Understanding Community Participation in Psychological Counselling for Maternal Depression: A Grounded Theory Approach

Understanding Community Participation in Psychological Counselling for Maternal Depression: A Grounded Theory Approach | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Understanding Community Participation in Psychological Counselling for Maternal Depression: A Grounded Theory Approach YA LING, Siti Roshaidai Mohd Arifin, Siew Pien Lee, Siti Hajar Mohamed Zain This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8572741/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The impact of maternal depression on maternal and infant health has attracted increasing attention. However, there are still obvious shortcomings in the current grassroots psychological service system in terms of resource allocation, service accessibility and professional ability. As an important carrier of grassroots governance, the community has shown the unique advantages of psychological support sinking, emotional companionship extension and resource integration and coordination in maternal psychological counseling. Methods Based on the grounded theory, this study selected typical communities in third-tier cities in central China, conducted qualitative research by interviewing 20 pregnant women and 10 CHW at risk of depression through semi-structured interviews, and sorted out the intervention mechanism through open, spindle and selective coding systems. Results The results identified five core elements: the establishment of trust and security, the construction of emotional support system, the implementation of cultural adaptation strategies, the ability to integrate resources, and the creation of non-directive counseling relationships. The above elements constitute a system structure of nested interaction and cyclical promotion. Among them, non-directive counseling runs through the whole process, emphasizing empathy, listening and subject autonomy, especially adapting to the cultural context of collectivism. Conclusion This study constructs a multi-dimensional integrated community-based maternal depression intervention model, which provides a theoretical basis and practical path for optimizing the grassroots psychological service system and improving the mental health of women during pregnancy and childbirth. Community engagement Maternal and childbirth depression Multisectoral collaboration Grounded theory Cultural adaptation Figures Figure 1 Introduction In recent years, maternal mental health has attracted increasing global attention. According to the World Health Organization, about 10%–20% of pregnant women experience depressive symptoms (WHO, 2020). Maternal depression not only seriously affects maternal and infant health and family stability but may also have adverse effects on the emotional and cognitive development of the baby and further trigger a series of social chain reactions (Nisar et al., 2020). Community health workers (CHW) are frontline public health workers who act as a bridge between community members and health and social services. They build support network for women and families through regular visits (Fellmeth et al., 2019; Yim et al., 2019), and integration of social services, and volunteering tasks within their medical care (Fisher et al., 2019). They also rely on health service centres and mutual support groups to provide emotional support and skills training (Shorey et al., 2018; Pilkington et al., 2020). Together, these approaches help compensate for limited psychological service resources within the formal medical system and promote a public health service model based on social co-governance (WHO, 2020; Reilly et al., 2020). This multidimensional intervention model not only responds to policy guidance but also highlights the pivotal value of the community in ensuring maternal mental health. Existing research generally affirms the positive role of the community in the prevention and treatment of maternal depression, especially in improving social support, reducing psychological stress, and promoting mental health (Davies et al., 2022). However, there is still a lack of systematic empirical research on how to effectively organize and implement psychological counseling in specific community situations and transform experience into replicable and generalizable practical logic. This deficiency limits the optimization and implementation of community intervention strategies to a certain extent (Sikander et al., 2019). Based on this, this study focuses on the following questions: What are the key elements of community participation in maternal depression counseling? How to construct and optimize the practical logic to improve the effectiveness of community psychological counseling? In order to answer the above questions in depth, this study adopts a grounded theoretical approach to try to extract the core mechanism and theoretical model of community participation intervention from empirical data. Specifically, the structure of this study consists of four main parts: the first part reviews the research progress on maternal depression mental health and community intervention at home and abroad; the second part introduces the study design and data collection; the third part presents the rooted theoretical coding results and the process of refining key elements; The fourth part puts forward policy suggestions and practical guidance based on research findings. This study not only helps to enrich the empirical basis in the field of community psychological intervention but also provides theoretical support and practical paths for policymakers, CHW and mental health professionals, and promotes the institutionalized and scientific development of community forces in the maternal mental health system. 1 Literature Review At present, psychological counseling is considered an effective means of intervening in maternal depression, however, the traditional medical system still has certain deficiencies in terms of accessibility, continuity and personalized services. Therefore, providing effective psychological counseling through community power to improve maternal mental health has become a hot topic of research in recent years (Dennis & Dowswell, 2021). Communities can not only provide low-threshold, long-term mental health support, but also integrate multiple resources to form a multi-dimensional social support network and improve maternal mental resilience (Barlow et al., 2020). This article will focus on two aspects: psychological counseling intervention methods for maternal depression and the role of community participation services in maternal depression intervention. 1.1 Psychological counseling intervention methods for maternal depression Psychological counseling intervention methods for maternal depression have been widely studied and applied, mainly including cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT), music therapy, mindfulness therapy, mental health education, peer support and other forms. CBT is a structured, short-term therapy, making it suitable for mild to moderate maternal depression (Li Zheng, 2021) and helping the women to identify and change negative thought patterns. However, for groups with large cultural differences, the effectiveness of CBT may be limited. IPT focuses on the transformation of maternal interpersonal relationships and social roles, emphasizing the improvement of social support networks, especially suitable for depression caused by interpersonal problems (Liu Yan et al., 2019). However, IPT has high requirements for therapist training, and limited resources hinder its promotion (Wang et al., 2023). Music therapy, as a non-invasive means, can help alleviate anxiety and depression (Sanfilippo et al., 2021), but the effectiveness is influenced by individual differences (Ji et al., 2024). Mindfulness therapy helps pregnant women regulate their mood by promoting self-awareness (Min et al., 2024), but inadequate adherence may weaken the effectiveness of interventions (Leng et al., 2024). Mental health education can improve maternal awareness of mood changes, but has limited effect on moderate to severe depression (Scroggins et al., 2024). Peer support can help reduce loneliness and depression through experience sharing and emotional exchange (Shah et al., 2024), but the effectiveness depends on engagement and the quality of interaction. Overall, although existing interventions have shown some efficacy, most studies focus on healthcare settings or tightly controlled clinical trial settings, which do not reflect the complexity of the real world (Singla et al., 2022). 1.2 The role of community in maternal mental health management The community plays a key role in the management of maternal mental health at multiple levels and dimensions. Studies have shown that the community-based intervention model can significantly reduce the incidence of perinatal depression and anxiety, improve maternal self-efficacy and service adherence, and provide important experience for optimizing full-cycle mental health services (Scroggins et al., 2024). CHWs are trained to implement programs such as problem solving, psychoeducation, and behavioral activation through home visits, thereby improving maternal symptoms of depression and anxiety (Wang et al., 2025). Peer support provides maternal emotional communication and empathetic understanding as part of a community intervention, reducing loneliness and psychological stress (Branjerdporn et al., 2024; However, the effectiveness of peer support is influenced by factors such as cultural differences, form of support, and quality of interaction (McLeish et al., 2023). In addition, community mobilization and education interventions have been shown to improve maternal mental health in rural South Asia, such as women's education groups and community mobilization activities that raise maternal awareness of mental health and promote healthy behaviors (Sharma et al., 2018). In the United States, community-engaged programs for single mothers with precarious housing have improved psychological conditions through mental health education and social support (Joseph et al., 2023). At the same time, new community innovation models have emerged internationally, such as the United Kingdom through community nurse home visits combined with AI mood monitoring tools to achieve precise intervention (NHS, 2023), and Australia's establishment of a "screening-referral-tracking" full-chain service network based on community centers (Beyond Blue, 2022). Nevertheless, there are several deficiencies in existing community intervention research. Although community interventions have shown positive results, their sustainability, cultural adaptability, and reproducibility have not been systematically demonstrated (Phoosuwan et al., 2020). In addition, there are still limited studies on the applicability and differences of intervention strategies in different community contexts, and relevant experiences have not been fully compared and summarized (Ward et al., 2020). Based on this, this paper intends to discuss the "organization and implementation of psychological counseling for maternal depression in community context", aiming to reveal its key elements and practical logic, and provide theoretical support and practical guidance for optimizing the community mental health service system. 2 Methods This study adopts the grounded theory in the qualitative research method, which emphasizes the induction of generative theories from first-hand data rather than the validation of existing theories, which is especially suitable for research fields where the psychosocial mechanism is still unclear (Glaser & Strauss, 2017). This study focuses on answering the following research questions: What are the key elements of community engagement in maternal depression counseling? How do these elements interact and influence intervention outcomes in different community contexts? How to extract replicable and generalizable practical logic from it? In view of the lack of mature theoretical framework in the existing literature, this study adopts a grounded theoretical approach, systematically analyzes the real experience of pregnant women and community workers, and gradually constructs an explanatory theoretical model to respond to the above research questions. The study strictly follows the grounded theoretical operation process proposed by Strauss and Corbin (2015), including three stages: open coding, spindle coding and selective coding, and identifies key concepts in turn, analyzes their interrelationships, and gradually integrates them into theoretical models. The data comes from field interviews and observations, and the research team maintains theoretical sensitivity during the coding process and repeatedly compares different materials to ensure the depth and reliability of the analysis. 2.1 Data sources This study uses a combination of online and on-site interviews to ensure the breadth and diversity of the data. Online interviews are conducted through video conferencing platforms, which can cover more pregnant women with different geographical and social backgrounds, and obtain more representative and extensive views and experiences. On-site interviews, on the other hand, help capture more real emotional reactions and psychological expressions of respondents through face-to-face in-depth communication, enhancing the depth and credibility of the data. The complementary use of the two interview formats can help to comprehensively understand the actual experience of pregnant women in the process of perinatal depression intervention and provide multi-dimensional empirical support for the construction of a psychological counseling intervention model based on community participation. The data were mainly from a community health service center in a third-tier city in central China. Third-tier cities are in the middle of China's urban hierarchy and have typical characteristics of urban-rural integration. The maternal population in the region includes both local residents and migrants from rural or other urban areas, with a diverse socio-economic and cultural background. This characteristic helps to reveal the state of maternal mental health and its influencing factors in different contexts. At the same time, due to the relatively limited medical resources in third-tier cities and the imperfect professional psychological service system, pregnant women are more likely to rely on community support systems to cope with pregnancy and postpartum psychological problems, thus providing a typical sample environment for research. The study targeted pregnant women from the second and third trimesters (≥ 20 weeks of gestation) to one year postpartum and set clear inclusion and exclusion criteria to ensure the representativeness of the sample and the validity of the data. Maternal inclusion criteria are as follows: age ≥ 18 years; 20 weeks of gestation ≥ or ≤ 12 months postpartum; self-rated presence of depression-related symptoms, or previous diagnosis of perinatal depression; participated in community-organized maternal and infant support groups, mental health education activities, or related online platform services; and able to complete semi-structured interviews in Mandarin. In this study, a total of 20 pregnant women from the central third-tier urban community were recruited to participate in the interviews. The basic demographic characteristics of the participating women, including age, education level, occupational status, marital status, birth history, duration of depressive symptoms, and interview method, are summarized in Table 1. To further assess the severity of depressive symptoms among the participants, the Edinburgh Postnatal Depression Scale (EPDS) was used. The individual EPDS scores and corresponding depression severity levels of the 20 pregnant and postpartum women are presented in Table 2. In order to obtain multi-perspective data and gain a deeper understanding of the reality of community interventions, the study also included 10 community health workers as the second type of interview subjects, including general practitioners, community nurses and mental health educators. Through semi-structured interviews, their practical experience, role positioning, implementation difficulties and service feedback in maternal psychological services were collected to supplement the individual perspective of pregnant women and enhance the practical applicability and theoretical depth of the research. Detailed information on the professional roles, service content, and working experience of the community health workers is shown in Table 3. The inclusion criteria for community health workers are as follows: works continuously in the community health service center where the institute is located for ≥ 6 months; directly involves in maternal mental health related services (such as health education, maternal and infant group organization, psychological support, etc.); and agree to participate in this study. Table 1 Basic information of women with pregnancy and childbirth depression Basic information Number （ n ） Percentage （ % ） Age 18-28 29-39 >40 6 12 2 30 60 10 Education High school University Graduate student 2 13 5 10 65 25 Occupational status Housewife Incumbency 8 12 40 60 Marital status Married Unmarried/divorced 19 1 95 5 Birth time Primiparous women Prolific mothers（2-4） 11 9 55 45 Duration of depressive symptoms ≤6 months 6-12months 8 12 40% 60% Interview method Face-to-face interviews Online interview 11 9 55% 45% Table 2 Pregnancy and childbirth depression scale (EPDS) Maternal number EPDS score Grade of depression P001 14 Moderate depression P002 17 Moderate to severe depression P003 20 Major depression P004 11 Critical value P005 15 Moderate depression P006 12 Moderate depression P007 15 Moderate depression P008 13 Moderate depression P009 14 Moderate depression P010 12 Moderate depression P011 15 Moderate depression P012 14 Moderate depression P013 17 Moderate to severe depression P014 16 Moderate to severe depression P015 13 Moderate depression P016 12 Moderate depression P017 14 Moderate depression P018 18 Moderate to severe depression P019 15 Moderate depression P020 17 Moderate to severe depression Table 3 Information on community health workers No. Occupation Service content Working hours in the current community (years) H1 General practitioners Health education / individual psychological support 5 H2 Community Nurse Health mission/mother and baby group 6 H3 Doctor Health education/mother and baby group / individual psychological support 6 H4 Mental health managers Health education 2 H5 General practitioners Health education / individual psychological support 3 H6 Doctor Mother and baby group / individual psychological support 5 H7 Community Nurse Health mission/mother and baby group 1 H8 Community Nurse Health mission/mother and baby group 2 H9 Community Nurse Health mission/mother and baby group 2 H10 Community Nurse Health mission/mother and baby group 4 2.1.3 Data collection and analysis The study adopts a grounded theory method and conducts semi-structured interviews based on a predefined interview outline. The interview outline is designed with open-ended questions focusing on social support, community intervention experiences, medical service linkage, and expectations for psychological support. The detailed interview outline for pregnant and postpartum women is presented in Table 4. In addition, to obtain complementary perspectives from service providers, a separate semi-structured interview outline was developed for community health workers. The structure and key guiding questions of the interviews with community health workers are shown in Table 5. Table 4 Outline of semi-structured interviews with pregnant women Interview theme Interview questions Social support network Who do you get support from when you feel down or depressed during pregnancy/postpartum? Including family, neighbors, friends, etc.? Are there any organizations or events in the community that offer you emotional support or help? Was this support helpful to you? Experience and expectation of community intervention model Have you heard of or participated in community-organized maternal mental health related events? Please describe it. If there is a peer support group (such as Sororcomet for Maternity), would you be willing to participate? Why? Are you willing to accept the psychological counseling services provided by some non-professional psychological support personnel (such as trained volunteers, health administrators, etc.)? Why? Community medical service linkage Does the community health service center provide mental health related services during pregnancy and childbirth? Have you been in contact with it? When you experience psychological stress or depression, do you think of going to a community health center, hospital or online platform for help? What is the reason? What do you think can be improved between community health services and hospitals in helping maternal mental health? Recommendations and expectations What else do you think the community can do to help with maternal mental health? If you could design a psychological support service that works for you, what features would you like it to have? (e.g. privacy protection, regular follow-up, family participation, etc.) Table 5 Outline of semi-structured interviews with community health workers Interview theme Interview questions Job responsibilities and practical experience 1. Do you involve maternal mental health related tasks in your daily work? What does it include? 2. What are the most common difficulties or challenges encountered in the process of providing psychological support? (such as insufficient resources, resistance of service recipients, etc.) Understanding and application of community intervention models Does your community organize maternal psychology activities? Please tell us about the content and format of the event. How do you think this intervention models have been effective in improving maternal psychological state? Is there an evaluation mechanism? Perceptions of non-professional psychological support roles Are there training volunteers, health administrators, etc. in the community to participate in psychological counseling? How would you rate their role? Do you personally have any psychology-related training? Do you feel the need to strengthen it? Collaboration with other healthcare resources In the work, is there a cooperation mechanism with the hospital psychology department or obstetrics and gynecology department? What exactly is it? What are some good experiences or problems with cross-agency cooperation (e.g., referral, resource sharing)? Policy and service improvement suggestions What do you think are the shortcomings in the current community in terms of maternal psychological intervention? If you were asked to design a more efficient service model, what new content or mechanics would you like to include? (e.g., regular screening, teleconsultation, family participation, etc.) In order to ensure the systematization of the interview process and the reliability of the research results, this study designs the interview implementation steps in detail and clarifies the process of information collection and analysis. Before the formal interview, the researcher will explain the background, purpose, implementation method and topic content of this study in detail to the participants and clearly inform the participants that the expected duration of the interview is 45 to 60 minutes, and the interview method will be mainly conducted through WeChat voice and other forms. At the same time, the researchers will solemnly promise to keep the information of all respondents strictly confidential, and the data obtained will only be used for this study and will not be used for other purposes without permission. Within 24 hours of each interview, the research team transcribed the audio content into text to ensure semantic accuracy and completeness, ultimately building a source database of more than 150,000 words. In order to ensure the depth and saturation of the grounded theoretical analysis, about two-thirds of the text data will be used for initial coding and category extraction, and the remaining one-third will be reserved for the theoretical saturation verification stage. 2.2 Coding process In this study, the basic process of grounded theory is followed, and the screened text data are numbered sequentially with the help of Nvivo 16 software, and open-ended, spindle-coded and selective coding are carried out according to the qualitative analysis steps. During the entire coding process, the research team combined expert advice to continuously compare, reflect and revise, continuously integrate concepts, improve the analysis level, finally identify and refine the core categories, and gradually build theoretical models according to the internal relationship between categories, so as to realize the spiral from empirical materials to theoretical construction. 