Traditional Healer Referral Pathways and Trauma-Related Mental Health Treatment Delay in Rural Sierra Leone: A Discrete-Time Survival Analysis of Care-Seeking Sequences

Trauma-related mental health treatment delay in rural Sierra Leone is shaped by care-seeking sequences that frequently begin with traditional healers, yet the referral pathways connecting traditional and biomedical sectors remain poorly characterised. The framework is operationalised using a discrete-time hazard specification in which the probability of biomedical treatment entry in each care-seeking interval depends on prior traditional healer contact, referral source, and pathway characteristics. The analysis is designed to identify the referral mechanisms that produce delay and to estimate the contribution of pathway structure to observed treatment gaps. The framework proposes that referral pathway characteristics, rather than traditional healer contact per se, constitute the principal modifiable determinant of treatment delay, and that interventions targeting referral coordination between sectors would produce larger reductions in delay than interventions targeting either sector alone. The contribution is a specification of the referral pathway mechanisms that link traditional healer use to treatment delay, and a methodological approach for estimating their effects using care-seeking sequence data.