Evaluating the effectiveness, facilitators and implementation challenges of perinatal mental health peer support interventions among ethnic minority perinatal women living in high-income countries

Abstract

Abstract Women from ethnic minorities in high-income countries face higher perinatal mental health challenges and encounter substantial barriers to accessing timely, culturally sensitive mental health services. Peer support interventions are seen as a promising strategy to reduce these disparities, but there is limited evidence comparing the effectiveness of digital versus non-digital delivery methods for this group. This systematic review evaluates the effectiveness, facilitators and implementation challenges of both digitally delivered and non-digitally delivered peer support interventions for the ethnic minority women experiencing perinatal mental health difficulties living in high-income countries. This systematic review used a mixed-methods approach, following PRISMA 2020 guidelines and registered with PROSPERO (CRD42025644255). It searched six electronic databases: MEDLINE, PubMed, Embase, Web of Science, CINAHL and Scopus, as well as grey literature sources, covering publications from 2000 onwards. The study designs included were randomised controlled trials (RCTs), non-RCTs, quantitative studies, mixed-methods research and qualitative studies. The quality assessment employed the ROB2 tool, the CASP checklist and the MMAT. Quantitative results were summarised narratively, while qualitative findings were analysed thematically based on the Thomas and Harden (2008) framework. Nineteen studies from seven high-income countries met the inclusion criteria. Non-digitally delivered interventions showed greater consistency and statistical significance. Digitally delivered interventions were reported to be effective for high-risk subgroups. Qualitative analysis revealed that digital interventions improved accessibility, flexibility, peer engagement and cost-effectiveness, but also faced barriers such as digital literacy gaps, connectivity issues, privacy concerns and cultural-linguistic disparities. Non-digital interventions offered stronger emotional bonds, cultural grounding and trust-building but encountered logistical, workforce and sustainability challenges. An equity paradox was identified: digital interventions aimed at increasing access sometimes inadvertently excluded individuals with limited digital skills, disproportionately impacting the ethnic minority women the interventions were intended to serve. Both modalities showed significant benefits in reducing perinatal mental health symptoms among the ethnic minority women; they operate through different mechanisms and face unique implementation challenges. No single approach was universally effective. Hybrid models appear particularly promising and warrant further research. Future studies should focus on direct comparative trials, community-co-designed cultural adaptations, long-term outcome assessments and strategies to address digital inequity in perinatal mental health care.