Posted: February 26th, 2023
I need help fixing the attached Dissertation. I have attached the Professor's comments on what needs to be done and I need your help to get it done. Please see the attached Professor's comments and the actual Dissertation.
PROFESSOR’S COMMENTS ON HWAT NEEDS TO BE FIXED
I have reviewed your chapters 2 and 3 and attached them.
You are supposed to have the Ten Strategic Points at the beginning of your document and then your title page, but you have the Ten Strategic Points document in appendix A and begin with your title page. You need to have this Ten Strategic Points document as the very first page in your document and appendix A should be left blank until you have completed your dissertation. I did notice when I read your Ten Strategic Points document that there are a sufficient number of incorrect entries and too much information in all of the sections of the document. What you should do is use bullets or very short sentences because you do not need to put a lot of information in this form since each section of the chapters will have the complete information of what is requested in this form.
Make sure that when you click on a page in the Table of Contents that you are taken to that specific page that is indicated. Currently when I click on chapter 2, I am taken instead to the title page. Next, you should delete the following pages:
ALL RIGHTS RESERVED
DISSERTATION COMMITTEE APPROVAL
The Dissertation Title Appears in Title Case and is Centered
Abstract page along with the accompanying template
Dedication page ,
Delete the List of Figures and List of Tables shown under the Table of Contents unless you actually have one or more entries of these items under one or both of this topics in your document.
All of these pages are not needed at the present time, since you must have your first three chapters approved by your committee. After approval by your committee the first three chapters will be submitted to level 2, which will then be reviewed and include the approval from an AQR reviewer, after which you must successfully defend your document. After approval of your three chapters, then you will need to reinsert all of the pages back in your document you deleted since you will be completing your dissertation.
There was item that I did not understand was whether or not you are going to concentrate on studying your topics in either South Texas or the entire State of Texas. It appeared that in some sections in the text you identified one area and then in the same paragraph you shifted to another area of Texas. You also have too many subheading that you use which are not necessary.
One of the major items that your entries in the text are judged on are the rubrics in each section of the chapter. Make sure that you always look at the rubric below each section and respond to that specific rubric in your text. This is what your text is graded on by your committee members and AQR reviewer.
Also noted was that you have too much text for your chapter 2. I counted a total of 67 pages, which is too much. Always check the template for each section for the number of pages or paragraphs for that section and use that number for your text entries.
I would like for you to address all of the comments or make the corrections that I have indicated in the either the text or the right-hand margin. I did notice that was a couple of entries in the right-hand margin with the name of Dr. June Maul , who I suppose was a previous committee member but should be deleted. However, if you should disagree with one or more of my comments or just want to make a comment on any issue in the text, just contact me. We can have a discussion on any issue that you disagree with concerning my comments or suggestions. You have four options that are available to contact me. First, you can contact me by either email, LDP, telephone call, or you can request a Zoom conference call. If you use an email response, i.e., word document, then send it to me with your concerns or questions listed along with the issue you want to discuss. Whenever you are through making the revisions, send me your document again and I will review it.
