Midwives’ and Public Health Nurses’ Experiences of Implementing a Guided Version of a Digital Intervention, Mamma Mia, in Maternity and Child Health Care Services: A Reflexive Thematic Analysis

Guided digital interventions in maternity and child health care may improve mental health outcomes by increasing user engagement and adherence. However, implementing such complex interventions remains challenging due to factors related to intervention characteristics, organizational dynamics, professionals' ompetencies, and user engagement. Understanding the experiences of those who deliver these interventions is essential to inform implementation efforts. This study explored midwives' and public health nurses' experiences of a guided digital intervention and the early implementation process three months post-training. Using a qualitative design, six focus groups were conducted with 32 professionals working in maternity and child health care services and participating in a multisite cluster-randomized trial of the universal digital intervention, Mamma Mia. Interviews were based on the Consolidated Framework for Implementation Research, and data were analyzed using reflexive thematic analysis. Three themes described how professionals made sense of implementing a guided digital intervention. "Broken Expectations - Navigating the Training-Practice Gap" reflected how abstract, decontextualized training left professionals' feeling unprepared once faced with real-world implementation. "Balancing Belief and Doubt - Navigating digital care in relational professions" captured tensions between valuing innovation and safeguarding professional values, as participants negotiated whether digital tools could align with relational care practices. "Learning by Doing and Support - Future Optimism" illustrated a gradual shift toward acceptance, as hands-on experience and collegial support helped professionals view the intervention as complementary rather than disruptive. These findings underscore that implementing digital interventions in relational care settings is not solely a technical process but a relational and interpretive one. Effective implementation should therefore support contextual adaptation, provide practical and collaborative training, foster trust, and ensure organisational alignment.