Abstract

Background
This thesis presents and critically evaluates a coherent programme of research conducted over thirteen years, centred on improving perinatal mental health care for British South Asian (BSA) women. The work describes a culturally humble, community-centred approach to research recruitment, intervention design, delivery, and evaluation.

Research Context and Development
The programme began with qualitative work exploring how BSA women express distress and navigate stigma, silence, and family dynamics. These insights informed the development and refinement of culturally adapted psychological interventions across the ROSHNI1 trials. Learning travelled bidirectionally between the UK and Pakistan, where task-sharing models and culturally grounded communication shaped UK practice. This global partnership also shaped my development from research assistant to research leader.

Methods and Outputs
The thesis draws on mixed-methods feasibility studies, nested qualitative analyses, intervention adaptation processes, training and governance frameworks, and a large
randomised controlled trial with an embedded economic evaluation. Across these trials, I contributed to management and embedded a cultural humility lens within recruitment and retention of participants, intervention refinement, research governance, facilitator training, patient and public involvement and engagement.

Key Contributions
The research demonstrates that culturally adapted interventions for postnatal depression are clinically effective, economically sound, and acceptable to women who have historically been underserved by mainstream services. A central conceptual contribution is the articulation of cultural humility as a methodology that moves beyond cultural competence, emphasising reflexivity, shared decision-making, and attention to power. The thesis reframes community engagement as a matter of epistemic justice, challenging labels such as “hard to reach”.

Impact and Future Directions
The programme has influenced policy, practice, and national research infrastructures. Its findings have contributed to global discussions on equity in perinatal mental health and shaped my leadership role in research. Future work will focus on embedding these insights within wider NIHR research infrastructures and contributing to national policy and programme development through my roles as coapplicant on emerging research trials.