title: User-generated quality standards for youth mental health in primary care: a participatory research design using mixed methods.
abstract: OBJECTIVE
  To develop user-generated quality standards for young people with mental health problems in primary care using a participatory research model.
  
  
  METHODS
  50 young people aged 16-25 from community settings and primary care participated in focus groups and interviews about their views and experiences of seeking help for mental health problems in primary care, cofacilitated by young service users and repeated to ensure respondent validation. A second group of young people also aged 16-25 who had sought help for any mental health problem from primary care or secondary care within the last 5 years were trained as focus groups cofacilitators (n=12) developed the quality standards from the qualitative data and participated in four nominal groups (n=28).
  
  
  RESULTS
  46 quality standards were developed and ranked by young service users. Agreement was defined as 100% of scores within a two-point region. Group consensus existed for 16 quality standards representing the following aspects of primary care: better advertising and information (three); improved competence through mental health training and skill mix within the practice (two); alternatives to medication (three); improved referral protocol (three); and specific questions and reassurances (five). Alternatives to medication and specific questions and reassurances are aspects of quality which have not been previously reported.
  
  
  CONCLUSIONS
  We have demonstrated the feasibility of using participatory research methods in order to develop user-generated quality standards. The development of patient-generated quality standards may offer a more formal method of incorporating the views of service users into quality improvement initiatives. This method can be adapted for generating quality standards applicable to other patient groups.
authors.affiliation: Florence Nightingale School of Nursing and Midwifery, King's College London, London, UK.
authors.forename: Tanya
authors.initials: T
authors.lastname: Graham
authors.affiliation: Health Services and Population Research Department, Institute of Psychiatry, King's College London, London, UK.
authors.forename: Diana
authors.initials: D
authors.lastname: Rose
authors.affiliation: Health Services and Population Research Department, Institute of Psychiatry, King's College London, London, UK.
authors.forename: Joanna
authors.initials: J
authors.lastname: Murray
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, School of Medicine, London, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Ashworth
authors.affiliation: Health Services and Population Research Department, Institute of Psychiatry, King's College London, London, UK.
authors.forename: André
authors.initials: A
authors.lastname: Tylee
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D017144:Focus Groups; D006302:Health Services Research; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008605:Mental Health Services / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D011787:Quality of Health Care
keywords: Health services research; Mental health; Primary care; Qualitative research; Quality improvement methodologies; Quality standards; User involvement; Young people