2.2.1 Open coding Open coding aims to gradually transform original qualitative data into concepts and categories, which is the initial key step in grounded theoretical analysis (Glaser et al., 1967; Corbin et al., 2015). In this stage, the interview data are analyzed sentence by sentence, keywords or core semantics are extracted, and they are encoded as free nodes, and 80 initial concepts and 27 basic categories (17 maternal, 10 community health workers) are initially formed through continuous comparison and classification. An example of open coding is shown in Table 6. Table 6 Summary of open coding and basic categories of maternal and community health workers Original statement Initial concept Basic categories “They never ask about the sensitive things of my mother-in-law and daughter-in-law relationship, they just care about my body and emotions, and I feel very safe.” The service boundaries are clear Privacy protection and data security “I consulted online in anonymous mode, and the system would not display my real name and contact information, so that I dared to say the most private things in my heart. ” Digital privacy protection ........ “Every time the same nurse called to greet me, and after a long time, she seemed to know my mood changes better than my husband, and I slowly trusted her very much. ” Continuous service builds trust Service continuity and responsibility mechanism “I stayed alone in the community on the day of the Spring Festival, but I didn't expect the social worker to come to chat with me, and I felt that I was really not forgotten.” Special companionship for festivals ........ "The psychological counseling certificate hanging on the wall made me feel at ease, as if she was really capable of understanding and helping me." Professional qualification display Professional qualifications and service trust "The community health worker told me in advance that I had been trained in psychological intervention, so I dared to tell her a lot of negative emotions with confidence." Professional training ........ “She explained the test results to me step by step, and I finally knew my physical condition and didn't have that feeling of being 'kept in the dark'. ” Transparency of inspection results Information transparency and trust building "The doctor told me in advance that the medication might have side effects, so I felt more at ease with the treatment instead of worrying about what might happen." Risk information disclosure ...... “The doctor did not make a direct decision for me but asked me which delivery method I wanted to choose, which made me feel respected. ” Decision-making participation opportunities Respect for autonomy and service consultation "The nurses will ask me for a convenient time before coming to my home, instead of suddenly coming to the door, which makes me very relaxed." Service arrangement negotiation ........ “I plucked up the courage to say that I was afraid of having a baby, and she didn't laugh at me, but held my hand and patiently comforted me。” Non-judgmental listening Emotional safety and non-judgmental support "I cried and talked about my anxiety in the mom group, no one criticized me, everyone said they understood me, and I felt particularly accepted." The group responded empathetically ........ “She told me, 'Your feelings are normal,' and I burst into tears, as if my long-suppressed emotions were finally allowed to be released. ” Emotional legitimacy feedback Daily emotional support “The doctor listened quietly to me, did not interrupt, and nodded lightly in response, and I felt that I was really understood. ” Empathetic response ........ “The postpartum ritual held by the community for our new mothers made me feel like I had undergone a formal transformation, as if I had regained my strength. ” Ritual transition support Ritual healing and psychological reconstruction “The process of lighting candles and praying for blessings made me feel like my soul was healed, as if I could start over with new hope.” Symbolic healing experience ........ “When I entered the service room, I saw flowers and soft music, and the tension of the whole person instantly relaxed. ” Environmental creation A space experience that enhances a sense of security “The warm slogan on the wall reminds me that 'this is a safe place', so that I can speak my heart with confidence。” Mood creation tips ........ “Since my husband joined the dad group, he began to take the initiative to change diapers and put the baby to sleep, and I feel that I am finally not alone。” Family collaborative participation Family Support and Cognitive Renewal “After my mother-in-law took a family communication class, she no longer always criticized me for 'not taking children', and our relationship eased a lot.” Improved family relationships ........ “Community doctors explained postpartum mood swings to the elders in our dialect, so that my parents really believed that depression was not 'hypocrisy'. ” Local language adaptation Cultural integration and service localization “The event combined the traditional customs of Spring Festival worship, which made me feel that the service was not cold, but very kind. ” Cultural customs are integrated ........ “I consult online in anonymous mode without worrying about being recognized by others, so I dare to say my most private thoughts。” Anonymous expression mechanism Integration of technology and digital resources “Online videos allow me to get psychological support at home without worrying about running to the hospital with my children.” Remote Accessibility Services ........ In the mom group, everyone did not shy away from sharing their experiences of crying and even throwing things when they collapsed. I saw that other mothers would do the same, and then I realized that I was not the only one who was out of control, and I finally dared to admit my vulnerability.” Non-judgment sharing Peer Support Network “There was a mother like me who was so anxious that she broke down with her baby in the middle of the night and told me how she came over little by little. Her experience made me feel that it was possible for me to persevere, and I felt a little strength in my heart.” Experience and support ........ “I was afraid to ask for help until one day in the community when I saw a sign saying 'safe house' hanging on the door, and at that moment I plucked up the courage to knock on the door, because I knew that this was a place dedicated to accepting me. ” Visualize security signs Service visibility in crisis scenarios “The social worker repeatedly told me that 'you can call at any time', and I really tried it in the middle of the night and found that she was really answering, and I felt very at ease at that moment。” Immediate support ........ “Once I had a complete emotional breakdown, I received an 'emotional first aid kit' from a social worker with soothing aromatherapy, breathing exercise cards, and a small note with words of encouragement. I survived that night with all of this.” Rapid intervention tool Crisis management and response “When I wanted to commit suicide, I dialed the hotline. The staff didn't force me to say a word, but patiently listened to me cry and accompanied me until I slowly calmed down, and I didn't do anything stupid.” Immediate crisis intervention ........ “After the miscarriage, I always felt like I was a failure and incomplete. It wasn't until I joined the group of mothers who had the same experience that I felt for the first time that someone could really understand my pain, rather than just saying 'I want to open up'.” Homogeneous group support Traumatic experience repair “Hearing that other mothers in the group had also experienced repeated self-blame and helplessness, I realized that I was not alone. I began to slowly accept the past and no longer felt like an 'abnormal one'. ” Trauma experience resonance ........ “In the 'mother-in-law class', the teacher taught us how to communicate with our elders in a gentler way. I tried to communicate with my mother-in-law using the sentences I learned in the course, but I didn't expect that there would be really a lot fewer conflicts. ” Intergenerational communication platform Intergenerational understanding and information integration “After listening to the lecture, the elders finally understood that postpartum depression is not hypocritical. They began to ask me, 'how are you feeling' instead of 'thinking too much', which made me feel understood.” Information and cognitive integration ........ “We mainly rely on experience to do emotional screening, and there is no unified tool. (Worker) Insufficient psychological assessment Professional support capacity for cultural adaptation “We also want to help with complex emotional problems but lack a psychological background. (Worker) Lack of professional support ........ “As long as it is heard, it does not need to be taught. (Worker) Listening is better than guidance Non-directive service concept “Sometimes just sitting quietly next to a pregnant woman makes her feel accepted. (Worker) Companion support ........ “The training emphasizes 'don't make judgments' and respond with empathy. (Worker) Empathy training Psychological literacy of service providers “We are also affected by the grief of pregnant women and need to self-regulate. (Worker) Self-emotional management ........ “We often ignore the role of husband or mother-in-law, and intervention is difficult to maintain. (Worker) Family intervention blind spots Culturally Adapted Strategies for Family Support “Without family education, it is difficult to be effective in the long term. (Worker) Lack of family support strategies ........ “The elderly think that we are labeling 'postpartum depression'. (Worker) Resistance to traditional concepts Culturally Adapted Strategies for Family Support “Going to a psychological consultation is considered shameful, and many mothers are afraid to come. (Worker) Mental health stigma ........ “Information is scattered across multiple systems and there is no unified platform. (Worker) Service fragmentation Integration of information and platform resources “Information is not shared between departments and is easy to miss. (Worker) Lack of coordination ........ “Moms prefer salon-style events to formal consultations. (Worker) Informal intervention preferences Service resource integration “The 'tea party' format makes them more willing to share. (Worker) Event attraction ........ “The referral process is slow, and pregnant women run back and forth. (Worker) Insufficient coordination Integration of medical and professional collaboration resources “If information is not shared with maternal and child and psychology departments, it is difficult to form an overall plan. (Worker) Missing information ........ "The project funding is short-term, and most services cannot be sustained." (Worker) Insufficient resources Continuous resource integration of systems and services "The service relies on the project system and is difficult to normalize." (Worker) Lack of long-term mechanisms ........ "I hope to form a team with doctors, psychologists, and social workers in the future." (Worker) Multidisciplinary cooperation needs Cross-professional collaboration and resource integration “The linkage of medical, psychological and community can be more comprehensive. (Worker) Crossfield integration ........ 2.2.2 Spindle coding The purpose of spindle coding is to further compare and analyze the initial concepts and basic categories derived from the previous step of open coding, try to find the potential connections between each independent basic category, so as to summarize and name them, and develop the main category (Strauss et al., 1990; Strauss et al., 1998; Charmaz, 2006）.The researchers further refined, integrated, and summarized the 27 basic categories of open coding, sorted out the logical relationship between the basic categories, and finally obtained 5 main categories. As shown in Table 7. Table 7 Spindle coding analysis Main category Basic categories Connotation explanation Building trust and security Privacy information security guarantee mechanism In psychological counseling, ensure that the mother's personal information, medical record data and communication content are not leaked. Protecting data security through encryption technology, permission management and institutional norms is a prerequisite for establishing basic trust. Transparency in trust formation Clearly inform the process, risks, rights and responsibilities and response plans at all stages of the service. Transparent information reduces uncertainty and increases trust in services. Autonomous and collaborative decision-making in the service process Respect the right of pregnant women to choose the intervention plan, communication method and rhythm. Reach a consensus through equal consultation, so that they have a sense of control over their own psychological support process. Emotional security supports the environment Create a safe, judgment-free atmosphere of dialogue where pregnant women can express their emotions freely. Avoid blaming and labeling and promote authentic communication with an attitude of acceptance. A space experience that enhances a sense of security Reduce the psychological defense of visitors through a quiet, private and comfortable physical environment. Lighting, color, layout and other details can help pregnant women feel safe. Service visibility in crisis scenarios In a crisis situation, pregnant women can quickly and clearly identify and receive help through visual safety signs (such as clear service guidelines, unified identification systems, and public contact information) and immediate support (such as 24-hour service hotlines and instant response psychological counseling channels). This visibility not only reduces the cost of seeking services and psychological thresholds, but also subtly conveys a sense of security and trust, thereby creating conditions for psychological intervention in a crisis. Crisis management and response Establish a standardized crisis intervention process and form a cross-agency collaboration mechanism such as psychological, medical, and social work, so that pregnant women can receive timely, accessible, and sustainable professional support in situations of emotional breakdown, loss of control, or high-risk situations. This system of "being seen in time, responding quickly, and being safely supported" strengthens the mother's sense of reliability, dependability and continuous security in the service system, thus becoming an important guaranteed mechanism for her overall "trust and security" experience. Emotional support system construction Daily emotional support It is emphasized that in the daily narrative and communication of pregnant women, the service provider understands and responds to the feelings of the pregnant woman based on acceptance and listening, so as to help them reduce stress and loneliness. Ritual healing and psychological reconstruction Give new meaning to life events with the help of cultural or personal rituals (e.g., welcoming new life, commemoration ceremonies). Help pregnant women rebuild their psychological balance and sense of hope. Family support and cognitive Renewal Mobilize family members to actively participate in psychological support and update their perception of mental health during pregnancy. Strengthen the support function of the family and reduce isolation and misunderstanding. Peer support network Form support groups or online communities where pregnant women can exchange emotions and experiences with people who have similar experiences. Support from similar backgrounds significantly reduces loneliness. Traumatic experience repair Focus on the deep psychological distress caused by maternal trauma or major life blows. Clients help clients gradually integrate their traumatic experiences and regain a sense of psychological safety and resilience by establishing a secure relationship and stability support. Intergenerational understanding and information integration By integrating useful knowledge about pregnancy and childbirth, it reduces conflicts caused by differences in perceptions, promotes communication between family members of different generations, and balances science and traditional experience. Cultural adaptation strategies Cultural integration and service localization Enhance the affinity and acceptance of services, integrate local languages, customs, and cultural symbols into services, so that interventions are closer to the life situation of pregnant women. Professional support capacity for cultural adaptation In response to the problem of insufficient psychological assessment and lack of professional support, service personnel need to enhance their sensitivity to maternal cultural background, values and belief systems on the basis of psychological professional ability. In the practice of psychological counseling, the assessment and intervention strategies are adjusted in combination with local cultural elements to ensure that the services are both scientific and standardized, and in line with individual cultural habits, so as to make up for the gap in professional support and realize the effective implementation of cultural applicability strategies. Cultural adaptation practice In specific psychological counseling situations, fine-tuning and contextualizing the expression methods, interaction processes and communication tools. Its core function is to make the psychological counseling content more smoothly understood and accepted during the interaction process through flexible expressions, examples, metaphorical choices, and contextualized question design, thereby improving cultural fit. Culturally Adapted Strategies for Family Support In view of the blind spots of family intervention and the lack of family support strategies, intervention programs that can integrate different family structures and cultural habits should be designed based on the professional ability of cultural adaptation. By guiding family members such as spouses and elders to participate in psychological counseling, strengthening the family support network, reducing the resistance caused by cultural conflicts, and enabling interventions to be smoothly integrated into maternal daily life, thereby making up for the blind spots of family intervention. Resource integration capabilities Service resource integration In the case of traditional psychological counseling forms that may be resisted, the community needs to explore activities that are closer to life, such as chat groups, handicraft activities or relaxation salons, and integrate elements of professional psychological intervention into acceptable activities, so as to improve maternal participation and compliance, and achieve effective integration of service resources. Integration of information and platform resources Psychological counseling involves multiple links such as screening, follow-up and referral, and if the information is scattered, it is easy to lead to service breakage. By establishing a unified platform to integrate data, it can not only avoid information omission, but also ensure service continuity and cross-link collaboration efficiency, and realize the optimal allocation of information resources. Integration of medical and professional collaboration resources Through cross-institutional collaboration between the community, hospitals and psychological institutions, the smooth connection between mothers from initial screening to professional intervention is realized. Effective integration of medical and professional resources can reduce referral interruptions and improve the professionalism and timeliness of interventions. Continuous resource integration of systems and services If psychological counseling lacks stable funding and institutional support, it can often only be operated in a short period of time. Through policy embedding, financial guarantee and system design, the long-term and normalization of services can be realized, so as to integrate institutional resources and ensure the sustainable development of psychological intervention. Interdisciplinary collaboration and multidisciplinary resource integration Maternal depression involves medical, psychological and social problems that require multidisciplinary collaboration among doctors, psychologists, social workers and peers. Through multidisciplinary team building and service system development, professional resources can be integrated to form a complete community psychological support network. Integration of technology and digital resources With online follow-up, anonymous consultations, and remote support, it is possible to break through geographical restrictions and provide ongoing assistance to pregnant women with limited mobility or migration. At the same time, digital tools are used to lower the threshold for help caused by stigma and achieve efficient integration of technical resources. Non-directive consulting relationship building Non-directive service concept In psychological counseling, non-directive methods based on listening and companionship can allow pregnant women to express their emotions and build trust in a safe atmosphere, which is more acceptable than simply "teaching". Psychological literacy of service providers If community workers have good empathy, boundary awareness and self-regulation ability, they can avoid secondary harm and better support maternal psychological recovery. Professional qualifications and service trust When the service provider has visible qualifications and standardized processes, it is easier for pregnant women and their families to build a sense of trust and be willing to accept psychological counseling and follow-up intervention. Service continuity and responsibility mechanism Establishing fixed contacts, substitution mechanisms, and follow-up tracking systems can ensure that women do not have services interrupted by holidays or relocation throughout their pregnancy and childbirth, enhancing a sense of security. 2.2.3 Selective Coding The purpose of selective coding is to systematically deal with the relationship between the main categories, which requires extracting the core categories with overarching characteristics from the main categories and analyzing the relationship between the core categories and the main categories, so as to depict the overall theory or phenomenon (Strauss et al., 1998; Charmaz,2006；Strauss et al.,2008） . Through repeated comparison and discussion, the researchers further summarized and integrated the main categories generated by spindle coding, and extracted "the key elements and practical logic of community participation in maternal depression psychological counseling" as the core category, and finally formed five main categories: the establishment of trust and security, the emotional support system, the implementation of cultural adaptability, the ability to integrate resources, and the non-guiding counseling relationship (code of conduct for service providers). By sorting out the relationship between concepts and categories, it can be found that the five main categories are interrelated and together constitute the key elements of community participation in perinatal depression psychological counseling. Focusing on the core elements and practical logic of community participation in maternal depression psychological counseling, the story clue is summarized as follows: the establishment of trust and security is the premise of pregnant women being willing to express their emotions and receive services, and is guaranteed by privacy protection, professional qualification certification and informed consent mechanism. The community responds to the emotional loneliness and psychological stress that pregnant women often experience during pregnancy and postpartum by building emotional support systems such as mutual support networks, family companionship, and environmental development. The implementation of cultural adaptability ensures the understanding and acceptance of psychological services in a multicultural context and improves the accessibility and inclusiveness of services. Resource integration capabilities leverage remote technology and cross-departmental collaboration to expand service accessibility and coverage, enabling the transition from case-by-case support to systematic intervention. Throughout the whole process is the establishment of a "non-directive counseling relationship", which takes empathy, listening and respect as the core principles, breaks the traditional power structure, and guides pregnant women to gradually regain their psychological resilience through free expression. The five main categories together constitute the key elements and practical logic of mutual support and progression in the community psychological intervention system. 