- Title
- Quality of mental health services: consumers’ and providers’ perspectives
- Creator
- Badu, Eric
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2022
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Introduction: Stakeholders worldwide are advocating for innovative approaches that extend beyond middle-range theories to measure health service outcomes. Evaluation frameworks, such as realistic evaluation, have recently been proposed to simplify complex processes by generating transferable lessons and mechanisms that inhibit change in health outcomes. Although such frameworks are relevant, limited research studies have used them to measure the outcomes of mental health services – for example, by incorporating the views of consumers and service implementers – regarding how services work and could be improved, particularly in low and middle-income countries such as Ghana. Methods: This thesis is the first research study reporting the use of a realistic evaluation approach, involving concurrent mixed methods, to develop a program theory that explores the contextual factors and mechanisms that enable or hinder the quality of mental health services in Ghana. The realistic evaluation cycle was conceptualised in three phases: initial theory and assumption, fieldwork (recruitment and data collection) and analysis of data. The components of the realistic evaluation include Context, Mechanism and Outcome (CMO). Phase 1 was used to identify initial theory and assumptions guiding the realistic evaluation using integrative reviews. This phase of the thesis involved six review papers that addressed initial theory and assumptions, methodological considerations and problem statement. Phase 2 of the thesis involved fieldwork. This phase aimed to collect empirical qualitative and quantitative data to be tested. A random sample of 510 consumers of mental health services were recruited from two psychiatric hospitals, as well as one psychiatric unit in the general hospital. The consumers were asked to complete the Verona Service Satisfaction Scale (54 items), together with the World Health Organization Disability Assessment Scale (36 items) using the REDCap application. This phase also involved a purposive sample of 30 mental health professionals and 21 consumers in in-depth interviews, together with fieldnotes. The participants for the qualitative interviews were recruited until saturation when no new information emerged. Phase 3 involved the analysis and configuration of the CMO configuration. The quantitative data were analysed using descriptive and inferential statistics, such as confirmatory factor analysis, structural equation modelling and hierarchical multiple regression model. The CFA was used to test the validity and reliability of the measurement models of the World Health Organization Disability Assessment Scale (36 items) and the Verona Service Satisfaction Scale (54 items). The structural equation modelling and hierarchical multiple regression model were used to test the structural model of the variables. Qualitative data integrating the CMO were analysed using thematic analysis. Phase 3 involved six empirical papers, informing a program theory to promote mental health quality assessment. Results: The thesis highlights that consumers experienced mild difficulties regarding global disability, particularly in cognition, mobility, getting along, life activities and participation. Consumers generally had mixed satisfaction with the quality of mental health services but were dissatisfied with the range of services and affordability or financing support. The program theory identified that there were ripple effects and limited sustainable financial protection for consumers. Even though the psychiatric facilities were expected to operate holistic and integrated care, they lacked the relevant equipment and logistics that could facilitate the continuous delivery of quality mental health services. This notwithstanding, the program theory identified several mechanisms that could enhance mental health service quality. These mechanisms include technical competencies, therapeutic alliance-building, inclusivity of vulnerable consumers, advocacy and awareness about services, as well as monitoring and evaluation of services through effective use of new technologies. Conclusion and implication for policy and practice: The thesis provides a program theory on quality improvement that go beyond the traditional middle-range theories addressing systemic weakness and challenges. The thesis concludes with implications for policies, mental health practice and future research as well as the training of mental health professionals and students.
- Subject
- mental health; consumers; quality improvement; health services; outcome; Ghana; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1512016
- Identifier
- uon:56578
- Rights
- Copyright 2022 Eric Badu
- Language
- eng
- Full Text
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