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

Eric Badu; Anthony Paul O’Brien; Rebecca Mitchell; Akwasi Osei

doi:10.1186/s12913-025-12372-x

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

Eric Badu^*, Anthony Paul O’Brien, Rebecca Mitchell, Akwasi Osei

^*Corresponding author for this work

Department of Management

Research output: Contribution to journal › Article › peer-review

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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.

Original language	English
Article number	264
Pages (from-to)	1-17
Number of pages	17
Journal	BMC Health Services Research
Volume	25
Issue number	1
DOIs	https://doi.org/10.1186/s12913-025-12372-x
Publication status	Published - 2025

Bibliographical note

Keywords

Context
Ghana
Mechanism
Mental health services
Outcome
Quality improvements
Realistic evaluation

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Publisher version (open access)Final published version, 1.13 MBLicence: CC BY

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abstract = "Background: Evaluation frameworks are relevant to understanding health service providers{\textquoteright} 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.",

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AB - 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.

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

Abstract

Bibliographical note

Keywords

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