2.3 Saturation test Theoretical saturation testing is a critical step in grounded theoretical research to determine whether the data has adequately revealed the core concepts of the studied phenomenon. In this study, the test of theoretical saturation was carried out through continuous data collection and analysis. Specifically, during the coding process, we constantly compare the newly obtained interview data with the existing coding framework to see if new concepts or categories emerge. When the subsequent third of the footage was included in the analysis, we found that the new data no longer generated new topics, concepts, or categories, indicating that the study had reached theoretical saturation. To ensure the reliability of saturation, we further repeatedly compared and analyzed the data collected in the early and late stages to confirm that there was no significant difference. 3 The key elements of community participation in maternal depression psychological counseling and its practical logic model are explained Based on the results of the grounded theory analysis, this study summarizes the key elements of community participation in maternal depression psychological counseling and constructs a practical logic model to illustrate the relationships among these elements. The overall framework and internal logic of this model are shown in Figure 1. 3.1 Building trust and security: the core cornerstone of maternal depression counseling Trust and security are the core prerequisites for maternal depression psychological counseling, and they are also the psychological and institutional foundation for the smooth operation of service relationships. Women during pregnancy and childbirth are fragile due to physical and psychological changes, and they need stable and reliable psychological support. Attachment theory (Bowlby, 1969) points out that individuals actively seek a "safe base" that can provide stability, protection and emotional comfort in the face of stress and uncertainty, which provides a theoretical explanation for the maternal need for trust and emotional support in psychological counseling. This study found that CHW has formed a multi-level trust and security support system through seven aspects: privacy protection, information transparency, respect for autonomy, emotional safety, space creation, crisis response and institutionalized management. Strict confidentiality allows pregnant women to be confident that information will not be leaked, reducing the risk of exposure and psychological defense. For example, a pregnant woman said: "She never asks about the specific situation at home, nor does she tell others what I say, and I feel safe to tell her what is in my heart." "Information transparency in trust formation reduces cognitive uncertainty and makes services predictable by informing the process, frequency and goals in advance." She told me what to talk about and how often from the beginning, and I felt much more at ease. These practices allow pregnant women to dare to express their true feelings and create conditions for in-depth communication. Autonomous and collaborative decision-making in the service process enhances the experience of being treated equally and reduces passivity by involving pregnant women in deciding the topic, rhythm and form of communication. Emotional safety support environments are based on acceptance and empathy, allowing mothers to be more open about themselves without fear of being criticized or labeled. The optimization of the spatial experience – such as quiet, private, and comfortable meeting places – reduces the tension of communication and ensures a sense of security from the environmental level. These factors work synergistically to make pregnant women have a sense of control, as well as full respect and acceptance in psychological counseling. Visibility into services in crisis situations demonstrates the reliability of providers at critical moments, and rapid response allows pregnant women to feel that support is readily available. "One night I had an emotional breakdown, and she replied to me in ten minutes, and I thought she really cared about me." The crisis management mechanism provides guarantees for the continuity and stability of services through institutionalized arrangements such as referral paths, emergency contact information, and cross-agency linkage. These mechanisms strengthen the reliability of services at both the emotional and institutional levels, so that pregnant women can continue to maintain trust and security in the process of psychological counseling, thus laying a solid foundation for the realization of intervention effects. 3.2 Emotional support system: build a service carrier that connects and resonates Once trust and security are established, emotional support becomes the most immediate restorative resource. The emotional support system is the core carrier of emotional regulation and psychological recovery in maternal psychological counseling, and its essence is to provide continuous psychological empowerment for pregnant women through the emotional connection between "being understood" and "being accepted". Under the framework of attachment theory and social support theory, this conclusion can be theoretically confirmed. Attachment theory believes that individuals gain trust and security through secure attachment relationships in their interactions with significant others, and this psychological foundation helps individuals regulate their emotions and restore mental balance in the face of stress (Bowlby, 2008). Social support theory emphasizes that emotional, instrumental, and informational support provided in social networks is an important protective resource for individual mental health, among which emotional support is regarded as the most core element, which can effectively buffer stress response and promote psychological recovery (Cohen & Wills, 1985). Therefore, in the practice of maternal psychological counseling, on the premise of building trust and security, emotional support plays a direct and critical restorative role through the interactive process of "being understood" and "accepted". In this study, the construction of emotional support systems includes daily emotional support, ritual healing and psychological reconstruction, family support and cognitive renewal, peer support networks, traumatic experience repair, and intergenerational understanding and information integration. This system can help pregnant women relieve loneliness and anxiety, improve psychological resilience, and form a stable sense of social belonging. Daily emotional support allows pregnant women to feel their emotions understood during psychological counseling through unconditional listening and gentle response, thereby reducing emotional isolation. The peer support network uses "shared experience - common understanding" as a link to reduce loneliness and helplessness in primiparous and high-risk pregnant women. "She encouraged me to join the group, saying that there were people in the same state as me. That was the first time I felt like I wasn't alone. (P17, Primiparas) Ritual healing and psychological reconstruction use symbolic activities (e.g., emotional first aid kits, breathing relaxation exercises) to help pregnant women regain emotional stability during a crisis. "Once I was so anxious that I couldn't breathe, and the 'emotional first aid kit' sent by the community with aromatherapy, music and soothing breathing instructions pulled me back from the brink of collapse little by little." (P4, 32 weeks gestation) These miniature rituals not only provide psychological security but also help the mother regain a sense of control over her life. At the same time, family support and cognitive renewal can help family members understand the emotional changes of pregnant women through training and guidance, reduce misunderstandings caused by cultural and intergenerational concepts, and improve the overall support function of the family. CHW have found that what pregnant women need most in sharing their trauma experiences is often to be heard and understood, "Some mothers later told me that their favorite thing is to meet and greet once a week, even if it's just a chat", so they will constantly adjust their methods to meet the needs of different groups, "Not everyone can come to meet during the day, especially second-born mothers." We were wondering if we could have an online chat at night. In terms of intergenerational communication, workers play the role of a bridge, not only to help young mothers understand the parenting concepts of their elders, but also to promote the elders to accept scientific mental health knowledge, "We will discuss with mothers-in-law and mothers in family classes how to share housework, so that mothers are less blamed." This mechanism, which focuses on emotional resonance and intergenerational communication, allows pregnant women to receive understanding and support in a safe atmosphere. 3.3 Implementation of cultural adaptability: Construct a moderation mechanism for understanding services The implementation of cultural adaptation strategies is a key moderating mechanism for mental health services during pregnancy and childbirth from "accessible form" to "understandable meaning". The core of cultural adaptation is not simply changing the discourse, but in realizing cultural meaning linkage in service practice, so that psychological support can be embedded in the daily situation, value framework and communication habits of the service recipient (Berry, 1997; Kirmayer, 2012). By reducing misunderstandings, shame, and psychological resistance caused by cultural barriers, such strategies enable pregnant women to understand the legitimacy and necessity of "psychological support" in a familiar cultural context (Rogers, 1951; Yao et al., 2022）。 This study divides cultural adaptation strategies into cultural integration and service localization, professional ability of mental health services, cultural adaptation practices, and family support. Cultural integration and service localization emphasize that psychological support should fit into the multicultural context of the maternal family-community ecosystem, rather than equating it with a single concept of a generation or group. The daily cognitive structure of pregnant women is often composed of multiple cultural resources, such as modern medical knowledge, shared experiences of online maternal and infant communities, and traditional parenting concepts of family elders (Shweder, 1990). Therefore, CHW will choose different cultural expressions according to different objects in actual services. when facing the elderly, translating psychological support into traditional Chinese medicine vocabulary such as "qi and blood conditioning" and "emotional dredging" can reduce unfamiliarity and resistance; When it comes to young pregnant women, modern psychological language, mood scales or APP tools are more used. Such "multi-cultural coding" is not simply a replacement, but improves the comprehensibility, credibility of service information through multi-context docking. Cultural adaptation challenges often manifest as differences in norms and expectations for emotional expression within families. In some collectivist family structures, emotional distress may be seen as "not strong" or "affect family harmony", triggering shame or repression (Hofstede, 2001). In the face of these resistances, CHW use the family participation mechanism as a breakthrough to invite elders to enter the "Family Parenting Support Meeting" to guide them to review their postpartum experiences and emotional needs, so that they can understand the sources of stress of contemporary pregnant women in intergenerational empathy. "In the past, when I said it was uncomfortable, my mother said don't be pretentious; Now she began to ask me how I was feeling today. (P10 Maternal) Such cultural translation strategies with "improving family relationships" and "improving parent-child well-being" as the value framework are more easily accepted by elders, thus gradually loosening the resistance to psychological counseling. The professional support ability of cultural adaptation is reflected in the service provider's situational judgment and expression adjustment according to different cultural identities, age group and communication preferences. In field practice, CHW should give priority to establishing maternal mutual aid groups with similar dialects, similar parenting concepts, or similar experiences, so as to improve language closeness and cultural consensus, and form a "cultural mirroring effect". This dynamic matching not only enhances the willingness to participate and the depth of communication, but also reduces shame and defensive responses, providing an empirical basis for the localization, acceptability and sustainability of maternal psychological services. 3.4 Resource integration ability: support the operation guarantees conditions of the system The ability to integrate resources is the core guarantee for the efficient operation of the psychological support system during pregnancy and childbirth, which determines whether the service can break through the limitations of time and space, personnel and information, and achieve multi-party collaboration and continuous accessibility. In maternal mental health services, resource integration not only includes cross-border cooperation between medical, psychological, community and social organizations, but also covers the overall management of information flow, service flow and capital flow. This process provides stable support for the construction of trust and security, because a continuous visible and interconnected service system can allow pregnant women to receive consistent and reliable support at different stages and in different situations. From the perspective of systems theory, maternal mental health needs have multiple attributes, and the intervention of a single department often cannot cope with complex situations. The resource integration mechanism effectively reduces the vacuum period of service interruption and psychological support by introducing remote psychological services, information exchange and institutionalized referrals (Blount et al., 2021; Selix et al.,2017）。 For example, in the face of traditional culture restrictions on going out during confinement, remote psychological counseling and online peer groups can maintain the continuity of emotional connection and psychological intervention without breaking cultural customs. This not only reduces the psychological cost of pregnant women in the process of seeking medical treatment or seeking help but also strengthens their trust in the system through a stable and predictable service experience. In practice, service form innovation and adaptation, medical collaboration mechanism and online support are the main paths of resource integration. CHW often conducts emotional screening and dynamic tracking through digital tools (such as online questionnaires, psychological self-assessment tools, and emotional self-test QR codes) and conduct standardized referrals and information sharing with higher-level hospitals and psychological assistance teams. A pregnant woman said: "Although I can't go out, I can chat with community volunteers every day, and I feel much more relaxed." (P07) This form of "people at home and services at home" not only breaks the support window brought about by physical isolation in special periods but also allows pregnant women to gain psychological comfort in a familiar living environment. Another participant mentioned: "They will help me contact the psychology department of the hospital and remind me to fill out the questionnaire, which feels very systematic." (P12) It can be seen that the systematic process and timely referral make pregnant women feel the professionalism and reliability of the service, so that they are more willing to open their hearts. At the same time, the flexible coordination of CHW in the gaps in the system is also an important embodiment of the ability to integrate resources. During the Spring Festival and other hospital outpatient closures, they will work with volunteers to provide door-to-door companionship and life care to ensure that pregnant women receive emotional support and life care. A health worker recalled: "During the Spring Festival, the hospital outpatient clinic was closed, and we coordinated volunteers to take turns to accompany her to ensure that she had both emotional support and hot meals. (P15) This flexible response not only addresses the risk of short-term service interruptions but also establishes a deeper emotional bond between the mother and the service system. In the long run, with the help of the municipal health information platform, CHW will be given cross-departmental data access and update permissions, and psychological risk hierarchical management will promote the psychological support system during pregnancy and childbirth from fragmentation to process-oriented, normalized and sustainable development. 3.5 Non-directive counseling relationship: emotional norms and relationship endpoints of service behavior The non-directive counseling relationship is centered on listening, acceptance, and empathy, avoiding excessive directives and judgments, and allowing the mother to dominate the rhythm of communication. This model originates from Rogers' (1957) "client-centered" theory, which emphasizes "unconditional positive attention", that is, responding with full respect regardless of the client's emotions and states. In specific practice, the creation of non-guiding counseling relationships can be carried out from the following aspects: First, the concept of non-directive service requires the service provider to take listening, acceptance and empathy as the core, avoid excessive instructions and judgments, and highlight the main position of pregnant women in communication. Secondly, the psychological literacy of the service provider is the key to ensuring the effectiveness of counseling, including sincerity and consistency, self-awareness and emotional adjustment ability. Third, professional qualifications and service trust provide institutional guarantee for the consulting relationship, and the professional background and continuous training of the service provider can enhance the mother's trust in the service. Finally, the service continuity and accountability mechanism ensures that the intervention is not limited to a single interaction but achieves long-term companionship and continuous support through institutional design and team collaboration. Together, the above elements constitute the core subcategory of non-directive counseling relationships and provide an operational path for maternal mental health services. In this study, multiple pregnant women clearly noted that undirected communication is more likely to build trust and emotional security than "what should you" guided communication. "I always thought I had something wrong, and she said, 'You're just trying too hard to adapt, it's understandable', and I relaxed all of a sudden." (P9, third trimester) This concept can especially weaken women's sense of shame and defense in the context of collectivist culture, making them more willing to express their inner feelings. Non-directive counseling not only relies on methods, but also on the psychological literacy of the service provider, including self-awareness, emotional regulation and continuous learning ability. One community health worker said: "At first, I always wanted to help them solve their problems, but now I have learned that it is actually more important to just listen to them. This shift from "problem solver" to "emotional bearer" gives pregnant women a sense of security in being heard. Maternal feedback confirms this effect: "At the mutual aid meeting, I cried for a long time, no one urged me, the staff just quietly accompanied me and listened to me. (P16, one month after giving birth) This stable, sincere and non-judgmental companionship helps to build a deep relationship of trust. The credibility of the service also depends on the professional qualifications and background certificates of the service provider, so that pregnant women feel that the service is safe and reliable. When the mother faces a severe emotional crisis, undirected relationships can also be an emotional bridge for professional intervention. "She didn't panic, she just said, 'Let's talk to the doctor together', and that was the first time I was willing to accept professional help." (P4, one month after delivery) This low-threshold, trust-first referral method not only improves the timeliness of crisis intervention but also reduces the maternal vigilance of the medical system. Some CHW incorporated culturally familiar ritual elements (such as making tea, lighting candles, etc.) into the meeting, effectively resolving the cultural barrier in the service and making it easier to build trust. The sustainability of non-directive counseling relationships depends on follow-up mechanisms and accountability implementation to prevent disruptions from causing trust breakdowns. One mother recalled: "My mother-in-law used to always ask, 'What's wrong with you', but now she just sits with me and doesn't force me to say it anymore." (P6, postpartum) This reflects that the impact of services has extended to family communication patterns, forming an emotionally responsive support network. In continuous companionship, CHW are both listeners and maintainers of trust; Through follow-up, anonymous confiding channels, responsible person systems, etc., they ensure that pregnant women always have a psychological "outlet" that they can rely on. In the end, this non-directive counseling relationship with listening and acceptance as the core, with professional qualifications and institutional support, has become the most stable emotional bond and support structure in maternal psychological counseling. 3.6 Exposition of logical relationships The psychological counseling system for maternal depression starts from the establishment of trust and security, which is not only the psychological entrance for the initiation of intervention, but also the basic condition throughout the whole process. In this process, the mother feels respected, understood and protected, and then forms an open expression and willingness to participate in the intervention. The establishment of trust not only directly affects the emotional support system but also influences the non-directive counseling relationship through the code of conduct, ensuring that the counseling interaction presents the characteristics of empathy and de-empowerment. As the main carrier of services, emotional support systems provide emotional responses and social connections at the individual, family, group and community levels for pregnant women driven by trust. This system is also moderated by culturally adaptive implementation, ensuring that support content and formats are aligned with local languages, values, and cultural practices, avoiding disjointed interventions due to cultural mismatch. The implementation of cultural adaptation is not an isolated link, but a horizontal adjustment mechanism that runs through the whole process of trust building and emotional support system and plays a key role in context-sensitive and differentiated demand satisfaction. It also influences the establishment of non-directive counseling relationships, making counseling dialogues understandable, acceptable, and emotionally resonant. Resource integration capabilities are the supporting conditions of the system, which provides a stable operation platform for the emotional support system and long-term external guarantee for non-directive consulting relationships through cross-agency cooperation, digital technology and remote services to break through manpower and geographical limitations. The non-guiding counseling relationship is the external manifestation and relationship form after the interaction and integration of the above elements, which not only establishes the action guidelines for service provision, but also constitutes the core window of the "temperature" and "credibility" of the maternal perception support system. As a result, the whole system forms the structural characteristics of multicentric drive, cyclic feedback, and dynamic optimization, which is continuously iterated and deepened in the actual experience of pregnant women, and finally builds a psychological support network with high adaptability and resilience. 