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Table 2 CMO from the configuration

From: A qualitative study of evidence-based therapeutic process in mental health services in Ghana– context-mechanisms-outcomes

CMO from the configuration Context + Mechanism = Outcome
CMO configuration one (theme one): Technical competency stimulates evidence-based mental health services MHPs have received specialist training, practical skills, certified license as well as being regulated, monitored and supervised (Context). This is achieved through continuous learning, in-service training, professional development plan, multi-disciplinary team, clinical and academic training sessions (tutorials, presentations and discussions) (Mechanisms). These are helping to deliver quality mental health services, by reducing hospitalization days for consumers, improved MHPs knowledge and skills on current treatment methods, providing effective and efficient services to consumers, consumers to built confidence and trust in the care (Outcome) This notwithstanding, MHPs needed in-service training (aggression and conflict management, training in using psychological tools and test, customer care, health promotion, communication skills, infection prevention, operating ECT as well as dealing with difficult family caregivers), inadequate MHPs in clinical and allied health specialties (child and adolescent, forensics, geriatric psychiatry, addiction substance as well as social work and psychological services), adhering to western protocols and clinical judgement with on-going deliberation regarding the need to get a local protocol (Mechanisms)
CMO configuration two (theme two): Therapeutic relationship building ensure effective interaction MHPs build the therapeutic relationship in psychoeducation, consultation, diagnosis, as well as family therapy session (Context). This was built through consumers involved in the care plan, considering consumers educational background, philosophical approach to admission (eg. voluntarily or involuntarily) dignity and respect, making consumers aware of the choices, building rapport, ethical principles (eg. respecting consumers privacy/confidentiality, dignity, preferences, informed consent, comfort, religion, gender, age, belief systems), need to stop wearing providers uniforms (Mechanisms) and this help equip consumers in management of the condition, enhance consumers’ knowledge and understanding, successful compliance with medications, consumers participating actively in the care plan (if educated), consumers feeling accepted, having hope and expectations, adhere to medications, making the service participatory, MHPs avoid being physically attacked or injured by angered consumers, promoting the quality of mental health services, help to avoid distinguishing consumers and providers on duty. (Outcome). This notwithstanding, MHPs have limited knowledge in sign language/no designated sign language interpreter to support communication, and using family caregivers, teachers or instructors or health professionals from other units to provide sign language support (Mechanisms) professional-consumers communication barriers (Outcome)