ix Factors Influencing Utilization of Mental Health Services in South Texas Submitted by Kehinde Alli A Dissertation Presented in Partial Fulfillment of the Requirements for the Degree Doctor of Education (or) Doctor of Philosophy (or) Doctor of Business Administration Grand Canyon University Phoenix, Arizona Comment by GCU: HINT: There are several “styles” that have been set up in this GCU Template. When you work on your proposal or dissertation, “save as” this template in order to preserve and make use of the preset styles. This will save you hours of work! [Insert Current Date Until Date of Dean’s Signature] QUAL GCU Dissertation Template V9.0 Final 08-10-20_cnb 7 am QUALITATIVE GCU Dissertation Template V9.0 08-10-2020 © by Your Full Legal Name (No Titles, Degrees, or Academic Credentials), 20xx All rights reserved. QUALITATIVE GCU Dissertation Template V9.0 08-10-2020 Factors Influencing Utilization of Public Mental Health Services in South Texas By Kehinde Alli Successfully Defended and Approved by All Dissertation Committee Members [Insert Date] DISSERTATION COMMITTEE APPROVAL: The following committee members certify they have read and approve this dissertation and deem it fully adequate in scope and quality as a dissertation for the degree of Doctor of XXX. Full Legal Name, EdD, DBA, or PhD, Dissertation Chair Full Legal Name, EdD, DBA, or PhD, Committee Member Full Legal Name, EdD, DBA, or PhD, Committee Member ACCEPTED AND SIGNED: ________________________________________ ____________________ Michael R. Berger, EdD Date Dean, College of Doctoral Studies Abstract The abstract is the most important component of your dissertation! It is required for the dissertation manuscript only. The abstract is typically the last item written and should be updated based on final acceptance of manuscript by the dissertation committee members and reviewer(s). The abstract is intended as a precise, non-evaluative, summary of the entire dissertation presenting the major elements and findings of the study in a highly condensed format. Although few people typically read the full dissertation, the abstract will be read by many scholars and researchers. Consequently, great care must be taken in writing this page of the dissertation. The content of the abstract should mirror the structure of the entire dissertation, covering the research problem purpose of the study to solve the problem, theoretical foundation, research questions stated in narrative format, sample, location, methodology, design, data sources, data analysis approach, major findings or trends based on the analysis. The most important finding(s) should state the themes that support the conclusion(s). The abstract should close with a conclusion statement of the study implications and contributions to the field. The abstract does not appear in the table of contents and has no page number. The abstract is double-spaced, fully justified with no indentations or citations, and no longer than one page. Refer to the APA Publication Manual, 7th Edition, for additional guidelines for the development of the dissertation abstract. Make sure to add the keywords at the bottom of the abstract to assist future researchers. Keywords: Abstract, one-page, vital information Criterion *(Score = 0, 1, 2, or 3) Learner Score Chair Score Methodologist Score Content Expert Score ABSTRACT (Dissertation Only—Not Required for the Proposal) (one page) The abstract provides a succinct summary of the study and MUST include: the purpose of the study, theoretical foundation, research questions stated in narrative format, sample, location, methodology, design, data sources, data analysis, results, and a valid conclusion of the research. Note: The most important finding(s) should be stated with actual codes and resulting themes data/numbers (qualitative). The abstract is written in APA format, one paragraph fully justified with no indentations, double-spaced with no citations, one page, and includes key search words. Keywords are on a new line and indented. The abstract is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, punctuation, and APA format. *Score each requirement listed in the criteria table using the following scale: 0 = Item Not Present or Unacceptable. Substantial Revisions are Required. 1 = Item is Present. Does Not Meet Expectations. Revisions are Required. 2 = Item is Acceptable. Meets Expectations. Some Revisions May be Suggested or Required. 3 = Item Exceeds Expectations. No Revisions are Required. Reviewer Comments: Dedication I would to dedicate this dissertation to my family for their immense contribution in my studies. Acknowledgments I would like to thank all my family members for supporting me while writing this dissertation. I would also like to thank all my professors for their immense contribution in my academics. Table of Contents List of Tables x List of Figures xi Chapter 1: Introduction to the Study 1 Introduction 1 Background of the Study 8 Definition of Terms 15 Anticipated Limitations 16 Summary and Organization of the Remainder of the Study 17 Chapter 2: Literature Review 20 Introduction to the Chapter and Background to the Problem 20 Identification of the Problem Space 24 Theoretical Foundations 29 Review of the Literature 33 Problem Statement 80 Summary 82 Chapter 3: Methodology 85 