Psychology: Dissertation Chapter 3
I still need a little bit more work done on some section in this chapter 3 of the Dissertation as follows:
REQUIRED EDITS
Under- STATEMENT OF THE PROBLEM. (The professor scored it 0/2 because—
The research problem (Problem Statement) is restated for the convenience of the reader from Chapter 1.
Under- RESEARCH METHODOLOGY. (The professor scored 1.5/2 because—-
It should provide a rationale for the research methodology for the study (quantitative, qualitative, or mixed) based on research books and articles
Under- RESEARCH METHODOLOGY. (The professor scored 1.5/2 because—-
Uses authoritative source(s) to justify the selected methodology. Note: Do not use introductory research textbooks (such as Creswell) to justify the research design and data analysis approach.
Under Research Materials, Instrumentation OR Sources of Data
Data Analysis Procedures
It should list the problem statement or purpose statement, along with the research question(s). Also includes the null and alternative hypotheses for quantitative studies.
It should describe in detail the relevant data collected for each stated research question and/or each variable within each hypothesis (if applicable).
There should be one or two interview questions per research question (Appendix XX) for the interview protocol. There will be one focus group question for each of research questions 1, X, X, and X.
Under- DATA ANALYSIS PROCEDURES. (The professor scored it 0/2 because—–
It should list the problem statement or purpose statement, along with the research question(s). Also includes the null and alternative hypotheses for quantitative studies.
Under- DATA ANALYSIS PROCEDURES. (The professor scored it 1/2 because—-
It should provide evidence that quantity and quality of data is sufficient to answer the research questions. This must be present in this section or in an appendix including data samples.
32
Dissertation Prospectus
Factors Influencing Individuals’ Decision to Utilize Mental Health in South Texas
Submitted by:
James Dada
May 31, 2020
The Prospectus Overview and Instructions
Prospectus Instructions:
1. Read the entire Prospectus Template to understand the requirements for writing your prospectus. Each section contains a narrative overview of what should be included in the section and a table with required criteria for each section. WRITE TO THE CRITERIA, as they will be used to assess the prospectus for overall quality and feasibility of your proposed research study.
2. As you draft each section, delete the narrative instructions and insert your work related to that section. Use the criterion table for each section to ensure that you address the requirements for that particular section. Do not delete/remove the criterion table as this is used by you and your committee to evaluate your prospectus.
3. Prior to submitting your prospectus for review by your chair or methodologist, use the criteria table for each section to complete a realistic self-evaluation, inserting what you believe is your score for each listed criterion into the Learner Self-Evaluation column. This is an exercise in self-evaluation and critical reflection, and to ensure that you completed all sections, addressing all required criteria for that section.
4. The scoring for the criteria ranges from a 0-3 as defined below. Complete a realistic and thoughtful evaluation of your work. Your chair and methodologist will also use the criterion tables to evaluate your work.
5. Your Prospectus should be no longer than 6-10 pages when the tables are deleted.
Score
Assessment
0
Item Not Present
1
Item is Present. Does Not Meet Expectations. Revisions are Required: Not all components are present. Large gaps are present in the components that leave the reader with significant questions. All items scored at 1 must be addressed by learner per reviewer comments.
2
Item is Acceptable. Meets Expectations. Some Revisions May Be Required Now or in the Future. Component is present and adequate. Small gaps are present that leave the reader with questions. Any item scored at 2 must be addressed by the learner per the reviewer comments.
3
Item Exceeds Expectations. No Revisions Required. Component is addressed clearly and comprehensively. No gaps are present that leave the reader with questions. No changes required.
