Introduction
Aim
Objectives
Methods
Eligibility criteria
Participants
Exclusion criteria
Search strategy
Search terms and Boolean operators
Selection process
Data management and extraction
Assessment of methodological quality/critical appraisal
Data synthesis
Theoretical framework
Results
Description of papers retrieved
Included paper | Study design | Type of study | Sampling | Type of data | Type of analysis | Sa (%) |
---|---|---|---|---|---|---|
Adjorlolo, Abdul-Nasiru [32] | Cross-sectional | Quantitative | Not reported | Questionnaire | Inferential statistics | 90 |
Ae-Ngibise, Cooper [45] | Not reported | Qualitative | Purposive | IDIs and FGD | Thematic analysis | 75 |
Ae-Ngibise, Adiibokah [42] | Longitudinal | Mixed methods | IDIs and review | Not reported | Thematic analysis | 60 |
Agyapong, Farren [47] | Cross-sectional | Mixed methods | Questionnaire | Purposive | Descriptive and inferential statistics | 73 |
Agyapong, Osei [56] | Cross-sectional | Mixed methods | Questionnaire | Purposive | Descriptive and inferential statistics | 77 |
Agyapong, Osei [31] | Cross-sectional | Mixed methods | Questionnaire | Purposive | Descriptive and inferential statistics | 77 |
Agyapong, Osei [51] | Cross-sectional | Mixed methods | Questionnaire and IDIs | Purposive | Descriptive statistics and Thematic content analysis | 77 |
Agyapong, Osei [48] | Cross-sectional | Mixed methods | Questionnaire | Purposive | Descriptive and inferential statistics | 63.6 |
Akpalu, Lund [55] | Cross-sectional | Mixed methods | IDIs and WHO Assessment Instrument | Purposive | Thematic analysis | 73 |
Appiah-Poku, Laugharne [58] | Not reported | Quantitative | Questionnaire | Not reported | Not reported | 81 |
Arias, Taylor [59] | Not reported | Qualitative | IDIs | Purposive | Constant comparative | 75 |
Asamoah, Osafo [44] | Not reported | Qualitative | IDIs | Not reported | Thematic analysis | 75 |
Awenva, Read [30] | Not reported | Mixed methods | IDIs, FGD and WHO Assessment Instrument | Not reported | Thematic analysis | 73 |
Bhana, Petersen [46] | Not reported | Mixed methods | IDIs, FGD and WHO Assessment Instrument | Not reported | Thematic analysis | 73 |
Bird, Omar [29] | Not reported | Qualitative | IDIs | Purposive | Thematic analysis | 75 |
Canavan, Sipsma [49] | Not reported | Quantitative | Document review | Not reported | Descriptive and inferential statistics | 63.6 |
Cohen, Raja [43] | Not reported | Qualitative | Participatory - Observations, field notes taking | Not reported | Not reported | 87.5 |
de Menil, Osei [60] | Cross-sectional | Quantitative | Questionnaire | Random, stratified and purposive | Descriptive and inferential statistics | 100 |
Doku, Ofori-Atta [41] | Not reported | Qualitative | IDIs and FGD | Purposive | Thematic analysis | 100 |
Gyamfi, Hegadoren [61] | Descriptive | Qualitative | In-depth interview | Not reported | Thematic analysis | 75 |
Ibrahim, Hor [62] | Cross-sectional | Quantitative | Questionnaire | Purposive | Descriptive and inferential statistics | 90.9 |
Jack, Canavan [36] | Not reported | Qualitative | IDIs | Snowballing | Constant comparative | 75 |
Kleintjes, Lund [10] | Not reported | Mixed methods | IDIs, FGD and WHO Assessment Instrument | Purposive | Thematic analysis | 60 |
Kpobi and Swartz [63] | Not reported | Qualitative | IDIs | Snowballing | Thematic analysis | 62.5 |
Kpobi and Swartz [52] | Not reported | Qualitative | IDIs | Snowballing | Thematic analysis | 75 |
Kyei, Dueck [64] | Not reported | Mixed methods | Questionnaire | Random sample | Descriptive and inferential statistics | 63.6 |
Mfoafo-M’Carthy, Sottie [37] | Not reported | Qualitative | Document review | Not reported | Thematic analysis | 45 |
Ofori-Atta, Attafuah [53] | RCT | Quantitative | Questionnaire | Randomisation | Descriptive and inferential statistics | 100 |
Ofori-Atta, Attafuah [35] | Not reported | Mixed methods | IDIs and WHO Assessment Instrument | Purposive | Thematic analysis | 80 |
Opare-Henaku and Utsey [38] | Not reported | Qualitative | IDIs | Not reported | Thematic analysis | 100 |
Oppong, Kretchy [65] | Not reported | Qualitative | IDIs | Convenience | Thematic analysis | 100 |
Osafo [66] | Not reported | Qualitative | Review | Not reported | Synthesis | 20 |
Osafo, Agyapong [67] | Not reported | Qualitative | IDIs | Purposive and Snowballing | Thematic analysis | 75 |
Quinn [33] | Not reported | Qualitative | IDIs | Not reported | Descriptive | 75 |
Raja, Wood [50] | Not reported | Qualitative | IDIs and document review | Purposive | Descriptive statistics and Thematic content analysis | 100 |
Read [57] | Ethnographic | Qualitative | IDIs, FGD and observation | Purposive | Grounded theory approach | 75 |
Read, Adiibokah [54] | Ethnographic | Qualitative | IDIs and FGD | Not reported | Not reported | 100 |
