JMIR Publications

ABSTRACT

Background:

Youth experiencing early psychosis in West Africa often face delays in accessing evidence-based treatment. Digital mental health interventions may offer an acceptable and scalable approach to improve access to early psychosis care in West Africa, yet few data exist about the experiences and perspectives of early psychosis patients and their caregivers to inform digital intervention development.

Objective:

To explore current experiences of early psychosis care, identify barriers and facilitators to facility-based care, and identify opportunities for digital interventions to support early psychosis patients and caregivers in Ghana.

Methods:

We conducted qualitative focus group discussions among early psychosis patients, their caregivers, and their mental health providers recruited at Accra Psychiatric Hospital in Accra, Ghana. Trained qualitative researchers facilitated discussions using a structured qualitative interview guide, exploring current care practices for early psychosis in Ghana, barriers and facilitators to facility-based care, and perceptions of digital mental health interventions. Transcripts were translated, transcribed, and analyzed thematically using a hybrid inductive and deductive approach grounded in the Theoretical Framework of Acceptability.

Results:

Overall, we conducted four focus groups discussions (n=31) among seven early psychosis patients (median age: 28 years, interquartile range [IQR]: 21-41), six caregivers (median age: 58 years, IQR: 29-34) and 18 clinicians (median age: 30, IQR: 29-34). Participants described current early psychosis care practices in Ghana including seeking spiritual and traditional healing, the dearth of information and resources about psychosis, and the integral role of caregivers in facilitating treatment engagement and continuation (at the cost of caregiver mental distress and burnout). Common barriers to facility-based mental health care included stigma for mental illness, lack of prior knowledge about early psychosis and treatment options, and practical constraints (e.g., financial, logistical, health system limitations). Motivating factors for facility-based care included success stories from community members and strong rapport and trust in mental health clinicians. Technology (e.g., mobile phone, laptop, radio, television) was commonly used among participants in typical daily tasks, health information seeking, and stress reduction. Participants expressed support for digital tools that could deliver psychoeducation about early psychosis, support treatment adherence, and extend patient-provider communication between clinic visits.

Conclusions:

Digital mental health interventions have potential to complement facility-based early psychosis services in Ghana by addressing misinformation, reducing access barriers, and supporting caregiver roles. Our qualitative research findings inform potential integration points, content, attributes, and strengths of digital modalities which could be leveraged to support early psychosis patients and their caregivers in Ghana.