Presentation
Uncovering What Hurts and What Helps: A Sociotechnical Investigation of Structural Barriers and Design Opportunities in Maternal Mental Health Care Systems
DescriptionIntroduction
Racialized birthing people face higher risk of maternal mental health conditions, including postpartum depression and anxiety [1]. Among mothers within the United States, Black mothers and birthing individuals are at a disadvantage in autonomous decision-making due to factors such as limited access to resources, lack of universal screening, disjointed healthcare systems, and inadequate mental health education [2]. In Canada, limited race-based data hinder precise prevalence statistics for mood and anxiety disorders among this group but also for understanding access barriers [3, 4]. Nonetheless, scholar have begun to explore disparities in treatment for maternal mental health among Black African newcomers. Cultural beliefs, racial discrimination, and immigration status are contributing factors to reduced utilization of postpartum mental health services among this group [4]. In the United States, approximately 1 in 5 new mothers experience mental health concerns, with approximately 40% of Black women reporting symptoms related to maternal mental health [5]. Alarmingly, nearly half of these women do not receive any treatment or support for these conditions, underscoring the urgent issue faced by Black birthing communities [6]. These figures underscore an urgent call for systemic transformation.
Historically, human factors and ergonomics (HFE) scholars have long investigated how individuals interact with complex sociotechnical systems to improve access to care[7]. From Balance Theory to the more recent SEIPS (Systems Engineering Initiative for Patient Safety) models, HFE has evolved to place greater emphasis on the role of patients within healthcare environments [8,9]. Over the years, SEIPS 3.0 has ended extended further, conceptualizing the patient journey as a distributed system of interactions across time, space, and stakeholders [10, 11]. SEIPS 3.0 provides an avenue to gain a deeper understanding of the situated patient journey of new mother in maternal mental health care. Furthermore, understanding the impact of multi-level factors and how they play a role in the patient's journey needs further exploration [12, 13]. Public health scholars have leveraged the socio-ecological model as a method to understand barriers and facilitators across multiple levels (individual, interpersonal, community, institutional, and systemic) [14, 15, 16]. Within this study who hope to bridge the use of both the SEIPS 3.0 and socio-ecological frameworks to inform how we think about care access concerns.
Objective
This study seeks to explore the lived experiences of mothers navigating the Canadian mental healthcare system during the perinatal and postpartum periods. Through a qualitative approach, the research aims to uncover individual experiences, identify systemic barriers, and highlight sources of resilience and positive engagement within the care system. By engaging directly with racialized mothers this research will contribute to a more holistic understanding of maternal mental health access experiences from diverse groups in Canada. The primary research question guiding this study is: What are the multifaceted experiences of racialized women in the Canadian mental healthcare system during the perinatal and postpartum periods? Specifically, this includes two core objectives: (1) identifying challenges that maternal women face in accessing mental healthcare in Canada, and (2) determining factors that contribute to successful mental healthcare experiences.
Methods
We conducted 14 semi-structured interviews with racialized mothers within the Greater Toronto Area (GTA). Participants self-identified as Black (n=9), and Southeast Asian (n=5). Data was analyzed using a collaborative thematic analysis approach leveraging both inductive and deductive coding (socio-ecological model). Two researchers used consensus building to cluster codes into the higher-level domains. Codes were clustered across five socio-ecological domains: individual, interpersonal, community, systemic, and institutional. To synthesize and visualize these insights, we developed a patient journey map that traced the continuum of care from prenatal through postpartum stages. This map was used to highlight persistent system breakdowns and highlighted the informal workarounds mothers devised to manage their mental health needs in the absence of accessible, culturally responsive services
Results
Findings revealed significant access barriers across multiple domains of the sociotechnical system. Most prominently, the individual domain revealed many moderating factors impacting access. Participants described trust within healthcare providers, level of comfort with disclosing emotional needs, and the use of self-coping strategies as a moderator to formal care-seeking. Among interpersonal factors constrained participants expressed perception of authentic emotional engagement with providers as a major moderator in their willingness to seek support. At the community level, peer support groups and informal networks emerged as critical and sometimes the only source of emotional care and coping. Lastly, systemic and institutional barriers, such as the fear of child apprehension, disjointed referral systems, service costs, and time constraints, created additional layers of difficulty in navigating mental health services during the perinatal and postpartum periods.
Conclusion
Our findings offer actionable strategies for system redesign, including the integration of universal screening during perinatal care, expansion of culturally grounded peer navigation infrastructure, creation of low-cost and flexible care delivery models, and development of collaborative care pathways that bridge obstetric, primary, and mental health services. As both a conceptual and practical tool, the journey map functioned as a systems-level artifact to inform future healthcare redesign. By situating participant experiences within journey maps, this study demonstrates how a sociotechnical analysis in combination with a socio-ecological lens can be used to identify critical points of failure, as well as leverage points for transformation within maternal mental health care.
