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Table 3 Identified themes, subthemes and quotes related to supporting PNA online

From: Supporting perinatal anxiety in the digital age; a qualitative exploration of stressors and support strategies

CategoriesQuotes
Better preparation and management of expectations of birth and motherhood
 1. Unbiased, balanced informationFG5.F4: So maybe just like more information about what happens after you have the baby… like a little factsheet… you know, like there is clusterfeeding, things about sleep, because I think that’s why you get the anxiety isn’t it. Because you’re all geared up to give birth, and then you do it and you get home and you’re like, shit… now I have a baby… and you don’t know what’s normal or not.
FG5.F1: Impartial advice. Which I know is really difficult, but just having facts for me would be really helpful. Like the reason people tell you to do stuff, rather than them just telling you to do it. So like the reason that we would tell you to do this is X, Y and Z… but if you didn’t want to do it then fine. I think it’s the way you use the language as well…
 2. Realistic informationF5.F5: I just think that they need to give you realistic information for when your baby doesn’t fit into the guideline… like when they won’t sleep on their backs or whatever. Realistically, are you supposed to stand over them all night and turn them back over each time? That’s impossible.
F2: So maybe some realistic advice would be good. Instead of it all being so black and white.
FG1.F3: I think just balanced views and like also some realistic, I can’t think of what the word is but realistic experience or something.
 3. Evidenced-based informationFG1.F3: KellyMom was quite good… because it’s not just everyone giving you their opinion. It’s hugely like y’know researched articles that they’ve got… In my experience that’s more balanced…
 4. Expert adviceFG1.F2: If there would be a specialist… you can ask questions and that you can get support. I think that could, I think maybe allay a little bit of the anxiety because then you know that you can trust the expert’s advice and then you can relax because you feel like you’re on the right track.
FG3.F2: If you could get like a list of all these worries that are quite common for mums, and then like some sort of answer to them. That would be really helpful wouldn’t it?
Peer support
 5. Moderated peer inputFG5.F1: There’s an app I use where people pose questions, and people answer them. But the answers are moderated and I think they pick like 5 or 6 answers that you see… You get like the expert answer and then you get like real mum’s answers. But the real mums answers, I think they pick them… ummm… moderate them. They’re generally quite like ummm… helpful. They’re not just like, ‘oh my god this happened to me and it was so awful…’ Which is good, because I don’t want to read someone’s nightmare story… that’s going to make me feel so much worse.
FG5.F5: For breastfeeding, uhhh… there’s a UK Facebook support group. And that’s quite good, because the admins will turn off commenting. Or they will come in and say… you’re giving inappropriate advice here, this is what we would suggest. And I find that a bit more balanced.
 6. Limited peer inputFG4.F5: One of my main sources of support is my NCT group because there’s eight of us, and that’s a nice number. It’s not too many voices and you feel like you can share and be open… so I don’t know if there is any scope to have an online version of that for people who can’t afford the NCT.
 7. Relevant adjunctive face-to-face supportFG2.F2: When you go in a baby group it’s not like this… it’s not focused on the parents. I think it would be nice if you go to a baby group like this, where it’s focused on the whole idea of getting you all to talk to one another and something like that would be really helpful for someone like me.
FG2.F1: If there was a postnatal depression or anxiety group where you could bring your kids but you could also chat to other people… that’d be good.
FG3.F1: it would be good to have something where you could have a chat with the other mums…where the babies are happy but you can actually have a conversation as well with other… because sometimes you pay for those groups, and then you arrive. And the whole session is really busy, you don’t really talk to anyone else, and then you all go… even having 20 min after groups where people can get their bags together slowly, or there’s toys out where the babies can slowly leave, rather than everyone out the door. Because then you can actually make other contacts with people.
Normalisation
 8. Normalisation of feelings through exposure to other mumsF1.FG1: I saw something really good… it was so simple, they had three women sat around with a cup of tea in a kitchen and they just spoke to each other like in a conversation about their postnatal anxiety problems. And it was just really lovely because you just felt like you weren’t alone... So something like that where there’s a bit of video content, and again like, you know, for someone who hasn’t had a lot of sleep and can’t read a lot, that would be really good I think.
FG2.F2: I think maybe if you had somewhere you could watch little video clips of people just talking openly with the kids in the background, or doing whatever. Maybe just little things like that…
 9. Humour as medicineFG1.F5: I ended up following a public figure who was writing a book The Unmumsy Mum and they just said like very silly things. So I just ended up reading a lot of silly things that she’s been doing with her kids that makes it OK not to be the perfect mum. And that helped me to let go of other stuff as well. So I think just making things funny, maybe sometimes a good laugh can release some of the negative energy as well.
Information about PNA symptoms and management
 10. Information about PNAFG3.F2: On this internet programme I have to do (questionnaires) every single week… and yeah they’re quite helpful. Because the first time I did them… I was like oh so other people think that too.
FG2.F1: Yeah, and also understanding what is actually wrong with you… And then I guess then once you know you’ve got something, or that something’s building up, you can, I read a lot about it and I understood a lot about it and it helped me, so maybe some information (about PNA) on a website.
 11. Anxiety managementFG2.F1: Coping strategies… I’d find that quite useful... just how to manage it almost.
Increasing maternal confidence and wellbeing
 12. General wellbeing supportFG1.F1: Could it be about helping mums with their wellbeing as well…So maybe that wellbeing as well as factual like about breastfeeding advice and that. I would love to have some more information about things that you can do to look after yourself.
FG1.F6: People always just say just trust your instincts, you’re the mother you know best. But I don’t know. I don’t have any instincts because I don’t know about this situation. So I actually find that… to be really anxiety inducing.
FG3.F2: If somebody actually text me and say ‘think about you for 5 min… I might actually do it… you know’
Accessible to audience
 13. Video and audio contentFG1.F1: I don’t have a lot of time to read as well, so I don’t know if there could be elements where it’s audio. So I listened to a lot of podcasts and that was really helpful in the early days… I just think when you’re so sleep deprived. I don’t know about anyone else but completing a form or reading, like, a website full of paragraphs I couldn’t do it. So thinking about how you translate that information would be really helpful.
FG3.F2: The only thing I can suggest is like… on You Tube, there’s some videos that you can watch… I could say to myself I’m going to have 10 min to watch this video, and it’ll be, I don’t know, just nice nature images and reaffirming things… something like that for mums postnatally to watch, that might be the way to just sit down and watch something. It would be nice when you can’t, you just haven’t got the energy to do it yourself.
 14. Easy to navigateFG1.F2: spend a lot of time on how the website looks, and how you navigate through it. And that will mean that people have the time and the inclination to use the resource, rather than it just to be too difficult, because when you’re sleep deprived and you don’t have time… y’know… I mean like easily structured and with headings and click routes on different categories of things.
 15. Easy to findFG1.F1: Make sure you make yourself visible because that is the hardest thing, is finding.
Privacy
 16. DiscreetFG2.F1: The only thing I find off putting… is if (websites) can post on my Facebook page… that’s the only thing that would annoy me, is that I don’t want posts on Facebook page about my (problems).