Introduction 85 Purpose of the Study 88 Research Questions 90 Rationale for a Qualitative Methodology 93 Rationale for Research Design 95 Population and Sample Selection 98 Qualitative Sample Size 100 Recruiting and Sampling Strategy 101 Sources of Data 104 Research Data 105 Additional Data 106 Trustworthiness 109 Credibility 110 Dependability 110 Transferability 111 Confirmability 111 Data Collection and Management 113 Data Analysis Procedures 116 Ethical Considerations 123 Assumptions, and Delimitations 128 Assumptions 129 Delimitations 129 Summary 131 References 134 Appendix A. Ten Strategic Points 167 Appendix B. Site Authorization 180 Appendix C. IRB Approval Letter 181 Appendix D. 182 Appendix F. 185 Appendix G. Focus Groups Questions 187 List of Tables Table 1. Correct Formatting for a Multiple Line Table Title is Single Spaced and Should Look Like this Example xii Table 2. Alignment Table 15 Table 3. Description of Building Blocks for the Theoretical Foundations Section 25 Table 4. Steps for the Theoretical Foundations Section 26 Table 5. Qualitative Core Designs and Descriptions 43 Table 6. Example of a Clean, Easy-to-Read Table 75 Table 7. Example of Clean, Easy-to-Read Table for Focus Group Data 75 Table 8. Example of Case Unit Profiling (in Narrative) 76 Table 9. Initial Codes 83 Table F10. Sample Codebook 113 List of Figures Figure 1. The Relationship of Things xiii Figure 2. Incorporating Theories and Models of Research 24 Figure 3. IRB Alert 64 Figure 4. Diagram of a Blank Sociogram 84 ix QUALITATIVE GCU Dissertation Template V9.0 08-10-2020 Chapter 2: Literature Review Introduction to the Chapter and Background to the Problem The mental health department in Texas has undergone a lot of changes and focus in the recent years. This is primarily due to the fact that mental health issues have been increasing as society progresses and encounters development. Stephenson (2020) stated that mental health issues have been increasing recently due to the issues related to Covid-19. The pandemic resulted in the majority of people staying indoors and not engaging in public gatherings (Viner et al., 2021; Pfefferbaum & North, 2020; Petrie et al., 2018 ). This is a negative effect for all persons since they lack cognitive balance and support during the trying moments of the pandemic. The study of mental health in Texas forms its basis on the argument that lack of social connections affects mental health status of people. According to Stephenson (2020), mental health has caused issues that influence people to encounter anxiety during adverse conditions. Another issue of mental health is that it leads to depression (Stephenson, 2020). This is a negative condition that is common especially when the affected persons do not receive help suitable to their issues. Substance abuse is another issue that occurs after prolonged negative mental health (Stephenson, 2020). People with mental health seek to resolve their issues using substance abuse as it gives them a temporary relief. This is one of the worst techniques of managing mental health since the persons introduce themselves to worse physical conditions. Development of suicidal thoughts is another problem that occurs due to mental health problems (Stephenson, 2020). People who find it hard to solve their issues can resort to suicide to end all their pain. In this regard, it is imperative to study mental health access. This would reveal any barriers to access of mental health services whether personal, financial, or due to influence of the government. The issue of mental health continues to progress even after the federal government and local government develop methods of managing the issues. According to Czeisler (2020), the process of mitigation of mental health has received a lot of focus yet there has been limited adaptation. The authors identified that the basis of lack of access to mental health was difficulty in aligning personal capabilities with communication strategies. This literature review shall conduct analysis of mental illness and lack of capability of affected persons to receive care and treatment suitable to their conditions. Lake & Turner, (2017) identified that the current environment requires effective study in order to deal with the prevalent mental health issues and to offer care that is required for persons suffering from the conditions. The urgency in improving access to mental health services is critical since it has the capability of affecting the strategies already implemented in society. According to Velasco et al., (2020) there are issues that limit access to healthcare such as family beliefs, stigma, self-will for improvement, literacy, and availability of access to mental health services. This often results in result in lack of access to mental health services (Volkow, 2020). The mentally ill persons get exposed to limited capability to access mental health based on their internal barriers and external barriers that limit adaptation. Knaak et al., (2017) identified that some persons suffering from mental health often reject treatment measures due to stigma in the healthcare industry (Luitel et al., 2017; Magaard et al., 2017; Mastapha, 2018). This is a negative aspect that is highly detrimental since the affected persons find it hard to function in all their