Roberts, Mogan [40] | Not reported | Mixed methods | WHO-AIMS tool and Questionnaire | Purposive | Thematic analysis | 86.6 |
Salifu Yendork, Kpobi [39] | Phenomenological | Qualitative | IDIs, FGD and observation | Purposive, Snowballing and Convenience | Interpretative Phenomenological analyses | 100 |
Stefanovics, He [34] | Exploratory | Qualitative | Questionnaire | Convenience | Descriptive and inferential statistics | 72.7 |
Tawiah, Adongo [68] | Cross-sectional | Mixed methods | IDIs and FGD | Random sample | Descriptive and inferential statistics | 77 |
van der Watt, Nortje [69] | Not reported | Qualitative | FGD | Not reported | Thematic analysis | 100 |
Study characteristics
Variable | Frequency | Percentage |
---|---|---|
Study design | ||
Not reported | 25 | 59.52 |
Cross-sectional design | 10 | 23.81 |
Descriptive | 1 | 2.38 |
Longitudinal | 1 | 2.38 |
Exploratory | 1 | 2.38 |
Phenomenological | 1 | 2.38 |
Ethnography | 2 | 4.76 |
Randomised controlled trial | 1 | 2.38 |
Type of study | ||
Mixed methods | 14 | 33.33 |
Qualitative | 21 | 50.00 |
Quantitative | 7 | 16.67 |
Sampling | ||
Probability | 4 | 9.25 |
Non-probability | 23 | 54.76 |
Not reported | 15 | 35.71 |
Type of analysis performed | ||
Qualitative analysisa | 23 | 54.76 |
Descriptive and inferential | 13 | 30.95 |
Descriptive statistics and content | 2 | 4.76 |
Not reported | 3 | 7.14 |
Outcome of included papers | ||
Treatment pathways | 16 | 38.09 |
Mental health systems | 17 | 40.47 |
Attitudes towards mental illness | 9 | 21.42 |
Type of participants | ||
Multi-stakeholder groups | 32 | 76.19 |
Mental ill patients | 6 | 14.28 |
Community members | 3 | 7.14 |
Study setting | ||
Multi-country | 6 | 14.28 |
Ghana alone | 36 | 85.71 |
Awareness
Barriers to access related to Awareness
Theory | Themes | Subthemes | Number of studies | Papers |
---|---|---|---|---|
Awareness | Barriers to access related to awareness | Knowledge about psychiatric care | 2 | |
Attitudes towards service users | 12 | |||
Low priority | 3 | |||
Enablers to access related to awareness | Support services | 9 | ||
Mental health law | 3 | |||
Affordability | Barriers to access related to affordability | Treatment and medication cost | 6 | |
Limited funding | 6 | |||
Accessibility | Barriers to access related accessibility | Transportation and geographical proximity | 2 | |
Enablers to access related to accessibility | Decentralisation and integration | 4 | ||
Referral system | 4 | |||
Irregular medicine supply and prescription | 6 | |||
Poor state of psychiatric facilities | 4 | |||
Poor management of mental health cadres | 8 | |||
Enablers to access related to accessibility | Task-shifting | |||
Acceptability | Barriers to access related acceptability | Perceived efficacy of medication | 7 | |
Relapsed treatment | 3 | |||
Discontinuity of medications | 1 | [57] | ||
Adequacy | Barriers to access related to adequacy | Limited mental health services for marginalised groups | 3 |
Enablers to access related to Awareness
Availability
Barriers to access related Availability
Enablers to access related to Availability
Affordability
Barriers to access related to Affordability
Accessibility
Barriers to access related Accessibility
Enablers to access related to Accessibility
Adequacy/Accommodation
Barriers to access related to Adequacy/Accommodation
Acceptability/Appropriateness
Barriers to access related to Acceptability/Appropriateness
Discussion
Summary of evidence
Limitation
Conclusion
Awareness
Availability
Affordability
Accessibility/Approachability
Adequacy/Accommodation
Acceptability/Appropriateness
Implications for policy and future research
-
Advocacy for, and awareness about, existing mental health services should be funded and prioritised in policy initiatives.
-
The existing psychiatric facilities should be resourced with infrastructure, modern equipment and logistics to effectively provide mental health services.
-
The current funding provided by government to mental health services should be increased in order to cover regional and sub-regional level services.
-
The existing task-shifting should be strengthened through efforts towards service integration and effective interprofessional training and supervision.
-
An adequate supply of medication should be ensured through public spending and this should be supplemented by an exemption for service users in the existing National Health Insurance Scheme.
-
Research on mental health services in Ghana should be directed towards measuring the outcome of services – effectiveness, efficacy, service user satisfaction and quality of life.
-
The existing evidence has largely neglected the provision of mental health services for marginalised users, including children and young people, people with disabilities and the elderly. Future research should aim at ensuring adequate mental health service provision to these vulnerable populations.