752805 HPQ0010.1177/1359105317752805Journal of Health Psychologyde-Graft Aikins
research-article2018
Article
Journal of Health Psychology
Health psychology in Ghana:  2018, Vol. 23(3) 425– 441© The Author(s) 2018
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origins of a young sub-field and its journals.sagepub.com/home/hpq
future prospects
Ama de-Graft Aikins
Abstract
This article presents a historical overview of psychology applied to health and health psychology in Ghana. A 
brief history of health, illness and healthcare in Ghana is introduced. Then, the history of psychology in Ghana 
is presented, with signposts of the major turns in the field in relation to psychology and other disciplines 
applied to health and the emergence of health psychology as a sub-field. Selected health psychology studies 
are reviewed to highlight ideological trends in the field. Finally, future prospects are considered in terms of 
how the sub-field can transition into an established critical field with unique contributions to make to global 
health psychology.
Keywords
anthropology, clinical psychology, critical health psychology, Ghana, health policy
Introduction
Health psychology in Ghana is a young sub-field, for tracking the evolution and scope of 
compared to sub-fields like social psychology psychology applied to health and of health psy-
and clinical psychology which were developed in chology. Part two focuses on a general history of 
the 1960s and 1970s. Its arrival in Ghana was sig- psychology in Ghana, signposting the major 
nalled professionally with publications in the turns in the field in relation to health and mental 
early 2000s. However, psychology applied to health, including the emergence of health psy-
health has a much longer history alongside a chology. Health psychology research trends are 
broader field of health research within the medi- examined in terms of leanings towards main-
cal, health and social sciences in Ghana (de-Graft stream or critical health psychology, drawing on 
Aikins, Ofori-Atta and Dzokoto, 2014; Van Der working definitions of health psychology 
Geest and Krause, 2012 [2013]). In this three-part 
article, a historical overview is presented of psy- University of Ghana, Ghana
chology applied to health and health psychology 
in Ghana, and the future prospects of a Ghanaian Corresponding author:
Ama de-Graft Aikins, Regional Institute for Population 
health psychology are considered. Studies, University of Ghana, P.O.Box LG96, Legon, 
Part one presents a brief history of health, ill- Ghana 
ness and healthcare in Ghana and sets the context Email: adaikins@ug.edu.gh
426 Journal of Health Psychology 23(3)
Box 1. Working definitions of health psychology, mainstream health psychology and critical health 
psychology.
Health psychology
Mattarazzo (1982) defined health psychology as intra-disciplinary sub-field and as an ‘aggregate of 
the specific educational, scientific and professional contributions of the discipline of psychology to 
the promotion and maintenance of health, the prevention and treatment of illness, the identification 
of etiologic and diagnostic correlates of health, illness and related dysfunction, and the analysis and 
improvement of the health care system and health policy formation’ (p. 4). Marks et al. (2010) offer this 
broader definition of health psychology as ‘an interdisciplinary field concerned with the application of 
psychological knowledge and techniques to health, illness and health care’ (p. 11).
The definition by Marks et al. (2010), which focuses on interdisciplinarity, is used as the broad working 
definition in this article. The definition by Mattarazzo (1982) which focuses on intra-disciplinarity is 
applied to the category of studies labelled ‘psychology applied to health in Ghana’. This category refers 
to the application of sub-fields of psychology – such as social, clinical and community psychology – to 
research on health, illness, healthcare and associated empirical problems. A distinguishing feature of 
‘psychology applied to health’ in Ghana is that research in this area is conducted: (1) by psychologists 
who do not explicitly define themselves as health psychologists or (2) by psychologists who have not 
received training in health psychology.
Mainstream health psychology
Marks (1996) offered a seven-point critique of mainstream psychology which is still valid 20 years on. 
He argued that mainstream health psychology: (1) offered derivative theories (e.g. social cognition 
models) decontexualized from the ‘real world of health and social care’; (2) had a predominantly clinical 
focus despite its endorsement of the biopsychosocial model; (3) was individualistic and problematically 
excluded broader societal political, economic and cultural factors in health analysis and intervention; 
(4) projected ‘value free’ ‘apolitical’ ‘scientific’ aspirations detached from social policy; (5) failed to 
develop ‘appropriate measures’ and methods for diverse contexts; (6) failed to deal with inequalities; 
and (7) lacked appropriate training models, such as the scientist–practitioner model.
Critical health psychology
Marks (1996) and other critics of mainstream health psychology (cf. Crossley, 2000; Hepworth, 2006) 
asserted that critical health psychology aimed to address the limitations of mainstream health psychology 
by: offering a more integrated biopsychosocial model; adopting a multilevel approach that theorized 
the individual, social, cultural, economic and political contexts of health and illness; applying context-
specific measures and methods; addressing problematic expert assumptions, ideologies and systems; and 
operationalizing a scientist–practitioner model that underscored accountability in research.