4 Research conclusions and discussion 4.1 Main conclusions This study constructs a theoretical model of maternal depression psychological counseling based on the grounded theory, revealing that the process has significant interformity, hierarchical interweaving and dynamic cyclical characteristics. The model is composed of five core elements: trust and security, emotional support system, cultural adaptation implementation, resource integration ability, and non-directive counseling relationship. Among them, trust and security are the psychological premise and entrance of intervention. The emotional support system is the main carrier of continuous emotional response and relationship maintenance. Cultural adaptation implementation plays a moderating role in ensuring intervention acceptability and contextual fit. Resource integration capabilities provide structural support for the stable operation of the intervention system. The non-guiding counseling relationship is an explicit form after the integration of multi-element interaction, which directly reflects the level of humanistic care and credibility of the intervention. The above five elements form a synergistic effect in actual intervention, construct a psychological support network with high adaptability, high persistence and humanistic temperature, and realize the individualized, continuous and community-based intervention path starting from the individual psychological needs of pregnant women. This model not only deepens the understanding of the internal mechanism of maternal depression psychological counseling but also provides a structured framework and theoretical basis for the optimization of mental health services under multicultural context and multi-resource conditions, which has important practical guiding significance for improving the accessibility, effectiveness and sustainability of primary maternal mental health services. 4.2 Innovation 4.2.1 Theoretical contribution Based on the grounded theory, this study constructs the key elements of maternal psychological counseling composed of five main categories: "trust and security building", "emotional support system construction", "cultural adaptation strategy implementation", "resource integration ability" and "non-guiding counseling relationship building” and reveals the dynamic mechanism of cyclic nesting. This model expands the focus of perinatal psychological intervention from individual emotional regulation to social interaction and cultural regulation in community contexts, which makes up for the lack of research on the social dynamic mechanism of grassroots psychological services and provides a new analytical framework for understanding psychological intervention in complex community settings. At the same time, the study clarifies the adaptive logic of "non-directive counseling relationship" in collectivist culture through expert interviews. This study points out that Chinese collective culture pays more attention to emotional expression and decision-making rules under the "relationship-role" structure, so non-directive counseling should be understood as an empathetic companionship method of "low intervention, high respect, and emphasis on relationship" in the local context, so as to promote maternal self-awareness without destroying the family structure. This result responds to existing discussions about cultural adaptation in counseling relationships and provides new explanations for the localization of non-directive services in the context of collective culture. Based on the integration of existing results, this study enriches the understanding of the interaction mechanism of "intervention-culture-structure" in perinatal psychological services and has enlightening significance in the refinement of local concepts and cross-cultural comparison. 4.2.2 Practical contribution This study establishes a perinatal psychological support intervention pathway based on community subjectivity, emphasizes the unique role of community participation in psychological counseling, and proposes a practical strategy through the joint participation of CHW and cultural resources, verifies the effectiveness of non-directive and de-labeled psychological support methods in improving maternal active expression, self-care and willingness to continue to participate, and provides a generalizable and actionable intervention reference for the grassroots public health system. 4.3 Research limitations and prospects Based on the grounded theory, this paper systematically studies the key elements and practical logic of community participation in maternal depression psychological counseling, constructs a theoretical model and puts forward practical strategies, but there are still certain limitations and need to be further improved and expanded in subsequent research. First, the interview samples in this study are mainly concentrated in the maternal group in third-tier urban communities, which are limited by factors such as region, culture, and economic level, and the applicability of the research conclusions to other regions (such as rural areas) and different backgrounds (such as low-income or ethnic minority groups) needs to be further verified. Therefore, future research can improve the representativeness and external validity of the research results by distributing online questionnaires and expanding the sample source to cover pregnant women of different cities, urban and rural differences, different ages, different education levels and occupational backgrounds. Secondly, since this study uses a qualitative interview-based approach, the psychological counseling process itself is affected by the differences in the personal style, experience level, and communication skills of the counselors, which may lead to certain individual differences in the intervention effect. This suggests that future studies can introduce standardized training for interventions, unify process guidelines, and systematically evaluate counselor traits and intervention effectiveness to ensure the consistency and reproducibility of interventions. Finally, this study mainly focuses on the process and mechanism of maternal depression counseling in the community but lacks systematic comparison with other intervention models (such as hospital-led psychotherapy and online psychological intervention). Subsequently, a controlled study can be designed to compare the effects of community participation intervention with other interventions in improving maternal emotional regulation, self-efficacy, and social support, so as to further verify the unique advantages and applicability boundaries of the multidimensional integrated intervention model proposed in this study. In summary, although this study provides a preliminary theoretical framework and practical reference for understanding the community-based participation in maternal depression psychological counseling, it still needs to be continuously improved and deepened in a broader sample base, standardized intervention process design, and multi-modal comparative research, so as to train workers to master more than three kinds of culturally adapted communication skills at the community level. At the government level, maternal psychological services should be included in community health assessment indicators, and funding should be allocated to support the green channel of "community-hospital" referrals, in order to provide a more universal and empirical basis for promoting maternal mental health. Declarations Acknowledgement The authors would like to thank all participants and community health workers who contributed to this study for their time and valuable insights. Ethics approval and consent to participate This study was approved by the Ethics Committee of Xiangnan University Affiliated Hospital (Approval No. K2024-017-01) and was conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants prior to enrollment. Competing interests The authors declare that they have no competing interests. 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10:31:25","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":255778,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8572741/v1/2a86804b06c6c8591949aaa0.html"},{"id":100134067,"identity":"8c85f11d-bb4f-4144-973a-60d8d209ca52","added_by":"auto","created_at":"2026-01-13 10:31:25","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":159381,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eKey elements of community participation in maternal depression psychological counseling and its practical logic model diagram\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8572741/v1/0a055cdf3e247dd608e1699d.png"},{"id":100625707,"identity":"49d80d61-2749-4429-979a-230386c96828","added_by":"auto","created_at":"2026-01-19 19:27:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1749106,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8572741/v1/bd25f527-6a08-44bd-af79-cb91a3b0b1a0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Understanding Community Participation in Psychological Counselling for Maternal Depression: A Grounded Theory Approach","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn recent years, maternal mental health has attracted increasing global attention. According to the World Health Organization, about 10%\u0026ndash;20% of pregnant women experience depressive symptoms (WHO, 2020). Maternal depression not only seriously affects maternal and infant health and family stability but may also have adverse effects on the emotional and cognitive development of the baby and further trigger a series of social chain reactions (Nisar et al., 2020).\u003c/p\u003e\n\u003cp\u003eCommunity health workers (CHW) are frontline public health workers who\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eact as a bridge between community members and health and social services. They build support network for women and families through regular visits (Fellmeth et al., 2019; Yim et al., 2019), and integration of social services, and volunteering tasks within their medical care (Fisher et al., 2019). They also rely on health service centres and mutual support groups to provide emotional support and skills training (Shorey et al., 2018; Pilkington et al., 2020). Together, these approaches help compensate for limited psychological service resources within the formal medical system and promote a public health service model based on social co-governance (WHO, 2020; Reilly et al., 2020). This multidimensional intervention model not only responds to policy guidance but also highlights the pivotal value of the community in ensuring maternal mental health.\u003c/p\u003e\n\u003cp\u003eExisting research generally affirms the positive role of the community in the prevention and treatment of maternal depression, especially in improving social support, reducing psychological stress, and promoting mental health (Davies et al., 2022). However, there is still a lack of systematic empirical research on how to effectively organize and implement psychological counseling in specific community situations and transform experience into replicable and generalizable practical logic. This deficiency limits the optimization and implementation of community intervention strategies to a certain extent (Sikander\u0026nbsp;et al., 2019). Based on this, this study focuses on the following questions: What are the key elements of community participation in maternal depression counseling? How to construct and optimize the practical logic to improve the effectiveness of community psychological counseling?\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn order to answer the above questions in depth, this study adopts a grounded theoretical approach to try to extract the core mechanism and theoretical model of community participation intervention from empirical data. Specifically, the structure of this study consists of four main parts: the first part reviews the research progress on maternal depression mental health and community intervention at home and abroad; the second part introduces the study design and data collection; the third part presents the rooted theoretical coding results and the process of refining key elements; The fourth part puts forward policy suggestions and practical guidance based on research findings.\u003c/p\u003e\n\u003cp\u003eThis study not only helps to enrich the empirical basis in the field of community psychological intervention but also provides theoretical support and practical paths for policymakers, CHW and mental health professionals, and promotes the institutionalized and scientific development of community forces in the maternal mental health system.\u003c/p\u003e"},{"header":"1 Literature Review","content":"\u003cp\u003eAt present, psychological counseling is considered an effective means of intervening in maternal depression, however, the traditional medical system still has certain deficiencies in terms of accessibility, continuity and personalized services. Therefore, providing effective psychological counseling through community power to improve maternal mental health has become a hot topic of research in recent years (Dennis \u0026amp; Dowswell, 2021). Communities can not only provide low-threshold, long-term mental health support, but also integrate multiple resources to form a multi-dimensional social support network and improve maternal mental resilience (Barlow et al., 2020). This article will focus on two aspects: psychological counseling intervention methods for maternal depression and the role of community participation services in maternal depression intervention. \u003cins cite=\"mailto:Siti%20Roshaidai%20Mohd%20Arifin\" datetime=\"2026-01-07T10:30\"\u003e\u003c/ins\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.1 Psychological counseling intervention methods for maternal depression\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePsychological counseling intervention methods for maternal depression have been widely studied and applied, mainly including cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT), music therapy, mindfulness therapy, mental health education, peer support and other forms. CBT is a structured, short-term therapy, making it suitable for mild to moderate maternal depression (Li Zheng, 2021) and helping the women to identify and change negative thought patterns. However, for groups with large cultural differences, the effectiveness of CBT may be limited. IPT focuses on the transformation of maternal interpersonal relationships and social roles, emphasizing the improvement of social support networks, especially suitable for depression caused by interpersonal problems (Liu Yan et al., 2019). However, IPT has high requirements for therapist training, and limited resources hinder its promotion (Wang et al., 2023). Music therapy, as a non-invasive means, can help alleviate anxiety and depression (Sanfilippo et al., 2021), but the effectiveness is influenced by individual differences (Ji et al., 2024). Mindfulness therapy helps pregnant women regulate their mood by promoting self-awareness (Min et al., 2024), but inadequate adherence may weaken the effectiveness of interventions (Leng et al., 2024). Mental health education can improve maternal awareness of mood changes, but has limited effect on moderate to severe depression (Scroggins et al., 2024). Peer support can help reduce loneliness and depression through experience sharing and emotional exchange (Shah et al., 2024), but the effectiveness depends on engagement and the quality of interaction.\u003c/p\u003e\n\u003cp\u003eOverall, although existing interventions have shown some efficacy, most studies focus on healthcare settings or tightly controlled clinical trial settings, which do not reflect the complexity of the real world (Singla et al., 2022).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1.2 The role of community in maternal mental health management\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe community plays a key role in the management of maternal mental health at multiple levels and dimensions. Studies have shown that the community-based intervention model can significantly reduce the incidence of perinatal depression and anxiety, improve maternal self-efficacy and service adherence, and provide important experience for optimizing full-cycle mental health services (Scroggins et al., 2024).\u003c/p\u003e\n\u003cp\u003eCHWs are trained to implement programs such as problem solving, psychoeducation, and behavioral activation through home visits, thereby improving maternal symptoms of depression and anxiety (Wang et al., 2025). Peer support provides maternal emotional communication and empathetic understanding as part of a community intervention, reducing loneliness and psychological stress (Branjerdporn et al., 2024; However, the effectiveness of peer support is influenced by factors such as cultural differences, form of support, and quality of interaction (McLeish et al., 2023). In addition, community mobilization and education interventions have been shown to improve maternal mental health in rural South Asia, such as women\u0026apos;s education groups and community mobilization activities that raise maternal awareness of mental health and promote healthy behaviors (Sharma et al., 2018). In the United States, community-engaged programs for single mothers with precarious housing have improved psychological conditions through mental health education and social support (Joseph et al., 2023). At the same time, new community innovation models have emerged internationally, such as the United Kingdom through community nurse home visits combined with AI mood monitoring tools to achieve precise intervention (NHS, 2023), and Australia\u0026apos;s establishment of a \u0026quot;screening-referral-tracking\u0026quot; full-chain service network based on community centers (Beyond Blue, 2022).\u003c/p\u003e\n\u003cp\u003eNevertheless, there are several deficiencies in existing community intervention research. Although community interventions have shown positive results, their sustainability, cultural adaptability, and reproducibility have not been systematically demonstrated (Phoosuwan et al., 2020). In addition, there are still limited studies on the applicability and differences of intervention strategies in different community contexts, and relevant experiences have not been fully compared and summarized (Ward\u0026nbsp;et al., 2020).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBased on this, this paper intends to discuss the \u0026quot;organization and implementation of psychological counseling for maternal depression in community context\u0026quot;, aiming to reveal its key elements and practical logic, and provide theoretical support and practical guidance for optimizing the community mental health service system.\u003c/p\u003e"},{"header":"2 Methods","content":"\u003cp\u003eThis study adopts the grounded theory in the qualitative research method, which emphasizes the induction of generative theories from first-hand data rather than the validation of existing theories, which is especially suitable for research fields where the psychosocial mechanism is still unclear (Glaser \u0026amp; Strauss, 2017). This study focuses on answering the following research questions: What are the key elements of community engagement in maternal depression counseling? How do these elements interact and influence intervention outcomes in different community contexts? How to extract replicable and generalizable practical logic from it? In view of the lack of mature theoretical framework in the existing literature, this study adopts a grounded theoretical approach, systematically analyzes the real experience of pregnant women and community workers, and gradually constructs an explanatory theoretical model to respond to the above research questions.\u003c/p\u003e\n\u003cp\u003eThe study strictly follows the grounded theoretical operation process proposed by Strauss and Corbin (2015), including three stages: open coding, spindle coding and selective coding, and identifies key concepts in turn, analyzes their interrelationships, and gradually integrates them into theoretical models. The data comes from field interviews and observations, and the research team maintains theoretical sensitivity during the coding process and repeatedly compares different materials to ensure the depth and reliability of the analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.1 Data sources \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study uses a combination of online and on-site interviews to ensure the breadth and diversity of the data. Online interviews are conducted through video conferencing platforms, which can cover more pregnant women with different geographical and social backgrounds, and obtain more representative and extensive views and experiences. On-site interviews, on the other hand, help capture more real emotional reactions and psychological expressions of respondents through face-to-face in-depth communication, enhancing the depth and credibility of the data. The complementary use of the two interview formats can help to comprehensively understand the actual experience of pregnant women in the process of perinatal depression intervention and provide multi-dimensional empirical support for the construction of a psychological counseling intervention model based on community participation.\u003c/p\u003e\n\u003cp\u003eThe data were mainly from a community health service center in a third-tier city in central China. Third-tier cities are in the middle of China\u0026apos;s urban hierarchy and have typical characteristics of urban-rural integration. The maternal population in the region includes both local residents and migrants from rural or other urban areas, with a diverse socio-economic and cultural background. This characteristic helps to reveal the state of maternal mental health and its influencing factors in different contexts. At the same time, due to the relatively limited medical resources in third-tier cities and the imperfect professional psychological service system, pregnant women are more likely to rely on community support systems to cope with pregnancy and postpartum psychological problems, thus providing a typical sample environment for research.\u003c/p\u003e\n\u003cp\u003eThe study targeted pregnant women from the second and third trimesters (\u0026ge; 20 weeks of gestation) to one year postpartum and set clear inclusion and exclusion criteria to ensure the representativeness of the sample and the validity of the data.\u003c/p\u003e\n\u003cp\u003eMaternal inclusion criteria are as follows: age \u0026ge; 18 years; 20 weeks of gestation \u0026ge; or \u0026le; 12 months postpartum; self-rated presence of depression-related symptoms, or previous diagnosis of perinatal depression; participated in community-organized maternal and infant support groups, mental health education activities, or related online platform services; and able to complete semi-structured interviews in Mandarin.\u003c/p\u003e\n\u003cp\u003eIn this study, a total of 20 pregnant women from the central third-tier urban community were recruited to participate in the interviews. The basic demographic characteristics of the participating women, including age, education level, occupational status, marital status, birth history, duration of depressive symptoms, and interview method, are summarized in Table 1.\u003c/p\u003e\n\u003cp\u003eTo further assess the severity of depressive symptoms among the participants, the Edinburgh Postnatal Depression Scale (EPDS) was used. The individual EPDS scores and corresponding depression severity levels of the 20 pregnant and postpartum women are presented in Table 2.\u003c/p\u003e\n\u003cp\u003eIn order to obtain multi-perspective data and gain a deeper understanding of the reality of community interventions, the study also included 10 community health workers as the second type of interview subjects, including general practitioners, community nurses and mental health educators. Through semi-structured interviews, their practical experience, role positioning, implementation difficulties and service feedback in maternal psychological services were collected to supplement the individual perspective of pregnant women and enhance the practical applicability and theoretical depth of the research. Detailed information on the professional roles, service content, and working experience of the community health workers is shown in Table 3.