Critical Realist Theory

Studying access to health services by people with mental disorders is complex, and requires a critical approach. Critical realist theory believes that there are a range of mechanisms mediating between cause and effects, including those linked to the actors (people with mental disorders, family members, community, health providers, 32managers and policy makers) and contexts. 49Their knowledge is that social reality exits independently of social actors, although the actor’s interpretations of reality have influence over the nature of social change. According to Pawson & Tilley (1997) in Gilson 2012 49argue that the pre-existing structures and processes of society have effects and are affected by actors influenced by a range of individual, group, organisational and social processes and structures.50 The assumption in this study is that there …show more content…
Penchansky and Thomas 1981 proposed five descriptive dimensions of access: availability, accessibility, acceptability, accommodation and affordability of potential and realised access to health services.52 Other recent studies suggest other dimensions worth considering including geography, accessibility, temporal, digital, approachability and awareness. 53, 54In this study some of the dimension of access listed are collapse in to four while integrating them as indicator to measure in this study. Therefore, this study adopt the framework to measure access to healthcare first proposed by Aday and Andersen in 1974. 51used by Khan et al in 1994. 29The characteristics of health services and potential population for health services will assess against accessibility, acceptability affordability and availability dimensions of access to capture both the supply and demand sides of health services (preventive, promotive, treatment and rehabilitative services) relevant to people with mental disorders in