The mental health service preferences of youth in Tasmania, Australia
Creators: name: Mseke, Edwin
Publisher: name: University of Tasmania
Year: 2024

description: Youth mental illness is a global issue, with almost one-quarter of youth being diagnosed with mental health problems worldwide. Around three-quarters of all mental illnesses develop between the ages of 14 and 25, making youth an important age group to target for early identification and intervention strategies. In Australia and other countries, access to mental health services is limited in rural and remote areas. Subsequently, rural and remote youth have to travel, sometimes long distances, to access mental healthcare. One of the best strategies to mitigate the barrier of travel is the use of telehealth. However, it is unclear whether youth from rural and remote areas prefer to access telehealth rather than travelling for traditional face-to-face mental health services. In order to address these gaps in understanding, this thesis drew upon a literature review to design a choice based conjoint analysis (CBC) to explore mental health service preferences for youth aged 13 to 25 years living in Tasmania, Australia. Tasmania, as a largely rural island that is geographically isolated from mainland Australia, offers the unique opportunity to investigate healthcare issues in a rural context. <br>This thesis begins with a review of rurality and remoteness measures across the Organization for Economic Cooperation and Development (OECD) countries, focusing on reviewing the historical measures used within Australia. A scoping literature review was then undertaken to explore the impact of distance and/or travel time on access to health services for rural and remote residents of OECD countries. This was supplemented by a systematic literature review of rural youth preferences for accessing mental health services between telehealth and face-to-face service delivery modalities in OECD countries. Given the paucity of literature on youth preferences for mental health service delivery in rural contexts, a CBC was then conducted to investigate the preferences of Tasmanian youth towards accessing mental health services. <br>A CBC is a quantitative technique that presents a series of choice sets about a particular topic to survey respondents. The survey respondents then choose their preferred choice from the various sets presented to them, which differ based on combinations of 'attributes' (characteristics) and their 'levels'. The CBC constructed for this thesis comprised twelve choice sets that differed according to seven attributes (<i>mental health concern,service provider, service delivery method, waiting time, out-of-pocket costs, travel time, and transport mod</i>e) and their associated levels. A sample of 214 youth aged between 13 and 25 years was recruited online through social media (Facebook) and consented to participate in the CBC. A Hierarchical Bayes mixed logit model was used to analyse data. <br>The review of the literature around measures of rural and remoteness identified differences both within and between countries. Predominantly, measures in Australia are based on population distribution, distance to service centres and extent of the choice of goods and services in an area. The scoping review found there is evidence of travel time/distance decay in healthcare service access, with rural and remote residents travelling further for specialist services. Travel time was found to be a good indicator of distance. Other factors influencing accessing healthcare services include location of residence, age, socio-economic status, gender, ethnicity, transportation costs, transport mode, parking charges and public transport safety. The systematic review of the literature on youth preferences located only four studies that met the inclusion criteria. Three of the four studies found that youth preferred face-to-face mental health services compared to telehealth. However, telehealth was seen as a useful adjunct to in-person services. <br>A total of 354 youth participated in the CBC. Of the valid responses (n= 214), greater importance was given to the attributes: the type of professional providing mental health services, costs and waiting time. Mode of transport was the lowest of the seven ranked attributes. A high preference was recorded for a psychologist, less waiting time and in person rather than online (telehealth) service delivery. A high preference was also noticed for services that were free. Youth preferred a 15 to 30 minute travel time from their home to mental health service locations compared to either 5 minutes (very close to home) or 45 minutes (furthest away). Most youth also preferred to travel to mental health services by private car or motorbike and were most motivated to access services when they were very concerned about their mental health status. <br>Factors associated with one of the seven attributes were education level (𝑝 = 0.02), those aged under 18 who indicated they spoke with a parent or other adult before completing the survey (𝑝 = 0.04), employment status (𝑝 ≤ 0.012), transport mode (𝑝 = 0.002), mental health service awareness (𝑝 = 0.022), rurality (assessed by applying Modified Monash Model (MMM) categories) (p=0.021), degree of socio-economic disadvantage (𝑝 = 0.037) and study status (𝑝 = 0.008). Further analysis of the CBC data sought to determine the effect of deleting 'irrational responses' from the sample. It was found this additional step may not be necessary because irrational responses may have been due to differences in socio-economic characteristics and background information, such as the MMM category (𝑝 = 0.019), degree of socio-economic disadvantage (𝑝 = 0.003), or transportation mode (𝑝 = 0.03).<br>This thesis has several strengths, including using the literature reviews to inform CBC development. Conducting a CBC study for young people aged 13 to 25 years, using a large sample with 80% statistical power and taking measures to reduce the burden on young people aged under 18 years were other strengths of the thesis. However, the thesis also has limitations; namely, the scoping and systematic literature reviews only included English language conferences and research papers; the CBC was developed based on a literature review only; and the low representation of males and survey respondents from MM4 to 7 in the CBC. Despite these limitations, this body of research has illustrated a need to grow the mental healthcare workforce in rural and remote areas. Further research is required to determine 'travel time', discrete choice models that can accommodate "irrational" samples and whether rural and remote youth healthcare preferences change with respondent's level of mental health literacy or type of 'telehealth' available.