(Marks et al., 2010; Mattarazzo, 1982), main- called Ghana was divided into four territories: 
stream health psychology (Marks, 1996) and the Gold Coast and Asante Protectorate covered 
critical health psychology (Crossley, 2000; the southern central/western coast and middle 
Marks, 1996) (see Box 1). In part three, the belt of present day Ghana; British Mandated 
future prospects of health psychology in Ghana Togoland covered the eastern coast, and the 
are considered in terms of its ideological focus Northern Territories covered the three northern 
and its contribution to global health psychology. regions. Many of the ethno-linguistic groups 
making up the current Ghanaian population are 
Health, illness and healthcare reported to have been settled in these territories 
in Ghana: an introduction by the end of the 16th century. Ghana, like 
much of Africa, has been historically associated 
Ghana was the first sub-Saharan African coun- with a high burden of infectious diseases. Even 
try to gain political independence, from the so, chronic diseases like cancer of the liver and 
British, in 1957. During the colonial era, span- sickle cell disease were reported by lay com-
ning 1867 to 1957, the geographical area now munities and in European medical and 
de-Graft Aikins 427
travellers’ records in the 19th century (Addae, including Chinese and Indian therapies) compete 
1996). When the first major hospital, the Gold with biomedical systems to provide healthcare 
Coast hospital – now the Korle-Bu Teaching for Ghanaians (de-Graft Aikins and Koram, 
Hospital – was built in Accra in 1924, records 2017). In many parts of the country, ethno-medi-
included stroke cases. In 1955, a social survey cine, religious healers and CAM are the first port 
of Accra documented infectious and parasitic of call for people with minor or serious health 
diseases, diseases of infancy, respiratory sys- conditions. Their professional emphasis on cur-
tems, digestive systems, nervous systems, old ing all conditions has been criticized as unethi-
age, circulatory systems, pregnancy and inju- cal, and aspects of their treatment repertoires 
ries resulting from violence as the major causes – such as prescribing untested herbal medicines 
of death (Acquah, 1958). Sixty years on Ghana’s and endorsing fasting – have led to iatrogenic 
public health burden is characterized by this outcomes including disease complications and 
double burden of infectious and chronic dis- premature deaths (de-Graft Aikins, 2005; 
eases. There is a growing prevalence of chronic Kretchy et al., 2014; Read et al., 2009). There are 
physical, mental health and neurodegenerative problematic tensions between expert and lay 
conditions such as diabetes, hypertension, can- understandings of health conditions, illness prac-
cers, depression and dementia. The burden of tices, healthcare and social support. These ten-
these chronic non-communicable diseases sions compound the challenges inherent in a 
(NCDs) co-exists with a persistent burden of top-down instrumentalist approach to healthcare 
infectious diseases like malaria, tuberculosis in the country, which is itself a product of une-
and HIV/AIDS and neglected tropical diseases qual and inequitable relations between national 
(NTDs) like Buruli ulcer and shistosomiasis1 health policymakers and powerful actors in 
(de-Graft Aikins and Koram, 2017). This dou- global development and health communities.
ble burden of disease has been attributed to There is a long history of health research and 
multifaceted factors. These include internal fac- the development of health interventions and pol-
tors like population ageing, urbanization, urban icy dating to Ghana’s colonial era. Earlier 
wealth, urban and rural poverty and western- research was dominated by medicine and the 
ized diets and external factors like food market health sciences, as the focus was on the epidemi-
globalization and the political economy of ology, clinical and public health aspects of dis-
global health financing and policies (Agyei- eases. The field has evolved and expanded to 
Mensah and de-Graft Aikins, 2010). include the social sciences (anthropology, sociol-
Ghana’s formal biomedical system is under- ogy, social work, social policy, psychology) and 
resourced and overstretched and healthcare the humanities (linguistics, theatre arts). These 
remains inaccessible and inequitable for many. shifts have occurred as the socio-cultural, reli-
Due to a long history of engagement with infec- gious, economic and political aspects of health, 
tious disease, biomedical systems are ideologi- illness and healthcare in Ghana have come to the 
cally oriented towards privileging time-limited fore. The evolution of psychology applied to 
treatment and cure over prevention and long- health and health psychology has been situated 
term illness management. As a result, public within this multidisciplinary context.
health education is poor and the prevalence rates 
of preventable infectious and chronic conditions Psychology in Ghana: trends 
continue to grow exponentially, as are rates of from the colonial era to 
disability and premature deaths from conditions present
which are managed better in countries with 
stronger health systems. Ethno-medical and reli- The first psychology department in Ghana – and 
gious healing systems (including herbalists, faith the West African sub-region – was established in 
healing centres and prayer camps) and comple- 1967 at the University of Ghana (UG), the coun-
mentary and alternative medicine (CAM, try’s oldest public university. However, the 
428 Journal of Health Psychology 23(3)
teaching of psychology at the university began The historian of psychology, Graham 
4 years earlier in 1963 at UG’s Department of Richards (1997), notes that there were three 
Sociology with a social psychology course taught ideological camps in Euro-American psychol-
by a European expatriate faculty, including the ogy in the colonial era: the racist, anti-racist and 
British-trained Austrian social psychologist ‘somewhere in between’. Some of the cogni-
Gustav Jahoda. Cyril E Fiscian, the first Ghanaian tive/perceptual studies in Gold Coast/Ghana 
to receive a doctorate in social psychology from fell under the racist category; while the work of 
the United Kingdom (London School of some anthropologists fell under the anti-racist 
Economics and Political Science (LSE)) was the category.2 The goal of these studies – like the 
first head of UG’s Psychology Department. intelligence studies that were conducted across 
Jahoda facilitated the development of undergrad- Africa at the time – was to highlight cultural 
uate courses leading to a BA or BS in psychology, and racial differences in cognitive processes, as 
which included social, experimental, develop- well as underscore the superiority of Euro-
mental, industrial, clinical, educational psychol- American cognitive processes. Many of these 
ogy and methods (including statistics, tests and were conceptually and methodologically flawed 
measurements, and psychometrics). Samuel and/or inconclusive, and received robust cri-
Danquah, the first Ghanaian clinical psychologist tiques from researchers who argued for a cul-
trained in the United Kingdom (at the University tural and environmental, rather than 
of Wales), established a master’s programme in psychological and genetic, analysis of cognitive 
clinical psychology/behavioural therapy in 1974. behaviour (Cryns, 1962; Fortes, 1981).