environments. It is thus imperative to study personal barriers and external barriers in order to formulate an effective plan of managing the issues. The approach used by this paper is effective since it shall study personal barriers that limit access to healthcare. It shall also study external factors that affect access of healthcare to persons who may not be willing to improve their conditions. The literature review shall address issues which affect availability of mental health treatment to affected persons. The next component is the study of measures setup by prominent institutions to provide mental health improvement initiatives. The next component of the study is external factors on people which results in them having limited access to healthcare improvement initiatives. The structure would offer effective comprehension of the mental health industry and ability to offer improvement in all areas. This chapter two of the paper shall identify different topics that shall form the basis of this paper’s development. The structure shall first get divided into the component of identification of the gap in society which results in limited mental health improvement. Identification of the issues is imperative since it would offer factual data related to the topic and the capability of creating suitable arguments that offer development. The next component is a theoretical foundation section that shall provide information related to concepts, theories, and models that offer improvement in the mental health industry. The fact that mental health improvement is the responsibility of every person results in the need to adopt this technique of study. The next section of this chapter two shall be review of the literature which corresponds to all factors affecting mental health improvement in all areas. The literature review shall offer unbiased study which shall improve access to mental health facilities and initiatives. The last section of chapter two shall be the summary which offers to the whole paper and improvement of access to information. Using this structure, it would be possible to offer improvement based on the possibility of creating effective guidance in mental health access. The review of literature section shall get divided based on different topics that improve access to healthcare. Each topic shall have an introduction, identification of suitability to the topics, and synthesis of all information which generates high-quality learning. The literature review got conducted using documents and journal articles found on Sciendirect, NCBI, Jama Network, SAGE Journals, MDPI, Wiley, BMC Health Services, PubMed, Plos One, Frontiers in Psychology, JMIR Publications, Elsevier, and Tandfonline databases. The literature review also includes information from credible organizations such as the CDC, The Rees-Jones Foundation, and Mental Health America which offer factual data of studies conducted to assess mental health prevalence. The literature review and all aspects of this paper used peer reviewed journal from these databases and only those crated within the last five years. Criterion *(Score = 0, 1, 2, or 3) Learner Score Chair Score Methodologist Score Content Expert Score Introduction (to the chapter) and Background (to the problem) (Minimum two to three pages) Introduction : The learner provides an orienting paragraph, so the reader knows what the literature review will address. X Introduction : The learner describes how the chapter is organized (including the specific sections and subsections). X Introduction: The learner describes how the literature was surveyed so the reader can evaluate thoroughness of the review. This includes search terms and databases used. X Background: The learner discusses how the problem has evolved historically into its current form. X Background : The learner describes the what still needs to be understood defined in the problem space in current literature and how it leads to the creation of the topic and problem statement for the study. Note: This section is a significant expansion on the Background of the Study section in Chapter 1. X The learner writes this section in a way that is well structured, has a logical flow, uses correct paragraph structure, sentence structure, punctuation, and APA format. X *Score each requirement listed in the criteria table using the following scale: 0 = Item Not Present or Unacceptable. Substantial Revisions are Required. 1 = Item is Present. Does Not Meet Expectations. Revisions are Required. 2 = Item is Acceptable. Meets Expectations. Some Revisions May be Suggested or Required. 