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Pearl

Preventing perinatal mental illness: An Economic evaluation and co-produced framework using a Realist approach

Project Description

What does this mean for health and social care professionals? For some women and birthing people, preventative, community-based support plays an important role alongside clinical care during the perinatal period. There is currently a limited understanding of what resources are required to deliver these interventions, how these translate into costs, what outcomes they achieve, and how wider economic consequences may arise. For clinicians such as midwives, health visitors, and mental health practitioners, these interventions may support engagement—especially among those facing barriers to formal services—and a better understanding of how they work can inform more appropriate referral and shared care. For commissioners and service planners, current decisions about investing in prevention are often based on limited and fragmented economic evidence; this research will help clarify what resources are required, where costs fall, and where benefits may emerge, without yet providing definitive conclusions on value for money. For VCFSE providers and community organisations, the work aims to support clearer articulation of how programmes create value and what is needed to deliver them, strengthening the case for funding while recognising that evidence on costs and longer-term outcomes is still developing.

What does this mean for the public?

Preventative, community-based support can help women and birthing people get help before problems become severe, improving wellbeing during and after pregnancy. These programmes are often free at the point of use, local, and tailored, making it easier for people—especially those facing barriers—to access support. They might also reduce the need for more intensive services later and improve long-term outcomes for parents and children, but these links are not yet well understood. Similarly, it is not well understood what resources are needed to make programmes successful in achieving important short- and long-term wellbeing and economic impacts. This research aims to improve understanding of how these interventions work, what resources they require, and how costs and benefits might arise. By strengthening this evidence base, the research seeks to support more informed and transparent funding decisions, helping ensure that effective support can be sustained and made available to more families.

Background

The period during pregnancy and up to two years after birth is a critical time for women’s and birthing people’s mental health. At least one in five experiences mental health difficulties, such as anxiety or depression. Those who face extra challenges, like financial difficulties, lack of family support, or limited access to culturally appropriate services, are at higher risk. Not everyone gets support from standard health services, although it can help reduce long-term problems for them and their families.

Community-based support plays an important role. Charities and voluntary groups offer programmes such as peer and group-based emotional support from people with similar experiences, in groups or one-to-one, activities like creative projects, outdoor walks, or gentle exercise, and being connected to community activities or services to support wellbeing, arts, nature and exercise-based activities. These programmes often reach women and birthing people who might not use standard health services.

Research shows that these programmes can improve wellbeing by helping women from different ethnic, cultural, socio-economic and LGBTQ backgrounds feel connected, supported, and more confident in caring for themselves and their children. We do not properly understand what types of resources are needed from different people or organisations, to make sure the programmes lead to long-term benefits for families and society.

Aim

Our study will explore how these programmes work, for whom, and in what situations. We will use a new approach called “realist economic evaluation”; this is a new way of studying to help us understand how a programme can be delivered using resources in the best possible ways to achieve value for money. This approach also helps us understand how support programmes might change current and future demands on public services and improve families’ lives, including through employment or volunteering.

Design and methods

The research is structured across three work packages. WP1 develops an initial programme theory through a targeted realist synthesis of existing literature and grey evidence, identifying how interventions operate across contexts and what resources and costs are involved. WP2 tests and refines this theory using primary qualitative data (focus groups and interviews) with VCFSE providers, women and birthing people, exploring how mechanisms, resources, and economic consequences play out in practice. In WP3, we will work closely with women, families, and community organisations to co-develop a practical framework for commissioners. The framework will show the types of costs involved in delivering these programmes, the short and long-term outcomes they achieve, including economic benefits.

WP1: Targeted realist synthesis (Months 1–4)

WP1 develops an initial programme theory explaining how prevention-focused, community-based interventions work across different contexts. Using a realist synthesis of existing academic and grey literature, the work identifies key context–mechanism–outcome (CMO) patterns, with explicit attention to resources, costs, and economic consequences. This stage maps how different types of support (e.g. peer, arts-based, social prescribing) generate outcomes, and produces a set of prioritised CMO configurations to be tested in WP2.

WP2: Realist economic evaluation (Months 4–10)

WP2 tests and refines the programme theory using primary qualitative data from focus groups and interviews with VCFSE providers and women with lived experience. It examines how interventions operate in practice, focusing on how resources are used, how mechanisms are triggered, and how outcomes and economic consequences arise in different contexts. Through iterative analysis, the programme theory is refined to produce robust, practice-informed explanations of how value may be generated.

WP3: Co-design of an economic impact framework (Months 11–15)

WP3 translates the refined programme theory into a practical economic impact framework co-designed with commissioners and stakeholders. The framework sets out what resources are required, how costs and benefits are distributed, and how outcomes and economic consequences can be understood and assessed in decision-making. It aims to support more transparent and consistent consideration of value in commissioning, and support future measurement and evaluation.

Public involvement

Public involvement in this study is embedded throughout design, delivery, and dissemination, reflecting a strong commitment to inclusive and co-produced research. The research is led by researchers and practitioners with lived experience. The proposal has been shaped by public health commissioners, VCFSE leaders, and practitioners with lived and professional experience, who highlighted the urgent need for better economic evidence to support sustainable investment in prevention-focused services. These partners have directly influenced the scope, including strengthening the focus on VCFSE roles in NHS pathways and ensuring relevance to commissioning practice. Lived experience contributors, working through established groups and partnerships, have also been central in shaping research priorities, ensuring attention to equity, inclusion, and the realities faced by women and families using community-based support. As the study progresses, a dedicated lived experience advisory group (LEAG) will, alongside the Professional Advisory Group (PAG), play a key role in refining programme theory, interpreting findings, and co-producing outputs and dissemination materials, supported by co-applicant VCFSE partners with expertise in inclusive engagement. The study will use accessible and flexible approaches to involvement, while also addressing barriers such as time and capacity constraints, and will actively evaluate the impact of public involvement through ongoing feedback, reflection, and documentation of how contributions shape decisions and outputs.

Dissemination

Knowledge mobilisation. Findings will be shared via academic and professional networks (e.g., NIHR, H&M, Maternal Mental Health Alliance), and social media platforms targeting practitioners, researchers and policymakers. Outputs will include short briefing notes, simple infographics, interactive workshops/webinars, or summaries, alongside one or two peer-reviewed publications. Knowledge mobilisation will be iterative: Early findings will be shared with LEAG/PAG and core stakeholders during WP1 and 2; dissemination of the programme theory will take place in WP3, engaging practitioners and commissioners; the economic impact framework will be distributed widely at project completion.

How findings will be implemented:

  • VCFSE organisations will be able to inform and use the framework to plan, improve, and seek funding for their programmes.
  • Commissioners and funders can inform and use it to compare services, understand who benefits, and make fair funding decisions.
  • We will share findings through workshops, briefings, and easy-to-read summaries so stakeholders can immediately apply the research.
  • Findings will also inform guidance for future programme design, helping services make changes that improve outcomes for women, families, and communities.

Further Project information

Date: April 2026 - July 2027

Funder: NIHR Three Schools Prevention Research Programme

Collaborators: Ruth Naughton-Doe, York University, SSCR Krysia Canvin, Keele University, SPHR Emily Lovett, Edge Hill University Amy Chidley, PPI Lead & Fellow of NIHR MHSC-I STiR programme Melanie Williamson, Hearts and Minds Partnership

CPEC research team: Tihana Matosevic, Madeleine Stevens and Naz Saleh

Contact: Annette Bauer; a.bauer@lse.ac.uk