There was a longer history of field-based The 1930s to 1960s also constituted a period 
psychological (and psychiatric) research dating during which psychiatrists and anthropologists 
back at least three decades. In the 1930s, the conducted research on mental health and mental 
British psychologist WM Beveridge (1939) health institutions3 in the Gold Coast (Field, 
published research on perception conducted 1937, 1958, 1960; Forster, 1960; Tooth, 1950; 
with young male students of the Presbyterian Weinberg, 1964, 1965) Fortes expanded his 
Training College in Akropong, the Gold Coast’s work to focus on the drivers of psychosis in 
first teacher training college established in Tallensi communities (Fortes and Mayer, 1966). 
1848. In the 1920s and 1930s, the British Margaret Field (1937, 1959, 1960), a British 
anthropologist Meyer Fortes (1981), who ethno-psychiatrist, conducted health and mental 
trained originally as a psychologist, conducted health ethnographic work among the Ga commu-
research on cognitive behaviour among Tallensi nities of the southern coast and Asante communi-
communities of the then Northern Territories. ties of the middle belt. Notably, Field’s (1958) 
Fortes’ approach blended psychological and work with women seeking help in Ashanti tradi-
anthropological theories and methods, in a tional shrines produced a socio-psychological 
framework akin to cultural psychology today. theory of witchcraft aligned with biographical 
The period spanning the colonial years until theories of chronic illness in social psychology 
the 1960s in sub-Saharan Africa was regarded and medical sociology (de-Graft Aikins, 2015). 
as the era of Euro-American psychologists Despite a popular narrative within colonial psy-
(Gupta, 1995; Wober, 1975). This was also the chiatry and mental health research that severe 
case in the Gold Coast/Ghana, where Euro- mental illnesses were rare among African popu-
American psychologists conducted research in lations, these rural and urban community-based 
cognitive psychology and developmental psy- surveys and analysis of institutional data sug-
chology on themes including racial differences gested a relatively high prevalence of depres-
in perception, pictorial depth perception in chil- sion, manic-depression and suicide attempts due 
dren, the social and psychological aspects of to extreme mental distress.
education and the development of self-concepts In Gold Coast/Ghana, cross-disciplinary 
among children (de-Graft Aikins et al., 2014a). meetings and workshops were held, which 
de-Graft Aikins 429
explored synergies between psychology, Ghana’s first sociology journal. Fiscian is 
anthropology and history. Darkwah et al. (2014) reported to have contributed an article on 
in their history of sociology in Ghana describe ‘crime and illness’ in the journal’s first volume 
the cross-disciplinary environment in which in 1962 (Darkwah et al., 2014).
UG sociology students were trained: The era of Ghanaian psychologists emerged 
in the 1970s with the work of Samuel Danquah 
students went to dinner on alternate Tuesdays at on psychological problems among children 
Dr Jahoda’s house where they met numerous and youth (cf. Danquah, 1975, 1979). 
dignitaries. These students were also exposed to Throughout the 1980s, Danquah was the sole 
the ideas of key scholars of the time such as Ghanaian psychologist publishing on Ghana in 
Melville Herskovits, Meyer Fortes and Evans a field still dominated by Euro-American 
Pritchard all of whom came in person to share psychologists.
their ideas with the students. These intimate 
The lack of research and publications by 
relationships inspired them to work hard to 
undertake post-graduate studies and become part Ghanaian psychologists – and indeed academ-
of that intellectual environment. (p. 98) ics from other disciplines – during the 1970s 
and 1980s has been partly attributed to the 
The consensus by chroniclers of psycholo- political and economic upheavals in Ghana. 
gy’s development in post-colonial Africa was During these ‘lost decades’ (as African politi-
that the 1970s would be the era of African psy- cal scientists have termed the period), a succes-
chologists (LeVine, 1970; Wober, 1975). sion of military coups and government 
Mallory Wober (1975), in a review of social overthrows followed by the introduction of 
psychology in colonial Africa, predicted this structural adjustment programmes (SAPs) by 
time would be when: the World Bank and International Monetary 
Fund (IMF) led to political unrest and deepen-
psychology in Africa [turned] a corner, in that ing job insecurity. The brain drain phenomenon 
[the discipline would] be increasingly in the emerged as several Ghanaian academics 
hands of new people, its own people, with their migrated from Ghana to other African coun-
own outlooks, needs and direction of enquiry. tries and to Europe and North America 
(pp. ix–x) (Agbodeka, 1998; Agyei-Mensah and de-Graft 
Aikins, 2010; Darkwah et al., 2014). Academics 
In many African countries, including Ghana, remaining carried multiple burdens of adminis-
the role of African psychologists in the produc- tration, teaching and research, with restricted 
tion of psychological research on Africans did resources and rewards. The early promise of 
not emerge until much later, even where the critical multidisciplinary scholarship in 
administration of psychology departments was Ghanaian public universities was crushed in an 
turned over to qualified Africans. In Ghana, increasingly under-resourced, undervalued and 
research by Euro-American psychologists con- politically precarious academic environment. 
tinued between the 1960s and 1970s, and this For example, academic journals at the UG, 
was dominated by research from Gustav which were established in the 1960s with great 
Jahoda, who published almost 60 percent of the excitement and participation by local and inter-
total output of papers (de-Graft Aikins et al., national contributors, ceased publication in the 
2014a). Jahoda’s research was wide ranging 1970s and 1980s due to lack of finance, staff-
and, crucially, introduced the first themes of ing and time. The aforementioned Acta 
health and qualitative research approaches to Sociologica, which was later renamed the 
health within the broader psychology field in Ghana Journal of Sociology, went the way of 
Ghana (cf. Jahoda, 1961). Cyril E Fiscian, the other UG journals, ceasing publication in 1977 
first head of UG’s Psychology Department, after a 15-year run, with two 3-year breaks 
was also the first editor of Acta Sociologica, (1962–1965 and 1971–1974).
