Widening access to perinatal mental health group interventions:learning from a trial of the Circle of Security-Parenting programme in England

Background: Perinatal mental health (PMH) difficulties can adversely affect family relationships across generations. Timely treatment can prevent these impacts, yet inequalities in access persist. Service delivery has also changed rapidly in recent years, including increased provision of online mental health care, creating additional access considerations. This paper offers a framework for widening access to group-based interventions, informed by an analysis of barriers and facilitators to birthing parents accessing the Circle of Security-Parenting (COS-P) programme - an attachment-based group provided by community Perinatal Mental Health Services (PMHS) in England. Methods: COS-P recipients (birthing parents, typically mothers) and COS-P providers (practitioners) were recruited from a randomised controlled trial involving 10 PMHS in England delivering 51 COS-P groups. The 10-session group intervention was delivered predominantly online, with babies present. Accessibility data were collected via surveys (165 parents), interviews (58 parents and 7 practitioners), and focus groups (6 practitioners). A research team, including co-researchers with lived experience, undertook qualitative content analysis to identify barriers and facilitators to accessing COS-P and to explore how these operated across different aspects of the intervention format. Recommendations were co-produced with a lived-experience panel to inform how access might be widened. Results: We developed an access framework conceptualising access as a pathway involving four steps: attend, take part, understand, and apply. This enabled examination of how 13 barriers and facilitators manifested in relation to each aspect of the intervention format, and how they influenced pathway steps individually, cumulatively, or in opposing ways. Features that supported attendance sometimes constrained opportunities to take part, understand, or apply learning. The influence of barriers and facilitators also varied by individual and family context, and by location context - defined as where access happens (community venues, homes, online spaces) and when it happens (during or between sessions). Conclusions: Recognising the complexity of accessibility may support efforts to widen access in ways that are more meaningful to individuals and families. These findings extend beyond COS-P, offering a framework to improve equitable access to group-based psychological interventions in the perinatal period and helping ensure that seemingly convenient ways of working do not inadvertently perpetuate inequalities.