Racialized birthing people face higher risk of maternal mental health conditions, including postpartum depression and anxiety [1]. Among mothers within the United States, Black mothers and birthing individuals are at a disadvantage in autonomous decision-making due to factors such as limited access to resources, lack of universal screening, disjointed healthcare systems, and inadequate mental health education [2]. In Canada, limited race-based data hinder precise prevalence statistics for mood and anxiety disorders among this group but also for understanding access barriers [3, 4]. Nonetheless, scholar have begun to explore disparities in treatment for maternal mental health among Black African newcomers. Cultural beliefs, racial discrimination, and immigration status are contributing factors to reduced utilization of postpartum mental health services among this group [4]. In the United States, approximately 1 in 5 new mothers experience mental health concerns, with approximately 40% of Black women reporting symptoms related to maternal mental health [5]. Alarmingly, nearly half of these women do not receive any treatment or support for these conditions, underscoring the urgent issue faced by Black birthing communities [6]. These figures underscore an urgent call for systemic transformation.
Historically, human factors and ergonomics (HFE) scholars have long investigated how individuals interact with complex sociotechnical systems to improve access to care[7]. From Balance Theory to the more recent SEIPS (Systems Engineering Initiative for Patient Safety) models, HFE has evolved to place greater emphasis on the role of patients within healthcare environments [8,9]. Over the years, SEIPS 3.0 has ended extended further, conceptualizing the patient journey as a distributed system of interactions across time, space, and stakeholders [10, 11]. SEIPS 3.0 provides an avenue to gain a deeper understanding of the situated patient journey of new mother in maternal mental health care. Furthermore, understanding the impact of multi-level factors and how they play a role in the patient's journey needs further exploration [12, 13]. Public health scholars have leveraged the socio-ecological model as a method to understand barriers and facilitators across multiple levels (individual, interpersonal, community, institutional, and systemic) [14, 15, 16]. Within this study who hope to bridge the use of both the SEIPS 3.0 and socio-ecological frameworks to inform how we think about care access concerns.
Objective
This study seeks to explore the lived experiences of mothers navigating the Canadian mental healthcare system during the perinatal and postpartum periods. Through a qualitative approach, the research aims to uncover individual experiences, identify systemic barriers, and highlight sources of resilience and positive engagement within the care system. By engaging directly with racialized mothers this research will contribute to a more holistic understanding of maternal mental health access experiences from diverse groups in Canada. The primary research question guiding this study is: What are the multifaceted experiences of racialized women in the Canadian mental healthcare system during the perinatal and postpartum periods? Specifically, this includes two core objectives: (1) identifying challenges that maternal women face in accessing mental healthcare in Canada, and (2) determining factors that contribute to successful mental healthcare experiences.
Methods
We conducted 14 semi-structured interviews with racialized mothers within the Greater Toronto Area (GTA). Participants self-identified as Black (n=9), and Southeast Asian (n=5). Data was analyzed using a collaborative thematic analysis approach leveraging both inductive and deductive coding (socio-ecological model). Two researchers used consensus building to cluster codes into the higher-level domains. Codes were clustered across five socio-ecological domains: individual, interpersonal, community, systemic, and institutional. To synthesize and visualize these insights, we developed a patient journey map that traced the continuum of care from prenatal through postpartum stages. This map was used to highlight persistent system breakdowns and highlighted the informal workarounds mothers devised to manage their mental health needs in the absence of accessible, culturally responsive services
Results
Findings revealed significant access barriers across multiple domains of the sociotechnical system. Most prominently, the individual domain revealed many moderating factors impacting access. Participants described trust within healthcare providers, level of comfort with disclosing emotional needs, and the use of self-coping strategies as a moderator to formal care-seeking. Among interpersonal factors constrained participants expressed perception of authentic emotional engagement with providers as a major moderator in their willingness to seek support. At the community level, peer support groups and informal networks emerged as critical and sometimes the only source of emotional care and coping. Lastly, systemic and institutional barriers, such as the fear of child apprehension, disjointed referral systems, service costs, and time constraints, created additional layers of difficulty in navigating mental health services during the perinatal and postpartum periods.
Conclusion
Our findings offer actionable strategies for system redesign, including the integration of universal screening during perinatal care, expansion of culturally grounded peer navigation infrastructure, creation of low-cost and flexible care delivery models, and development of collaborative care pathways that bridge obstetric, primary, and mental health services. As both a conceptual and practical tool, the journey map functioned as a systems-level artifact to inform future healthcare redesign. By situating participant experiences within journey maps, this study demonstrates how a sociotechnical analysis in combination with a socio-ecological lens can be used to identify critical points of failure, as well as leverage points for transformation within maternal mental health care.
Event Type
Oral Presentations
TimeWednesday, March 259:37am - 10:00am EDT
LocationMurray Hill East
Patient Safety Research and Initiatives