Instruments to assess the impact of QualityRights on professional attitudes and practices
In the strategy for change and transformation of mental health services to ensure respect for quality rights ( QualityRights), it is essential to conduct pre- and post-implementation assessments to identify and eliminate poor-quality care and rights violations, and to evaluate the impact of the implemented actions. The World Health Organization (WHO) offers a Toolkit , available in Spanish, with best practices and tools for assessing and improving quality and human rights standards in mental health and social care facilities. This toolkit is based on the United Nations Convention on the Rights of Persons with Disabilities and provides practical guidance on:
- Human rights and quality standards that must be respected, protected and fulfilled in mental health and social care centers, both for hospitalized people and those cared for in community settings.
- Prepare and carry out a comprehensive evaluation of the centers.
- Report on the results and make appropriate recommendations based on the evaluation.
These are instruments designed to support countries and their mental health services in their compliance with international human rights standards.
Foster a culture of service based on human rights
These tools can be used by different organizations, including specialized evaluation committees, non-governmental organizations, national human rights institutions, national health or mental health commissions, health service accreditation bodies and national mechanisms established under international treaties to monitor the implementation of human rights standards and other stakeholders in promoting the rights of persons with disabilities.
Validated tools
A study was recently published (Moro et al., 2024) with the aim of validating the reliability of the tools designed by the WHO that aim to assess changes in attitudes, and specifically with a look at attitudes towards people with disabilities in their role as rights holders, although this aspect is fundamental to achieving full participation in society, as well as the impact of knowledge and attitudes on changing practices.
The study includes the analysis carried out on the validity and reliability of three instruments from the World Health Organization:
- The QualityRights Knowledge (WHO QR Knowledge) questionnaire measures knowledge about the rights of people with psychosocial disabilities and mental health conditions as outlined in the UN CRPD. This instrument includes questions about the meaning of different rights, their application or violation, and the obligations of states. It is a dichotomous questionnaire (respondents must judge whether the statements are true or false).
- The QualityRights Attitudes Questionnaire (WHO QR Attitudes) measures attitudes toward people with psychosocial disabilities or mental health conditions as rights holders. This instrument consists of items organized into three subscales: Subscale 1 includes questions about attitudes toward the approach to mental health services; Subscale 2 includes questions about attitudes toward involuntary and coercive practices; and Subscale 3 includes questions about attitudes toward people with psychosocial disabilities or mental health conditions as decision-makers and full members of society.
- The QualityRights Practices questionnaire (WHO practices on the rights of persons with disabilities) measures practices related to surrogate decision-making and coercion in mental health units. This instrument is divided into two subscales. The first subscale measures how frequently the respondent has used practices such as isolation or restraints in the past three months. The second subscale assesses the level of agreement between respondents and mental health professionals working in their units regarding the use of practices related to surrogate decision-making and coercion.
The study was conducted in Ghana as part of the European Commission-funded project Empowering people with psychosocial disabilities to fight for their rights: an implementation of the CRPD and QualityRights principles in Ghana, Lebanon and Armenia .
The analyses carried out in this study indicate that "the three questionnaires are valid and reliable instruments for assessing knowledge about the rights of people with mental health problems and psychosocial disabilities, attitudes towards their role as rights holders and the practices of mental health professionals related to substitute decision-making and coercion."
According to the authors, the questionnaires demonstrated "excellent content validity. Their items were found to be consistent with the content area, clear, easy to understand, and worthy of inclusion in the instruments. Only one item from the WHO QR knowledge questionnaire was deemed inappropriate and was removed. Face validity was also high, with stakeholders from the general population reporting that the items were clear, easy to understand, and worthy of inclusion in the questionnaires. This indicates that the questionnaires contain clear and relevant questions that reflect the domains of interest."
