Table 2 Themes and subthemes

Theme 1. Lack of awareness and understanding of perinatal mental illness and service structure in both healthcare professionals and patients

1.1 Cultural and spiritual attributions: “[Patients] don’t like to accept that they have depression, they don’t believe in it”

1.2 Not knowing where to get help: “[There is] a lack of knowledge that PMHS exist in the first place”

1.3 Remit and scope of services are unknown and misunderstood across groups: “Services could be better at explaining what is going to happen”

Theme 2: Patients’ relationships with family, friends and healthcare professionals can both hinder and facilitate access to services

2.1 Personal support networks are pivotal: Friends and family can both support or prevent patients from accessing help

2.2 Interpreters have power to affect the patient-healthcare professional dynamic: “You do explain the confidentiality grounds but even still, it feels like an invasion”

2.3 Peer support workers are trusted by communities: “They are a bridge to bringing people in”

Theme 3: Healthcare professionals promote raising awareness, flexibility, developing shared understandings, and questioning assumptions to improve the accessibility and acceptability of services

3.1. Work towards shared meanings between HCPs and patients: “There’s a different type of understanding of mental health and what mental health means to some cultural groups”

3.2. Reflexive and reflective practices are needed to uncover biases: “I think people are scared to say that they have an unconscious bias”

3.3. Services should offer choice where possible: “We’ll learn how to adapt our service for [patients’] needs.”

3.4. Awareness campaigns about perinatal mental disorders: “It can happen to you, it can happen to me, it can happen to anyone”