We will conduct the systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and standards [23].
Study Eligibility
Inclusion Criteria:
Quantitative
We will include studies which meet the following eligibility criteria:
Population: Studies including adolescents aged 10 to 19 years residing in LMICs as defined by the World Bank [24]. Participants from any study setting such as homes, schools, healthcare facilities, online, or across community will be considered.
Intervention: Any intervention targeted to improve mental health care
Condition: Mental illnesses/conditions (Depression, stress, suicide, alcohol and substance use, drug disorders)
Comparator: Usual care, control group, no control, as defined in the study
Outcomes: Facilitators and barriers to seeking mental health care
The primary outcome is facilitators for adolescents to seek mental health care. A facilitator can be any strategy/process/event that improves the ease with which adolescents seek care for their mental health. Examples of facilitators include mental health, use of technology-driven tools to seek help for mental illnesses. This includes the results of clinical trials where the intervention of interest has increased the number of people seeking appropriate care, accessing care, studies with clinical outcomes, which would be considered a facilitator. Studies will be included if this information is provided regardless of whether this was the primary aim of the published research.
The secondary outcome is barriers for adolescents who seek mental health care. A barrier can be any strategy/process/event that reduces the ease with which adolescents seek care for their mental health. Examples of barriers include but are not limited to but not limited to unavailability of resources to seek help, resources or facilities which offer help and are of poor quality and do not have any improvement among people who seek help, stigma for seeking help, socio economic determinants like poverty, unemployment, use of substance use, migration, access to healthcare facilities etc.
Study Types: We will include primary peer-reviewed published study designs relevant to the scope of our review. Quantitative studies; including retrospective cohort; prospective cohort and cross-sectional studies; experimental designs, or mixed-methods studies with quantitative data relevant to the review.
Qualitative
Types of participants: Studies including adolescents aged 10 to 19 years residing in LMICs as defined by the World Bank [24].
Phenomenon of Interest: Adolescents’ perceptions, experiences of facilitators and barriers to seeking mental health care, knowledge, attitudes, behaviours towards getting treated for mental illnesses etc.
Context: Participants from any study setting such as homes, schools, healthcare facilities, online, or across community, from low-middle income countries will be considered.
Study Types: Qualitative studies using grounded theory approach, phenomenology, ethnography, action research or any qualitative research designs, which explicitly answer the research questions in this review. We will also include descriptive qualitative studies. Qualitative data from mixed-methods designs will also be considered.
Exclusion criteria: Studies which do not have primary data on facilitators or barriers to help seeking, which do not specifically answer the research question. We a will exclude case studies, case-reports, case series, editorials/commentaries/overviews and systematic reviews (though their reference lists will be screened for eligible studies). Studies reporting on children (age below 10 years) or adults (age above 18 years) will also be excluded, unless disaggregated data for adolescents is available. Conditions such as personality disorders, post-traumatic stress disorder, major depressive disorder, anxiety and other acute mental health conditions will not be considered within the scope of this review. Language will be limited to only English only. We will also screen the reference lists of all the review articles that have been included for additional relevant articles. Studies conducted in nations not considered on by World Bank as a part of LMICs will be excluded. Studies conducted before 2010 will not be included for the study
Search Strategy:
Electronic databases:
Databases such as PubMed, Embase, PsychINFOand CINAHL will be searched. Searches will be conducted from inception; no date cut-off will be employed. A wide array of search terms will be used in order to detect relevant articles. Search strategies aimed at maximising both sensitivity and specificity will be customised to each database, where possible using Medical Subject Headings (MeSH) and key words. A detailed sample search strategy is presented in Appendix 1. Studies published in English will only be included in this review. Studies conducted in nations not considered on by World Bank as a part of LMICs will be excluded. Studies conducted before 2010 will not be included for the study
Additional Resources:
We will also screen the reference lists of all the review articles that have been included for any additional information.
Data Collection and Analysis:
Study selection:
All research articles (titles and abstracts) identified during the search will be imported into EndNote library and transferred to Rayyan for screening after removal of duplicates. Two reviewers (SK) and (PK) will review titles and abstracts according to the pre-defined criteria, to screen articles relevant to the review. Full text articles will be retrieved, and articles included at screening at the title and abstract levels will be independently examined by two reviewers for eligibility.
Any disagreements will be resolved by discussion or reviewed by a third reviewer (MH or PM), if a consensus cannot be reached. Reason(s) for exclusion will be recorded.
Quality Appraisal:
Methodological quality of studies included in the review will be assessed using standardized critical appraisal tools from Joanna Briggs Institute (JBI) or other tools, contingent on the research design. Risk of bias assessments will be conducted by two reviewers (SK and PK), independently. Any disagreements will be resolved by discussion or reviewed by a third reviewer (MH or PM), if a consensus cannot be reached. We will not exclude any studies based on methodological or reporting quality.
Data Extraction:
Data will be extracted on the aims/purpose, study design, LMIC, study population, study duration, interventions (if applicable), outcomes, and results of included studies.
If there is a lack of clarity surrounding the research project or program, up to three attempts will be made to contact the authors, via phone or email, to determine if further documents are publicly available.
For studies reporting on the effectiveness of interventions, the definition of facilitators and barriers to accessing services as described by the authors of the original article will be used.
Data extraction will be completed by one reviewer SK and will be validated for accuracy by another reviewer PK
Data Synthesis
Characteristics of all included studies and risk of bias assessments will be presented in a tabulated form. The main findings will be presented as funnel plots, in tables, figures or as a narrative summary, as appropriate. We will adopt JBI’s methodological guidance for conducting mixed methods systematic reviews which uses a convergent approach to data synthesis and integration [26]. The convergent segregated approach consists of conducting separate quantitative synthesis and qualitative synthesis, followed by integration of evidence derived from both syntheses. By integrating the quantitative and qualitative synthesized findings, a greater depth of understanding of the phenomena of interest can be obtained, compared to undertaking two separate component syntheses without formally linking the two sets of evidence. We will interpret the findings in consideration of study quality. For the quantitative evidence a meta-analysis (fixed or random effects depending on data) will be performed if scientifically admissible studies do not have significant heterogeneity; clinically, methodologically and statistically. Heterogeneity of included studies will be assessed using I² statistic (>50% representing significant heterogeneity). If we are unable to conduct a meta-analysis, we will synthesise abstracted findings using a narrative approach. For the qualitative synthesis, in the case of significant heterogeneity, a thematic synthesis of findings from the empirical qualitative studies will be performed to develop evidence statements.
We will then compare the synthesized quantitative results with the synthesized qualitative findings and link these findings into a line of argument to produce an overall configured analysis. Two reviewers will then independently code each line of text and develop descriptive themes according to its meaning and content, and subsequently generate analytical themes to answer our review questions. Reviewers will finalize the descriptive and analytical themes through discussion. Findings will be triangulated with the findings of the quantitative synthesis to understand the fit between end-user perspective (e.g., adolescents) of studies conducted and the appropriateness of the evaluation of those studies to address those perspectives.
Dissemination information
We will publish the results of this review through peer-reviewed publications and will disseminate the data through evidence policy briefs to stakeholders in governments, public institutions and communities through open access.
Study status
Preliminary search Strategies have been developed and executed.
Data availability
There are no data additional data that have been published as a part of this article.
This paper contains the following extended dataset:
Study search strategy
Prisma-P flowchart
Presentation of data: This data will be presented as series of systematic reviews, depending on the extent and range of results identified in the searches.