430 Journal of Health Psychology 23(3)
Public health, mental health and This early collaborative work, and engage-
clinical psychology after 1980 ment with the MOH, grew into an advocacy 
movement – spanning a decade and a half – to 
During the 1980s and 1990s, health research integrate clinical and social psychology into for-
projects and interventions in the fields of medi- mal healthcare delivery. A major initiative was 
cine, health sciences and health policy were the establishment of the Psych Corps Programme 
informed partly by global psychological theo- in 2012, which seconded psychology graduates 
ries and concepts. For example, early public to regional hospitals to support institutional and 
health interventions on HIV/AIDS in Ghana community mental healthcare delivery. At a 
were informed by knowledge–attitude–behav- broader organizational level, the Ghana 
iour models derived from social cognition mod- Psychological Association (GPA) was revived in 
els in psychology, as was the case in other 2012. GPA had been established in the 1990s to 
African countries (Kalipeni et al., 2003; Yen provide leadership to a growing community of 
and Vaccarino, 2017). psychologists being trained in public universities 
A growing consciousness about psychology beyond UG. However, leadership and financial 
within the Ghanaian health professional and challenges forced GPA into dormancy for over 
policy community coincided with the emer- two decades. This period also saw advocacy for 
gence of a new wave of Ghanaian psychologists, the development of policies for disability 
trained in the sub-fields of clinical psychology, (Persons with Disability Act 715 launched in 
neuropsychology and cognitive psychology. 2006), ageing (National Ageing Policy, 2010), 
Ghana’s first and second female clinical psy- mental healthcare (Ghana Mental Health Act 
chologists – Araba Sefa-Dedeh, trained in the 846, 2012) and chronic NCDs (National Policy 
United States and Angela Ofori-Atta trained in for the Prevention and Control of Chronic Non-
Canada – joined UG’s Department of Psychiatry, Communicable Diseases, 2012). In 2013, the 
in 1980 and 1992, respectively. They taught Health Professions Regulatory Bodies Act 857 
medical students and collaborated with Samuel was passed. Act 857 included provision for the 
Danquah in strengthening the graduate pro- establishment of a Ghana Psychology Council 
gramme in clinical psychology at UG’s (GPC) as a body that certified and regulated psy-
Psychology Department. Sefa-Dedeh and Ofori- chology practitioners and aimed ‘to secure in the 
Atta were physically based at the Accra public interest the highest standards in the train-
Psychiatric Hospital, where they provided clini- ing and practice of applied psychology’ (p. 54). 
cal assessments, counselling, clinical psychol- This Act supported the long-term fight to confer 
ogy training and community-based rehabilitation recognition on applied psychology as an allied 
work.4 They were consulted by the Ministry of health field. The development of the aforemen-
Health (MOH), the Ghana Health Service (GHS) tioned policies on disability, mental health, age-
and development partners working on commu- ing and NCDs involved contributions by the 
nity development, to deliver clinical care and to clinical psychology community, within a broader 
develop interventions in mental health to under- community of medical and social scientists, civil 
served communities. In the early 2000s, Ofori- society groups and non-governmental organiza-
Atta was a co-investigator in the Mental Health tions (NGOs).
and Poverty Project (MHaPP), a multicountry 
project funded by the UK development agency, The emergence of health psychology 
Department for International Development in Ghana
(DFID), which aimed to develop evidence-
based interventions and policy on the mental Health psychology emerged in Ghana in the 
health in Ghana, South Africa, Uganda and early 2000s. The first set of articles was based on 
Zambia (Flisher et al., 2007; Ofori-Atta et al., PhD research by the social psychologist Ama de-
2010). Graft Aikins (2005) – trained in the UK at the 
de-Graft Aikins 431
Figure 1. Evolution of health psychology in Ghana.
LSE – on the social representations of diabetes in Salifu Yendork). Doctoral research themes 
Ghana. This work applied concepts from the included social representations of HIV/AIDS 
social psychology of health and health psychol- (Baah-Odoom), psychological wellbeing of 
ogy and focused on the lived experience of dia- children affected by HIV/AIDS (Doku), psy-
betes within the contexts of family, community chological wellbeing of orphans (Salifu 
and pluralistic health systems. Over the next dec- Yendork) and street children (Oppong Asante), 
ade and a half, de-Graft Aikins conducted suicide (Osafo), diabetes (Amankwah-Poku) 
research on mental health (de-Graft Aikins and and youth sexual behaviour (Teye-Kwadjo).
