Organisational readiness and perceived sustainability of mental health integration in primary care: A multistakeholder survey in Lagos, Nigeria.

Abstract

ObjectivesTo assess organisational readiness and stakeholder-rated sustainability of the Mental Health in Primary Care initiative in Lagos, Nigeria, and to identify factors associated with perceived sustainability.MethodsA cross-sectional survey was conducted across 30 primary health care facilities during June-August, 2019. Participants comprised policymakers (n = 40), programme managers (n = 60), primary health care workers (n = 120) and service users (n = 120). Four sustainability-related measures were adapted and evaluated psychometrically; because each instrument was administered to a different subset of stakeholders, the integrated regression was restricted to the 120 primary health care workers with complete data on all model variables.ResultsThe adapted measures showed acceptable to excellent internal consistency and preliminary structural support. Stakeholders generally reported favourable expectations of continued implementation, although service users were less confident than professional stakeholders. Among primary health care workers, perceived programme benefits, feasibility and facilitation were independently associated with greater confidence that the initiative would continue; workplace support and programme burden did not retain independent associations in the adjusted model.ConclusionsStakeholders generally perceived favourable conditions for continued delivery, although service users were less confident. Programme value, feasibility and facilitation were the principal correlates among primary health care workers. Perception-based measures should be combined with longitudinal indicators of service continuation, quality and user experience.