Dissertation Prospectus
Introduction
Kohn et al. (2018) noted that in the United States (US), there is the existence of a gap between mental health patients that require treatment and those that successfully receive the treatment. Overall, there is a need to identify the social determinants of mental disorders, align it with its sustainable development goals, and identify potential mechanisms and targets for interventions (Lund, et al. 2018). Specifically, Lund et al., (2018) have expressed a need for further research on the reasons why people decide to utilize or reject mental health services. The mental health patients that seek mental health treatment and medication are fewer than the number of patients suffering. This research study will examine the factors according to mental health providers that influence an individuals’ decision to utilize or reject mental health services in South Texas. The mental health providers will be asked for strategies to encourage patients to accept and to not reject treatment at the start of treatment and when continuing treatment. The target population for the study is South Texas, this research is needed to systematically review evidence regarding the potential mechanisms that cause people to utilize or reject mental health treatment.
The previous research on mental health seeking behaviors according to the National Alliance on Mental Health, indicated that people seek self-help for mental health treatment when there is self-awareness and self-discipline (NAMI, 2020). This is when people understand what is going on in their minds or emotions and the raging thoughts in the mind; and realizes that help is not far away. Previous research also indicated that mental health patients reject treatment because they fear social stigmatization from the society (Hipes & Gemoets, 2018). The society lacks awareness about mental health, and they tend to stigmatize patients with mental disorders. The mental health providers and healthcare staffers have failed to openly sensitize, encourage and encourage equality in the society between mental and physical wellness (Hipes & Gemoets, 2018). Campbell, & Aulisio, (2012), also asserts that people tend to refuse mental health due to the stigma of the disease. Furthermore, in the 2004 bulletin of the World Health Organization, WHO stated that Anosognosia is another reason why people reject mental health treatment. Anosognosia is the lack of an individuals insight. When there are clear signs that an individual is suffering from mental health but he or she says theres nothing wrong with me, or I am not sick, or I dont need to see a psychiatrist, this are signs of severe lack of insight (WHO, 2004). In summary, the previous studies on this topic have found broad reasons for rejecting mental health treatment are because of stigma and denial of illness.
These studies have not focused on what Lund et al. (2018) recommended additional research on as specific reasons why people accept or reject mental health treatment. This study adds to the research in that it asks the first line of defense what they have seen and what they believe is needed to support patients use of mental health treatment.
There is a need for the research at several levels. The reasons why people choose to utilize or reject treatment lead to a treatment gap. According to Kohn, et al. (2018), there is a gap in mental health treatment in America when examined through the prevalence of mental health disorders and the lack of use of mental health services. For example, while 42.6% of children and adolescents in the US suffered mental illness, the treatment gap in this group was 64%. The use or rejection of mental health services depends upon the collaborative nature of participating in treatment; the patient and the provider work together to make the therapy worthwhile.
Patients have choices and they may choose to reject treatment, not adhere to advice, or reject taking prescriptions. The providers of the mental health treatment are those that experience the different circumstances and will be interviewed in this study to access those lived experiences with patient acceptance or rejection of mental health treatment. This is a need in South Texas, but also across the globe. Indeed, mental health is a major issue around the World. The United Nations (UN, 2015) has identified mental health as one of its Sustainable Development Goals.
Mental health is a national problem as well. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the Centers for Disease Control and Prevention (CDC) and the U.S. Department of Justice, millions of people suffer from mental illness in this country. According to the National Alliance on Mental Health (2019), 47.6 million people in the U.S. experienced signs of a mental illness in 2018. This amounts to one in every five adults. Roughly 11.4 million Adults between the ages of 25 and 35 had an episode of serious mental illness that same year. In 2016, 7.7 million young people between the ages of 6 and 17 experienced some sort of mental health disorder, while 9.2 million people were reported to have experienced a substance use disorder (National Alliance on Mental Illness, 2019). The high numbers necessitate raising public awareness and campaigning for a better health care system (Hamilton.et al. 2016). Part of this effort is identifying the reasons why people choose to utilize or reject mental health support.
