A cross-sectoral perinatal assessment and support intervention from the perspective of parents living with psychosocial vulnerabilities: A qualitative realist evaluation

Expectant parents experiencing psychosocial vulnerability face significant risk of adverse perinatal outcomes, including higher susceptibility to mental health challenges, preterm birth, and intrauterine growth restriction. These vulnerabilities necessitate differentiated and tailored perinatal care services. This study explored how, for whom, and under what circumstances a cross-sectoral psycho-social vulnerability assessment and support intervention in the North Denmark Region worked to improve coping abilities and parenting skills among expectant and new parents in vulnerable positions. Guided by a realist evaluation framework, we conducted 25 interviews with parents. They included 10 dyadic interviews with mothers and fathers and 15 individual interviews with mothers. We tested and refined key assumptions about mechanisms and contextual factors influencing intervention outcomes. Compassion, acceptance, and emphasis on both parental resources and vulnerabilities were central mechanisms fostering engagement in supportive dialogues about parenting and support needs. Critical contextual factors included sufficient interaction time, professionals’ experience and confidence, and integrated collaborative practices among relevant services to create effective and timely safety nets for parents. The findings underscore the importance of relational continuity and trust in facilitating positive outcomes. The study shows that the intervention holds significant potential to achieve its goals when it successfully engages parents in supportive dialogues about their vulnerabilities and transition into parenthood. It further offers actionable insights into how cross-sectoral interventions can address the complex needs of vulnerable parents and advance care to reduce adverse outcomes.