Ofori-Atta, 2007) and on the community context Figure 1 presents a summary of the evolu-
of diabetes and cardiovascular disease risk, expe- tion of psychology applied to health and health 
rience and care (de-Graft Aikins et al., 2014a). psychology in Ghana, focusing on the patterns 
The next sets of articles appeared from 2009 of change with respect to groups of researchers, 
onwards and were also based on doctoral key researchers and important milestones from 
research by a cohort of seven researchers based the 1930s to present. Table 1 presents a sum-
at UG’s Department of Psychology and trained mary of research under the categories of psy-
in mental health and wellbeing (Paul Narh chology applied to health and health psychology, 
Doku), health science (Joseph Osafo) and dating from the 1970s (‘era of the Ghanaian 
health psychology (Margaret Amankwah-Poku, psychologists’) to present. The summary is 
Dinah Baah-Odoom, Kwaku Oppong Asante, based on an evolving bibliographic database on 
Enoch Teye-Kwadjo and Joana Salifu Yendork). psychology research in Ghana, aspects of which 
Three health psychologists were trained in the have been published elsewhere (de-Graft Aikins 
United Kingdom (Paul Narh Doku, Dinah et al., 2014a; de-Graft Aikins, 2014).
Baah-Odoom, Margaret Amankwah-Poku) one To examine the ideological focus of health 
in Norway (Joseph Osafo), and the remaining psychology research in Ghana, 25 selected publi-
three in South African universities (Kwaku cations produced by seven health psychologists 
Oppong Asante, Enoch Teye-Kwadjo, Joana based at UG were analysed. The publications 
432 Journal of Health Psychology 23(3)
were based on researchers’ doctoral theses and lack of good fit between conceptual frameworks 
on pre- and post-doctoral research for which they (where clearly defined or inferred), analytical 
were lead authors or co-authors. The analysis method (e.g. interpretative phenomenological 
focused on thematic areas, conceptual frame- analysis (IPA) superficially applied), interpreta-
works, methods and analytical approaches of the tion (lacking in theoretical rigour) and practical 
reported studies (Supplementary Table 2 pre- policy impact (e.g. Asante, 2016; Osafo et al., 
sents a summary of the studies). Three types of 2015a, 2015b; Salifu Yendork and Somhlaba, 
research approaches emerged. 2015a; 2015b; 2015c; Salifu Yendork et al., 
The first set of reported studies (N = 10) were 2016). They belonged to the category of qualita-
informed by critical health psychology princi- tive descriptive studies, which Lambert and 
ples. The studies blended culturally sensitive Lambert (2012) observe are ‘the least “theoreti-
(mainly mixed qualitative) research with an cal” of all the qualitative approaches to research’ 
explicit concern for the development of practi- despite attempts to project ‘epistemological 
cal interventions and policy and attention to the credibility’ (p. 255). Two studies drew from 
challenges of health systems and health policy aforementioned mixed methods PhD theses 
implementation in Ghana (e.g. de-Graft Aikins, (Asante, 2015a; Salifu Yendork, 2014).
2002, 2003, 2005, 2006, de-Graft Aikins et al., Two key insights emerged from the analy-
2012, 2015; Osafo et al., 2011; Teye-Kwadjo sis. First, the impact of PhD training on capac-
et al., 2013). Seven studies were drawn from ity building in Ghanaian health psychology 
doctoral theses (de-Graft Aikins, 2005; Osafo, was clear. Of the 120 articles presented in 
2012) and a master’s thesis (Teye-Kwadjo, Table 1, 72 (60%) were categorized under 
2011) that were conceptually informed by criti- health psychology – these were sole and co-
cal (health) psychology. authored articles produced by the seven fea-
A second set of publications (N = 10) applied tured psychologists. Research themes covered 
mainstream health psychology approaches. important health problems in Ghana, although 
Studies drew on mainstream concepts and mod- studies were restricted to only four of Ghana’s 
els such as the health belief model, self-regula- 10 regions (see Supplementary Table 2). 
tion model and theory of planned behaviour in Second, the collective research output showed a 
conceptualizing their research problems (e.g. lack of shared ideological focus. The heteroge-
Kugbey et al., 2017; Teye-Kwadjo et al., 2016, neity of research approaches clearly stemmed 
2017), were explicitly clinically focused and from different graduate training traditions 
individualistic (Anim et al., 2016), applied quan- received by group members in their European 
titative methods to problems requiring mixed and South African institutions. However, the 
methods or phenomenological approaches (e.g. dominance of mainstream studies and the 
Baah-Odoom and Riley, 2013; Doku, 2009, emerging preference for descriptive qualitative 
Doku and Minnis, 2016; Riley and Baah-Odoom, study approaches in postdoctoral research pro-
2010; Teye-Kwadjo et al., 2016, 2017) and repli- jects presented a challenge for developing a 
cated studies conducted in ‘western communi- critical sub-field in the future.
ties’ without cultural validation of the tools (e.g. 
Doku, 2009). Seven studies were drawn from 
doctoral theses that were mainly quantitative Health psychology in Ghana: 
(Doku, 2012; Teye-Kwadjo, 2014) or applied transitioning to an established 
mixed quantitative-qualitative methods with a critical sub-field
quantitative bias (Baah-Odoom, 2009; Asante, 
2015a; Salifu Yendork, 2014). Cartwright (1979) described the successful 
A third set (N = 5) occupied a space between development of post second world war social 
mainstream and critical approaches. They were psychology in the United States, by European 
qualitative studies, but were characterized by a expatriate psychologists as follows:
de-Graft Aikins 433
Table 1. Health psychology and psychology applied to health in Ghana, 1970–2017.
