Facilitators and barriers to Mental Health Care Uptake of older African American people with type 2 diabetes (n=30)
| Domain/question | Construct | Facilitator | Barrier |
| Social identity/role In your opinion, would women, particularly Black women, be open to talking to a professional, such as a counsellor, to help you deal with stress and/or depression? | Group norms | Encouragement from family/friends Opinions of mental health changing to socially accept help Past experience with mental health professionals Faith in professional | |
| Social norms | Fear of appearing weak Lack of trust in medical/mental health community Not approached in a culturally appropriate manner Distrust of doctors | ||
| Beliefs about capabilities One a scale of 0–10, where 0 is ‘not at all confident’ and 10 is ‘very confident’, how confident are you that you can talk to your doctor or counsellor about mental health concerns? What makes it easy/hard? | Self-efficacy | Responsibility to take care of holistic self Faith in current doctor ‘Just have to let it out’ Not afraid to speak up for self Faith practices as a support | |
| Knowledge What makes women at risk for depression? What can someone do to reduce their risk of depression? | Knowledge about condition | Receive education and start a job/career Reach out to others and offer support | |
| Knowledge | Loneliness, feeling unsupported by family and relatives Financial barriers and/or lack of finances Systemic, interpersonal and experienced racism | ||
| Beliefs about consequences What are the positive benefits to having a mental health exam? What are the negatives or downsides to having a mental health exam? | Beliefs | Tests run to diagnose any mental health concerns may scare people from going | |
| Beliefs about consequences What do you expect will happen if you or someone you know was depressed but did not have regular mental health examinations? | Outcome expectancies | Family and/or friends would step in as a support to encourage a mental health visit | |
| Beliefs | Stigma around mental health visits still exist and may preclude people from seeking help | ||
| Consequences | Someone may be depressed for so long, they think it is normal Their mental health concern would become worse and they would experience decision-making problems | ||
| Reinforcement Did the experience of talking with a mental health care provider make it more or less likely that you would have another one in the future? | Incentives | Past experience with a counsellor or mental health professional was helpful | Learning the coping strategies helped in a such a way that they would not return because they would have learnt the skills needed for a particular mental health concern |
| Knowing that the counsellor would keep discussions confidential made them more likely to return | |||
| Feeling better about a particular mental health concern as a result of therapy made it more likely to go back to the counsellor | |||
| Goals Considering your other priorities, if you or someone you knew was feeling depressed or stressed how important would it be to seek help? What are higher priorities and why? | Goal priority | Seeking help is very important because if a mental health concern is not addressed, it can decline in such a way that could be fatal Seeking help is very important and it is advantageous if the person recognises that they need and want help Seeking help would release the stress and pressure off the person | Priority level would depend on the person, but the financial cost of seeking help can preclude people from attending sessions |
| Environmental context and resources Sometimes our plans are hindered by things outside of our control. What things, outside of your control, could make it harder for you to have regular PCP exams for your diabetes and mental health treatment? What things could make it easier? | Environmental stressors | People not recognising what their needs are may make it harder to receive regular care Only receiving telephonic/virtual ‘visits’ makes it harder to receive care Financial costs of care Unreliable or lack of transportation Insufficient or unreliable medical insurance to pay for care High cost of necessary medications Changes to assistance programme that make it more difficult or impossible to receive regular care | |
| Barriers and facilitators | Past experience as a motivating factor to go and receive care Feeling good about receiving care Appointments scheduled consistently and on a regular basis | ||
| Social influences Have you been prompted by someone to have mental health treatment? If Y, who? | Social support | 6 respondents have been prompted to receive mental healthcare Examples of prompters include pain doctors, family, friends, academic leaders, employers | 7 respondents have never been prompted to receive mental healthcare |
| Social influences What do you think prevents women, particularly Black men/women, from seeking depression treatment? | Social norms | Not wanting to tell someone about their private life, wanting to maintain privacy Fear of being judged, fear of being seen as weak Seeking professional help is highly stigmatised Insufficient or lack of financial resources to seek care Lack of awareness of resources as professional help is not talked about and/or stigmatised Not aware that a problem exists that may require professional help A sense of pride may inhibit someone from recognising or acknowledging a problem and seeking help | |
| Social Influences influences What resources would be helpful to you if you were feeling stressed or depressed? | Resources | Seeing a mental health professional Having regular therapy-related discussions with a group Exercise groups or classes Going to social events or seeking supports from social networks Being able to reach a doctor or other medical professional when needed Being able to take medications regularly Journaling and conscious gratitude |
PCP, Primary Care Physician.