Mental health is a serious issue in South Texas. There is a high need for this research in South Texas. One reason is because this region receives the second-largest allocation of governmental funds for mental health in the United States (Mista et al., 2017). The large allocation is because there is a documented high need for mental health services in South Texas (Kohn, et al., 2018). This means that there are significant funds available, and therefore greater possibility for people to accept or reject mental health treatment. Texas (2017) asserts that people suffering from mental illness still face problems despite the huge costs that are directed towards healthcare. Understanding why people use or reject this available mental health may help policymakers to successfully market mental health treatment and get people the services they need (Kohn, et al., 2018). Another reason is that mental health services in this southern state have faced several population growths challenges. Schwartz (2017), in support of the Southern State Region, argues that the increased growth-rate of populations in one specific county located in a southern state has impacted the health sector at large. The high population together with economic constrains has led to a decrease in the number of health insurance policies. The access to and utilization of mental health care for the populations living in this county has created a gap within the State (Children at Risk, 2013).
Given the above noted societal needs documented in the world, the nation, and the region of South Texas (Mista et al., 2017), this study will examine the gap: there is a need to understand why people choose to utilize or reject mental health services (Lund, et al., 2018). The successful use of mental health treatment has been called social inclusion. This is also recommended by Hall, Kakuma, Palmer, Minas, Martins, & Kermode, (2019), stated that, promoting social inclusion of people with mental illness is consequently a key goal of human rights and global mental health programming to achieve people-centered mental health care, and interventions to promote social inclusion aim to minimize the impact of attitudinal, structural and behavioral drivers of social exclusion. There is good evidence that supported employment programs for people with mental illness and interventions to reduce mental health stigma (e.g. mental health education, direct contact with people with mental illness) are effective in high income countries (Hall, et al., 2019. p. 20 – 22).
In summary, this section introduced the topic of the factors influencing decisions of seeking or rejecting mental health treatment. Then a summary on the research on the topic was presented including problem of the study. Finally, the societal context for the study was detailed at the global, national, and regional levels demonstrating that the mental health problem is significant and requires intervention.
Criteria
Learner Self-Evaluation Score
(0-3)
Chair Evaluation Score
(0-3)
Reviewer Score
(0-3)
Introduction
This section briefly overviews the research focus or problem, why this study is worth conducting, and how this study will be completed.
The recommended length for this section is two to three paragraphs.
1. Dissertation topic is introduced along with why the study is needed.
2
2. Provides a summary of results from the prior empirical research on the topic.
2
3. Using results, societal needs, recommendations for further study, or needs identified in three to five research studies (primarily from the last three years), the learner identifies the stated need, called a gap
2
4. Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.
2
NOTE: This Introduction section elaborates on the Topic from the 10 Strategic Points
. This Introduction section provides the foundation for the Introduction section in Chapter 1 of the Proposal.
Reviewer Comments:
Background of the Problem
According to the Centers for Disease Control and Prevention (2018), mental health has become a significant public health issue in the United States that requires immediate attention. There is a gap in the research regarding the reasons people utilize or reject mental health treatment (Lund, Hall et al, 2018). Literature indicates that mental health patients tend to terminate treatment plan before the doctors specified date and others neglect seeking treatment from healthcare facilities. Tomczyk, (2020), stated that there was concurrent impact of structural and attitudinal factors on help-seeking behavior for mental health problems. Furthermore, (Vega, 1999), stresses that further study in needed to ascertain the extent of underutilization of mental health services and issues among urban and rural Mexican American adults. While Vega, et al. (1999) states that research indicates that only 8.8 percent of the overall of the Mexican-Americans utilize mental health care providers by persons with diagnosed mental disorders, which raises the questions on the appropriateness, accessibility, and cost-effectiveness of mental health care for this population; hence, the need to examine the reasons for low utilization of services in future research (Vega, et al., 1999).