3 = Item Exceeds Expectations. No Revisions are Required. Reviewer Comments: Identification of the Problem Space The study of mental health access in Texas has undergone some issues in regard to the motivation of affected persons to seek care. The fact that Texas is in the rural areas usually influences access to mental health services. According to the Rees-Jones Foundation (2020), Texas is the worst state when it comes to access to mental health facilities and services. The foundation performed factual analysis of Dallas whereby it was revealed that mental health access in Texas was detrimental and there was a prevalence of about 2000 persons every year. This data directs this research to perform critical analysis of access to mental health services since it is imperative to address the gap in access to healthcare and the will of different people to desire to access care. The Mental Health America reported that in 2020, Texas was the third state to experience the most mental health issues for its citizens. In terms of access to mental care services, Texas ranked as the 50th state (Mental Health America, 2020). This data reveals that there is a gap that must get addressed to deal with the issues of access to mental health facilities and services. Regardless of these issues, the local of Texas using Texas Health and Human Services department attempted to improve access to healthcare by constantly performing research and directing government resources to the department of mental health (Lai et al., 2019; Laura et al., 2017; THHS, 2021). The first gap is that these initiatives have not borne profitable outcomes since many people still do not access required mental health services. The second gap is that stigma is common in healthcare institutions and often causes the affected person to reduce their desire to seek care (Knaak & Mantler, 2017; Woods et al., 2021). This is a detrimental factor because it causes progression in mental health issues even after measures get set up to manage the problems. The fact that healthcare institutions have professionally trained persons who lack drive to reduce stigma also results in limited improvement of access to healthcare. According to Luitel et al. (2017), there is a third gap whereby the procedure of treating mental health often experiences gaps whereby there is limited connection between socio-demographic factors and the influence of people to access treatment (Johnson, 2020). The socio-demographic factors that are common shall get discussed in the literature review since each factor has a broad impact. There is a fourth gap of mental health access whereby socio-economic factors, particularly finances result in limited access to mental health improvement (Butryn et al., 2017; Evans-Lacko et al., 2018; Veenhoven, 2017). Healthcare is often expensive in all states especially when the affected persons lack insurance. This forms a large gap since it is difficult to improve access when the sick persons do not receive appropriate and high-quality care. Mental health improvement experiences issues whereby out-of-pocket payments are often expensive to all persons (Qin & Hsieh, 2020). This results in limited capability of access to care since it is difficult to receive care when the issue of finance does not get addressed. There is a fifth gap of access to healthcare whereby geographical distance to treatment centers affects the capability of patients to receive treatment (Carbonell et al., 2020; Cohen et al., 2020). The type of infrastructure existent in certain areas affects the possibility of accessing healthcare. It becomes difficult to manage issues since the affected persons would find it difficult to engage with qualified persons. There is a fifth gap of access to healthcare which is shame. Dolezal & Lyons (2017) identified that accessing mental healthcare can be shameful yet there is limited research into the topic by the majority of studies. These issues causes limited conformity between health improvement measures and the ability to promote wellbeing for all persons. There is a sixth gap to improvement of mental health in regard to public health information (Alegria, et al., 2021; Bekhet et al., 2018; Lindert et al., 2017). The government always develops mental health information and improvement for its citizens. Issues occur whereby the affected persons do not conform to the proposed measures whenever they attempt to receive quality care. The lack of adherence to information results in a limited capability of improving any type of mental health issue. The gap becomes bigger when the credible departments encounter limited research when dealing with the prevalent conditions. The study of mental health has transformed over the last five years as different researchers and government bodies conducted studies of improvement (CDC, 2018). According to Mental Health America (2021), the mental health industry in the past five years encountered prevalence in terms of 19% of the majority of adults. This reveals that mental health improvement is a required component in the field of healthcare. The department further reported that people have increased their desire to receive treatment regardless of the gaps identified in this section. This results in the effective identification of the fact that mental health improvement has been a top factor for all persons since it affects their capability of generating required improvement. According to the process of identification of gaps from the peer reviewed studies, the key findings were that mental health improvement encounters gaps and barriers in regard to intrapersonal issues, interpersonal barriers, and systemic issues. There is prior research that identified these key findings in regard to improvement of mental health (Penney, 2018). Riffel & Chen (2019) explored the fact that mental health improvement was critical for improvement of all persons regardless of being knowledgeable about mental health improvement measures. This results in the need to study mental health and