A Prospective Evaluation of Structures and Processes Associated with the Quality of Mental Health Care in the Kingdom of Saudi Arabia

Abstract

Introduction: Quality of care is important for improving outcomes of service users in inpatient mental health settings. There is a lack of research investigating the predictors of quality of mental health care and their relationship with service user outcomes, particularly in Saudi Arabia, despite the high priority given to this in the Kingdom of Saudi Arabia (KSA) national health strategy. Objective: This study investigates the factors associated with the quality of mental care and their relationship with service users’ outcomes, disability, disease, discomfort, and dissatisfaction, using Donabedian’s framework. Methods: A questionnaire survey was distributed to 176 nurses and 321 service users in an inpatient psychiatric hospital in Saudi Arabia. Data were gathered on structures (staff and service users’ characteristics) and processes (staff attitudes to mental illness, competency, and level of interaction with service users) linked to service users’ outcomes. Results: Multilevel modelling showed that service users’ characteristics, for example, age, marital status, employment status, educational level, area of residence, and diagnosis, significantly predicted disability. With 1 exception (unemployment), none of the service users’ characteristics was found to be a statistically significant predictor of disease, although educational level was found to be a significant predictor of discomfort and dissatisfaction. Age and years of experience were found to significantly predict service user disability among nurses, and years of experience was a significant predictor of users’ dissatisfaction. Nurses’ competence was found to be a statistically significant predictor of disability, while their attitudes to mental illness and their interactions with users did not significantly predict the latter’s outcomes. Conclusions: These findings suggest that factors other than those studied here have more currency in relation to quality of care in Saudi Arabia, despite these factors have been shown to relate to quality of care outside the KSA. A more detailed qualitative approach to better understand factors relevant to the quality of mental care in Saudi Arabia is reported by the authors in a concomitant article.