Unpacking Access to Mental Health Care through the Levesque's Framework: A Conceptual and Thematic Scoping Review

This scoping review is conducted as part of the Horizon Europe project “Community-driven Healthcare Access and Mental Health Promotion for Inclusive, Equitable, and Resilient European Societies (EQUICARES; Grant Agreement No. 101156500) and focuses on how the Levesque's Conceptual Framework for Access to Healthcare has been applied, conceptualized, and operationalized in mental health research. The review aims to generate empirical and conceptual clarity on the ten dimensions of the framework five supply-side dimensions (approachability, acceptability, availability and accommodation, affordability, appropriateness) and five demand-side dimensions (ability to perceive, ability to seek, ability to reach, ability to pay, ability to engage)—in the context of access to mental health and care services. Despite the increasing use of the Levesque's Framework in health systems research, there remains a lack of consistency in how its dimensions are defined and measured, particularly in mental health contexts. This study addresses that gap by systematically identifying: 1. Which dimensions have been included in the studies 2. How these dimensions have been conceptually framed 3. Which sub-concepts or thematic elements have been associated with each dimension 4. How these concepts have been operationalized (e.g., indicators, qualitative codes, questionnaire items) The review distinguishes between studies that use the framework a priori (to guide data collection or study design) and those that apply it a posteriori (for data interpretation or thematic structuring), to capture variation in usage patterns. Purpose: 1. To explore how each dimension of the Levesque Framework has been conceptualized in mental health access studies 2. To identify the concepts commonly linked to each dimension 3. To document how these concepts have been operationalized (qualitatively or quantitatively) 4. To generate a conceptual map of dimensions, concepts, and their interrelations 5. To prepare a preliminary codebook draft that defines each concept, illustrates its scope, and compiles examples of measurement approaches 6. To inform the development of more structured and valid tools for assessing access to mental health care, particularly within the EQUICARES project Expected Outcomes: 1. A structured conceptual map showing relationships between framework dimensions, sub-concepts, and overlapping constructs 2. A detailed codebook draft including definitions and example indicators or measurement approaches for each concept 3. A synthesis of how the Levesque's Framework has been applied (a priori vs. a posteriori), including which dimensions are overrepresented or underexplored 4. Foundations for the development of a multi-dimensional tool to assess access to mental health care.