Table 5 Qualitative interview results

1. Facilitators to community acceptability

1.1 High level of need

I used to think a lot, whether I will survive my pregnancy or not? I was unsure and scared, everyone used to say that I did not look very well. 08M

Women are afraid of arguments in the house. Some have very strict husbands while others have strict mothers- in- law. Women know that they have to tolerate this because if they argue they might be asked to leave home. This leaves them with no option other than to stay quiet and be compliant. 32M

1.2 Desirable PV characteristics

It gave me the opportunity to off load myself. Only a mother, who has gone through similar problems, can understand how another mother is feeling. 32M

Her nature and style of talking was really good. She was like a friend. Her company used to make me feel happy. When she used to leave, I felt someone close to me has gone. 29M

1.3 Linkage with local PHC system

Nobody knows about us whereas LHWs are working for the last 18–19 years. It would be really difficult for the PVs to work without their involvement. 33PV

1.4 Intervention perceived positive

I think the pictures were most effective. The majority of the mothers in our village are not able to read, so just by looking at the pictures you can tell the whole story. 02M

In every following session I used to ask her about her mood and daily routine. She used to tell me what she has done, how she has taken care of her baby. This makes me realise that she is following my suggestions. Moreover the improvement in her says it all. 01PV

2. Facilitators to PV motivation

2.1 Personal gains

It has given me an opportunity to learn and gain experience. I hope I can get LHW’s post, as I would like to contribute to house income and want my daughter to feel proud of me. 07PV

Before they were sitting at home, only focusing on their children and domestic chores, now working with other women has changed their thinking for the better. It had provided them the opportunity to interact with women in their neighbourhood, which has enhanced their social functioning. 19LHW

2.2 Family and community endorsement

My family is supportive, without their encouragement, I would not have done this work. It would have been really difficult to leave housework and children. 01PV

They ask us about our programme, about our role, where we have received our training, how do we operate, what do we do? When I explain to them they get satisfied, knowing that we are doing this work with an objective. PV05

2.3 Good training and supervision

I like the training…the trainers were friendly…the way they explained the content was very good. I didn’t experience any problems in understanding it. Through it I have learned a lot, which has helped me to overcome my own depression. 15PV.

When xx (supervisor) accompanied me, mothers took me more seriously and shared their concerns more openly knowing that I have been properly trained and supervised. IDI-15PV

3. Barriers to community acceptability

3.1 Stigma of mental illness

She got upset when I told her that the assessment indicated that she has depression. She said that she is not mad and stopped me from coming in when I went for my next visit. 22PV

3.2 Societal and cultural barriers

I could not go to attend groups; it is not a custom in Pathan families for women to visit other people’s homes unaccompanied. If I will go and my husband will find out he will get upset. 09M

They say that she (mother) is being possessed, so instead of medicines they go for talisman (spiritual treatment). 19LHW

4. Barriers to PV motivation

4.1 Lack of engagement of mothers

I had to leave my housework to sit with her, so I stopped her from coming. 13M

My husband business is not doing well, financially we are struggling, we have children to look after, we have the responsibility to marry them off and give them dowry etc., all these worries are pulling me down. Talking to xx (PV) can’t help me. 09M

4.2 Resistance from mothers family

Groups are held outside; our women observe the veil and do not go out. FGD-02H

Some families are financially struggling and would like to receive more than just the information given by the PV. I have the experience of upbringing five children, I can give her the information she needs. What is difficult for me is to buy fruits and medications for her, so if the PV can help with buying what is required to keep her well, it will be appreciated. FGD-01ML