The history of how this problem began dates back to the beginning of mental health services in the US. The U.S. Mental Health Care & Policy known as Mental Health America (MHA) was developed in 1909. The biggest mental health societal problem at the time included, Bipolar Disorder (manic depressive illness), Dementia, and schizophrenia (Mental Health America, 2020). Mandell, (1995) described the origins of mental health and its history as a mental hygiene. The term mental hygiene was first used in the United States by William Sweetzer in 1843 after the civil war when there was increased concern about the effects of unsanitary conditions. There was the vision for a community-based mental hygiene that would operate through education, social culture, religion and involvement in national life. Later research on use of mental health services according to Armbruster (1997) noted that there were those that had the opinion that there should be efforts at bridging the gap between service need and service utilization among the socioeconomically disadvantaged, minority, and the psychiatrically impaired population. According to Lake, (2017), current research on use of mental health services found that current treatments and the dominant model of mental health care do not adequately address the complex challenges of mental illness that accounts for about one-third of adult disability globally. While Tomczyk, (2020), suggests that to date, little is known in the concurrent impact of structural and attitudinal factors influencing behavior for mental health problems especially for treatment purposes.
Criteria
Learner Self-Evaluation Score
(0-3)
Chair or Score
(0-3)
Reviewer Score
(0-3)
Background of the Problem
This section uses the literature to provide the reader with a definition and statement of the research gap and problem the study will address. This section further presents a brief historical perspective of when the problem started and how it has evolved over time.
The recommended length for this section is two-three paragraphs.
1. Includes a brief discussion demonstrating how literature has established the gap and a clear statement informing the reader of the gap.
2
2
2. Discusses how the need or defined gap has evolved historically into the current problem or opportunity to be addressed by the proposed study (citing seminal and/or current research).
2
2
3. ALIGNMENT: The problem statement for the dissertation will be developed from and justified by the need or defined gap that is described in this section and supported by the empirical research literature published within the past 3-5 years.
2
2
4. Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.
2
2
NOTE: This Background of the Problem section uses information from the Literature Review in the 10 Strategic Points. This Background of the Problem section becomes the Background of the Study in Note, this section develops the foundation for Chapter 1 in the Proposal. It is then expanded to develop the comprehensive Background to the Problem section and Identification of the GAP sections in Chapter 2 (Literature Review) in the Proposal.
Reviewer Comments:
Theoretical Foundations/Conceptual Framework and Review of the Literature/Themes
Theoretical literature
The theoretical model for this research gap is Albert Banduras Social Cognitive Theory (Morin & Cherry, 2019). According to Morin & Cherry, (2019), the Social Cognitive Theory can be applied to the context of mental health promotion and prevention. It helps to describe how motivations in health and behaviors are influenced by the interaction of people’s beliefs, environment, and behaviors (Lake, 2017). It was advocated by famous psychologist Albert Bandura (Morin, 2019). It is important to determine the limiting factors behind individuals and families not currently getting the mental health services and treatment plan.
Major components of the theory concerning individual behavior change include:
Self-efficacy: refers to the belief and self confidence that an individual can control and execute a behavior successfully in. It is unique and influenced by an individual’s specific capabilities and other environmental factors. In terms of mental health use or rejection, self-efficacy is an individual’s belief about his or her capabilities to produce designated levels of performance, which may influence over events that impact life. Self-efficacy beliefs tend to regulate how individuals feel, think, motivate themselves and behave. These beliefs lead to diverse effects through four major processes including cognitive, motivational, affective and selection processes (Bandura, 1994).
Behavioral capability: involves an understanding and the possession of skills and ability to perform behavior. To successfully carryout a task as behavioral skill, an individual is required to know what to do and how to do it. By performing the tasks, individuals will learn from poor performance in their behavior and the consequences thereof.
In terms of mental health use or rejection, behavioral capability is peoples change models including health behaviors and intentions that includes smoking, drinking, health services utilization, and substance use, among others. A mental health persons behavioral achievement primarily depends on both motivation (intention) and ability (behavioral control). This also involves the extent to which the person has a favorable or unfavorable evaluation of the behavior of interest, which also include the motivational factors that influences behavior. For example, the stronger the intention, the more likely the behavior will be performed. However, social norms such as rejection may impact behavior negatively, this include emotion, cognition and even physical health. Sometimes, behavior become aggressive and can turn to violence (Weir, 2012).
