The Conceptualization of Mental Health Service Quality Assessment: Consumer Perspective

Pre-implementation patient, provider, and administrator perspectives of remote measurement-based care in a safety net outpatient psychiatry department

Introduction

Psychiatric measurement-based care (MBC) can be more effective than usual care, but health systems face implementation challenges. Achieving attitudinal alignment before implementing MBC is critical, yet few studies incorporate perspectives from multiple stakeholders this early in planning. This analysis identifies alignment and themes in pre-implementation feedback from patients, providers, and administrators regarding a planned MBC implementation in a safety net psychiatry clinic.

Methods

We used interview guides informed by Conceptual Model of Implementation Research to gather qualitative pre-implementation attitudes about perceived Appropriateness, Acceptability, and Feasibility of an MBC measure (Computerized Adaptive Test-Mental Health; CAT-MH) from five patients, two providers, and six administrators. We applied rapid qualitative analysis methods to generate actionable feedback for department leadership still planning implementation. [Correction added on 22 January 2025, after first online publication: In the previous sentence, the word 'general' was replaced with the word 'generate'.] We used a multistep process to generate thematic findings with potential relevance for other similar mental health settings.

Results

There was more attitudinal alignment across stakeholder groups regarding MBC's Acceptability and Feasibility than its Appropriateness. All three groups agreed that it was important to contextualize MBC for patients and providers, anticipate MBC's impact on patient-provider relationships, and consider the system's capacity to respond to patient needs unearthed by CAT-MH before implementation began. Our thematic analysis suggests: (1) Introducing MBC may complicate patient-provider relationships by adding a new and potentially conflicting input for decision making, that is, MBC data, to the more typical inputs of patient report and provider expertise; [Correction added on 22 January 2025, after first online publication: In the previous sentence, the word 'complicated' was replaced with the word 'complicate'.] (2) MBC poses theoretical risks to health equity for safety net patients because of limitations in access to MBC tools themselves and the resources needed to respond to MBC data; and (3) Tension exists between individual- and system-level applications of MBC.

Conclusions

Our analysis highlights shifting treatment dynamics, equity considerations, and tension between individual- and population-level needs that our participants anticipated when planning for MBC implementation in a safety net psychiatry clinic.

Models and frameworks of mental health recovery: a scoping review of the available literature

BACKGROUND

The recovery approach involves providing a holistic and integrated service that is centered on and adapts to the aspirations and needs of consumers, who are seen as the expert on their health and well-being. Evidence is needed to address the current ambiguities related to the concept of recovery and its application.

AIM

A scoping review was conducted to identify papers describing theories, models, and frameworks of recovery to delineate the central domains of recovery.

METHODS

Three literature search strategies were used: electronic database searching; hand-searching of key journals; and a reference list review of included papers. Inclusion criteria outlined theories, models and frameworks developed to support consumers' recovery and those supporting mental health professionals (MHPs) to deliver recovery-oriented services.

RESULTS

Twelve studies (eleven articles and one book) were included in the review. The dimensions of recovery were synthesized into a framework named the Consolidated Framework for Recovery-oriented Services (CFRS). There are three domains within the framework: mechanisms/strategies; recovery as an internal process; and recovery as an external process. Each of these domains, as well as their relationships, are discussed.

CONCLUSIONS

The CFRS can be used by practitioners, researchers, funders, and collaborative members to conceptualize, implement, and evaluate recovery-oriented services.

Providers' insight into quality mental health services - Context-Mechanism-Outcome (CMO) approach

BACKGROUND

Evaluation frameworks are relevant to understanding health service providers' views regarding existing services and possible improvements, but their application to mental health services is limited, particularly in Low Middle-Income Countries.

AIM/QUESTION

To identify a program theory that explains the contextual factors and mechanisms that could enhance mental health service outcomes in Ghana.

METHOD

A three-phase approach was followed: initial theory and assumption, analysis, and CMO configuration. Systematic reviews were used to develop a middle-range theory and assumptions in phase 1. A purposive sample of 30 mental health professionals was recruited to participate in in-depth interviews in phase 2. Thematic analysis was used to analyze the qualitative data and further configure the CMO in phase 3.

RESULTS

The analysis identified five CMO configurations: ripple effects and financing source sustainability; unavailability of modern equipment and logistics to support holistic services; promoting inclusivity and geographical proximity of services; information, sensitization, and awareness encourage mental health quality; and monitoring and evaluation improve mental health service quality.

CONCLUSION

This study concludes that government stakeholders should integrate mental health services into the ongoing insurance policy and provide adequate modern equipment and logistics. Moreover, mechanisms and priorities given to vulnerable consumers should be integrated into policies.

