Introduction

Maternal Mental Health in Minoritized Populations

Maternal mental health (MMH) encompasses a variety of psychological, emotional, and social well-being concerns that arise during pregnancy and the postpartum period. Symptoms can range from acute anxiety and suicidal thoughts to melancholy and feelings of inadequacy. Untreated disorders, such as anxiety and depression, may significantly compromise the health of both the mother and the infant. Birthing people may experience enduring mental health issues, while developmental complications for infants, such as cognitive impairments and behavioral difficulties, may result from unaddressed maternal mental health conditions

Be Mom Aware: Addressing Maternal Mental Health Disparities

Be Mom Aware (BMA) is a Sacramento Maternal Mental Health Collaborative project. Trainings were funded by First 5 Sacramento and Anthem Blue Cross. BMA’s primary goal is to reduce stigma and ensure that African American/Black and Latina mothers have access to maternal mental health services. BMA offers 90-minute training sessions to community-based organizations (CBOs) to enhance participants' comprehension and equip them with the necessary resources to address perinatal mental health-related issues. These trainings are culturally tailored to improve participants' understanding of the cultural factors that influence mental health and to mitigate implicit biases.

Methodology

Evaluation Plan and Ethical Standards

Quantitative and qualitative data collection methodologies were implemented while evaluating BMA’s training program. Pretest and post-test questionnaires were administered to 102 individuals from various community-based organizations in the Sacramento area. The questionnaires assessed participants’ knowledge, confidence, and understanding of maternal mental health before and during the training sessions. The ethical considerations for this evaluation were rigorous. After data collection, personal identifiers were eliminated from surveys, ensuring anonymity and confidentiality were maintained throughout the procedure. Tulane University granted the experiment Institutional Review Board (IRB) exemption, and all participants were informed of the study’s objectives, nature, and potential hazards. Before completing the questionnaires, participants were encouraged to pose inquiries and received comprehensive responses.

• Comprehensive Perinatal Health Workers

• Public Health Nursing, among others.

The diversity of the participants ensured that feedback was representative of various cultural and socioeconomic backgrounds, making the findings more robust.

Data Collection and Analysis

The data was collected between January and May of 2024. Pretest surveys were administered electronically to participants before the 90-minute training sessions, and posttest surveys were administered afterward to evaluate the program’s efficacy.

Excel was employed to analyze quantitative data to identify trends and patterns. Bar charts were developed to demonstrate participants’ confidence and knowledge distinctions. Thematic analysis was performed on qualitative data to identify key themes and recurring patterns. subsequently, the data was employed to develop an action plan that included recommendations for future training improvements.

Survey Design

The program’s six primary objectives were assessed by developing pretest and posttest questionnaires. The surveys included open-ended responses and Likert-scale inquiries, allowing participants to offer qualitative feedback on the training experience (see Table 1).

Participants

The participants in this evaluation came from a wide range of CBOs, including:

• Haven for Birth

• Women, Infants, and Children (WIC)

• WellSpace Health

Results

Quantitative Findings

Sixty out of one hundred and two participants completed the post-test survey, yielding a completion percentage of 59%. The statistics indicated a significant improvement in participants’ confidence and understanding of maternal mental health concerns, notwithstanding the low response rate.

After the training, all participants reported being “somewhat confident” (Level 3) or “confident” (Level 4) in recognizing perinatal mental health concerns. No individual exhibited differing degrees of confidence. Upon completing the training, all participants indicated feeling at least “somewhat confident” with a significant percentage advancing to the “confident” group (See Table 2).

Participants assessed the training methodologies on a scale from 1 to 5, where 1 indicated “not effective” and 5 denoted “highly effective.” The pre-training answers exhibited significant variability, with many participants categorizing current approaches as “somewhat effective” or “not effective.” Most participants assessed the methods as “effective” (Level 4) or “highly effective” (Level 5), indicating a substantial increase in post-training feedback (see Table 3).

The program also aimed to improve understanding of how cultural influences affect perinatal mental health outcomes. Many participants exhibited insufficient knowledge of these aspects before the training, with cultural awareness scores below 3 and “somewhat knowledgeable.” Most participants showed a significant improvement in their understanding after the instruction. Cultural awareness increased “somewhat improved” (Level 3) and “improved” (Level 4), with very few indicating “little improvement.” A similar number of participants came in with a high level of prior knowledge, which could explain the lower improvement scores for a small subset of participants (see Table 4).

Qualitative Findings

Participants provided significant qualitative comments on the training sessions, highlighting areas for improvement and further assistance needs including:

Enhanced Resource Availability: The participants requested the allocation of supplementary materials, especially in languages other than English. They emphasized the importance of language accessibility in engaging with minority populations.

Frequency: Participants advocated for BMA to enhance the frequency of training sessions to improve learning and extend community engagement via home visits.

Role-playing and Case Studies: To enhance the training’s practical applications, several participants proposed incorporating additional interactive components, such as real-world case studies and role-playing situations.

Discussion

The Importance of Cultural Competency in Maternal Mental Healthcare

The significance of cultural competence in improving maternal mental health outcomes for ethnic minority populations is a critical result of this assessment. The Be Mom Aware program successfully highlighted the cultural elements that affect the perception, detection, and treatment of mothers’ mental health concerns. Maternal mental health issues, such as postpartum depression and anxiety disproportionately impact African American and Latina women. Therefore, culturally relevant treatments are necessary to address these discrepancies.

The notion of cultural competence involves more than only acknowledging differences in language, race, and ethnicity. This requires a deep understanding of how historical, social, and economic variables affect health outcomes and people’s relationships with healthcare institutions. In minority populations, the healthcare system poses a substantial barrier to treatment access, sometimes owing to distrust rooted in past injustices. The BMA’s training sessions featured talks on these matters, enhancing participants’ comprehension of the effects of implicit biases and systemic discrimination on the health outcomes of ethnic minorities in maternal health.