Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Feb 17;25(1):264.
doi: 10.1186/s12913-025-12372-x.

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

Eric Badu  1 , Anthony Paul O'Brien  2 , Rebecca Mitchell  3 , Akwasi Osei  4
Affiliations

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

Eric Badu et al. BMC Health Serv Res. .

Abstract

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.

Keywords: Context; Ghana; Mechanism; Mental health services; Outcome; Quality improvements; Realistic evaluation.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by the Human Research Ethics Committee (HREC) of the University of Newcastle(Approval No.: H-2019–0082) as well as the Ghana Health Service Ethics Review Committee(Approval No: GHS-ERC 003/07/19). The researchers sought written permission from the Ghana Mental Health Authority before conducting the study. The study protocols as well as data collection instruments, the participant information statement were reviewed by the ethics committees for approval. No interviews were conducted without the permission of the respective ethics committee. The right of participants to safeguard their anonymity and integrity was respected. Therefore, all participants were adequately informed of the aims, methods, consent to participation, potential risk/benefits, voluntary participation, privacy/confidentiality, compensation, declaration of conflict of interest, and data. They signed a written informed consent form before participation. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Initial program theory
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Sunderji N, Ion A, Ghavam-Rassoul A, Abate A. Evaluating the implementation of integrated mental health care: a systematic review to guide the development of quality measures. Psychiatr Serv. 2017;68(9):891–8. - PubMed
    1. Kilbourne AM, Keyser D, Pincus HA. Challenges and opportunities in measuring the quality of mental health care. The Canadian journal of psychiatry. 2010;55(9):549–57. - PMC - PubMed
    1. Kilbourne AM, Beck K, Spaeth-Rublee B, Ramanuj P, O’Brien RW, Tomoyasu N, et al. Measuring and improving the quality of mental health care: a global perspective. World Psychiatry. 2018;17(1):30–8. - PMC - PubMed
    1. Badu E, O’Brien AP, Mitchell R. The Conceptualization of Mental Health Service Quality Assessment: Consumer Perspective. Administration and Policy in Mental Health and Mental Health Services Research. 2019;26(6):790–806. - PubMed
    1. Thornicroft G, Slade M. New trends in assessing the outcomes of mental health interventions. World Psychiatry. 2014;13(2):118–24. - PMC - PubMed

LinkOut - more resources