\u003c/p\u003e\n\u003cp\u003eThe inclusion criteria for community health workers are as follows: works continuously in the community health service center where the institute is located for \u0026ge; 6 months; directly involves in maternal mental health related services (such as health education, maternal and infant group organization, psychological support, etc.); and agree to participate in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1 Basic information of women with pregnancy and childbirth depression\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"517\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43.0502%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBasic information\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.6062%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003en\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.3436%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e%\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43.0502%;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003cp\u003e18-28\u003c/p\u003e\n \u003cp\u003e29-39\u003c/p\u003e\n \u003cp\u003e\u0026gt;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.6062%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.3436%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43.0502%;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003cp\u003eUniversity\u003c/p\u003e\n \u003cp\u003eGraduate student\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.6062%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 13\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.3436%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43.0502%;\"\u003e\n \u003cp\u003eOccupational status\u003c/p\u003e\n \u003cp\u003eHousewife\u003c/p\u003e\n \u003cp\u003eIncumbency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.6062%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 8\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.3436%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43.0502%;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003cp\u003eUnmarried/divorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.6062%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 19\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.3436%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43.0502%;\"\u003e\n \u003cp\u003eBirth time\u003c/p\u003e\n \u003cp\u003ePrimiparous women\u003c/p\u003e\n \u003cp\u003eProlific mothers（2-4）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.6062%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 11\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.3436%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43.0502%;\"\u003e\n \u003cp\u003eDuration of depressive symptoms\u003c/p\u003e\n \u003cp\u003e\u0026le;6 months\u003c/p\u003e\n \u003cp\u003e6-12months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.6062%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 8\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.3436%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e40%\u003c/p\u003e\n \u003cp\u003e60%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 43.0502%;\"\u003e\n \u003cp\u003eInterview method\u003c/p\u003e\n \u003cp\u003eFace-to-face interviews\u003c/p\u003e\n \u003cp\u003eOnline interview\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 27.6062%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.3436%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e55%\u003c/p\u003e\n \u003cp\u003e45%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 Pregnancy and childbirth depression scale\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;(EPDS)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"517\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1779%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal number\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.5609%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEPDS score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45.2611%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGrade of depression\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1779%;\"\u003e\n \u003cp\u003eP001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.5609%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45.2611%;\"\u003e\n \u003cp\u003eModerate depression\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1779%;\"\u003e\n \u003cp\u003eP002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.5609%;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45.2611%;\"\u003e\n \u003cp\u003eModerate to severe depression\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1779%;\"\u003e\n \u003cp\u003eP003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.5609%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45.2611%;\"\u003e\n \u003cp\u003eMajor depression\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1779%;\"\u003e\n \u003cp\u003eP004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.5609%;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45.2611%;\"\u003e\n \u003cp\u003eCritical value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1779%;\"\u003e\n \u003cp\u003eP005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.5609%;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45.2611%;\"\u003e\n \u003cp\u003eModerate depression\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1779%;\"\u003e\n \u003cp\u003eP006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.5609%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45.2611%;\"\u003e\n \u003cp\u003eModerate depression\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1779%;\"\u003e\n \u003cp\u003eP007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.5609%;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45.2611%;\"\u003e\n \u003cp\u003eModerate depression\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1779%;\"\u003e\n \u003cp\u003eP008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.5609%;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45.2611%;\"\u003e\n \u003cp\u003eModerate depression\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1779%;\"\u003e\n \u003cp\u003eP009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.5609%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45.2611%;\"\u003e\n \u003cp\u003eModerate depression\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1779%;\"\u003e\n \u003cp\u003eP010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.5609%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45.2611%;\"\u003e\n \u003cp\u003eModerate depression\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1779%;\"\u003e\n \u003cp\u003eP011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.5609%;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45.2611%;\"\u003e\n \u003cp\u003eModerate depression\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1779%;\"\u003e\n \u003cp\u003eP012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.5609%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45.2611%;\"\u003e\n \u003cp\u003eModerate depression\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1779%;\"\u003e\n \u003cp\u003eP013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.5609%;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45.2611%;\"\u003e\n \u003cp\u003eModerate to severe depression\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1779%;\"\u003e\n \u003cp\u003eP014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.5609%;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45.2611%;\"\u003e\n \u003cp\u003eModerate to severe depression\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1779%;\"\u003e\n \u003cp\u003eP015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.5609%;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45.2611%;\"\u003e\n \u003cp\u003eModerate depression\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1779%;\"\u003e\n \u003cp\u003eP016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.5609%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45.2611%;\"\u003e\n \u003cp\u003eModerate depression\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1779%;\"\u003e\n \u003cp\u003eP017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.5609%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45.2611%;\"\u003e\n \u003cp\u003eModerate depression\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1779%;\"\u003e\n \u003cp\u003eP018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.5609%;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45.2611%;\"\u003e\n \u003cp\u003eModerate to severe depression\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1779%;\"\u003e\n \u003cp\u003eP019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.5609%;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45.2611%;\"\u003e\n \u003cp\u003eModerate depression\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 24.1779%;\"\u003e\n \u003cp\u003eP020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 30.5609%;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45.2611%;\"\u003e\n \u003cp\u003eModerate to severe depression\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3 Information on community health workers\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"542\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6451%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6266%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40.6654%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eService content\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0628%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWorking hours in the current community (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6451%;\"\u003e\n \u003cp\u003eH1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6266%;\"\u003e\n \u003cp\u003eGeneral practitioners\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40.6654%;\"\u003e\n \u003cp\u003eHealth education / individual psychological support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0628%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6451%;\"\u003e\n \u003cp\u003eH2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6266%;\"\u003e\n \u003cp\u003eCommunity Nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40.6654%;\"\u003e\n \u003cp\u003eHealth mission/mother and baby group\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0628%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6451%;\"\u003e\n \u003cp\u003eH3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6266%;\"\u003e\n \u003cp\u003eDoctor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40.6654%;\"\u003e\n \u003cp\u003eHealth education/mother and baby group / individual psychological support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0628%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6451%;\"\u003e\n \u003cp\u003eH4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6266%;\"\u003e\n \u003cp\u003eMental health managers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40.6654%;\"\u003e\n \u003cp\u003eHealth education\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0628%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6451%;\"\u003e\n \u003cp\u003eH5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6266%;\"\u003e\n \u003cp\u003eGeneral practitioners\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40.6654%;\"\u003e\n \u003cp\u003eHealth education / individual psychological support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0628%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6451%;\"\u003e\n \u003cp\u003eH6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6266%;\"\u003e\n \u003cp\u003eDoctor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40.6654%;\"\u003e\n \u003cp\u003eMother and baby group / individual psychological support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0628%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6451%;\"\u003e\n \u003cp\u003eH7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6266%;\"\u003e\n \u003cp\u003eCommunity Nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40.6654%;\"\u003e\n \u003cp\u003eHealth mission/mother and baby group\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0628%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6451%;\"\u003e\n \u003cp\u003eH8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6266%;\"\u003e\n \u003cp\u003eCommunity Nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40.6654%;\"\u003e\n \u003cp\u003eHealth mission/mother and baby group\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0628%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6451%;\"\u003e\n \u003cp\u003eH9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6266%;\"\u003e\n \u003cp\u003eCommunity Nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40.6654%;\"\u003e\n \u003cp\u003eHealth mission/mother and baby group\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0628%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6451%;\"\u003e\n \u003cp\u003eH10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6266%;\"\u003e\n \u003cp\u003eCommunity Nurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 40.6654%;\"\u003e\n \u003cp\u003eHealth mission/mother and baby group\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 26.0628%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e2.1.3 Data collection and analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study adopts a grounded theory method and conducts semi-structured interviews based on a predefined interview outline. The interview outline is designed with open-ended questions focusing on social support, community intervention experiences, medical service linkage, and expectations for psychological support. The detailed interview outline for pregnant and postpartum women is presented in Table 4.\u003c/p\u003e\n\u003cp\u003eIn addition, to obtain complementary perspectives from service providers, a separate semi-structured interview outline was developed for community health workers. The structure and key guiding questions of the interviews with community health workers are shown in Table 5.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4 Outline of semi-structured interviews with pregnant women\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5824%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInterview theme\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82.4176%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInterview questions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5824%;\"\u003e\n \u003cp\u003eSocial support network\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82.4176%;\"\u003e\n \u003cp\u003eWho do you get support from when you feel down or depressed during pregnancy/postpartum? Including family, neighbors, friends, etc.?\u003c/p\u003e\n \u003cp\u003eAre there any organizations or events in the community that offer you emotional support or help? Was this support helpful to you?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5824%;\"\u003e\n \u003cp\u003eExperience and expectation of community intervention model\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82.4176%;\"\u003e\n \u003cp\u003eHave you heard of or participated in community-organized maternal mental health related events? Please describe it.\u003c/p\u003e\n \u003cp\u003eIf there is a peer support group (such as Sororcomet for Maternity), would you be willing to participate? Why?\u003c/p\u003e\n \u003cp\u003eAre you willing to accept the psychological counseling services provided by some non-professional psychological support personnel (such as trained volunteers, health administrators, etc.)? Why?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5824%;\"\u003e\n \u003cp\u003eCommunity medical service linkage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82.4176%;\"\u003e\n \u003cp\u003eDoes the community health service center provide mental health related services during pregnancy and childbirth? Have you been in contact with it?\u003c/p\u003e\n \u003cp\u003eWhen you experience psychological stress or depression, do you think of going to a community health center, hospital or online platform for help? What is the reason?\u003c/p\u003e\n \u003cp\u003eWhat do you think can be improved between community health services and hospitals in helping maternal mental health?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 17.5824%;\"\u003e\n \u003cp\u003eRecommendations and expectations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82.4176%;\"\u003e\n \u003cp\u003eWhat else do you think the community can do to help with maternal mental health?\u003c/p\u003e\n \u003cp\u003eIf you could design a psychological support service that works for you, what features would you like it to have? (e.g. privacy protection, regular follow-up, family participation, etc.)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5 Outline of semi-structured interviews with community health workers\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3297%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInterview theme\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79.6703%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInterview questions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3297%;\"\u003e\n \u003cp\u003eJob responsibilities and practical experience\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79.6703%;\"\u003e\n \u003cp\u003e1. Do you involve maternal mental health related tasks in your daily work? What does it include? 2. What are the most common difficulties or challenges encountered in the process of providing psychological support? (such as insufficient resources, resistance of service recipients, etc.)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3297%;\"\u003e\n \u003cp\u003eUnderstanding and application of community intervention models\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79.6703%;\"\u003e\n \u003cp\u003eDoes your community organize maternal psychology activities? Please tell us about the content and format of the event.\u003c/p\u003e\n \u003cp\u003eHow do you think this intervention models have been effective in improving maternal psychological state? Is there an evaluation mechanism?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3297%;\"\u003e\n \u003cp\u003ePerceptions of non-professional psychological support roles\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79.6703%;\"\u003e\n \u003cp\u003eAre there training volunteers, health administrators, etc. in the community to participate in psychological counseling? How would you rate their role?\u003c/p\u003e\n \u003cp\u003eDo you personally have any psychology-related training? Do you feel the need to strengthen it?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3297%;\"\u003e\n \u003cp\u003eCollaboration with other healthcare resources\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79.6703%;\"\u003e\n \u003cp\u003eIn the work, is there a cooperation mechanism with the hospital psychology department or obstetrics and gynecology department? What exactly is it?\u003c/p\u003e\n \u003cp\u003eWhat are some good experiences or problems with cross-agency cooperation (e.g., referral, resource sharing)?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.3297%;\"\u003e\n \u003cp\u003ePolicy and service improvement suggestions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79.6703%;\"\u003e\n \u003cp\u003eWhat do you think are the shortcomings in the current community in terms of maternal psychological intervention?\u003c/p\u003e\n \u003cp\u003eIf you were asked to design a more efficient service model, what new content or mechanics would you like to include? (e.g., regular screening, teleconsultation, family participation, etc.)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eIn order to ensure the systematization of the interview process and the reliability of the research results, this study designs the interview implementation steps in detail and clarifies the process of information collection and analysis. Before the formal interview, the researcher will explain the background, purpose, implementation method and topic content of this study in detail to the participants and clearly inform the participants that the expected duration of the interview is 45 to 60 minutes, and the interview method will be mainly conducted through WeChat voice and other forms. At the same time, the researchers will solemnly promise to keep the information of all respondents strictly confidential, and the data obtained will only be used for this study and will not be used for other purposes without permission.\u003c/p\u003e\n\u003cp\u003eWithin 24 hours of each interview, the research team transcribed the audio content into text to ensure semantic accuracy and completeness, ultimately building a source database of more than 150,000 words. In order to ensure the depth and saturation of the grounded theoretical analysis, about two-thirds of the text data will be used for initial coding and category extraction, and the remaining one-third will be reserved for the theoretical saturation verification stage.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Coding process\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, the basic process of grounded theory is followed, and the screened text data are numbered sequentially with the help of Nvivo 16 software, and open-ended, spindle-coded and selective coding are carried out according to the qualitative analysis steps. During the entire coding process, the research team combined expert advice to continuously compare, reflect and revise, continuously integrate concepts, improve the analysis level, finally identify and refine the core categories, and gradually build theoretical models according to the internal relationship between categories, so as to realize the spiral from empirical materials to theoretical construction.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2.1 Open coding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOpen coding aims to gradually transform original qualitative data into concepts and categories, which is the initial key step in grounded theoretical analysis (Glaser et al., 1967; Corbin et al., 2015). In this stage, the interview data are analyzed sentence by sentence, keywords or core semantics are extracted, and they are encoded as free nodes, and 80 initial concepts and 27 basic categories (17 maternal, 10 community health workers) are initially formed through continuous comparison and classification. An example of open coding is shown in Table 6.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eSummary of open coding and basic categories of maternal and community health workers\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"535\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOriginal statement\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInitial concept\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBasic categories\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;They never ask about the sensitive things of my mother-in-law and daughter-in-law relationship, they just care about my body and emotions, and I feel very safe.\u0026rdquo;\u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eThe service boundaries are clear\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 107px;\"\u003e\n \u003cp\u003ePrivacy protection and data security\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;I consulted online in anonymous mode, and the system would not display my real name and contact information, so that I dared to say the most private things in my heart. \u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eDigital privacy protection\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e........\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;Every time the same nurse called to greet me, and after a long time, she seemed to know my mood changes better than my husband, and I slowly trusted her very much. \u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eContinuous service builds trust\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 107px;\"\u003e\n \u003cp\u003eService continuity and responsibility mechanism\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;I stayed alone in the community on the day of the Spring Festival, but I didn\u0026apos;t expect the social worker to come to chat with me, and I felt that I was really not forgotten.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eSpecial companionship for festivals\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e........\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026quot;The psychological counseling certificate hanging on the wall made me feel at ease, as if she was really capable of understanding and helping me.\u0026quot;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eProfessional qualification display\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 107px;\"\u003e\n \u003cp\u003eProfessional qualifications and service trust\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026quot;The community health worker told me in advance that I had been trained in psychological intervention, so I dared to tell her a lot of negative emotions with confidence.\u0026quot;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eProfessional training\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e........\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;She explained the test results to me step by step, and I finally knew my physical condition and didn\u0026apos;t have that feeling of being \u0026apos;kept in the dark\u0026apos;. \u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eTransparency of inspection results\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 107px;\"\u003e\n \u003cp\u003eInformation transparency and trust building\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026quot;The doctor told me in advance that the medication might have side effects, so I felt more at ease with the treatment instead of worrying about what might happen.\u0026quot;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eRisk information disclosure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e......