Improving patient satisfaction based on service quality in clinical trials: A cross-sectional study

BACKGROUND

Participants' satisfaction is an important factor in securing competitiveness in clinical trials. In many industries, such as healthcare, customer service quality has been analyzed to increase customer satisfaction. However, no study so far has attempted to measure participants' perceptions of service quality in the clinical trial area and identify its effect on participant satisfaction.

OBJECTIVE

This study examined the experiences and perceptions of clinical trial participants in terms of service quality and identified the factors that impact participant satisfaction in clinical trials.

METHODS

This study used a cross-sectional descriptive and explanatory research design. Data were collected from March 29 to May 26, 2023, via a survey. The survey was conducted with 206 adults participating in clinical trials at two hospitals in Korea. The collected data were analyzed using descriptive statistics, independent t-tests, one-way ANOVA, Pearson's correlation, and multiple linear regression analysis.

RESULTS

Participants' perceptions of the service quality and their satisfaction in clinical trials were generally positive. The variables that significantly predicted participant satisfaction in clinical trials included quality of interaction with researchers, physical environment, performance results in clinical trials, changes in health status after participating in the trial, and consideration of discontinuing the trial.

CONCLUSIONS

Participants' perception of the service quality significantly affected their satisfaction in clinical trials. Thus, all components of service quality should be considered in the overall clinical trial process to increase participants' satisfaction.

Experience of psychosocial rehabilitation; perspectives of depressed adolescents

Given the multifaceted character of depression and its related symptoms, an adolescent living with it is at increased risk for a wide range of adverse events. This research aimed to understand and characterize the psychosocial rehabilitation experiences of depressed teenage participants in the Greater Accra Region of Ghana. A cross-sectional semi-structured interview design influenced by an interpretive phenomenological analysis (IPA) technique was adopted. We employed a nonprobability, purposeful sampling approach to recruit twenty-one adolescents (6 males, 15 females) diagnosed with depression from the community after one month of discharge from admission and undergoing psychosocial rehabilitation. Using separate interviews, we gathered and analyzed data using interpretive phenomenological analysis to produce themes and sub-themes. These were presented with the participants' direct quotations. We discovered that the perspectives of adolescents' psychosocial rehabilitation experience include hopelessness and suicide ideation, coping difficulties, undesirable attitudes from support networks, challenges related to school, and isolation. Participants suggested appropriate therapeutic environments, encouraging support systems, and the media's role in preventing and treating depression among young people as rehabilitation approaches that could assist adolescents to remain lucid for longer intervals. These results shed light on the tragic realities faced by depressed adolescents. There is an urgent need to put well-defined structures in place to aid their rehabilitation and develop coping strategies for a better life.

Adaption and Cultural Validation of the Quality in Psychiatric Care-Outpatient Staff (QPC-OPS) Instrument to a Norwegian Community Mental Health Context

The aim was to culturally adapt and validate the Swedish Quality in Psychiatric Care-Outpatient Staff (QPC-OPS) instrument for use in a Norwegian community mental health service context. The translated and culturally adapted instrument was named Quality in Psychiatric Care-Community Outpatient Staff (QPC-COPS). Three expert panels of mental health staff (n = 9) assessed the face and content validity. The internal consistency and test–retest reliability were assessed on a sample of community mental health staff (n = 64). The QCP-COPS had adequate face and content validity, and the full instrument showed excellent internal consistency (alpha = 0.90) and test–retest reliability (ICC = 0.87:0.94). In conclusion, the QPC-COPS is a valid and reliable instrument suitable for measuring staff’s perception of the quality of care they deliver in community mental health services.

Factors associated with the quality of mental health services and consumers' functionality using tertiary-based services

PURPOSE

Assess factors associated with the quality of mental health services.

DESIGN AND METHODS

Cross-sectional design, quantitative data, and 510 consumers from three psychiatric facilities.

RESULTS

The average age of consumers was 34 years and 51.57% males. Consumers reported mixed satisfaction with the quality of mental health services (mean = 3.2; SD = 0.56) but were dissatisfied with the range of interventions (mean = 1.57; SD = 0.77). Predisposing (age, education, and primary occupation), enabling (insurance status), and need factors (mental health status) were significantly associated with quality indicators (range of interventions, efficacy, and overall satisfaction). These factors were significantly associated with consumers' functionality (cognition, mobility, self-care, getting along, life activities, and participation).

PRACTICE IMPLICATIONS

Policymakers and clinicians are encouraged to incorporate the predisposing, enabling, and need factors into mental health planning, monitoring, and advocacy to improve service outcomes.

