Perceptions of Mothers In a Rural Community Impacted By Mental Health Inequities: Mental Health Services Change for the Common Good through Community-Based Participatory Research.

Background: Improving maternal mental health during pregnancy and early childhood is a critical strategy to improve health and developmental outcomes for mothers, children and families. Rural residency increases risk for negative health outcomes, particularly mental health. To address inequities in rural maternal mental health and transform systems, holistic approaches incorporating rural mothers’ lived experience including strengths and resilience are needed to achieve sustainable social change, health equity and to develop interventions that prevent and treat psychiatric illnesses.

Methods: This IRB approved exploratory, community-based participatory research study was conducted in partnership with a diverse, rural NC community. We used qualitative methods and critical methodologies to answer: What are rural mothers’ challenges and strengths related to mental health? What do rural mothers need to promote their mental health?

Data from surveys, semi-structured qualitative interviews, and focus groups was collected from 2023-2026 from a community convenance sample of 88 pregnant and/or self-identified ‘mothers’ with children under age five recruited by the community advisory board (CAB). Most mothers identified as Black (39%) or American Indian (36%); had annual household incomes < $10,000 (50%), were single (56%), and had a high school education or less (75%). Positive screenings for depression (40.7%), post-traumatic stress disorder (38.5%) and anxiety (19.9%) were above national averages.

The interview guide was developed collaboratively with the CAB. Individual interviews were conducted in-person or online and transcribed verbatim. Transcript checking, reflexivity, triangulation of coders, member checking, and negative case analysis ensured data trustworthiness. Inductive codes were developed using grounded theory. Codes and themes were reviewed by content experts, members, and the CAB. Transcript were coded by two coders. Discrepancies were resolved by consensus. Data was coded beyond saturation. Analysis focused on multiple intersecting areas generating overarching and subthemes.

Results: Overarching themes emerged in two categories: strengths and areas for growth. Resilience and self-reliance emerged as dominant individual strengths while support from local programs and faith-based support were critical community strengths. Dominant themes in areas for growth included the need for additional practical, individual, familial, and relational supports; unmet mental health needs; community safety concerns and lack of resources, policies to protect and support mothers and young children; and maternal burnout and fear of judgement as a barrier for help seeking. Mothers reported policies and community needs created barriers to accessing mental health services. Mothers expressed a desire for peer and professional led support groups and access to confidential therapeutic services.

Implications: Findings represent rich data from the lived expertise of rural mothers. While limited by geographic location, findings mirror many barriers reported by rural individuals and mothers surviving poverty and discrimination in urban and suburban setting though rural locations present with additional challenges. Important implications for practice include mothers’ desire for peer and professional support and resource sharing to support mental health. Gaps in existing resources, mental health programming, and policies to support health equity for rural mothers and families are also described. A proposed plan to transform rural maternal mental health through a combined prevention/treatment intervention will be presented.