Type of Research Instrument
Data collection was conducted in two phases. The first phase involved quantitative data abstraction from facilities providing mental health services in Nairobi County. The second phase applied qualitative methods, including KIIs and IDIs, to explore barriers and facilitators of adolescent mental health referrals and to identify existing referral pathways. A total of 62 respondents were recruited: 12 mental health focal persons, 30 religious leaders, and 20 secondary school guidance and counselling teachers and resident school nurses.
1) Key Informant Interviews with Mental Health Focal Persons
>The key thematic areas included:
-Burden of mental health conditions in the community (extent, types of conditions, affected groups)
-Mental health services provided (types of care, available interventions, unmet needs)
-Mental health among adolescents and youth (knowledge levels, sources of care, services sought)
-Facilitators of access to mental health services (enabling factors at individual, community, and system levels)
-Barriers to access and service provision (knowledge gaps, stigma, financial constraints, resource limitations, system-level barriers)
-Challenges in providing care for adolescents with mental health conditions
-Capacity of community and health facilities to provide mental health care (school nurses, counsellors, religious leaders, etc.)
-Referral processes for adolescents and youth (existence, clarity, gaps, and possible improvements)
-Strategies to strengthen referral pathways (recommendations for system, community, and provider-level improvements)
2) In-depth Interviews with Secondary School Guidance and Counselling Teachers and School Nurses
>The key thematic areas included:
-Burden of mental health conditions among students (extent, comparison with general public, most prevalent conditions)
-Types of services provided in schools (treatment, counselling, referral, outreach, screening, rehabilitation, unmet needs)
-Challenges in providing mental health care (resource constraints, stigma, difficult cases, barriers encountered)
-Students’ challenges in seeking care (awareness, stigma, financial constraints, perceptions)
-Referral practices and attitudes (perceptions of referral as part of role, existing referral practices, facilitators, barriers)
-Training and support needs (skills, resources, or support required to improve referral and care capacity)
-Strategies for improving referral pathways (recommendations to overcome barriers and strengthen links with health facilities)
3) In-depth Interviews with Religious Leaders
>The key thematic areas included:
-Knowledge and perceptions of mental health (awareness, conditions affecting community, perceived causes)
-Role of religious leaders in providing mental health support (types of care/support offered, age groups served, situations prompting care-seeking)
-Barriers faced in addressing mental health needs of adolescents (conditions or circumstances difficult to manage, challenges in practice)
-Facilitators of providing support (cultural/religious practices, enabling factors, successful experiences)
-Collaboration with the healthcare system (experience with referrals, perceived role, training/resources needed)
-Attitudes towards referrals (comfort with referring adolescents, factors that encourage or discourage referral)
-Stigma and misconceptions (community beliefs, stigma in adolescents vs adults, role of leaders in stigma reduction)
-Community education and awareness (leaders’ role in raising awareness, strategies to reduce stigma, leveraging religious/cultural practices)