Evidence-based guideline implementation of quality assurance and quality control procedures in the Saudi National Mental Health Survey

Background & Methods

The World Mental Health surveys, carried out in collaboration with World Health Organization and Harvard Medical School - Harvard University have been known to apply high standards of quality control, but few studies have been published to document this. Furthermore, the effectiveness of quality control has rarely been reported in the Middle East. The focus of this paper was to highlight the implementation of quality control procedures in the Saudi National Mental Health Survey (SNMHS) under the World Mental Health Survey Consortium. The paper summarizes the guidelines implemented for the various phases of survey quality control —the quality assurance procedures, the quality control procedures and the quality control appraisal components—as per previously prescribed recommendations in literature.

Between 2013-2016, the SNMHS conducted household interviews with more than 4000 respondents, males and females between the ages of 15 and 65, who were selected randomly from Saudi households. This sample covered all the different regions in the Kingdom. Face-to-face computer-administered interviews were conducted in the homes of the participants.

Results

The SNMHS implemented various quality procedures both before launching the survey as well as throughout the survey process, ensuring continuous quality improvement. This in turn guaranteed that the data collected by the SNMHS was robust and reliable.

Survey Cycle

Quality assurance, which begins at the start of a survey and continues on during the later stages, included forming operational team, finalizing sampling methods, carrying out translation of survey instrument, training of survey team, cognitive interviews, pilot study and quality audit from the Office of Research Affairs, KFSH&RC. .

Quality Monitoring & Control Tools

Quality monitoring and control (QC) procedures included quality control cube, WebTrak (sample management system), verification, evaluation of interviewers, and interventions for field interviewer when they breached protocol.

The Survey Team

The QC appraisal process included documentation of process protocols and feedback exchange between all members of the survey team to improve the survey process.

Discussion

Survey quality management is a process and not reducible to a single event. Midstream corrections are warranted by detecting problems and intervening appropriately. As the SNMHS was the first national mental health household survey in KSA, it experienced several challenges. However, we surpassed these challenges by continuously recruiting to build a strong field team and training the interviewers to convince respondents to participate in the national survey. Prospective studies should consider employing computer-assisted instruments, as their success has been recorded in literature.

Conclusion

Developing a strong QC team, alongside adopting and employing well-established and efficient QC tools to manage quality procedures should be a high priority. The quality procedures implemented by the SNMHS are one of its greatest achievements. We hope that its findings will better serve the country’s mental health needs and guide health policy-makers to implement preventative measures and provide appropriate care to the public.