Sociodemographic and Geographic Influences of Mental Health Literacy: A Cross-Sectional Survey Among Community Health Clinic Attendees in Tshwane, South Africa

TL;DR

This study explores how sociodemographic and geographic factors affect mental health literacy among clinic attendees in Tshwane, South Africa.

Contribution

The study identifies urban vs. township disparities in mental health disorder recognition and understanding.

Findings

Urban clinic attendees were more likely to correctly identify mental disorders than township attendees.

Education level and gender significantly predicted accurate recognition and understanding of mental health causes.

Abstract

Background: Mental health literacy remains low in South Africa, particularly in nonurban settings. This study aims to determine the sociodemographic and geographic influences of mental health literacy among community health clinic attendees. Methods: This study used secondary data which adopted a cross-sectional study design and was conducted between November 2019 and January 2020. A total of 385 participants were recruited through convenience sampling, with approximately 77 individuals per clinic across five sites. A two-part questionnaire was used, where part A included demographic information and part B consisted of the three fictive clinical case studies which measured the participants’ mental health literacy. The participants’ responses regarding disorder recognition and perceived causes were analyzed via Pearson’s chi-square tests. Using three fictive cases with clinical pictures indicative of mental depressive disorder, schizophrenia and general anxiety disorder, the following were assessed: (1) what type of illness do you think the person is suffering from, and (2) what do you think causes the persons’ suffering? To identify predictors of recognition and perceived causes, hierarchical logistic regression was performed. Statistical significance was set at p < 0.05. All analyses were conducted via STATA version 18.1 (StataCorp, College Station, TX, USA). Results: The mean age of the study participants was 37.39 ± 11.14 years (range: 13–80). Factors such as geographic location, gender and level of education were significant predictors of recognition. Participants attending urban clinics were more likely to correctly identify correct mental disorders than those attending township clinics were [OR = 0.32; 95% CI: (0.11, 0.93); Wald χ2(1): 4.3681; p value = 0.036]. For correct causes, significant predictors included gender, education level, and geographic location. Urban clinic attendees were significantly more accurate at identifying the correct cause of mental disorders than township attendees [OR = 0.42; 95% CI: (0.21, 0.83); Wald χ2(1): 6.1504; p value = 0.013]. Conclusions: Mental health literacy in Tshwane community healthcare clinics reflects deep-rooted sociodemographic and geographic inequalities. Strengthening township clinic capacity, integrating culturally relevant health education, and prioritizing gender-sensitive outreach are essential to improve the recognition and understanding of mental disorders in underserved communities.