\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;The doctor did not make a direct decision for me but asked me which delivery method I wanted to choose, which made me feel respected. \u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eDecision-making participation opportunities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 107px;\"\u003e\n \u003cp\u003eRespect for autonomy and service consultation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026quot;The nurses will ask me for a convenient time before coming to my home, instead of suddenly coming to the door, which makes me very relaxed.\u0026quot;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eService arrangement negotiation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e........\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;I plucked up the courage to say that I was afraid of having a baby, and she didn\u0026apos;t laugh at me, but held my hand and patiently comforted me。\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eNon-judgmental listening\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 107px;\"\u003e\n \u003cp\u003eEmotional safety and non-judgmental support\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026quot;I cried and talked about my anxiety in the mom group, no one criticized me, everyone said they understood me, and I felt particularly accepted.\u0026quot;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eThe group responded empathetically\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e........\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;She told me, \u0026apos;Your feelings are normal,\u0026apos; and I burst into tears, as if my long-suppressed emotions were finally allowed to be released. \u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eEmotional legitimacy feedback\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 107px;\"\u003e\n \u003cp\u003eDaily emotional support\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;The doctor listened quietly to me, did not interrupt, and nodded lightly in response, and I felt that I was really understood. \u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eEmpathetic response\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e........\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;The postpartum ritual held by the community for our new mothers made me feel like I had undergone a formal transformation, as if I had regained my strength. \u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eRitual transition support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 107px;\"\u003e\n \u003cp\u003eRitual healing and psychological reconstruction\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;The process of lighting candles and praying for blessings made me feel like my soul was healed, as if I could start over with new hope.\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eSymbolic healing experience\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e........\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;When I entered the service room, I saw flowers and soft music, and the tension of the whole person instantly relaxed. \u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eEnvironmental creation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 107px;\"\u003e\n \u003cp\u003eA space experience that enhances a sense of security\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;The warm slogan on the wall reminds me that \u0026apos;this is a safe place\u0026apos;, so that I can speak my heart with confidence。\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eMood creation tips\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e........\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;Since my husband joined the dad group, he began to take the initiative to change diapers and put the baby to sleep, and I feel that I am finally not alone。\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eFamily collaborative participation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 107px;\"\u003e\n \u003cp\u003eFamily Support and Cognitive Renewal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;After my mother-in-law took a family communication class, she no longer always criticized me for \u0026apos;not taking children\u0026apos;, and our relationship eased a lot.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eImproved family relationships\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e........\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;Community doctors explained postpartum mood swings to the elders in our dialect, so that my parents really believed that depression was not \u0026apos;hypocrisy\u0026apos;. \u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eLocal language adaptation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 107px;\"\u003e\n \u003cp\u003eCultural integration and service localization\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;The event combined the traditional customs of Spring Festival worship, which made me feel that the service was not cold, but very kind. \u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eCultural customs are integrated\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e........\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;I consult online in anonymous mode without worrying about being recognized by others, so I dare to say my most private thoughts。\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eAnonymous expression mechanism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 107px;\"\u003e\n \u003cp\u003eIntegration of technology and digital resources\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;Online videos allow me to get psychological support at home without worrying about running to the hospital with my children.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eRemote Accessibility Services\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e........\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eIn the mom group, everyone did not shy away from sharing their experiences of crying and even throwing things when they collapsed. I saw that other mothers would do the same, and then I realized that I was not the only one who was out of control, and I finally dared to admit my vulnerability.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eNon-judgment sharing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 107px;\"\u003e\n \u003cp\u003ePeer Support Network\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;There was a mother like me who was so anxious that she broke down with her baby in the middle of the night and told me how she came over little by little. Her experience made me feel that it was possible for me to persevere, and I felt a little strength in my heart.\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eExperience and support\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e........\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;I was afraid to ask for help until one day in the community when I saw a sign saying \u0026apos;safe house\u0026apos; hanging on the door, and at that moment I plucked up the courage to knock on the door, because I knew that this was a place dedicated to accepting me. \u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eVisualize security signs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 107px;\"\u003e\n \u003cp\u003eService visibility in crisis scenarios\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;The social worker repeatedly told me that \u0026apos;you can call at any time\u0026apos;, and I really tried it in the middle of the night and found that she was really answering, and I felt very at ease at that moment。\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eImmediate support\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e........\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;Once I had a complete emotional breakdown, I received an \u0026apos;emotional first aid kit\u0026apos; from a social worker with soothing aromatherapy, breathing exercise cards, and a small note with words of encouragement. I survived that night with all of this.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eRapid intervention tool\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 107px;\"\u003e\n \u003cp\u003eCrisis management and response\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;When I wanted to commit suicide, I dialed the hotline. The staff didn\u0026apos;t force me to say a word, but patiently listened to me cry and accompanied me until I slowly calmed down, and I didn\u0026apos;t do anything stupid.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eImmediate crisis intervention\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e........\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;After the miscarriage, I always felt like I was a failure and incomplete. It wasn\u0026apos;t until I joined the group of mothers who had the same experience that I felt for the first time that someone could really understand my pain, rather than just saying \u0026apos;I want to open up\u0026apos;.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eHomogeneous group support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 107px;\"\u003e\n \u003cp\u003eTraumatic experience repair\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;Hearing that other mothers in the group had also experienced repeated self-blame and helplessness, I realized that I was not alone. I began to slowly accept the past and no longer felt like an \u0026apos;abnormal one\u0026apos;. \u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eTrauma experience resonance\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e........\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;In the \u0026apos;mother-in-law class\u0026apos;, the teacher taught us how to communicate with our elders in a gentler way. I tried to communicate with my mother-in-law using the sentences I learned in the course, but I didn\u0026apos;t expect that there would be really a lot fewer conflicts. \u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eIntergenerational communication platform\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 107px;\"\u003e\n \u003cp\u003eIntergenerational understanding and information integration\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;After listening to the lecture, the elders finally understood that postpartum depression is not hypocritical. They began to ask me, \u0026apos;how are you feeling\u0026apos; instead of \u0026apos;thinking too much\u0026apos;, which made me feel understood.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eInformation and cognitive integration\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e........\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;We mainly rely on experience to do emotional screening, and there is no unified tool. (Worker)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eInsufficient psychological assessment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 107px;\"\u003e\n \u003cp\u003eProfessional support capacity for cultural adaptation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;We also want to help with complex emotional problems but lack a psychological background. (Worker)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eLack of professional support\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e........\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;As long as it is heard, it does not need to be taught. (Worker)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eListening is better than guidance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 107px;\"\u003e\n \u003cp\u003eNon-directive service concept\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;Sometimes just sitting quietly next to a pregnant woman makes her feel accepted. (Worker)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eCompanion support\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e........\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;The training emphasizes \u0026apos;don\u0026apos;t make judgments\u0026apos; and respond with empathy. (Worker)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eEmpathy training\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 107px;\"\u003e\n \u003cp\u003ePsychological literacy of service providers\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;We are also affected by the grief of pregnant women and need to self-regulate. (Worker)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eSelf-emotional management\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e........\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;We often ignore the role of husband or mother-in-law, and intervention is difficult to maintain. (Worker)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eFamily intervention blind spots\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 107px;\"\u003e\n \u003cp\u003eCulturally Adapted Strategies for Family Support\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;Without family education, it is difficult to be effective in the long term. (Worker)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eLack of family support strategies\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e........\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;The elderly think that we are labeling \u0026apos;postpartum depression\u0026apos;. (Worker)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eResistance to traditional concepts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 107px;\"\u003e\n \u003cp\u003eCulturally Adapted Strategies for Family Support\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;Going to a psychological consultation is considered shameful, and many mothers are afraid to come. (Worker)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eMental health stigma\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e........\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;Information is scattered across multiple systems and there is no unified platform. (Worker)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eService fragmentation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 107px;\"\u003e\n \u003cp\u003eIntegration of information and platform resources\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;Information is not shared between departments and is easy to miss. (Worker)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eLack of coordination\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e........\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;Moms prefer salon-style events to formal consultations. (Worker)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eInformal intervention preferences\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 107px;\"\u003e\n \u003cp\u003eService resource integration\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;The \u0026apos;tea party\u0026apos; format makes them more willing to share. (Worker)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eEvent attraction\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e........\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;The referral process is slow, and pregnant women run back and forth. (Worker)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eInsufficient coordination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 107px;\"\u003e\n \u003cp\u003eIntegration of medical and professional collaboration resources\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;If information is not shared with maternal and child and psychology departments, it is difficult to form an overall plan. (Worker)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eMissing information\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e........\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026quot;The project funding is short-term, and most services cannot be sustained.\u0026quot; (Worker)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eInsufficient resources\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 107px;\"\u003e\n \u003cp\u003eContinuous resource integration of systems and services\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026quot;The service relies on the project system and is difficult to normalize.\u0026quot; (Worker)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eLack of long-term mechanisms\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e........\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026quot;I hope to form a team with doctors, psychologists, and social workers in the future.\u0026quot; (Worker)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eMultidisciplinary cooperation needs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 107px;\"\u003e\n \u003cp\u003eCross-professional collaboration and resource integration\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u0026ldquo;The linkage of medical, psychological and community can be more comprehensive. (Worker)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003eCrossfield integration\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e........\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e2.2.2 Spindle coding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe purpose of spindle coding is to further compare and analyze the initial concepts and basic categories derived from the previous step of open coding, try to find the potential connections between each independent basic category, so as to summarize and name them, and develop the main category (Strauss et al., 1990; Strauss et al., 1998; Charmaz, 2006）.The researchers further refined, integrated, and summarized the 27 basic categories of open coding, sorted out the logical relationship between the basic categories, and finally obtained 5 main categories. As shown in Table 7.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7 Spindle coding analysis\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"556\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 105px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMain category\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBasic categories\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConnotation explanation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"7\" style=\"width: 105px;\"\u003e\n \u003cp\u003eBuilding trust and security\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003ePrivacy information security guarantee mechanism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eIn psychological counseling, ensure that the mother\u0026apos;s personal information, medical record data and communication content are not leaked. Protecting data security through encryption technology, permission management and institutional norms is a prerequisite for establishing basic trust.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eTransparency in trust formation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eClearly inform the process, risks, rights and responsibilities and response plans at all stages of the service. Transparent information reduces uncertainty and increases trust in services.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eAutonomous and collaborative decision-making in the service process\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eRespect the right of pregnant women to choose the intervention plan, communication method and rhythm. Reach a consensus through equal consultation, so that they have a sense of control over their own psychological support process.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eEmotional security supports the environment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eCreate a safe, judgment-free atmosphere of dialogue where pregnant women can express their emotions freely. Avoid blaming and labeling and promote authentic communication with an attitude of acceptance.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eA space experience that enhances a sense of security\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eReduce the psychological defense of visitors through a quiet, private and comfortable physical environment. Lighting, color, layout and other details can help pregnant women feel safe.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eService visibility in crisis scenarios\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eIn a crisis situation, pregnant women can quickly and clearly identify and receive help through visual safety signs (such as clear service guidelines, unified identification systems, and public contact information) and immediate support (such as 24-hour service hotlines and instant response psychological counseling channels). This visibility not only reduces the cost of seeking services and psychological thresholds, but also subtly conveys a sense of security and trust, thereby creating conditions for psychological intervention in a crisis.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eCrisis management and response\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eEstablish a standardized crisis intervention process and form a cross-agency collaboration mechanism such as psychological, medical, and social work, so that pregnant women can receive timely, accessible, and sustainable professional support in situations of emotional breakdown, loss of control, or high-risk situations.\u003c/p\u003e\n \u003cp\u003eThis system of \u0026quot;being seen in time, responding quickly, and being safely supported\u0026quot; strengthens the mother\u0026apos;s sense of reliability, dependability and continuous security in the service system, thus becoming an important guaranteed mechanism for her overall \u0026quot;trust and security\u0026quot; experience.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" style=\"width: 105px;\"\u003e\n \u003cp\u003eEmotional support system construction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eDaily emotional support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eIt is emphasized that in the daily narrative and communication of pregnant women, the service provider understands and responds to the feelings of the pregnant woman based on acceptance and listening, so as to help them reduce stress and loneliness.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eRitual healing and psychological reconstruction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eGive new meaning to life events with the help of cultural or personal rituals (e.g., welcoming new life, commemoration ceremonies). Help pregnant women rebuild their psychological balance and sense of hope.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eFamily support and cognitive Renewal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eMobilize family members to actively participate in psychological support and update their perception of mental health during pregnancy. Strengthen the support function of the family and reduce isolation and misunderstanding.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003ePeer support network\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eForm support groups or online communities where pregnant women can exchange emotions and experiences with people who have similar experiences. Support from similar backgrounds significantly reduces loneliness.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eTraumatic experience repair\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eFocus on the deep psychological distress caused by maternal trauma or major life blows. Clients help clients gradually integrate their traumatic experiences and regain a sense of psychological safety and resilience by establishing a secure relationship and stability support.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eIntergenerational understanding and information integration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eBy integrating useful knowledge about pregnancy and childbirth, it reduces conflicts caused by differences in perceptions, promotes communication between family members of different generations, and balances science and traditional experience.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 105px;\"\u003e\n \u003cp\u003eCultural adaptation strategies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eCultural integration and service localization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eEnhance the affinity and acceptance of services, integrate local languages, customs, and cultural symbols into services, so that interventions are closer to the life situation of pregnant women.