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Abstract

Aims
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.

Methods
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).

Results
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.

Conclusion
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.

Publication Type:	Article
Additional Information:	© 2026 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent.
Publisher Keywords:	Peer support, perinatal mental health, take-up, realist, mother, volunteer
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Departments:	School of Health & Medical Sciences School of Health & Medical Sciences > Department of Nursing & Midwifery
SWORD Depositor:	Symplectic Administrator

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