Date of Award

1-6-2021

Degree Type

Thesis

Degree Name

Master of Health Policy and Management

First Advisor

Dr. Zafar Fatmi

Second Advisor

Dr. Muhammad Asim

Third Advisor

Mr. Waqas Hameed

Department

Community Health Sciences

Abstract

Background: Adolescent mental health is not receiving adequate attention. Socio-cultural environment, dearth of scientific information, and research on health systems factors including lack of trained health workforce and political will are considered a broader impediment for provision of mental health. Substantial gaps exist within the current service delivery model that creates barriers for parents to seek mental health care for their adolescents. The challenges in turn impact the provision of mental health services particularly for low- and middle-income countries like Pakistan.
Objectives: The study focused on exploring the perceptions of users and providers regarding barriers and facilitators to utilizing mental health services for their adolescents aged 10 to 19 years old.
Method: The study employed qualitative methodology to study barriers and facilitators from the perspective of parents who were seeking care mental health care for their adolescents and mental health service providers. Using Andersen’s health service utilization model as a framework, the semi-structured interview guide was developed to conduct in-depth interviews. The study was conducted in public and private tertiary care hospitals of Karachi. Participants were selected from the psychiatry department in outpatient and inpatient units of study sites. Twenty-one interviews were conducted with senior management, clinical psychiatrists, psychologists, and occupational therapists (providers). To include user perspective, 19 parents were interviewed, who had at least one child diagnosed with mental illness and seeking care from mentioned facilities. The data was collected in one month i.e., from 1st October till 1st November 2021. The interview progressed iteratively with the inclusion of further relevant themes and probes. The recordings were transcribed, coded and thematic data analysis was conducted using a deductive approach.
Result: The responses obtained were analyzed through a deductive approach within the conceptual framework. The users and providers indicated lack of awareness, negative perceptions, religious beliefs and misconceptions, poverty, the stigma for mental illness, absence of specialized service delivery practices for adolescents, inappropriate diagnosis, and family and household pressure as prominent barriers. Likewise, progression of the disease, affordability to seek care, referrals from other providers, and availability of nearby services were identified as facilitators to utilize service. There were several gaps in service delivery that were identified by providers in particular such as the poor outlook of health facilities, lack of culturally valid assessment tools, absence of child and adolescent inpatient units and facilities, and overburdened clinics. However, users were essentially concerned with accessing and affording the services instead of the quality of care. Lastly, the barriers and facilitators revealed by participants from different study sites were similar up to some extent.
Conclusion: The study highlighted the barriers and facilitators that influence mental health service utilization. From the findings, it was revealed that service utilization was largely dependent on the severity of illness instead of personal choices, positive health beliefs, and service quality and availability. To address identified factors, the prioritization of adolescent mental health is needed along with improved awareness at the community level to promote early detection and utilization of available facilities. This, in turn, will reduce barriers that result in the delay of mental health service utilization, Additionally, to reduce service delivery gaps, planned strategies are required for health promotion and prevention and development of adolescent-friendly mental health services. along with task shifting and capacity building of the health workforce.

First Page

1

Last Page

87

Download

Share

COinS