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eProfessional support capacity for cultural adaptation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eIn response to the problem of insufficient psychological assessment and lack of professional support, service personnel need to enhance their sensitivity to maternal cultural background, values and belief systems on the basis of psychological professional ability. In the practice of psychological counseling, the assessment and intervention strategies are adjusted in combination with local cultural elements to ensure that the services are both scientific and standardized, and in line with individual cultural habits, so as to make up for the gap in professional support and realize the effective implementation of cultural applicability strategies.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eCultural adaptation practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eIn specific psychological counseling situations, fine-tuning and contextualizing the expression methods, interaction processes and communication tools.\u003c/p\u003e\n \u003cp\u003eIts core function is to make the psychological counseling content more smoothly understood and accepted during the interaction process through flexible expressions, examples, metaphorical choices, and contextualized question design, thereby improving cultural fit.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eCulturally Adapted Strategies for Family Support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eIn view of the blind spots of family intervention and the lack of family support strategies, intervention programs that can integrate different family structures and cultural habits should be designed based on the professional ability of cultural adaptation. By guiding family members such as spouses and elders to participate in psychological counseling, strengthening the family support network, reducing the resistance caused by cultural conflicts, and enabling interventions to be smoothly integrated into maternal daily life, thereby making up for the blind spots of family intervention.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" style=\"width: 105px;\"\u003e\n \u003cp\u003eResource integration capabilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eService resource integration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eIn the case of traditional psychological counseling forms that may be resisted, the community needs to explore activities that are closer to life, such as chat groups, handicraft activities or relaxation salons, and integrate elements of professional psychological intervention into acceptable activities, so as to improve maternal participation and compliance, and achieve effective integration of service resources.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eIntegration of information and platform resources\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003ePsychological counseling involves multiple links such as screening, follow-up and referral, and if the information is scattered, it is easy to lead to service breakage. By establishing a unified platform to integrate data, it can not only avoid information omission, but also ensure service continuity and cross-link collaboration efficiency, and realize the optimal allocation of information resources.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eIntegration of medical and professional collaboration resources\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eThrough cross-institutional collaboration between the community, hospitals and psychological institutions, the smooth connection between mothers from initial screening to professional intervention is realized. Effective integration of medical and professional resources can reduce referral interruptions and improve the professionalism and timeliness of interventions.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eContinuous resource integration of systems and services\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eIf psychological counseling lacks stable funding and institutional support, it can often only be operated in a short period of time. Through policy embedding, financial guarantee and system design, the long-term and normalization of services can be realized, so as to integrate institutional resources and ensure the sustainable development of psychological intervention.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eInterdisciplinary collaboration and multidisciplinary resource integration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eMaternal depression involves medical, psychological and social problems that require multidisciplinary collaboration among doctors, psychologists, social workers and peers. Through multidisciplinary team building and service system development, professional resources can be integrated to form a complete community psychological support network.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eIntegration of technology and digital resources\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eWith online follow-up, anonymous consultations, and remote support, it is possible to break through geographical restrictions and provide ongoing assistance to pregnant women with limited mobility or migration. At the same time, digital tools are used to lower the threshold for help caused by stigma and achieve efficient integration of technical resources.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 105px;\"\u003e\n \u003cp\u003eNon-directive consulting relationship building\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eNon-directive service concept\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eIn psychological counseling, non-directive methods based on listening and companionship can allow pregnant women to express their emotions and build trust in a safe atmosphere, which is more acceptable than simply \u0026quot;teaching\u0026quot;.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003ePsychological literacy of service providers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eIf community workers have good empathy, boundary awareness and self-regulation ability, they can avoid secondary harm and better support maternal psychological recovery.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eProfessional qualifications and service trust\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eWhen the service provider has visible qualifications and standardized processes, it is easier for pregnant women and their families to build a sense of trust and be willing to accept psychological counseling and follow-up intervention.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eService continuity and responsibility mechanism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 318px;\"\u003e\n \u003cp\u003eEstablishing fixed contacts, substitution mechanisms, and follow-up tracking systems can ensure that women do not have services interrupted by holidays or relocation throughout their pregnancy and childbirth, enhancing a sense of security.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2.3 Selective Coding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe purpose of selective coding is to systematically deal with the relationship between the main categories, which requires extracting the core categories with overarching characteristics from the main categories and analyzing the relationship between the core categories and the main categories, so as to depict the overall theory or phenomenon (Strauss et al., 1998; Charmaz,2006；Strauss et al.,2008）\u003cins cite=\"mailto:Siti%20Roshaidai%20Mohd%20Arifin\" datetime=\"2026-01-07T10:38\"\u003e.\u003c/ins\u003eThrough repeated comparison and discussion, the researchers further summarized and integrated the main categories generated by spindle coding, and extracted \u0026quot;the key elements and practical logic of community participation in maternal depression psychological counseling\u0026quot; as the core category, and finally formed five main categories: the establishment of trust and security, the emotional support system, the implementation of cultural adaptability, the ability to integrate resources, and the non-guiding counseling relationship (code of conduct for service providers). By sorting out the relationship between concepts and categories, it can be found that the five main categories are interrelated and together constitute the key elements of community participation in perinatal depression psychological counseling.\u003c/p\u003e\n\u003cp\u003eFocusing on the core elements and practical logic of community participation in maternal depression psychological counseling, the story clue is summarized as follows: the establishment of trust and security is the premise of pregnant women being willing to express their emotions and receive services, and is guaranteed by privacy protection, professional qualification certification and informed consent mechanism. The community responds to the emotional loneliness and psychological stress that pregnant women often experience during pregnancy and postpartum by building emotional support systems such as mutual support networks, family companionship, and environmental development. The implementation of cultural adaptability ensures the understanding and acceptance of psychological services in a multicultural context and improves the accessibility and inclusiveness of services. Resource integration capabilities leverage remote technology and cross-departmental collaboration to expand service accessibility and coverage, enabling the transition from case-by-case support to systematic intervention. Throughout the whole process is the establishment of a \u0026quot;non-directive counseling relationship\u0026quot;, which takes empathy, listening and respect as the core principles, breaks the traditional power structure, and guides pregnant women to gradually regain their psychological resilience through free expression. The five main categories together constitute the key elements and practical logic of mutual support and progression in the community psychological intervention system.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Saturation test\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTheoretical saturation testing is a critical step in grounded theoretical research to determine whether the data has adequately revealed the core concepts of the studied phenomenon. In this study, the test of theoretical saturation was carried out through continuous data collection and analysis. Specifically, during the coding process, we constantly compare the newly obtained interview data with the existing coding framework to see if new concepts or categories emerge. When the subsequent third of the footage was included in the analysis, we found that the new data no longer generated new topics, concepts, or categories, indicating that the study had reached theoretical saturation. To ensure the reliability of saturation, we further repeatedly compared and analyzed the data collected in the early and late stages to confirm that there was no significant difference.\u003c/p\u003e\n"},{"header":"3 The key elements of community participation in maternal depression psychological counseling and its practical logic model are explained","content":"\u003cp\u003eBased on the results of the grounded theory analysis, this study summarizes the key elements of community participation in maternal depression psychological counseling and constructs a practical logic model to illustrate the relationships among these elements. The overall framework and internal logic of this model are shown in Figure 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.1 Building trust and security: the core cornerstone of maternal depression counseling\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTrust and security are the core prerequisites for maternal depression psychological counseling, and they are also the psychological and institutional foundation for the smooth operation of service relationships. Women during pregnancy and childbirth are fragile due to physical and psychological changes, and they need stable and reliable psychological support. Attachment theory (Bowlby, 1969) points out that individuals actively seek a \u0026quot;safe base\u0026quot; that can provide stability, protection and emotional comfort in the face of stress and uncertainty, which provides a theoretical explanation for the maternal need for trust and emotional support in psychological counseling. This study found that CHW has formed a multi-level trust and security support system through seven aspects: privacy protection, information transparency, respect for autonomy, emotional safety, space creation, crisis response and institutionalized management.\u003c/p\u003e\n\u003cp\u003eStrict confidentiality allows pregnant women to be confident that information will not be leaked, reducing the risk of exposure and psychological defense. For example, a pregnant woman said: \u0026quot;She never asks about the specific situation at home, nor does she tell others what I say, and I feel safe to tell her what is in my heart.\u0026quot; \u0026quot;Information transparency in trust formation reduces cognitive uncertainty and makes services predictable by informing the process, frequency and goals in advance.\u0026quot; She told me what to talk about and how often from the beginning, and I felt much more at ease. These practices allow pregnant women to dare to express their true feelings and create conditions for in-depth communication.\u003c/p\u003e\n\u003cp\u003eAutonomous and collaborative decision-making in the service process enhances the experience of being treated equally and reduces passivity by involving pregnant women in deciding the topic, rhythm and form of communication. Emotional safety support environments are based on acceptance and empathy, allowing mothers to be more open about themselves without fear of being criticized or labeled. The optimization of the spatial experience \u0026ndash; such as quiet, private, and comfortable meeting places \u0026ndash; reduces the tension of communication and ensures a sense of security from the environmental level. These factors work synergistically to make pregnant women have a sense of control, as well as full respect and acceptance in psychological counseling.\u003c/p\u003e\n\u003cp\u003eVisibility into services in crisis situations demonstrates the reliability of providers at critical moments, and rapid response allows pregnant women to feel that support is readily available. \u0026quot;One night I had an emotional breakdown, and she replied to me in ten minutes, and I thought she really cared about me.\u0026quot; The crisis management mechanism provides guarantees for the continuity and stability of services through institutionalized arrangements such as referral paths, emergency contact information, and cross-agency linkage. These mechanisms strengthen the reliability of services at both the emotional and institutional levels, so that pregnant women can continue to maintain trust and security in the process of psychological counseling, thus laying a solid foundation for the realization of intervention effects.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Emotional support system: build a service carrier that connects and resonates\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOnce trust and security are established, emotional support becomes the most immediate restorative resource. The emotional support system is the core carrier of emotional regulation and psychological recovery in maternal psychological counseling, and its essence is to provide continuous psychological empowerment for pregnant women through the emotional connection between \u0026quot;being understood\u0026quot; and \u0026quot;being accepted\u0026quot;. Under the framework of attachment theory and social support theory, this conclusion can be theoretically confirmed. Attachment theory believes that individuals gain trust and security through secure attachment relationships in their interactions with significant others, and this psychological foundation helps individuals regulate their emotions and restore mental balance in the face of stress (Bowlby, 2008). Social support theory emphasizes that emotional, instrumental, and informational support provided in social networks is an important protective resource for individual mental health, among which emotional support is regarded as the most core element, which can effectively buffer stress response and promote psychological recovery (Cohen \u0026amp; Wills, 1985). Therefore, in the practice of maternal psychological counseling, on the premise of building trust and security, emotional support plays a direct and critical restorative role through the interactive process of \u0026quot;being understood\u0026quot; and \u0026quot;accepted\u0026quot;.\u003c/p\u003e\n\u003cp\u003eIn this study, the construction of emotional support systems includes daily emotional support, ritual healing and psychological reconstruction, family support and cognitive renewal, peer support networks, traumatic experience repair, and intergenerational understanding and information integration. This system can help pregnant women relieve loneliness and anxiety, improve psychological resilience, and form a stable sense of social belonging.\u003c/p\u003e\n\u003cp\u003eDaily emotional support allows pregnant women to feel their emotions understood during psychological counseling through unconditional listening and gentle response, thereby reducing emotional isolation. The peer support network uses \u0026quot;shared experience - common understanding\u0026quot; as a link to reduce loneliness and helplessness in primiparous and high-risk pregnant women. \u0026quot;She encouraged me to join the group, saying that there were people in the same state as me. That was the first time I felt like I wasn\u0026apos;t alone. (P17, Primiparas)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRitual healing and psychological reconstruction use symbolic activities (e.g., emotional first aid kits, breathing relaxation exercises) to help pregnant women regain emotional stability during a crisis. \u0026quot;Once I was so anxious that I couldn\u0026apos;t breathe, and the \u0026apos;emotional first aid kit\u0026apos; sent by the community with aromatherapy, music and soothing breathing instructions pulled me back from the brink of collapse little by little.\u0026quot; (P4, 32 weeks gestation) These miniature rituals not only provide psychological security but also help the mother regain a sense of control over her life. At the same time, family support and cognitive renewal can help family members understand the emotional changes of pregnant women through training and guidance, reduce misunderstandings caused by cultural and intergenerational concepts, and improve the overall support function of the family.\u003c/p\u003e\n\u003cp\u003eCHW have found that what pregnant women need most in sharing their trauma experiences is often to be heard and understood, \u0026quot;Some mothers later told me that their favorite thing is to meet and greet once a week, even if it\u0026apos;s just a chat\u0026quot;, so they will constantly adjust their methods to meet the needs of different groups, \u0026quot;Not everyone can come to meet during the day, especially second-born mothers.\u0026quot; We were wondering if we could have an online chat at night. In terms of intergenerational communication, workers play the role of a bridge, not only to help young mothers understand the parenting concepts of their elders, but also to promote the elders to accept scientific mental health knowledge, \u0026quot;We will discuss with mothers-in-law and mothers in family classes how to share housework, so that mothers are less blamed.\u0026quot; This mechanism, which focuses on emotional resonance and intergenerational communication, allows pregnant women to receive understanding and support in a safe atmosphere.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 Implementation of cultural adaptability: Construct a moderation mechanism for understanding services\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe implementation of cultural adaptation strategies is a key moderating mechanism for mental health services during pregnancy and childbirth from \u0026quot;accessible form\u0026quot; to \u0026quot;understandable meaning\u0026quot;. The core of cultural adaptation is not simply changing the discourse, but in realizing cultural meaning linkage in service practice, so that psychological support can be embedded in the daily situation, value framework and communication habits of the service recipient (Berry, 1997; Kirmayer, 2012). By reducing misunderstandings, shame, and psychological resistance caused by cultural barriers, such strategies enable pregnant women to understand the legitimacy and necessity of \u0026quot;psychological support\u0026quot; in a familiar cultural context (Rogers, 1951; Yao et al., 2022）。\u0026nbsp;This study divides cultural adaptation strategies into cultural integration and service localization, professional ability of mental health services, cultural adaptation practices, and family support.\u003c/p\u003e\n\u003cp\u003eCultural integration and service localization emphasize that psychological support should fit into the multicultural context of the maternal family-community ecosystem, rather than equating it with a single concept of a generation or group. The daily cognitive structure of pregnant women is often composed of multiple cultural resources, such as modern medical knowledge, shared experiences of online maternal and infant communities, and traditional parenting concepts of family elders (Shweder, 1990). Therefore, CHW will choose different cultural expressions according to different objects in actual services. when facing the elderly, translating psychological support into traditional Chinese medicine vocabulary such as \u0026quot;qi and blood conditioning\u0026quot; and \u0026quot;emotional dredging\u0026quot; can reduce unfamiliarity and resistance; When it comes to young pregnant women, modern psychological language, mood scales or APP tools are more used. Such \u0026quot;multi-cultural coding\u0026quot; is not simply a replacement, but improves the comprehensibility, credibility of service information through multi-context docking.\u003c/p\u003e\n\u003cp\u003eCultural adaptation challenges often manifest as differences in norms and expectations for emotional expression within families. In some collectivist family structures, emotional distress may be seen as \u0026quot;not strong\u0026quot; or \u0026quot;affect family harmony\u0026quot;, triggering shame or repression (Hofstede, 2001). In the face of these resistances, CHW use the family participation mechanism as a breakthrough to invite elders to enter the \u0026quot;Family Parenting Support Meeting\u0026quot; to guide them to review their postpartum experiences and emotional needs, so that they can understand the sources of stress of contemporary pregnant women in intergenerational empathy. \u0026quot;In the past, when I said it was uncomfortable, my mother said don\u0026apos;t be pretentious; Now she began to ask me how I was feeling today. (P10 Maternal) Such cultural translation strategies with \u0026quot;improving family relationships\u0026quot; and \u0026quot;improving parent-child well-being\u0026quot; as the value framework are more easily accepted by elders, thus gradually loosening the resistance to psychological counseling.\u003c/p\u003e\n\u003cp\u003eThe professional support ability of cultural adaptation is reflected in the service provider\u0026apos;s situational judgment and expression adjustment according to different cultural identities, age group and communication preferences. In field practice, CHW should give priority to establishing maternal mutual aid groups with similar dialects, similar parenting concepts, or similar experiences, so as to improve language closeness and cultural consensus, and form a \u0026quot;cultural mirroring effect\u0026quot;. This dynamic matching not only enhances the willingness to participate and the depth of communication, but also reduces shame and defensive responses, providing an empirical basis for the localization, acceptability and sustainability of maternal psychological services.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4 Resource integration ability: support the operation guarantees conditions of the system\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe ability to integrate resources is the core guarantee for the efficient operation of the psychological support system during pregnancy and childbirth, which determines whether the service can break through the limitations of time and space, personnel and information, and achieve multi-party collaboration and continuous accessibility. In maternal mental health services, resource integration not only includes cross-border cooperation between medical, psychological, community and social organizations, but also covers the overall management of information flow, service flow and capital flow. This process provides stable support for the construction of trust and security, because a continuous visible and interconnected service system can allow pregnant women to receive consistent and reliable support at different stages and in different situations.