Table 2 Foundation and rationale for the final intervention design

Sample population

Nulliparous women in the second trimester of pregnancy.

Advisory group and service user group: focus on nulliparous women forpreliminary testing (facilitate data analysis and more likely to have and abilityto participate).

Participant eligibility

Inclusion criteria:

1. Nulliparous pregnant women

2. Self- report mild-moderate anxiety

Exclusion criteria:

1.Receiving treatment for a severe and enduring mentalhealth condition.

2. Complex social factors (NICE [60]).

Current clinical policy: women with severe mental health concerns andcomplex social factors have established referral pathways to specialist services.

Eligibility screening method: Consider using validated anxiety measurementtools (NICE [61], Sinesi et al. [76], Nath et al. [59]).

Inclusion screening

The anxiety measurement tool will be administered by thecommunity midwife to indicate women who meet the cut-offscore for mild to moderate.

Systematic review: rationale for inclusion screening should be discussedwithin a supportive context.

Advisory group suggested: midwives may require training of anxiety tooladministration.

Service user feedback: inclusion screening would be acceptable; the midwifeshould be aware of concerns women may have about disclosing symptoms.

Intervention facilitator

The intervention will be facilitated by midwives and co-facilitatedby MSWs. They will receive training to deliver the intervention.One midwife and one support worker will facilitate each group.

Systematic review: delivered by psychiatrists, psychologists, midwives,instructors, self-help and volunteers.

Advisory group suggested: women may be more willing to seek supportfrom midwives than mental health professionals.

Service user feedback: supported midwife facilitation

Consultations with trainers: two facilitators optimal for group interventions.

Service Manager feedback: Suggestions to include support workers asco-facilitators.

Intervention components

Delivered in three components:

Component 1: one to one pre-group meeting with the midwifefacilitator.

Systematic review: some women had concerns about disclosing symptomsand feared the judgment of others (in groups). Initial meetings with facilitatorshelped women feel more confident to join the group.

Advisory group: one to one meetings provide opportunity to discussconcerns and answer questions.

Component 2: Four sessions facilitated by a midwife and MSW.Sessions will take place fortnightly and will be held in communityhealthcare centres. Each session will last for 90 min (either earlyevening or weekends).

Systematic review: group discussion sessions were highlighted as animportant and valued component

Advisory group: self-help resources with discussion sessions supported asan option. CBT may not be feasible for the study due to the intensive trainingrequired for delivery.

Advisory group: support for community locations

Service user feedback: groups may help normalise experiences and buildsocial support.

Service user feedback: offer outside daytime working hours.

Component 3: Choice of self-help resources for completionbetween sessions:

Systematic review: some participants reported self-help interventions aschallenging but also helpful

Advisory group: self-help resources supported as an option

Service user feedback: considered useful, women should be able to choosefrom different formats.