ABSTRACT
A meta-analysis of pathway studies indicates an approximately equal initial choice of biomedical and alternative mental health care pathways in sub-Saharan Africa. However, regional variations can also be observed. For instance, while studies from West and Eastern Africa report that more than half of patients initially took the alternative care pathways before arriving at biomedical psychiatric facilities, the reverse appears to be the case in southern Africa. However, these studies dealt mostly with clinical samples that eventually presented at biomedical psychiatric services. Given that pathways taken by many distressed persons do not lead to or end at such formal services, the study of a non-clinical sample becomes significant. This found mixed treatment preferences with more than half of the respondents endorsing each of the three (traditional, spiritual, biomedical) treatment models but significantly greater preference for the biomedical treatment pathway. While the findings could be interpreted as reflecting a paradigm shift from the earlier prevalence of superstitious conceptualisations of mental illness to increasing scientific understanding, possibly based on improved mental health literacy, there may also be a case of discrepancy between attitude (high endorsement of the biomedical psychiatry in a non-clinical situation) and behaviour (actual patronage of a care provider in a clinical situation) informed by the social desirability factor.