\u003c/p\u003e\n\u003cp\u003eFrom the perspective of systems theory, maternal mental health needs have multiple attributes, and the intervention of a single department often cannot cope with complex situations. The resource integration mechanism effectively reduces the vacuum period of service interruption and psychological support by introducing remote psychological services, information exchange and institutionalized referrals\u0026nbsp;(Blount et al., 2021; Selix et al.,2017）。\u0026nbsp;For example, in the face of traditional culture restrictions on going out during confinement, remote psychological counseling and online peer groups can maintain the continuity of emotional connection and psychological intervention without breaking cultural customs. This not only reduces the psychological cost of pregnant women in the process of seeking medical treatment or seeking help but also strengthens their trust in the system through a stable and predictable service experience.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn practice, service form innovation and adaptation, medical collaboration mechanism and online support are the main paths of resource integration. CHW often conducts emotional screening and dynamic tracking through digital tools (such as online questionnaires, psychological self-assessment tools, and emotional self-test QR codes) and conduct standardized referrals and information sharing with higher-level hospitals and psychological assistance teams. A pregnant woman said: \u0026quot;Although I can\u0026apos;t go out, I can chat with community volunteers every day, and I feel much more relaxed.\u0026quot; (P07) This form of \u0026quot;people at home and services at home\u0026quot; not only breaks the support window brought about by physical isolation in special periods but also allows pregnant women to gain psychological comfort in a familiar living environment. Another participant mentioned: \u0026quot;They will help me contact the psychology department of the hospital and remind me to fill out the questionnaire, which feels very systematic.\u0026quot; (P12) It can be seen that the systematic process and timely referral make pregnant women feel the professionalism and reliability of the service, so that they are more willing to open their hearts.\u003c/p\u003e\n\u003cp\u003eAt the same time, the flexible coordination of CHW in the gaps in the system is also an important embodiment of the ability to integrate resources. During the Spring Festival and other hospital outpatient closures, they will work with volunteers to provide door-to-door companionship and life care to ensure that pregnant women receive emotional support and life care. A health worker recalled: \u0026quot;During the Spring Festival, the hospital outpatient clinic was closed, and we coordinated volunteers to take turns to accompany her to ensure that she had both emotional support and hot meals. (P15) This flexible response not only addresses the risk of short-term service interruptions but also establishes a deeper emotional bond between the mother and the service system. In the long run, with the help of the municipal health information platform, CHW will be given cross-departmental data access and update permissions, and psychological risk hierarchical management will promote the psychological support system during pregnancy and childbirth from fragmentation to process-oriented, normalized and sustainable development.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.5 Non-directive counseling relationship: emotional norms and relationship endpoints of service behavior\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe non-directive counseling relationship is centered on listening, acceptance, and empathy, avoiding excessive directives and judgments, and allowing the mother to dominate the rhythm of communication. This model originates from Rogers\u0026apos; (1957) \u0026quot;client-centered\u0026quot; theory, which emphasizes \u0026quot;unconditional positive attention\u0026quot;, that is, responding with full respect regardless of the client\u0026apos;s emotions and states. In specific practice, the creation of non-guiding counseling relationships can be carried out from the following aspects: First, the concept of non-directive service requires the service provider to take listening, acceptance and empathy as the core, avoid excessive instructions and judgments, and highlight the main position of pregnant women in communication. Secondly, the psychological literacy of the service provider is the key to ensuring the effectiveness of counseling, including sincerity and consistency, self-awareness and emotional adjustment ability. Third, professional qualifications and service trust provide institutional guarantee for the consulting relationship, and the professional background and continuous training of the service provider can enhance the mother\u0026apos;s trust in the service. Finally, the service continuity and accountability mechanism ensures that the intervention is not limited to a single interaction but achieves long-term companionship and continuous support through institutional design and team collaboration. Together, the above elements constitute the core subcategory of non-directive counseling relationships and provide an operational path for maternal mental health services.\u003c/p\u003e\n\u003cp\u003eIn this study, multiple pregnant women clearly noted that undirected communication is more likely to build trust and emotional security than \u0026quot;what should you\u0026quot; guided communication. \u0026quot;I always thought I had something wrong, and she said, \u0026apos;You\u0026apos;re just trying too hard to adapt, it\u0026apos;s understandable\u0026apos;, and I relaxed all of a sudden.\u0026quot; (P9, third trimester) This concept can especially weaken women\u0026apos;s sense of shame and defense in the context of collectivist culture, making them more willing to express their inner feelings. \u0026nbsp; \u0026nbsp;Non-directive counseling not only relies on methods, but also on the psychological literacy of the service provider, including self-awareness, emotional regulation and continuous learning ability. One community health worker said: \u0026quot;At first, I always wanted to help them solve their problems, but now I have learned that it is actually more important to just listen to them. This shift from \u0026quot;problem solver\u0026quot; to \u0026quot;emotional bearer\u0026quot; gives pregnant women a sense of security in being heard. Maternal feedback confirms this effect: \u0026quot;At the mutual aid meeting, I cried for a long time, no one urged me, the staff just quietly accompanied me and listened to me. (P16, one month after giving birth) This stable, sincere and non-judgmental companionship helps to build a deep relationship of trust.\u003c/p\u003e\n\u003cp\u003eThe credibility of the service also depends on the professional qualifications and background certificates of the service provider, so that pregnant women feel that the service is safe and reliable. When the mother faces a severe emotional crisis, undirected relationships can also be an emotional bridge for professional intervention. \u0026quot;She didn\u0026apos;t panic, she just said, \u0026apos;Let\u0026apos;s talk to the doctor together\u0026apos;, and that was the first time I was willing to accept professional help.\u0026quot; (P4, one month after delivery) This low-threshold, trust-first referral method not only improves the timeliness of crisis intervention but also reduces the maternal vigilance of the medical system. Some CHW incorporated culturally familiar ritual elements (such as making tea, lighting candles, etc.) into the meeting, effectively resolving the cultural barrier in the service and making it easier to build trust. \u0026nbsp; \u0026nbsp;The sustainability of non-directive counseling relationships depends on follow-up mechanisms and accountability implementation to prevent disruptions from causing trust breakdowns. One mother recalled: \u0026quot;My mother-in-law used to always ask, \u0026apos;What\u0026apos;s wrong with you\u0026apos;, but now she just sits with me and doesn\u0026apos;t force me to say it anymore.\u0026quot; (P6, postpartum) This reflects that the impact of services has extended to family communication patterns, forming an emotionally responsive support network. In continuous companionship, CHW are both listeners and maintainers of trust; Through follow-up, anonymous confiding channels, responsible person systems, etc., they ensure that pregnant women always have a psychological \u0026quot;outlet\u0026quot; that they can rely on. In the end, this non-directive counseling relationship with listening and acceptance as the core, with professional qualifications and institutional support, has become the most stable emotional bond and support structure in maternal psychological counseling.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.6 Exposition of logical relationships\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe psychological counseling system for maternal depression starts from the establishment of trust and security, which is not only the psychological entrance for the initiation of intervention, but also the basic condition throughout the whole process. In this process, the mother feels respected, understood and protected, and then forms an open expression and willingness to participate in the intervention. The establishment of trust not only directly affects the emotional support system but also influences the non-directive counseling relationship through the code of conduct, ensuring that the counseling interaction presents the characteristics of empathy and de-empowerment.\u003c/p\u003e\n\u003cp\u003eAs the main carrier of services, emotional support systems provide emotional responses and social connections at the individual, family, group and community levels for pregnant women driven by trust. This system is also moderated by culturally adaptive implementation, ensuring that support content and formats are aligned with local languages, values, and cultural practices, avoiding disjointed interventions due to cultural mismatch.\u003c/p\u003e\n\u003cp\u003eThe implementation of cultural adaptation is not an isolated link, but a horizontal adjustment mechanism that runs through the whole process of trust building and emotional support system and plays a key role in context-sensitive and differentiated demand satisfaction. It also influences the establishment of non-directive counseling relationships, making counseling dialogues understandable, acceptable, and emotionally resonant.\u003c/p\u003e\n\u003cp\u003eResource integration capabilities are the supporting conditions of the system, which provides a stable operation platform for the emotional support system and long-term external guarantee for non-directive consulting relationships through cross-agency cooperation, digital technology and remote services to break through manpower and geographical limitations.\u003c/p\u003e\n\u003cp\u003eThe non-guiding counseling relationship is the external manifestation and relationship form after the interaction and integration of the above elements, which not only establishes the action guidelines for service provision, but also constitutes the core window of the \u0026quot;temperature\u0026quot; and \u0026quot;credibility\u0026quot; of the maternal perception support system. As a result, the whole system forms the structural characteristics of multicentric drive, cyclic feedback, and dynamic optimization, which is continuously iterated and deepened in the actual experience of pregnant women, and finally builds a psychological support network with high adaptability and resilience.\u003c/p\u003e"},{"header":"4 Research conclusions and discussion","content":"\u003cp\u003e\u003cstrong\u003e4.1 Main conclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study constructs a theoretical model of maternal depression psychological counseling based on the grounded theory, revealing that the process has significant interformity, hierarchical interweaving and dynamic cyclical characteristics. The model is composed of five core elements: trust and security, emotional support system, cultural adaptation implementation, resource integration ability, and non-directive counseling relationship. Among them, trust and security are the psychological premise and entrance of intervention. The emotional support system is the main carrier of continuous emotional response and relationship maintenance. Cultural adaptation implementation plays a moderating role in ensuring intervention acceptability and contextual fit. Resource integration capabilities provide structural support for the stable operation of the intervention system. The non-guiding counseling relationship is an explicit form after the integration of multi-element interaction, which directly reflects the level of humanistic care and credibility of the intervention.\u003c/p\u003e\n\u003cp\u003eThe above five elements form a synergistic effect in actual intervention, construct a psychological support network with high adaptability, high persistence and humanistic temperature, and realize the individualized, continuous and community-based intervention path starting from the individual psychological needs of pregnant women. This model not only deepens the understanding of the internal mechanism of maternal depression psychological counseling but also provides a structured framework and theoretical basis for the optimization of mental health services under multicultural context and multi-resource conditions, which has important practical guiding significance for improving the accessibility, effectiveness and sustainability of primary maternal mental health services.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2 Innovation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2.1 Theoretical contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on the grounded theory, this study constructs the key elements of maternal psychological counseling composed of five main categories: \u0026quot;trust and security building\u0026quot;, \u0026quot;emotional support system construction\u0026quot;, \u0026quot;cultural adaptation strategy implementation\u0026quot;, \u0026quot;resource integration ability\u0026quot; and \u0026quot;non-guiding counseling relationship building\u0026rdquo; and reveals the dynamic mechanism of cyclic nesting. This model expands the focus of perinatal psychological intervention from individual emotional regulation to social interaction and cultural regulation in community contexts, which makes up for the lack of research on the social dynamic mechanism of grassroots psychological services and provides a new analytical framework for understanding psychological intervention in complex community settings.\u003c/p\u003e\n\u003cp\u003eAt the same time, the study clarifies the adaptive logic of \u0026quot;non-directive counseling relationship\u0026quot; in collectivist culture through expert interviews. This study points out that Chinese collective culture pays more attention to emotional expression and decision-making rules under the \u0026quot;relationship-role\u0026quot; structure, so non-directive counseling should be understood as an empathetic companionship method of \u0026quot;low intervention, high respect, and emphasis on relationship\u0026quot; in the local context, so as to promote maternal self-awareness without destroying the family structure. This result responds to existing discussions about cultural adaptation in counseling relationships and provides new explanations for the localization of non-directive services in the context of collective culture. Based on the integration of existing results, this study enriches the understanding of the interaction mechanism of \u0026quot;intervention-culture-structure\u0026quot; in perinatal psychological services and has enlightening significance in the refinement of local concepts and cross-cultural comparison.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2.2 Practical contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study establishes a perinatal psychological support intervention pathway based on community subjectivity, emphasizes the unique role of community participation in psychological counseling, and proposes a practical strategy through the joint participation of CHW and cultural resources, verifies the effectiveness of non-directive and de-labeled psychological support methods in improving maternal active expression, self-care and willingness to continue to participate, and provides a generalizable and actionable intervention reference for the grassroots public health system.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.3 Research limitations and prospects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; Based on the grounded theory, this paper systematically studies the key elements and practical logic of community participation in maternal depression psychological counseling, constructs a theoretical model and puts forward practical strategies, but there are still certain limitations and need to be further improved and expanded in subsequent research.\u003c/p\u003e\n\u003cp\u003eFirst, the interview samples in this study are mainly concentrated in the maternal group in third-tier urban communities, which are limited by factors such as region, culture, and economic level, and the applicability of the research conclusions to other regions (such as rural areas) and different backgrounds (such as low-income or ethnic minority groups) needs to be further verified. Therefore, future research can improve the representativeness and external validity of the research results by distributing online questionnaires and expanding the sample source to cover pregnant women of different cities, urban and rural differences, different ages, different education levels and occupational backgrounds.\u003c/p\u003e\n\u003cp\u003eSecondly, since this study uses a qualitative interview-based approach, the psychological counseling process itself is affected by the differences in the personal style, experience level, and communication skills of the counselors, which may lead to certain individual differences in the intervention effect. This suggests that future studies can introduce standardized training for interventions, unify process guidelines, and systematically evaluate counselor traits and intervention effectiveness to ensure the consistency and reproducibility of interventions.\u003c/p\u003e\n\u003cp\u003eFinally, this study mainly focuses on the process and mechanism of maternal depression counseling in the community but lacks systematic comparison with other intervention models (such as hospital-led psychotherapy and online psychological intervention). Subsequently, a controlled study can be designed to compare the effects of community participation intervention with other interventions in improving maternal emotional regulation, self-efficacy, and social support, so as to further verify the unique advantages and applicability boundaries of the multidimensional integrated intervention model proposed in this study.\u003c/p\u003e\n\u003cp\u003eIn summary, although this study provides a preliminary theoretical framework and practical reference for understanding the community-based participation in maternal depression psychological counseling, it still needs to be continuously improved and deepened in a broader sample base, standardized intervention process design, and multi-modal comparative research, so as to train workers to master more than three kinds of culturally adapted communication skills at the community level. At the government level, maternal psychological services should be included in community health assessment indicators, and funding should be allocated to support the green channel of \u0026quot;community-hospital\u0026quot; referrals, in order to provide a more universal and empirical basis for promoting maternal mental health.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all participants and community health workers who contributed to this study for their time and valuable insights.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of Xiangnan University Affiliated Hospital (Approval No. K2024-017-01) and was conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants prior to enrollment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was supported by the Health Research Project of Hunan Provincial Health and Health Commission of China (No. D202305038871).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAckerman, A., Afzal, N., Lautarescu, A., Wilson, C. A., \u0026amp; Nadkarni, A. (2024). Non-specialist delivered psycho-social interventions for women with perinatal depression living in rural communities: A systematic review. PLOS global public health, 4(7), e0003031. https://doi.org/10.1371/journal.pgph.0003031\u003c/li\u003e\n\u003cli\u003eAnyanwu, I. S., \u0026amp; Jenkins, J. (2024). 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R., Tuan, M., \u0026amp; Ibaraki, A. Y. (2019). Cultural adaptations of psychotherapy: Therapists\u0026rsquo; applications of conceptual models with Asians and Asian Americans. Asian American journal of psychology, 10(1), 68.\u003c/li\u003e\n\u003cli\u003eSingla, D. R., Savel, K., Dennis, C. L., Kim, J., Silver, R. K., Vigod, S., Dalfen, A., \u0026amp; Meltzer-Brody, S. (2022). Scaling up Mental Healthcare for Perinatal Populations: Is Telemedicine the Answer? Current psychiatry reports, 24(12), 881\u0026ndash;887. https://doi.org/10.1007/s11920-022-01389-2\u003c/li\u003e\n\u003cli\u003eWard, E. A., Iron Cloud-Two Dogs, E., Gier, E. E., Littlefield, L., \u0026amp; Tandon, S. D. (2022). Cultural Adaptation of the Mothers and Babies Intervention for Use in Tribal Communities. Frontiers in psychiatry, 13, 807432. https://doi.org/10.3389/fpsyt.2022.807432\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Community engagement, Maternal and childbirth depression, Multisectoral collaboration, Grounded theory, Cultural adaptation","lastPublishedDoi":"10.21203/rs.3.rs-8572741/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8572741/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe impact of maternal depression on maternal and infant health has attracted increasing attention. However, there are still obvious shortcomings in the current grassroots psychological service system in terms of resource allocation, service accessibility and professional ability. As an important carrier of grassroots governance, the community has shown the unique advantages of psychological support sinking, emotional companionship extension and resource integration and coordination in maternal psychological counseling.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eBased on the grounded theory, this study selected typical communities in third-tier cities in central China, conducted qualitative research by interviewing 20 pregnant women and 10 CHW at risk of depression through semi-structured interviews, and sorted out the intervention mechanism through open, spindle and selective coding systems.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe results identified five core elements: the establishment of trust and security, the construction of emotional support system, the implementation of cultural adaptation strategies, the ability to integrate resources, and the creation of non-directive counseling relationships. The above elements constitute a system structure of nested interaction and cyclical promotion. Among them, non-directive counseling runs through the whole process, emphasizing empathy, listening and subject autonomy, especially adapting to the cultural context of collectivism.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study constructs a multi-dimensional integrated community-based maternal depression intervention model, which provides a theoretical basis and practical path for optimizing the grassroots psychological service system and improving the mental health of women during pregnancy and childbirth.\u003c/p\u003e","manuscriptTitle":"Understanding Community Participation in Psychological Counselling for Maternal Depression: A Grounded Theory Approach","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-13 10:31:20","doi":"10.21203/rs.3.rs-8572741/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c5a3a1c1-e752-46a7-8689-1c5d6c7d7e85","owner":[],"postedDate":"January 13th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-16T09:24:18+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-13 10:31:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8572741","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8572741","identity":"rs-8572741","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}