Developing and Evaluating a Perceived Access Metric for Global Mental Health

Access to mental health care is a fundamental human right that should be a critical performance metric for all governments and healthcare systems. However, there are few psychometrically evaluated measures of access, especially for low-and-middle income countries. Theoretically informed, culturally grounded, and psychometrically

sound access metrics are needed to hold governments and healthcare systems accountable for making mental health services accessible to all people, and to help design and evaluate new programs and policies focused on improving access. This proposed project is a collaboration between investigators at the University of Ibadan in Nigeria and the

University of Washington in the United States. The project has two major objectives. The first objective is to develop

and psychometrically evaluate a metric of perceived access to mental health care that is cultural appropriate for Nigeria.

The second objective is to enhance the research capacity of early-state global mental health researchers in Nigeria. The proposed research activities include three specific aims. For Specific Aim #1, we will conduct in-depth qualitative interviews with patients with depression and/or anxiety living in Ibadan, Nigeria, along with their caregivers and

clinicians, to identify common impactful barriers that prevent or delay people from receiving needed care. Qualitative research with the intended population is needed to ensure that the perceived access metric contains items about

barriers that are relevant for the population. However, because not all barriers to mental healthcare are modifiable, we will need to divide barriers into two groups: 1) access barriers and 2) non-access barriers (i.e., attitudinal and need barriers). For Specific Aim #2, we will obtain consensus from health providers and policy makers regarding the

modifiability of the identified barriers by healthcare systems and/or ministries of health. Once the access barriers are identified, we will generate items to include in the perceived access metric and then revise them using cognitive interviews with patients. Working with patients to first identify barriers and then providers and policy makers to

determine which barriers are modifiable will optimize the content validity of the access metric. For Specific Aim #3, we

will conduct a survey with 250 patients with depression and/or anxiety to assess the critical psychometric properties of reliability, construct validity and cross-cultural validity. At the conclusion of the proposed research, we will have a patient-centered metric of perceived access that is ready to use for policy evaluations, quality improvement, and

research. With valid and reliable metrics of access, gaps and inequities in access can be detected and the impact of policies and programs designed to enhance access and address disparities can be meaningfully evaluated. The proposed

research is closely aligned with NIMH’s Strategic Plan Goal 4 (Objectives 4.1 and 4.3). Specifically, the access metric can

be used to test the mechanism of actions for interventions designed to engage hard to reach patients in effective mental health treatments. The proposed research is also responsive to World Health Organization’s Mental Health Action Plan

that has a focus on health disparities with the following objective: “Proactively identify and provide appropriate support for groups at particular risk of mental illness who have poor access to services.”