Exploring community midwives’ experiences of the SM-ART intervention to improve perinatal mental health: A qualitative inquiry

Background: Maternal healthcare is an integral part of the public health system, yet the mental well-being of pregnant women is often overlooked in lower- to middle-income countries (LMICs). Midwives, as frontline workers, can provide psychological care to pregnant women, yet their experiences in this role remain unexplored. The study aimed to explore community midwives’ experiences of delivering the Safe Motherhood Accessible Resilience Training (SM-ART) resilience intervention and its perceived impact on their practice and on women's perinatal mental health. Method: A qualitative exploratory design was used. A sample was recruited using purposive sampling. A focus group discussion (FGD) was conducted in Urdu with all five community midwives who had delivered the intervention at a midwifery-led clinic in Karachi, Pakistan. The data were transcribed and then translated into English. Manual coding was independently performed by two researchers. Words and phrases were first coded, then grouped by similarity into categories, and finally aggregated into themes, which were iteratively reviewed to represent participants’ experiences. Rigor and trustworthiness were ensured through regular check-ins and reflective journals. Results: Thematic analysis revealed four themes: “SM-ART” leading towards impacting personality, “SM-ART”- a way towards empowerment, growth, and change, Operational feasibility of SM-ART intervention, and Integration of SM-ART intervention in the community midwives' curriculum. Overall, the study findings revealed that midwives experienced positive changes in their behavior, gained confidence, and enhanced their knowledge of mental health and resilience. They found the intervention feasible and recommended it be embedded in their Midwifery Education. Conclusion: The study signifies the voices of midwives, reflecting the SM-ART module's capacity to foster resilience among health care professionals.