Open Access Highly Accessed Open Badges Correspondence

Researching the mental health needs of hard-to-reach groups: managing multiple sources of evidence

Christopher Dowrick1, Linda Gask2*, Suzanne Edwards1, Saadia Aseem2, Peter Bower2, Heather Burroughs2, Amy Catlin2, Carolyn Chew-Graham2, Pam Clarke1, Mark Gabbay1, Simon Gowers1, Derek Hibbert1, Marija Kovandzic1, Jonathan Lamb2, Karina Lovell3, Anne Rogers2, Mari Lloyd-Williams1, Waquas Waheed2 and the AMP Group

Author Affiliations

1 School of Population, Community and Behavioural Sciences, Whelan Building, University of Liverpool, Liverpool L69 3GB, UK

2 Primary Care Research Group, 5th Floor, Williamson Building, University of Manchester, Oxford Road, Manchester, M13 9PL, UK

3 School of Nursing, Midwifery and Social Work, University Place, University of Manchester Oxford Road, Manchester, M13 9PL, UK

For all author emails, please log on.

BMC Health Services Research 2009, 9:226  doi:10.1186/1472-6963-9-226

Published: 10 December 2009



Common mental health problems impose substantial challenges to patients, carers, and health care systems. A range of interventions have demonstrable efficacy in improving the lives of people experiencing such problems. However many people are disadvantaged, either because they are unable to access primary care, or because access does not lead to adequate help. New methods are needed to understand the problems of access and generate solutions. In this paper we describe our methodological approach to managing multiple and diverse sources of evidence, within a research programme to increase equity of access to high quality mental health services in primary care.


We began with a scoping review to identify the range and extent of relevant published material, and establish key concepts related to access. We then devised a strategy to collect - in parallel - evidence from six separate sources: a systematic review of published quantitative data on access-related studies; a meta-synthesis of published qualitative data on patient perspectives; dialogues with local stakeholders; a review of grey literature from statutory and voluntary service providers; secondary analysis of patient transcripts from previous qualitative studies; and primary data from interviews with service users and carers.

We synthesised the findings from these diverse sources, made judgements on key emerging issues in relation to needs and services, and proposed a range of potential interventions. These proposals were debated and refined using iterative electronic and focus group consultation procedures involving international experts, local stakeholders and service users.


Our methods break new ground by generating and synthesising multiple sources of evidence, connecting scientific understanding with the perspectives of users, in order to develop innovative ways to meet the mental health needs of under-served groups.