its effect on all persons regardless of their level of expertise in different academic fields. The appropriate future research needs are connected to the requirement of improving accessibility and affordability of mental health improvement services. This study shall identify all the gaps explained and how they affect mental health improvement. It shall be possible to identify how people can form personal objectives to improve their health conditions. The problem of mental health improvement would get addressed in all areas since it shall be possible to provide insight into to intrapersonal issues, interpersonal barriers, and systemic issues that affect access to mental health services. These topics are broad and shall offer effective improvement in all areas based on the capability of generating suitable improvement. Criterion *(Score = 0, 1, 2, or 3) Learner Score Chair Score Methodologist Score Content Expert Score Identification of the Problem Space (Minimum two-three pages) The learner provides a detailed description of how the problem space has evolved over time, and the effects it has had on the research (research trends). The learner summarizes the problem space, highlighting what has been discovered and what still needs to be understood related to the topic from literature or research dated primarily within the last five years. The learner discusses and synthesizes the evolution of the research on the problem. Specifically: · Identifies the key sources used as the basis for the problem space · Identifies trends in research and literature. · Identifies how the research focus has changed over the recent past (five years). · Discusses key findings that emerged from recent studies. · Discusses prior research and defined future research needs. From the findings of research studies and evolution of recent literature on the topic, the learner defines the parameters for problem statement for the study. The learner describes how the study will contribute to the body of literature. The learner describes the potential practical or professional applications from the research. The learner writes this section in a way that is well structured, has a logical flow, uses correct paragraph structure, sentence structure, punctuation, and APA format. *Score each requirement listed in the criteria table using the following scale: 0 = Item Not Present or Unacceptable. Substantial Revisions are Required. 1 = Item is Present. Does Not Meet Expectations. Revisions are Required. 2 = Item is Acceptable. Meets Expectations. Some Revisions May be Suggested or Required. 3 = Item Exceeds Expectations. No Revisions are Required. Reviewer Comments: Theoretical Foundations This dissertation’s theoretical foundation is based on the psychodynamic theory and how it relates to the mental health improvement department. Ribeiro et a., (2017) identified that the psychodynamic theory is connected to the emotional, personal barriers to improvement, interpersonal issues, and patterns that develop throughout a person’s life. The next theory applicable in this paper is the social cognitive theory which correlates to the field of psychology. Middleton et al., (2018) explained that the social cognitive theory is connected to psychology whereby the behavior of people is connected to their capability of improving in different aspects of their wellbeing. It is imperative to study each theory uniquely the to connect it to mental health improvement initiatives. Lee et al., (218) further agreed that mental health improvement is possible using the social cognitive theory. The psychodynamic theory got developed by Sigmund Freud as the sought an explanation to the connections that different people have in terms of personal aspects in them, their unconscious influence on their daily procedures, and their ability to form personalities (Ribeiro et al., 2017). The theory explains that human beings’ behaviors often develop as a result of actions that took part in previous years of their lives. The theory is connected the output of each person in terms of their feelings whereby they behave based on internal feelings. It is often difficult for any person to hide their inner feelings according to this theory. Human behavior is also connected to the internal aspects of people and their backgrounds whereby they get to produce effective outputs based on their frequent encounters. The psychodynamic theory explains that the unconscious is critical to all types of output that a person has (Ribeiro et al., 2017). This is connected to the decision-making procedure that each person has since the theory relates to pas experiences and the ability of people to adapt. The second theory that forms this paper’s theoretical foundation is the social cognitive theory. This theory forms a connection with different behavioral aspects of human being whereby their experiences have an influence on their health behaviors. The social cognitive theory is connected to environmental factors of each human being whereby they display different outputs based on their ability to receive positive support from different persons they interact with. In this regard, the psychodynamic and social cognitive theory have a connection whereby environmental factors affect the ability of each person to function properly. It is possible to