Innovation summary

The Ministry of Public Health in Qatar has long recognised the importance of raising mental health literacy to counter the low levels of awareness of mental health and high levels of stigma in the Country. Qatar’s commitment to improving mental health care is evidenced by their work in developing more effective and accessible mental health services and a dedicated policy and strategy to govern implementation1.

Strengthening M&E systems and detection was the first goal to accomplish in achieving the National Health Strategy (2018-2022) which states that 20% of mental health services in the country should be provided through primary care by 2020. The Qatar Mental Health Attitudes and Awareness Index (QMHAAI) was developed with the purpose of identifying a more accurate understanding of the attitudes and awareness to mental health in Qatar. This includes the key practices and attitudes preventing people from seeking help and knowing where and how to access services. By developing the survey and measurement tool the Ministry and its key stakeholders has been able to target specific population groups and address the issues of stigma and raise people’s awareness of mental health across the country.

Impact summary

  • The QMHAAI Survey was administered to 1068 respondents
  • Improvements in attitude towards mental health and people with mental health conditions were reported in young people (aged years 16-24) in the second wave of reporting
  • Higher levels of knowledge and awareness of mental health and mental illness were reported among non-Arab expatriates, females and young respondents (16 to 24 years), and lower among Qatari nationals, males and respondents aged 35 years and older

“The Qatar Mental Health Attitudes and Awareness Index (QMHAAI) provides an effective tool to track the effectiveness of mental health promotion and prevention initiatives. It also provides a quick reference to assess improvements and deteriorations amongst key measures over time”

– Susan Clelland, Executive Director, National Mental Health Office (Policy Maker)

Innovation details

Development of Qatar’s Mental Health Attitudes and Awareness Index (QMHAAI) as a measurement tool took place to track the effectiveness of the country’s mental health promotion and prevention initiatives. The QMHAAI provides a quick reference to assess improvements and deteriorations amongst key measures over time.   The QMHAAI is comprised of four measures:

  • Communications: increasing public dialogue on mental health and mental illness
  • Awareness: increasing awareness about mental health and mental illness
  • Attitudes: improving attitudes towards those affected by mental health and mental illness (stigma)
  • Services: increasing awareness of mental health services and support available in Qatar

Goal: To measure improvements in attitudes and awareness of mental health amongst a representative sample of segments of the Qatar population including Qatari nationals, Arab expatriates and other expatriates every 2 years.

Content of the Intervention:

  • A quantitative research methodology in Arabic and English to measure improvements in attitudes and awareness of mental health.
  • Survey instruments for conducting online and Computer-Assisted Personal Inteviewing (CAPI) surveys.

Design, analyses and reporting features on the findings from the full data set filtered from a survey of 1068 responses to gain an all-inclusive picture of Qatari individual knowledge and attitudes towards mental health.

Key drivers

Commitment

  • Garnering support from senior leaders to conduct the Survey and implement the recommendations.

Expertise

  • Having existing expertise to support the development of the Survey as well as conducting the Survey

Resources

  • Utilizing experts to support delivery and implementation of the findings from the Survey.

Funding

  • Having government investment to implement the findings of the Survey.
  • Funding for promotion and prevention initiatives is available however the findings from the survey will allow for a more targeted approach across the different themes, utilizing funds more effectively to get the greatest impact.

Working Partnership 

  • Ensuring all population groups are targeted effectively to increase awareness and reduce stigma
  • Ensuring key partners were supportive of the survey and provided expertise in development of key questions which affected their services.

Challenges

The were no significant challenges in developing the Attitudes and Awareness Survey and the QMHAAI. However to ensure full implementation of the findings will require the support of partners and the right levels of investment in promotion and prevention initiatives to see real changes to attitudes and the levels of awareness related to mental health in the future.

Continuation

In order to measure the changes in attitudes and awareness the Survey will be undertaken every two-years. 

Plans are also underway to develop a similar Survey specifically to measure and monitor the attitudes and awareness of health professionals across Qatar.  This will seek to inform future training and education programs.

Partners

To support the development of the Survey 'Intelligence Qatar' (a research and marketing company) were commissioned to support with the methodology and conducted the Survey Questionnaire on behalf of the Ministry of Public Health.

