Article |
| Language: | English |
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BMC
2023-08-01
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| Series: | BMC Pregnancy and Childbirth |
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| Online Access: | https://doi.org/10.1186/s12884-023-05843-8 |
| _version_ | 1797555824772513792 |
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| author | Jenny McLeish Susan Ayers Christine McCourt |
| author_facet | Jenny McLeish Susan Ayers Christine McCourt |
| author_sort | Jenny McLeish |
| collection | DOAJ |
| description | Abstract Background Peer support has been suggested as an alternative or complement to professional support for mothers with perinatal mental health difficulties. The aim of this realist review was to synthesise the evidence on perinatal mental health peer support programmes outside mental health services, to understand what is it about community-based perinatal mental health peer support that works, for whom, in what circumstances, in what respects, and why. Methods Applying realist methodology, an initial theoretical model was tested against evidence from empirical studies. 29 empirical studies were included, covering 22 antenatal and postnatal mental health interventions that offered one-to-one or group peer support, in person or by telephone. Data extraction identified the configurations of contexts (C), mechanisms (M) and outcomes (O) relevant to mothers’ use of peer support and to the positive and negative effects of using peer support. Results 13 C-M-O configurations explained take-up of peer support. These were based on mothers’ perceptions that peer support would offer empathetic understanding and non-judgemental acceptance outside their social circle; their relationships with primary health professionals; their cultural background and perspectives on mental health; their desire for professional support; overcoming practical barriers; the format of the support; and the use of volunteers. A further 13 C-M-O configurations explained positive impact on mothers. These were based on receiving empathetic listening, acceptance, affirmation and normalisation; peers sharing ideas about self-care, coping, and services; peers using therapeutic techniques; the opportunity to give support to others; meaningful social relationships with volunteers and other mothers; and other benefits of attending a group. There were 8 C-M-O configurations explaining negative impact. These were based on lack of validation; self-criticism from downward and upward social comparison; a culture of negativity; peers being judgemental or directive; not feeling heard; peer support as a stressful social relationship; and distress at endings. Conclusions Peer support works in complex ways that are affected by personal and social contexts. Providers, commissioners and evaluators can use this review to understand and maximise the valuable benefits of peer support, to minimise potential risks, and to devise ways of reaching mothers who do not currently engage with it. |
| first_indexed | 2024-03-10T16:53:08Z |
| format | Article |
| id | doaj.art-9da981c936ab4eeba216789625c2adcf |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-03-10T16:53:08Z |
| publishDate | 2023-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-9da981c936ab4eeba216789625c2adcf2023-11-20T11:13:52ZengBMCBMC Pregnancy and Childbirth1471-23932023-08-0123111210.1186/s12884-023-05843-8Community-based perinatal mental health peer support: a realist reviewJenny McLeish0Susan Ayers1Christine McCourt2Centre for Maternal and Child Health Research, School of Health Sciences, City, University of LondonCentre for Maternal and Child Health Research, School of Health Sciences, City, University of LondonCentre for Maternal and Child Health Research, School of Health Sciences, City, University of LondonAbstract Background Peer support has been suggested as an alternative or complement to professional support for mothers with perinatal mental health difficulties. The aim of this realist review was to synthesise the evidence on perinatal mental health peer support programmes outside mental health services, to understand what is it about community-based perinatal mental health peer support that works, for whom, in what circumstances, in what respects, and why. Methods Applying realist methodology, an initial theoretical model was tested against evidence from empirical studies. 29 empirical studies were included, covering 22 antenatal and postnatal mental health interventions that offered one-to-one or group peer support, in person or by telephone. Data extraction identified the configurations of contexts (C), mechanisms (M) and outcomes (O) relevant to mothers’ use of peer support and to the positive and negative effects of using peer support. Results 13 C-M-O configurations explained take-up of peer support. These were based on mothers’ perceptions that peer support would offer empathetic understanding and non-judgemental acceptance outside their social circle; their relationships with primary health professionals; their cultural background and perspectives on mental health; their desire for professional support; overcoming practical barriers; the format of the support; and the use of volunteers. A further 13 C-M-O configurations explained positive impact on mothers. These were based on receiving empathetic listening, acceptance, affirmation and normalisation; peers sharing ideas about self-care, coping, and services; peers using therapeutic techniques; the opportunity to give support to others; meaningful social relationships with volunteers and other mothers; and other benefits of attending a group. There were 8 C-M-O configurations explaining negative impact. These were based on lack of validation; self-criticism from downward and upward social comparison; a culture of negativity; peers being judgemental or directive; not feeling heard; peer support as a stressful social relationship; and distress at endings. Conclusions Peer support works in complex ways that are affected by personal and social contexts. Providers, commissioners and evaluators can use this review to understand and maximise the valuable benefits of peer support, to minimise potential risks, and to devise ways of reaching mothers who do not currently engage with it.https://doi.org/10.1186/s12884-023-05843-8Peer supportMental healthAntenatalPostnatalCommunity-basedRealist |
| spellingShingle | Jenny McLeish Susan Ayers Christine McCourt Community-based perinatal mental health peer support: a realist review BMC Pregnancy and Childbirth Peer support Mental health Antenatal Postnatal Community-based Realist |
| title | Community-based perinatal mental health peer support: a realist review |
| title_full | Community-based perinatal mental health peer support: a realist review |
| title_fullStr | Community-based perinatal mental health peer support: a realist review |
| title_full_unstemmed | Community-based perinatal mental health peer support: a realist review |
| title_short | Community-based perinatal mental health peer support: a realist review |
| title_sort | community based perinatal mental health peer support a realist review |
| topic | Peer support Mental health Antenatal Postnatal Community-based Realist |
| url | https://doi.org/10.1186/s12884-023-05843-8 |
| work_keys_str_mv | AT jennymcleish communitybasedperinatalmentalhealthpeersupportarealistreview AT susanayers communitybasedperinatalmentalhealthpeersupportarealistreview AT christinemccourt communitybasedperinatalmentalhealthpeersupportarealistreview |