Rural-urban variation in user satisfaction with outpatient mental health services in Southern Malawi: a cross-sectional survey

Blessings Chikasema, Xanthe Hunt, Katherine Sorsdahl, Mark Tomlinson

Research output: Contribution to journalArticlepeer-review


BACKGROUND User satisfaction with outpatient mental health services is an important factor in ensuring continued engagement with mental health services for people with mental health conditions. Yet, in many low and middle-income countries, including Malawi, there is a dearth of information about user’s experiences of outpatient mental health care services, and little is known about which factors might affect user satisfaction.
AIM The aim of the present work was to evaluate user satisfaction with outpatient mental health services in southern Malawi and to explore whether social demographic variables, mental health status, and treatment characteristics explain variance in user satisfaction.
METHODS This cross-sectional study was conducted in Malawi at one urban (Blantyre) and one rural (Thyolo) outpatient psychiatric clinics. Two-hundred and sixteen randomly sampled service users were enrolled into the study and completed the Charlestone Psychiatric Outpatient Satisfaction Scale (CPOSS). The unadjusted and adjusted associations between user satisfaction as the dependent variable, and participant socio-demographic characteristics as independent variables, were examined.RESULTS Eighty percent of all participants were satisfied with the outpatient mental health services, although participants presenting to the rural clinic were less likely to be satisfied than participants presenting at the urban clinic, according to the adjusted odds ratio (AOR; AOR = 0.31; 95% confidence interval (CI): 0.13–0.76; p < 0.05). Any admission due to a mental health condition significantly explained variance in user satisfaction at the rural (Thyolo) study site; as those who had been admitted previously were less satisfied than those who had never been admitted (AOR = 0.11; 95% CI: 0.02–0.54; p < 0.05).
CONCLUSION As may be expected, these findings demonstrate that service user satisfaction is linked to service quality and past service experiences. Further research is required in order to nuance these findings in the context of Malawi’s efforts to strengthen service quality. Nonetheless, rural facilities may require additional support to deliver satisfactory care.
Original languageEnglish
Pages (from-to)224-231
Number of pages8
JournalJournal of Mental Health
Issue number2
Early online date26 Mar 2020
Publication statusPublished - 04 Mar 2021


  • Psychiatry and Mental health
  • General Medicine


Dive into the research topics of 'Rural-urban variation in user satisfaction with outpatient mental health services in Southern Malawi: a cross-sectional survey'. Together they form a unique fingerprint.

Cite this