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

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From: PLoS ONE(Vol. 15, Issue 5)
Publisher: Public Library of Science
Document Type: Report
Length: 7,115 words
Lexile Measure: 1470L

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Author(s): Eric Badu 1,*, Anthony Paul O'Brien 2, Rebecca Mitchell 3, Akwasi Osei 4


The quality of mental health services generally describes the degree to which services for consumers and populations increase the likelihood of desired outcomes and are consistent with current professional knowledge and practice [1,2]. Several strategies have been proposed to improve the quality of mental health services as experienced by consumers. For example, several high-income countries have developed national strategic approaches to mental health reform with quality initiatives to achieve clinical improvements [2-5]. Specifically, quality checklists, glossaries, and documentation of health policy, programs, and institutional quality assurance reviews have been implemented by professional and government agencies to determine, monitor and improve the level of quality of services [2,3]. The Organisation for Economic Co-operation and Development, as well as International Organisation for Standardisation, have recently promulgated quality assurance indicators to assist countries in assessing their health service outcomes, including those of mental health services [3,6,7]. These quality indicators have provided a firm foundation to engage governments, healthcare organisations and clinicians in the ongoing quest for quality measurement and improvement [3,4].

The efforts towards understanding and improving the quality of mental health services delivery are often focused on issues of data source, segmentation, and thresholds [5,8]. These thresholds generally focus on stakeholders, like the public or society, mental health professionals, as well as consumers and family caregivers [8]. The quality of mental health services from the public perspective measures the investment of the public in mental health services (eg. taxation and financing) against long-run improvement in antisocial behaviour related to aggression, begging and shouting at voices among consumers [2,8]. Mental health professional perspectives of quality tend to focus on perception regarding the strengths and weaknesses of the health system as well as the recovery of consumers [8,9].

Conversely, consumers and family caregivers' perspectives of mental health service quality are usually centred on their subjective experiences like the quality of life and satisfaction [2,10]. This method of measuring the quality of mental health services focuses on holistic recovery, the facilitation of consumer social inclusion, as well as reduction of stigmatization [2,10].

Although some studies have suggested the need to incorporate consumers' perspectives into mental health quality assessment [10], there is little evidence to suggest that this is occurring successful, particularly into clinical practice. Research evidence on mental health quality assessment has been limited to service providers, particularly in developed countries (eg, Sweden [11], USA [12].

To date, mental health research in Ghana has focused on issues such as health system weakness, enablers and barriers to accessing services [13,14], the burden of family caregiving [15-17] and treatment pathways [18,19]. Despite this increasing evidence, none of these studies have attempted to measure the quality of mental health services from a consumer perspective. There is a gap in the literature regarding how health system structure and process impact the perceived outcome of mental health services. To address this gap, a quantitative study using structural equation modelling was undertaken to assess the mediation...

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Gale Document Number: GALE|A624652776