Expectations: determines the outcomes of behavior change. It is the anticipated consequences of a person’s behavior. This can include expectations on health-related or not health-related issues. Some people anticipate consequences from their actions before actually participating in a behavior, and the consequences tend to influence successful completion of the behavior. Expectations are mostly derived from past experiences. In terms of mental health use or rejection, expectations involve personal relevance of an individuals beliefs that others devalue, discriminate against, and label mental patients. This can lead to self-stigma and self-devaluation in various psychosocial outcomes and quality of life, including self-esteem and general functioning. This is because people often develop the conceptions of what others already perceived about mental patients even before they become patients and what they will feel or think about them now (Picco, et al., 2017).
Reciprocal Determinism: it refers to the dynamic and reciprocal interaction of individual learned experiences that include environment (external social context), and behavior (responses to stimuli to achieve goals). In terms of mental health use or rejection, a mental health individuals behavior is controlled and determined the person himself through processes, and by his environment. For example, there is every possibility that an adolescent who dislikes going to school will act out negatively in class; and if his teachers and classmates react to his behavior, it reinforces his dislike for school, which can create a hostile environment (Cherry, 2018).
Observational learning: refers to observing outcomes of others performance or modeled behavior. It explains that people can witness and observe the behaviors of others, and then reproduce those actions. Mostly exhibited by “modeling” of such behaviors. Literarily means that when a person sees a successful demonstration of a habit, they tend to repeat the same behavior successfully. In terms of mental health use or rejection, observational learning help people with mental disorders to observe others and retain information, and later replicate the behaviors that were observed. This play important roles in their socialization process as they observe other caregivers interact and respond among themselves. It helps them to developing a therapeutic relationship, communicating and creating a dialogue, and working to overcome problematic thoughts or behaviors (Cherry, 2018).
Reinforcements: means promoting incentives and rewards that encourage behavior change. It can be either internal or external responses to an individual’s behavior that may likely impact the continuing or discontinuing of the behavior. It may be self-initiated or in the environment and can be either positive or negative. In terms of mental health use or rejection, reinforcements can have positive or negative effects on people with mental health disability. Reward such as praises are offered for showing and expressing good behavior is positive and can influence future good behavior. Religious reinforcement about mental health and the stigma associated with is an obstacle to treatment and is considered negative. In addition, the way the new media treat the issue of mental health in the society encourages societal stigma related to it (Peteet, 2019).
Literature Themes
Review of the literature review identified the following themes:
Mental Health Infrastructure
The mental health infrastructure is the mental health professionals that include psychologists, psychiatrists, counselors, psychiatric nurses and clinical social workers. The healthcare sector has limited number of mental health providers that increases the challenges of combating increasing mental health patients and conditions. In the U.S the access to competent mental health providers is scarce in rural areas making it difficult for treating mental health illness (Prince, 2015). This infrastructure may impact reasons to accept or reject treatment.
Reasons for Lack of Access to Mental Health
These include lack of insurance according to Kung, (2004) and Kohn, et al., (2018), lack of mental health professionals (Scripps Media, 2020), (Moore, & Krehbiel, 2016) and even poverty (Grayson, 2016). Research has shown that many people due to poor economic status have left many people without health insurance as they cannot afford it. This limits many average and lower-class families from accessing mental illness services (Children at Risk, 2013). Impoverished people may mislabel mental illness as mere signs of hunger and poor diet instead of mental illness (Children at Risk, 2013).
In the United States, 42% of the population believe that cost and poor insurance coverage are the top barriers that prevents them from accessing mental health care. While only 25% reported that they make decisions between using mental health treatment or paying for daily necessities (National Council for Behavioral Health, 2018). Getting face-to-face services remains a top priority for many Americans who are seeking mental health treatment than getting access to medication. Approximately 38% of Americans, or 96 million, on several occasions have waited longer than a week for mental health treatment services. Distance is another barrier in that about 46% of the population, have experienced or knew someone who has had to travel for over one-hour roundtrip to seek treatment (National Council for Behavioral Health, 2018).
Although many Americans have tried seeking mental health treatment, in addition to the 29% of the population who want to; however, failed to seek the treatment for either themselves or loved ones due to lack of knowing where to go for the services. Statistics also indicate that 21% of adults in the US have tried to see a professional but were unable to do so because of reasons outside of their control (National Council for Behavioral Health, 2018).
