Table 4.
Manuscript-level research agenda
| Gap | Why it matters | Suggested next study design |
|---|---|---|
| Validated measurement | Most studies classify barriers or quantify utilization but do not measure Levesque dimensions with validated scales; broader applications also often represent the framework only partially (12), and adult UK mental health research is dominated by utilization rather than need, perception, or consequences (13). | Develop and validate population-sensitive Levesque instruments for mental health access, including perinatal, older-adult, and youth modules that distinguish potential access from realized access. |
| Supply-side operationalization | Approachability, acceptability, availability, affordability, and appropriateness are often discussed but not measured as service characteristics. | Link patient surveys with service audits, workforce data, referral metrics, cost data, and cultural safety indicators. |
| Interaction of dimensions | Barriers rarely operate in isolation; stigma, affordability, transport, and service fit may compound each other. | Use longitudinal pathway models, mixed methods, and causal diagrams to examine how dimensions interact over time. |
| Equity and intersectionality | Marginalised groups face compounded barriers that can be obscured by single-axis analyses; underrecorded or underexamined characteristics and missing routine demographic data can hide inequalities (13). | Design studies powered or purposively sampled for intersections of race, migration, language, age, gender, rurality, disability, income, religion, sexual orientation, and social capital; improve routine data completeness and patient self-report. |
| Intervention evaluation | Many proposed facilitators are descriptive rather than tested. | Evaluate integrated care, navigation, screening-to-referral pathways, digital tools, and culturally responsive training using access outcomes at multiple stages. |
| Framework fidelity and completeness | Incomplete or post hoc use limits comparability and may obscure the paired service–population structure of the framework. | Report a priori versus post hoc use, operational definitions, coding rules, modifications, overlapping dimensions, and whether all ten components were examined. |
| Representation of affected people | Caregiver, professional, and organizational accounts may describe different aspects of access from affected people’s own experiences; population-specific evidence is not necessarily first-person evidence. | Distinguish service users, informants, and decision-makers. Use accessible direct participation and separate or dyadic interviews; examine divergent accounts and include people who have not reached services. |