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

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 t...

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Main Authors: Eric Badu, Anthony Paul O’Brien, Rebecca Mitchell, Akwasi Osei
Format: Article
Language:English
Published: BMC 2025-02-01
Series:BMC Health Services Research
Subjects:
Online Access:https://doi.org/10.1186/s12913-025-12372-x
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author Eric Badu
Anthony Paul O’Brien
Rebecca Mitchell
Akwasi Osei
author_facet Eric Badu
Anthony Paul O’Brien
Rebecca Mitchell
Akwasi Osei
author_sort Eric Badu
collection DOAJ
description 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.
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spelling doaj-art-e827c65b8ecc4ff8a69bfa5eb60dd62d2025-08-20T02:14:59ZengBMCBMC Health Services Research1472-69632025-02-0125111710.1186/s12913-025-12372-xProviders’ insight into quality mental health services – Context-Mechanism-Outcome (CMO) approachEric Badu0Anthony Paul O’Brien1Rebecca Mitchell2Akwasi Osei3Social Policy Research Centre, The University of New South WalesSchool Nursing and Midwifery, Monash UniversityMacquarie Business School, Macquarie UniversityGhana Mental Health Authority, Ghana Health ServicesAbstract 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.https://doi.org/10.1186/s12913-025-12372-xQuality improvementsMental health servicesRealistic evaluationContextMechanismOutcome
spellingShingle Eric Badu
Anthony Paul O’Brien
Rebecca Mitchell
Akwasi Osei
Providers’ insight into quality mental health services – Context-Mechanism-Outcome (CMO) approach
BMC Health Services Research
Quality improvements
Mental health services
Realistic evaluation
Context
Mechanism
Outcome
title Providers’ insight into quality mental health services – Context-Mechanism-Outcome (CMO) approach
title_full Providers’ insight into quality mental health services – Context-Mechanism-Outcome (CMO) approach
title_fullStr Providers’ insight into quality mental health services – Context-Mechanism-Outcome (CMO) approach
title_full_unstemmed Providers’ insight into quality mental health services – Context-Mechanism-Outcome (CMO) approach
title_short Providers’ insight into quality mental health services – Context-Mechanism-Outcome (CMO) approach
title_sort providers insight into quality mental health services context mechanism outcome cmo approach
topic Quality improvements
Mental health services
Realistic evaluation
Context
Mechanism
Outcome
url https://doi.org/10.1186/s12913-025-12372-x
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AT anthonypaulobrien providersinsightintoqualitymentalhealthservicescontextmechanismoutcomecmoapproach
AT rebeccamitchell providersinsightintoqualitymentalhealthservicescontextmechanismoutcomecmoapproach
AT akwasiosei providersinsightintoqualitymentalhealthservicescontextmechanismoutcomecmoapproach