A Qualitative Study of Consumers' Experiences of the Quality of Mental Health Services in Ghana

Integrating consumers' experiences into quality mental health service assessment is relevant to improve service outcomes. Despite this, limited studies have attempted to explore consumers' experiences, particularly in developing countries, such as Ghana. This paper aims to explore consumers' subjective experiences of the quality of mental health services. A qualitative method involving in-depth interviews was used to collect data from 21 consumers of mental health services. Thematic analysis was used to analyse the data, which is discussed using a realistic evaluation approach. The study identifies four themes, 33 inductive codes and 594 references. The themes used to interpret the verbatim narratives are the available mental health services, therapeutic interaction with the professionals, competency and skills of the professionals, and the changes experienced in the consumers' lives. The study indicates that the mental health services aim to provide a range of treatments and medications as well as recovery-oriented services, using mechanisms such as ensuring an effective therapeutic relationship and improving technical competency and skills. The contextual factors and the mechanisms have helped to achieve some changes in the lives of consumers (increased satisfaction, reduced symptoms, improved functionality, feeling normal, improved living skills and self-care, work and capabilities, and social inclusion). The study concludes that policymakers and clinicians should integrate evidence-based recovery services, principles and values into the existing mental health services. The mechanisms used to promote quality of mental health services should be strengthened, through periodic monitoring and evaluation, using approaches such as sensor data capturing, to ensure good coordination and continuity.

Measuring Disability in Consumers of mental health services - psychometric properties of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in Ghana

The World Health Disability Assessment Scale (WHODAS-2.0) has widely been accepted as the standard measure of disability. However, psychometric testing is mostly performed in developed countries. This paper aims to assess the psychometric properties (reliability, validity) of the WHODAS-2.0 among consumers of mental health services in Ghana. Two translators (expert in English language and Akan language) performed forward and backward translation of the WHODAS-2.0 from English language to Ghanaian language (Twi). A total of 510 consumers of mental health services were recruited consecutively to complete the WHODAS-2.0 using RedCAP. Confirmatory factor analysis was used to analyse the data. All domains in the 6-factor solutions had excellent internal consistency (ω = 0.90-0.98), sufficient convergent validity and had satisfactory discriminant validity except for domain on participation. The CFA model confirmed that the data had a good model fit, CFI = 0.97, TLI = 0.96, RMESA = 0.05, RMR = 0.03; NFI = 0.94; χ²  = 1243.8, df = 529, P < 0.001. Although the WHODAS 2.0 had satisfactory psychometric properties and was thus considered to be a reliable and valid measure for assessing disability and level of functioning in consumers of mental health services, researchers and clinicians should re-consider items within the participation domain. Also, practitioners are encouraged to integrate the WHODAS-2.0 into the collection of data on clinical outcomes, as well as, collecting data on government social protection intervention programmes for consumers.

A qualitative study of evidence-based therapeutic process in mental health services in Ghana- context-mechanisms-outcomes

Background

Evidence-based clinical practice is an inherent component of mental health professional practice in developed countries. However, little is known about professional perspectives of evidence-based practice in mental in developing countries such as Ghana. This paper describes the processes involved in the delivery of best practice in Ghana. The paper reports on a realistic evaluation of mental health nurses and allied health professionals’ views on the evidence-based therapeutic process in Ghana.

Methods

A purposive sample of 30 mental health professionals (MHPs) was recruited to participate in semi-structured, in-depth interviews. Thematic analysis was used to analyse the data. A program theory of Context + Mechanism = Outcome (CMO) configuration was developed from the analysis.

Results

The thematic analysis identified two contexts, mechanism and outcome configurations (themes): 1) technical competency stimulates evidence-based mental health services, and 2) therapeutic relationship building ensures effective interaction. The study demonstrates that contextual factors (technical competencies and therapeutic relationship building) together with mechanisms (intentional and unintentional) help to promote quality in mental health service provision. However, contextual factors such as a lack of sign language interpreters yielded unintended outcomes including barriers to communication with providers for consumers with hearing impairment and those from linguistic minority backgrounds.

Conclusion

Government stakeholders and policymakers should prioritise policies, periodic monitoring and adequate financial incentives to support the mechanisms that promote technical competence in MHPs and the building of therapeutic relationship.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06993-1.

An Integrative Review of Recovery Services to Improve the Lives of Adults Living with Severe Mental Illness

There is an increasing call for recovery-oriented services but few reviews have been undertaken regarding such interventions. This review aims to synthesize evidence on recovery services to improve the lives of adults living with severe mental illness. An integrative review methodology was used. We searched published literature from seven databases: Medline, EMBASE, PsycINFO, CINAHL, Google Scholar, Web of Science, and Scopus. Mixed-methods synthesis was used to analyse the data. Out of 40 included papers, 62.5% (25/40) used quantitative data, 32.5% used qualitative and 5% (2/40) used mixed methods. The participants in the included papers were mostly adults with schizophrenia and schizoaffective disorder. This review identified three recovery-oriented services—integrated recovery services, individual placement services and recovery narrative photovoice and art making. The recovery-oriented services are effective in areas such as medication and treatment adherence, improving functionality, symptoms reduction, physical health and social behaviour, self-efficacy, economic empowerment, social inclusion and household integration. We conclude that mental health professionals are encouraged to implement the identified recovery services to improve the recovery goals of consumers.