Sub-fields and research themes No. Referencesa
Health psychology 72  
Child/adolescent health and 17 Asante (2015b, 2016a); Asante and Meyer-Weitz 
wellbeing (orphans, homeless and (2015aa, 2015b); Asante et al. (2015)a; Doku (2009a, 
street children) 2010aa, 2010b, 2016a, 2016b); Doku et al. (2015); 
Oti-Boadi (2009); Salifu Yendork and Somhlaba (2014; 
2015a; 2015ba; 2015c; 2016);
Chronic illness (experiences, 8 Anim et al. (2016)a; Asante (2012); Asante and Andoh-
perceptions, representations; Arthur (2015); Oti-Boadi and Asante (2017); Kugbey 
diabetes, mental illness, sickle cell et al. (2017)a; Mensah et al. (2015); Nyarko and Asante 
disease, HIV/AIDS); disability (2014); Salifu Yendork et al. (2016)a
Crimes, misdemeanours (abuse, 3 Quarshie et al. (2017); Parimah et al. (2016a, 2016b)
incest, violence)
Medical pluralism (traditional 5 Andoh-Arthur et al. (2015); Asamoah et al. (2014); 
medicine, faith healing, biomedicine Kretchy et al. (2016); Osafo (2016a); Osafo et al. 
and allied health); help seeking (2015)
Relationships (includes intimate 2 Asante et al. (2014); Doku and Asante (2015b);
partner violence)
Religion, health and wellbeing 3 Kpobi et al. (2017); Salifu Yendork and Somhlaba 
(2016); Salifu Yendork et al. (2017)
Sexual and reproductive behaviour 21 Ababio et al. (2017); Ananga et al. (2017); Asampong 
and health (includes HIV/AIDS) et al. (2013); Asante (2013); Asante and Oti-Boadi 
(adolescents, youth); maternal (2013); Asante and Doku (2010); Asante et al. (2014aa, 
health 2014b; 2016); Baah-Odoom and Riley (2010, 2012, 
2013a); de-Graft Aikins (2014)a; Doku et al. (2012); 
Osafo et al. (2014); Doku and Minnis (2016)a; Riley and 
Baah-Odoom (2010)a; Teye-Kwadjo et al. (2016, 2017a, 
2017b); Wilson et al. (2016)
Suicide (ideation, attempts, 13 Asante and Meyer-Weitz (2017); Asante et al. (2017); 
perceptions) Asare-Doku et al. (2017); Osafo (2016b); Osafo and 
Akotia (2015); Osafo et al. (2011aa, 2011b, 2012, 2013, 
2015, 2016, 2017a, 2017b)
Social and community psychology 21  
Health/illness knowledge, 7 Abor (2006); Cogan et al. (1996); de-Graft Aikins 
perceptions and representations (2002a, 2010, 2011); de-Graft Aikins et al. (2012)a; 
Borzekowski et al. (2006)
Illness experiences and 6 de-Graft Aikins (2003, 2005a, 2006a); de-Graft Aikins  
representations (Diabetes, HIV/ et al. (2015)a; Kratzer (2012); Okraku et al. (2009)
AIDS, Sickle-Cell)
Mental health/illness (depression, 5 Akotia and Anum (2014); de-Graft Aikins and Ofori-
psychosis, suicide) Atta (2007); De Menil et al. (2012); Hjelmeland et al. 
(2008); Knizec et al. (2011)
Road traffic safety behaviour 3 Anakwah et al. (2015); Teye-Kwadjo et al. (2013)a; 
(driving, transport laws and Teye-Kwadjo (2017)
interventions
Clinical psychology, neuropsychology 27  
Child/adolescent health and 6 Danquah (1975a, 1975b, 1975c, 1976, 1979a, 1979b)
wellbeing; psychological disorders 
(substance use)
 (Continued)
434 Journal of Health Psychology 23(3)
Table 1. (Continued)
Sub-fields and research themes No. Referencesa
Life stressors and (mental) health; 3 Appiah-Poku et al. (2004); Ofori-Atta and Linden 
representations; mental health (1995); Ofori-Atta et al. (2010a)
seeking behaviour
Mental health disorders 4 Eshun (1999, 2000, 2003); Turkson and Dua (1996)
(depression, suicide)
Mental Health Systems and Policy 9 Akpalu et al. (2010); Awenva et al. (2010); Bhana et al. 
(2010); Flisher et al. (2007); Kleintjes et al. (2013); Lund 
et al. (2010); Ofori-Atta et al. (2010b); Omar et al. 
(2010); Raja et al. (2010);
Scale validation and use (depression 2 Weobong et al. (2009); Wilson et al. (2017)
– postpartum, adult)
Other: Malnutrition and social/ 3 Appoh (2004); Appoh and Krekling (2004); Krafona 
emotional behaviour; addiction (2014).
 120  
aReviewed papers. All references provided in supplementary reference list.
when the war was over, the field was incomparably and the private sector’ akin to the ‘governmental 
different from what had been three or four years agencies, foundations and business firms’ of 
before. Prospects were bright, morale was high post-war US social psychology. Manpower and 
and social psychologists set about the task of finance referred to numbers of trained psycholo-
converting into reality their new vision of what gists and conditions of work and remuneration. 
social psychology might become. They 
In the case of Zambia, in the late 1980s, major 
established new research facilities … they began 
submitting research proposals to governmental challenges undermined these essential factors. 
