Factors Associated with Mental Health Service Utilization Among Adults in Gasabo District, Kigali City, Rwanda: A Convergent Mixed-Methods Study.

Background: Mental health disorders constitute a major public health concern globally, especially in low- and middle-income countries. Despite the increase of mental disorders and integration of mental health services into primary healthcare in Rwanda, the evidence on contextual and structural factors of service utilization remains scarce. This research aimed to investigate factors associated with utilization of mental health services among adults and healthcare professionals (HCPs) in Gasabo District, Kigali.

Methods: A convergent mixed-methods design was used, with quantitative and qualitative data collected concurrently. Quantitative data were collected from 149 adults using a structured questionnaire, and qualitative data were collected through key informant interviews with 29 mental health professionals. Quantitative data were analyzed using descriptive statistics and logistic regression, while qualitative data were analyzed using inductive thematic analysis. The results from both methods were integrated during interpretation to provide a comprehensive understanding of factors associated with mental health service utilization.

Results: Overall, 62.4% of adults reported using mental health services. Service utilization was lower among those endorsing traditional explanations of mental illness (AOR=0.52, 95% CI: 0.27-0.98; p=0.041), and those reporting high perceived stigma (AOR=0.46, 95% CI: 0.23-0.91; p=0.028). Qualitative interviews with mental health professionals identified four themes: sociocultural barriers, health-system factors, accessibility challenges, and strategies to improve access. Qualitative results converged with quantitative results by identifying stigma and traditional beliefs as key barriers to service utilization, while additionally reporting limited-service availability, workforce constraints, and transportation as structural challenges.

Conclusion: Our study underscores that improving access to mental health services requires culturally responsive community engagement alongside sustained efforts to reinforce service availability, workforce capacity, and accessibility. Further research is needed to better understand long-term and context-specific mental health service needs, especially given the country's history of genocide against the Tutsi and its persistent implications for mental health and access to care.