Uncovering what hurts and what helps: a patient work systems analysis of contextual factors impacting access to perinatal mental health care in Toronto, Canada

Perinatal mental health (PMH) challenges impact numerous mothers in Canada, with disproportionate effects observed within racialised populations. Despite increasing awareness, disparities in access to care continue to persist. This study explores the lived experiences of racialised mothers accessing PMH care in the Greater Toronto Area (GTA), with a focus on contextual factors across the patient work system. Semi-structured interviews were conducted with sixteen racialised mothers within one-year postpartum. Data analysis employed an inductive thematic approach with emergent themes and contextual factors mapped across the patient work system. Findings underscored an interaction between micro- and macro-level, wherein varying levels of trust, comfort, and self-reliance corresponded with care that was fragmented, delayed, or absent. At the meso-level, emotionally engaged providers, multimodal services, and robust community-based support emerged as areas of resilience. Grounded in the patient work of racialised mothers, preliminary design recommendations are proposed for the design of proactive PMH care systems.