Key Informants in Applied Qualitative Health Research

Local Dynamics of Intersectional Stigma for Black LGBTQ People in Montreal, Quebec

Much academic literature on intersectional stigma is limited by a focus on relatively static and "universal" identity traits, such as ethnicity, gender, and sexuality. This paper addresses local dynamics of intersectional stigma for Black LGBTQ people in Montreal, QC, Canada. Findings draw from fourteen semi-structured, virtual interviews with key informants providing critical services to Black LGBTQ people living in Montreal. Findings suggest intersectional stigmatization via social identity and local power dynamics converge. Specifically, language and immigration are two domains determining intersectional stigma challenges and ameliorative opportunities for Black LGBTQ people in the city. Specific immigration-related challenges included (1) insecurity (e.g. concerning Canadian residency), (2) barriers to resource access (e.g. social and legal services), and (3) stressful identity challenges. Specific language issues included (1) Francophone limitations for expressing gender and sexual diversity and (2) exclusionary linguistic divisions (i.e. Franco/Anglo, Franco/non-Franco, and Western/non-Western). Local, place-based power inequities may determine black LGBTQ experiences of intersectional stigma.

Increasing Access To Perinatal Mental Health Care: The Perinatal Psychiatry Access Program Model

Perinatal psychiatry access programs offer a scalable approach to building the capacity of perinatal professionals to identify, assess, and treat mental health conditions. Little is known about access programs' implementation and the relative merits of differing approaches. We conducted surveys and semistructured interviews with access program staff and reviewed policy and procedure documents from the fifteen access programs that had been implemented in the United States as of March 2021, when the study was conducted. Since then, the number of access programs has grown to thirty state, regional, or national programs. Access programs implemented up to five program components, including telephone consultation with a perinatal psychiatry expert, one-time patient-facing consultation with a perinatal psychiatry expert, resource and referral to perinatal professionals or patients, trainings for perinatal professionals, and practice-level technical assistance. Characterizing population-based intervention models, such as perinatal psychiatry access programs, that address perinatal mental health conditions is a needed step toward evaluating and improving programs' implementation, reach, and effectiveness.

Acceptability and Feasibility of Maternal Mental Health Assessment When Managing Small, Nutritionally At-Risk Infants Aged < 6 Months: A Key Informant Interview Study

Maternal mental health (MMH) conditions and infant malnutrition are both major global public health concerns. Despite a well-established link between the two, many nutrition programmes do not routinely consider MMH. New World Health Organization (WHO) malnutrition guidelines do, however, emphasise MMH. To inform guideline rollout, we aimed to assess the feasibility and acceptability of MMH assessments in nutrition programmes in low-resource settings. Ten semi-structured interviews were conducted with international key informants who work on nutrition programmes or MMH research. Interview transcripts were coded using subthemes derived from the key points discussed. The benefits and risks were highlighted. These included ethical dilemmas of asking about MMH if local treatment services are suboptimal. Commonly reported challenges included governance, staff training and finance. Community and programme staff perceptions of MMH were primarily negative across the different settings. Many points were raised for improvements and innovations in practice, but fundamental developments were related to governance, care pathways, advocacy, training, funding and using existing community networks. Future implementation research is needed to understand whether assessment is safe/beneficial (as it is in other settings) to promote MMH screening. Current service providers in low-resource settings can undertake several steps, as recommended in this paper, to improve the care offered to mothers and infants.