agencies, foundations and business firms … they The dominant psychology in practice was 
organised doctoral programmes in most of the Eurocentric and inimical to a preferred African-
leading universities and within a few years had centred emancipatory psychology; the relation-
trained more social psychologists that there had ships between psychologists, universities, the 
been in the entire history of the field. And they government and private sector were weak, and 
began to publish large quantities of research. (pp. the low numbers of trained psychologists were 
84–85) poorly paid and thus forced into careers outside 
psychology (Peltzer and Bless, 1989). There was 
Peltzer and Bless (1989) made similar obser- no structured system of training psychologists to 
vations of the development of psychology in doctoral level or the enabling intellectual envi-
Zambia in the late 1980s when they attributed ronment for conducting and publishing ‘large 
prospects and challenges to three factors: ‘cul- quantities of research’.
ture’, ‘organisation’ and ‘manpower and finance’. Accounts of the status and challenges of 
Culture referred to the shared ideological vision p sychology in Ghana (de-Graft Aikins et al., 
of psychologists and, as Cartwright noted of the 2014a) and other countries, such as Cameroon 
US social psychologists, the ‘conversion into (Nsamenang et al., 2007), Nigeria (Eze, 1991) 
reality their new vision of what’ their kind of and South Africa (Yen and Vaccarino, 2017) dur-
psychology ‘might become’. Organisation ing the 1980s and 1990s, fit the Peltzer and Bless 
referred to the relationship between psycholo- (1989) model. While cultural, organizational and 
gists, their ‘university and government, different human resources challenges have been addressed 
departments and institutions in the university and for sub-fields like clinical psychology, these chal-
government as well as associations, parastatals lenges remain for health psychology in Ghana.
de-Graft Aikins 435
Identifying and addressing the culturally appropriate health psychology through 
challenges for health psychology in networking, mentoring and funded collaborative 
Ghana research (culture).
Within Ghana, there are practical models to 
There is no shared ideological vision of what guide the systematic development of health psy-
health psychology in Ghana should be, currently. chology. The scientist–practitioner clinical psy-
Research driven by critical health psychology chology model developed by Danquah, 
principles is conducted by a minority of psychol- Sefa-Dedeh and Ofori-Atta has trained over 200 
ogists. UG’s psychology department, where clinical psychology master’s students over the 
most of the Ghanaian health psychologists are last two decades. The majority of practicing psy-
based, has a mainstream quantitative bias. This chologists registered with GPC, including psy-
stifles efforts to create an enabling environment chologists with doctorates in health psychology, 
for mentoring and research support that empha- received training from the UG clinical psychol-
sizes doing and publishing critical health psy- ogy MPhil programme.5 Recent research reports 
chology research. While GPA is progressing that these practising psychologists share a train-
under stable leadership, it has focused largely on ing ideology as scientist–practitioners (de-Graft 
convening annual conferences and thematic Aikins et al., submitted). Another model focused 
meetings and has yet to develop chapters for on community-based health research and inter-
various active sub-fields including health psy- ventions has been developed by de-Graft Aikins. 
chology. GPC registers psychologists from the This has involved funding master’s and doctoral 
all sub-fields, but has not created a category for training for a multidisciplinary group of students 
health psychologists; registered health psycholo- – from population studies, social policy studies 
gists have been subsumed under the clinical psy- and social psychology – and has produced nine 
chology category. The establishment of a master’s and PhD theses examining different 
restructured PhD programme at the UG in 2013 facets of community health development in one 
has led to increased enrolment of graduate stu- urban poor community in Accra (de-Graft Aikins 
dents from UG and other Ghanaian universities et al., 2014b). The current phase of the capacity 
into psychology PhD programmes. However, building project is focused on social psychology 
these programmes focus on clinical, social and PhD training, with the theses-in-progress 
organizational psychology. An ‘official origin’ of informed by the critical psychology models of 
a sub-field, in many countries, often involves the community health development (Campbell and 
founding of a professional organization or a pro- Jovchelovitch, 2000) and of scholar-activist 
gramme to train the sub-group of psychologists. approaches (Campbell and Murray, 2004). These 
By this measure, health psychology in Ghana is models have informed successful projects on 
yet to gain official status. HIV/AIDS interventions in South Africa (e.g. 
What is required for Ghanaian health psychol- Campbell, 2003) and urban slum development in 
ogy to transition into an established critical sub- Brazil (e.g. Jovchelovitch and Priego-Hernandez, 
field is strong investment in the triad of culture, 2013).
organization and human resource/finance. This 
can be done by establishing health psychology 
chapters under the current GPA and GPC systems Conclusion: reflections on 
(organization), and developing graduate health the place of Ghanaian health 
psychology programmes as well as dedicated psychology in global health 
funding for doctoral and postdoctoral training psychology
(human resource and financing) and through 
these organizational and human resource capacity ‘What is African Psychology the psychology 
building interventions can support the develop- of?’ asks Augustine Nwoye (2015) in a paper 
ment shared vision of a community-centred and that revisits recurrent themes and tensions in 
436 Journal of Health Psychology 23(3)
contemporary debates on the identity and global economics and politics of healthcare systems. 
relevance of psychological research in Africa. The persistent gap between policy rhetoric and 
Theoretically, the available evidence points to a implementation requires researchers who 
desire by some African psychologists to pro- understand the political economy of public 
duce African-centred or indigenized psycho- health, including the unequal power relations 
logical research (Lazarus et al., 2006; Nwoye, between local and global policy and funding 
2015) and for others a ‘worlding’ of African communities, and apply this understanding to 
psychology (Painter, 2012). Practically, the research, interventions and advocacy. There is 
answer depends on the specific histories of psy- a clear need for critical health psychology 
chology training in different African countries, approaches in Ghana that situate health and ill-
a conscientization of the politics of global sci- ness perceptions, experiences, care and out-
entific knowledge production in national acad- comes within their complex multilevel 
emies and whether there is a shared vision of contexts. There is also a need for scientist–
the kind of psychology local psychologists are practitioner and scholar–activist models that 
committed to converting into reality. The conti- engage in research as well as the development 
nental debates about indigenizing and worlding of evidence-based practice, interventions and 
African psychology are reflected in similar policies tailored to the Ghanaian context. 