People who do have Access to Mental Health
Medicaid, Medicare, Obamacare started covering mental health care after the implementation of the Affordable Care Act. The shortage of healthcare professionals means they are not willing to participate in treating insured patients because the payments are too low (Carroll, 2019).
Populations that Use Mental Health Services.
Goldman et al. (2018) in their research found out that women who had been exposed to sexual abuse and drug abuse formed the high numbers of people who utilize mental health services among the Hispanic and non-white people in the county.
Populations that Reject Mental Health Services.
Augsberger et al. (2015) in support of this research argued that mental health services had been underutilized by Asian women living in this county, as a result of both cultural needs and mismatch of the services offered in the health facilities in this Southern State.
Reasons for Use of Mental Health Services
Behavioral health treatment, such as psychotherapy and counseling (Barrett, et al., 2009). Mental and behavioral health inpatient and outpatient treatment services (Cohen, 2002), (Peteet, 2019), and (North Texas Help, 2020). Substance use disorder (commonly known as substance abuse) treatment (HealthCare.gov, 2020), (Wang, & Xie, 2019) and (England et al., 2015).
Reasons for Rejection of Mental Health Services
According to National Council for Behavioral Health, (2018), 31% of Americans are worried about being judged for seeking mental health services, and 21% of the population, have lied to people about seeking mental health services. The stigma is accurate among young Americans, who of course worried of being judged by others when they confess of seeking mental health services (National Council for Behavioral Health, 2018).
Criteria
Learner Self-Evaluation Score
(0-3)
Chair or Score
(0-3)
Reviewer Score
(0-3)
Theoretical Foundations and/or Conceptual Framework
This section identifies the theory(s) or model(s) that provide the foundation for the research. This section should present the theory(s) or models(s) and explain how the problem under investigation relates to the theory or model. The theory(s) or models(s) guide the research questions and justify what is being measured (variables) as well as how those variables are related (quantitative) or the phenomena being investigated (qualitative).
Review of the Literature/Themes
This section provides a broad, balanced overview of the existing literature related to the proposed
research topic. It describes the literature in related topic areas and its relevance to the proposed research topic findings, providing a short 3-4 sentence description of each theme and identifies its relevance to the research problem supporting it with at least two citations from the empirical literature from the
past 3-5 years.
The recommended length for this section is 1 paragraph for Theoretical Foundations and a bulleted list for Literature Themes section.
1.
Theoretical Foundations section identifies the theory(s), model(s) relevant to the variables (quantitative study) or phenomenon (qualitative study). This section should explain how the study topic or problem coming out of the need or defined gap in the as described in the Background to the Problem section relates to the theory(s) or model(s) presented in this section.
1.5
2
2. Review of the Literature Themes section: This section is a bulleted list of the major themes or topics related to the research topic. Each theme or topic should have a one-two sentence summary.
1.5
2
3. ALIGNMENT: The Theoretical Foundations models and theories need to be related to and support the problem statement or study topic. The sections in the Review of the Literature are topical areas needed to understand the various aspects of the phenomenon (qualitative) or variables/groups (quantitative) being studied; to select the design needed to address the Problem Statement; to select surveys or instruments to collect information on variables/groups; to define the population and sample for the study; to describe components or factors that comprise the phenomenon; to describe key topics related to the study topic, etc.
1.5
2
4. Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.
1.5
2
NOTE: The two parts of this section use information about the Literature Review and Theoretical Foundations/Conceptual Framework from the 10 Strategic Points.
This Theoretical Foundations section is expanded upon to become the Theoretical Foundations section in Chapter 2 (Literature Review). The Theoretical Foundations and the Literature Review sections are also used to help create the Advancing Scientific Knowledge/Review of the Literature section in Chapter 2 (Literature Review).
Reviewer Comments:
Problem Statement
The problem is that it is not known how mental health providers describe the factors influencing individual decisions to utilize or
