RT journal article
T1 Healthcare ecosystems research in mental health: a scoping review of methods to describe the context of local care delivery
A1 Furst, Mary Anne
A1 Gandre, Coralie
A1 Romero López Alberca, Cristina
A1 Salvador Carulla, Luis
A2 Medicina
A2 Medicina
A2 Psicología
K1 Mental health care systems
K1 Mental health care comparison
K1 Mental health care delivery
K1 Mental health systems research
AB Background: Evidence from the context of local health ecosystems is highly relevant for research andpolicymaking to understand geographical variations in outcomes of health care delivery. In mental health systems,the analysis of context presents particular challenges related to their complexity and to methodological difficulties.Method guidelines and standard recommendations for conducting context analysis of local mental health care areurgently needed. This scoping study reviews current methods of context analysis in mental health systems toestablish the parameters of research activity examining availability and capacity of care at the local level, and toidentify any gaps in the literature.Methods: A scoping review based on a systematic search of key databases was conducted for the period 2005–2016. A systems dynamics/complexity approach was adopted, using a modified version of Tansella and Thornicroft’smatrix model of mental health care as the conceptual framework for our analysis.Results: The lack of a specific terminology in the area meant that from 10,911 titles identified at the initial search,only 46 papers met inclusion criteria. Of these, 21 had serious methodological limitations. Fifteen papers did notuse any kind of formal framework, and five of those did not describe their method. Units of analysis varied widelyand across different levels of the system. Six instruments to describe service availability and capacity were identified,of which three had been psychometrically validated. A limitation was the exclusion of grey literature from thereview. However, the imprecise nature of the terminology, and high number of initial results, makes the inclusion ofgrey literature not feasible.Conclusion: We identified that, in spite of its relevance, context studies in mental health services is a very limitedresearch area. Few validated instruments are available. Methodological limitations in many papers mean that theparticular challenges of mental health systems research such as system complexity, data availability andterminological variability are generally poorly addressed, presenting a barrier to valid system comparison. Themodified Thornicroft and Tansella matrix and related ecological production of care model provide the main modelfor research within the area of health care ecosystems.
PB BMC
SN 1472-6963
YR 2019
FD 2019-03
LK http://hdl.handle.net/10498/21173
UL http://hdl.handle.net/10498/21173
LA eng
DS Repositorio Institucional de la Universidad de Cádiz
RD 08-nov-2026