calls for the transformation of psychology in Crucially, there are local and global psychol-
Ghana (de-Graft Aikins, 2015; Mate-Kole, ogy models that can guide health psychology 
2013; Asante et al., 2014). in Ghana towards a critical locally situated and 
Critical health psychology, critical global globally relevant future.
health and associated fields (e.g. Campbell 
and Jovchelovitch, 2000; Biehl and Petryna, Funding
2013; Campbell and Murray, 2004) are aligned The author(s) received no financial support for the 
with the concepts of indigenizing and world- research, authorship and/or publication of this 
ing. These fields emphasize the importance of article.
understanding the heterogeneity of local 
knowledge and identities as well as double- Notes
edged power relations that shape social lives. 
They advocate the use of meaningful methods 1. For a summary on neglected tropical dis-
informed by the research questions and soci- eases (NTDs), visit http://www.who.int/
neglected_diseases/diseases/summary/en/
etal problems at hand and the application of 
2. It is important to note here that the Richards 
reflexivity in the interpretation of data, results typology applied also to anthropologists. 
and interventions. Concepts, methods and Darkwah et al. (2014: 105) detail the prob-
interpretive frameworks employed in the criti- lematic work of British anthropologists in the 
cal health field are crucial to the challenges of Gold Coast such as Eva Meyerowitz, who pub-
transforming health, illness and healthcare in lished five books on Bono communities based 
Ghana. Ghana’s public health challenges are on flawed ethnography. They note that in the 
complex. The roots of illness and responses to 1970s, a politically conscious undergradu-
illness span medical, psychosocial, socio-cul- ate student community demanded that social 
tural, economic and geo-political domains. anthropology in Ghana move beyond ‘towing 
The pluralistic nature of healthcare delivery the tail of Malinowski’ towards progressive, 
modern and useful discipline that recorded the 
requires attention to complex ideologies and dynamic evolution of Ghanaian society.
regimes of care that may align with or diverge 3. Focusing largely on the Accra Psychiatric 
from the needs of individuals seeking care in Hospital, the oldest psychiatric hospital estab-
ways that can be beneficial or harmful. The lished in 1906. The country now has two addi-
economics of care in the home and in the com- tional psychiatric hospitals: Ankaful Hospital 
munity cannot be separated from the established in 1965 in Ankaful; Cape Coast and 
de-Graft Aikins 437
Pantang Hospital established in 1975 in Pantang, Asante KO (2015a) Health and well-being of home-
Accra. less youth in Ghana. PhD Thesis, University of 
4. In the late 1990s, the author joined the clini- KwaZulu-Natal, Durban, South Africa.
cal psychology group established by Ofori- Asante KO (2015b) Exploring age and gender differ-
Atta and Sefa-Dedeh, as an unpaid research ences in health risk behaviours and psychologi-
intern. Activities were wide ranging and cal functioning among homeless children and 
included group therapy sessions at the Accra adolescents. International Journal of Mental 
Psychiatric Hospital, patient rehabilitation and Health Promotion 17(5): 278–292.
community-based research projects. One pro- Asante KO (2016) Street children and adolescents 
ject involved taking discharged patients home in Ghana: A qualitative study of trajectory 
to their families (in the author’s private car) and behavioural experiences of homelessness. 
and supporting their re-integration. This pro- Global Social Welfare 3(1): 33–43.
ject, which focused on patients living in Accra Asante KO, Boafo IM and Nyamekye M (2014a) 
and Kumasi (Ghana’s second largest city in the Identifying gender differences in Ghanaian 
Ashanti Region), was short-lived due to lack university students’ sexual practices, attitudes 
of funds and of community-based psychiatric and knowledge regarding HIV. Journal of 
nurses. Another project, funded by the Danish Psychology 5(1): 9–18.
Development Agency (DANIDA), focused on Asante KO, Meyer-Weitz A and Petersen I (2014b) 
developing interventions for foetal alcohol syn- Substance use and risky sexual behaviours 
drome in the Upper West Region, a (still per- among street connected children and youth in 
sistent) public health problem which lay at the Accra, Ghana. Substance Abuse Treatment, 
intersection of female poverty, regional malnu- Prevention, and Policy 9(1): 45.
trition and cultural representations of a popular Asante KO, Osafo J and Nyamekye GK (2014c) 
homebrew (pito) – consumed by adults includ- An exploratory study of factors contributing 
ing pregnant women – as a ‘food of the gods’ to divorce among married couples in Accra, 
(Ofori-Atta et al., 1998). Ghana: A qualitative approach. Journal of 
5. Visit www.ghanapsychologycouncil.org.gh/ for Divorce & Remarriage 55(1): 16–32.
the registered list. Baah-Odoom D (2009) The link between social rep-
resentations of HIV/AIDS and Sexual Behaviour 
ORCID iD amongst young people in Ghana and the UK. PhD 
Thesis, University of Birmingham, Birmingham.
Ama de-Graft Aikins  http://orcid.org/0000- Baah-Odoom D and Riley GA (2013) The role HIV-
0001-9215-0134 Related Blame and Stigmatization play on risk 
perception, self-efficacy and sexual behaviour 
among students in Ghana. IFE PsychologIA 
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