Recovery services and expectation of consumers and mental health professionals in community-based residential facilities of Ghana

BACKGROUND

In the past decades, considerable global attention has been drawn to recovery services that seek to promote the personal recovery journey of consumers with mental illness. However, in most settings, including Ghana, limited empirical studies have attempted to explore, from the perspectives of Mental Health Professionals (MHPs) and consumers, the effectiveness of recovery services and expectation towards the recovery. This study, therefore, explored consumers' and MHPs perspectives concerning recovery services and expectations towards recovery in two community-based residential facilities in Ghana.

METHODS

A qualitative method, involving in-depth interviews and observations, were used to collect data from 24 participants (5 MHPs and 19 consumers). Thematic analysis was used to analyze the data.

RESULTS

The study identified three global themes and nine organizing themes. The global themes were recovery services offered to consumers, expectation regarding personal recovery and challenges in achieving recovery. The study found that recovery services were expected to improve the internal and external recovery processes of consumers. The internal recovery process was independent living whilst the external recovery process were management of illness, economic empowerment and social inclusion. Several systemic and consumer-related factors influenced consumers' and MHPs expectation concerning the recovery journey.

CONCLUSION

The study concludes that the government should prioritize the use of recovery services through policies, financial incentives, infrastructure support, and adequate training of MHPs.

Knowledge and attitudes of mental health professionals and students regarding recovery: A systematic review

This review was conducted to synthesize and critically appraise the literature on knowledge, attitudes, understanding, perceptions, and expectations of mental health professionals (MHPs) and mental health professional (MHP) students' regarding recovery. A systematic search in Scopus, CINAHL, PsycINFO, Web of Science, Medline, and Embase as well as Google scholar and web-based repositories was conducted. The searches were conducted using a combination of key terms: "mental health professionals", "students", 'knowledge', "understanding", "perception" "attitude", "expectation", "recovery". After screening and quality assessment, the review included 29 studies (18 quantitative, 8 qualitative, and 3 mixed-method studies) published in English, from January 2006 to June 2019, and was analysed systematically using a mixed-method synthesis. The findings revealed that there is increasing evidence (especially among MHPs) of knowledge, attitudes, understanding, perceptions, and expectations regarding recovery. However, there are disparities in how MHPs perceive and understand recovery. While some understood it to mean a personal process, others explained it as a clinical process. In addition, there was limited knowledge among the MHPs and MHP students regarding the nonlinearity nature of the recovery process and expectations regarding recovery. The implications from these findings are the need for more in-service training for MHPs, and examination of the curriculum used to educate MHP students. In particular, they should be sufficiently informed about the nonlinearity nature of the recovery process and how to develop hopeful and realistic expectations for consumers throughout the recovery process. The review was preregistered with PROSPERO (Registration No: CRD42019136543).

Mediation and moderation effects of health system structure and process on the quality of mental health services in Ghana - structural equation modelling

INTRODUCTION

Incorporating consumers' perspectives into the quality of mental health service measurement is a growing priority among mental health professionals' and policymakers. Despite this, there is limited empirical evidence related to consumer perspectives of quality of mental health services. This study, therefore, aims to measure the mediation and moderation effects of health system structure and process on mental health quality in Ghana.

METHODS

A random sample of 510 consumers were recruited to complete the Verona Satisfaction Scale (54-items), together with the WHO Disability Assessment Instrument (36 items) using the Redcap application. Confirmatory factor analysis (CFA) and Structural Equation Modelling were used to test the hypothesised theory using STATA 15.

RESULTS

The CFA showed that the hypothesised model had a good fit to the data. The findings confirmed the hypothesis that the process constructs mediate the relationship between the health system structure and the outcome of mental health services. Specifically, the health system structure had a positive and significant causal relationship with the mediator-process (β = 0.60; p<0.01) and outcome (β = 0.47; p<0.01). Additionally, the mediator-process had a positive causal relationship with the outcome of the mental health services (β = 0.32; p<0.01). Insurance status (β = 0.07; p>0.05) and type of services (β = 0.025; p>0.05) had a positive moderating effect on the relationship between health system structure and outcome but were not significant.

CONCLUSION

Improvements to mental health system structure and the process could promote the quality of services as experienced by consumers. Government stakeholders are encouraged to accordingly strengthen health systems with the aim of improving the mental health outcomes for consumers.