The findings from the Survey will be implemented with the support of key stakeholders from across Qatar including but not limited to:

  • Hamad Medical Corporation
  • Primary Health Care Corporation
  • Sidra Medicine (Women & Children Health Care)
  • Naufar (Wellness and Treatment behavioural disorders)

Funders

Funding for the Survey was provided by the Ministry of Public Health and managed and monitored by the National Mental Health Office.

Evaluation methods

The Qatar Mental Health Attitudes and Awareness Index (QMHAAI) is and will be the main evaluation tool to continue to measure and monitor attitudes and awareness to mental health. The findings will be incorporated into the Promotion and Prevention Workstream which is multi-sector driven to ensure initiatives are implemented across the whole system in partnership.

The QMHAAI was revisited during the analysis stage, with changes made to ensure the validity of the variables and that the weighting applied corresponded with the changes in the questionnaire and updated priorities for the Qatar National Mental Health Strategy (QNMHS). This was important given that the first wave of research was conducted three years earlier in 2015, and the QNMHS has progressed since then. Thus, the following considerations and changes were applied to the QMHAAI for Wave 2 (in 2019):

  • Social media consumption: A new section related to the impact of social media on mental health was added to the questionnaire.
  • Perceptions on personal mental health awareness: A variable relating to the extent that people consider themselves aware of mental health was also added in Wave 2.
  • Reference to stigma: The Stigma Sub Index in Wave 1 has been renamed ‘Attitudes Sub Index’ in Wave 2. In Wave 1, this sub index was focused on measuring Qatar people’s attitudes towards mental illness in general. In Wave 2, it has incorporated broader attitudes towards mental health and mental illness, which is why it was renamed to Attitudes Sub Index.
  • Willingness to seek help at primary healthcare centers: The percentage of respondents that would visit a primary healthcare centers if they thought they had a mental illness for advice or treatment has been added to the Services Sub Index in Wave 2. This was deemed important given the increased emphasis on early diagnosis of mental health conditions at primary healthcare centres since the first wave of research.

Given the changes applied to the QMHAAI in Wave 2, it was decided that a complete comparison between the two waves would not provide an accurate indication. The Wave 2 QMHAAI will therefore be used in future as the baseline for comparisons and measures of any improvement or deterioration amongst the key measures.

Cost of implementation

The cost of developing the Survey Tool and conducting/evaluating the findings was approximately QR 210,000 (approximately USD 57,676)

The cost of implementing the recommendations is currently being evaluated along with identifying key partners to support delivery of mental health promotion and prevention initiatives which will demonstrate improvements in the attitudes of mental health in the country.

Impact details

Impact details (complete findings and recommendations can be found in the Attitudes and Awareness Measure Report, 2019):

  • There have been some positive shifts in knowledge and attitudes towards mental health and mental illness in Qatar when comparing research results from Wave 1.
    • While misconceptions and stigma associated with mental illness still remain prevalent within the community, the results indicate a shift towards greater acceptance and understanding of mental illness in Qatar.
  • The results also indicate that awareness of the signs and symptoms of depression and anxiety have increased from Wave 1.
    • Overall, there are higher levels of knowledge and awareness of mental health and mental illness among non-Arab expatriates, females and young respondents (16 to 24 years), and lower among Qatari nationals, males and respondents aged 35 years and older. 
  • The results also indicate improvements in attitudes particularly among young people.
    • A greater proportion of 16 to 24-year old’s in Wave 2 indicate they would maintain a friendship with someone who has developed a mental illness and would accept marrying into a family where someone has a mental illness. This indicates a greater level of tolerance of people with mental health issues among the younger generation.
  • Young people are also actively seeking information on the topic of mental health through the internet and social media. Greater understanding and acceptance of mental illness among young people will help to address the stigma, discrimination and misconceptions at a broader community level.

References

  1. Gulf Times (2019). Public Awareness Central to Mental Healh Services. News Article [Link] 
  2. MoPH Qatar (2019). Attitudes and Awareness Measure Report - Wave 2

Associates

Susan Clelland Executive Director National Mental Health Office
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