Rural-urban variation in user satisfaction with outpatient mental health services in Southern Malawi: a cross-sectional survey

Abstract

Background

User satisfaction with outpatient mental health services is an important factor in ensuring continued engagement with mental health services for people with mental health conditions. Yet, in many low and middle-income countries, including Malawi, there is a dearth of information about user’s experiences of outpatient mental health care services, and little is known about which factors might affect user satisfaction.

Aim

The aim of the present work was to evaluate user satisfaction with outpatient mental health services in southern Malawi and to explore whether social demographic variables, mental health status, and treatment characteristics explain variance in user satisfaction.

Methods

This cross-sectional study was conducted in Malawi at one urban (Blantyre) and one rural (Thyolo) outpatient psychiatric clinics. Two-hundred and sixteen randomly sampled service users were enrolled into the study and completed the Charlestone Psychiatric Outpatient Satisfaction Scale (CPOSS). The unadjusted and adjusted associations between user satisfaction as the dependent variable, and participant socio-demographic characteristics as independent variables, were examined.

Results

Eighty percent of all participants were satisfied with the outpatient mental health services, although participants presenting to the rural clinic were less likely to be satisfied than participants presenting at the urban clinic, according to the adjusted odds ratio (AOR; AOR = 0.31; 95% confidence interval (CI): 0.13–0.76; p < 0.05). Any admission due to a mental health condition significantly explained variance in user satisfaction at the rural (Thyolo) study site; as those who had been admitted previously were less satisfied than those who had never been admitted (AOR = 0.11; 95% CI: 0.02–0.54; p < 0.05).

Conclusion

As may be expected, these findings demonstrate that service user satisfaction is linked to service quality and past service experiences. Further research is required in order to nuance these findings in the context of Malawi’s efforts to strengthen service quality. Nonetheless, rural facilities may require additional support to deliver satisfactory care.

Keywords:

• Satisfaction
• mental health condition
• users
• mental health service
• low and middle-income countries
• Charlestone Psychiatric Outpatient Satisfaction Scale

Acknowledgements

The authors deeply appreciate Alan J. Flisher Centre for Public Mental Health whose AFFIRM scholarship enabled the completion of this study who gave us the full support throughout the project. We especially wish to express our deep thanks to management and staff of Thyolo district hospital and Queen Elizabeth Central Hospital for allowing us to conduct this study. We also wish to acknowledge the contributions of Andy Bauleni for the help in his area of expertise: statistical analysis of the data collected. We want to take this opportunity to acknowledge Miss Jacqueline Gamble who edited the thesis write up of this study. Finally, we want to convey our bottomless thanks to the study participants who voluntarily enrolled into the study, their enthusiasm to provide indispensable information was delightful.

Author contribution

BC: write up of thesis, manuscript writing and reference search; XH: manuscript writing and review; KS (co-supervisor) and MT (Supervisor): manuscript reviewing as well as data analysis review.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The work was supported by AFFIRM through Alan J. Flisher Centre for Public Mental Health.