Explanatory models of mental distress and influencing factors in a multi-cultural setting, Khartoum, Sudan

Background: It has been recognized that explanatory models (EMs) of mental distress play an important role in how people perceive causes of mental illness, how these illnesses are presented and where treatment is sought. The main objective of this study was to explore EMs within a non-clinical sample in a low-income and multicultural setting and to identify the most common category of EMs. The secondary objectives were to assess the influence of demographic factors, perceived accessibility of health services, and choice of health service for mental distress across the EM categories. Methods: Cross-sectional data were collected using the Mental Distress Explanatory Model Questionnaire (MDEMQ) from 399 participants resident in Mayo, Khartoum. The frequency distribution across different EMs was assessed to reveal the most common EMs and category of EMs. Frequencies of perceived accessibility were conducted to identify the preferred health service. Predictive Analytic SoftWare Statistics (PASW) Version 18 was used for all analysis. Results: The most prevalent EMs of mental distress were found to be in the category of stress, but supernatural/magical EMs were also prevalent in the sample. Factors significantly associated with the EM categories stress and supernatural were found to be area of origin and years since migration from the area of origin. Choice of health service was not found to be significantly associated with EMs, with 84 % of the sample choosing hospital as their first choice for mental illness. Conclusion: Cultural beliefs of mental distress are important to recognize to facilitate positive interactions between health workers and the patient. Findings from this study indicates that both western and non-western EMs are prevalent in Mayo, which suggests a heterogeneous approach to EMs of mental distress, and that beliefs in one EM category not automatically excludes other categories of EMs

Inpatients’ experiences with interdisciplinary treatment for substance dependence: Measurement, quality indicators and use of results

The increasing focus on the openness of results and outcomes from health services as well as the quality of care that patients receive has led to increased initiatives for assessing and reporting the quality of health care as well as monitoring quality improvement initiatives. The overall aims of this thesis were to validate a questionnaire used in national cross-sectional surveys among patients receiving residential treatment for substance dependence in Norway, to test the data material gathered via these surveys for use as quality indicators and to follow employees’ reported use of these results in local quality-improvement work. Survey data based on paper and online questionnaires from four years among patients and employees were explored. The exploratory factor analyses with data from the 2013 patient-experience survey resulted in three scales: “treatment and personnel” with 12 items, “milieu” and “outcome” with five items each. The intraclass correlation coefficient for the patient-reported experience scales was 2.3% for the “treatment and personnel” scale, 8.1% for “milieu” and 4.8% for “outcome”. The employees reported generally positive attitudes towards patient-experience surveys, and 40–50% of them had implemented quality initiatives based on the results of the patient surveys. The analyses of survey data demonstrated the good psychometric properties of the patient questionnaire. When adjusted for a specific set of variables, the three scales comprising the patient questionnaire functioned well as patient-experience-based quality indicators, and employees’ reported use of the results suggests that patient-experience surveys are viewed as useful and valuable tools in quality improvement