connect the psychodynamic theory to mental health improvement initiatives for each person. Internal factors of each person have a connection to their mental health whereby it is difficult for people to find mental balance when they are stressed or undergo issues that reduce their happiness (AJN, 2020; VanderLind, 2017). Whenever people get exposed to adverse social conditions, the resulting effect is mental health issues since they find it hard to balance unfamiliar situations and stressful encounters (Pascoe et al., 2019). Mental has a wide effect on the wellbeing of people since it is difficult to get rid of unconscious factors in every person. The type of personality that each person displays has an effect on their ability to manage mental health issues. It becomes difficult to reduce negative effects that each person has in terms of their improvement. The social cognitive theory can get connected to this paper’s study of mental health since it focuses on personal experiences and their ability to influence each person to produce positive output. Whenever a person gets exposed to stressful environments, the resulting effect is mental health problems that affect their overall wellbeing (Mofatteh, 2021). In this regard, it is evident that health behavior is critical since it can get influenced by negative social encounters. The ability of people to form required output is often connected to different aspects of their social cognitive balance. The ability of each person to interact with their surrounding is connected to the mental health aspect since it becomes difficult to manage issues when the affected persons do not receive required improvements. Research Questions After analysis of the theoretical foundation, it is possible to develop the following research questions to guide this topic of mental health improvement and factors affecting its improvement. All the research questions shall get addressed in the review of literature section where it shall be possible to develop different topics. The following are the appropriate research questions: RQ1: How do mental health providers describe the factors influencing utilization of mental health services? RQ 2: How do caregivers describe the factors influencing patient’s utilization of mental health services? Criterion *(Score = 0, 1, 2, or 3) Learner Score Chair Score Methodologist Score Content Expert Score Theoretical Foundations (Minimum two to three pages) The learner discusses the theoretical foundation and, where appropriate, the extended conceptual framework that undergird and frame the study. X The learner identifies theory(ies) models, and/or concepts from seminal source(s) that provide the theoretical foundation to use in developing the research questions, identifying phenomena, and describing the sources of data. X The learner cites the appropriate seminal source(s) for each theory, model, or concept. X The learner includes a cogent discussion/synthesis of the theories, models and concepts, and justifies the theoretical foundation/framework as relevant to the problem statement for the study. The learner connects the study directly to the theory and describes how the study adds or extends the theory, model, or concept. X The learner’s discussion reflects understanding of the foundational and historical research relevant to the theoretical foundation. X The learner writes this section in a way that is well structured, has a logical flow, uses correct paragraph structure, sentence structure, punctuation, and APA format. X *Score each requirement listed in the criteria table using the following scale: 0 = Item Not Present or Unacceptable. Substantial Revisions are Required. 1 = Item is Present. Does Not Meet Expectations. Revisions are Required. 2 = Item is Acceptable. Meets Expectations. Some Revisions May be Suggested or Required. 3 = Item Exceeds Expectations. No Revisions are Required. Reviewer Comments: Review of the Literature Description of Phenomenon Getting Studied The mental health industry has received a lot of focus in the recent years due to adaptability to mental health improvement measures and the ability of different types of environments to offer the required advancement in the field. All articles involved in development of this section have a connection to the mental health industry and factors that promote study of the area. There are articles that focus on environmental factors that reduce adoption of mental health improvement measures. It is evident the aspect of environment has a strong correlation to mental health improvement measures (Cuncic, 2021; Goetzel et al., 2018; Snow et al., 2019). The issue of environment was the focus of the articles mentioned since it is imperative to study interpersonal, intrapersonal, and structural issues which limit mental health improvement. There are articles that performed study on barriers of access to healthcare whereby it was evident that the barriers have been prevalent for a very long time now. The barriers involved issues such as discrimination at mental health facilities by trained persons (Johnson et al., 2020; Lee-Tauler et al., 2018; Mace et al., 2018). In this regard, it is possible to offer improvement in the mental health industry using the proper study conducted in this paper. Access to healthcare facilities in Texas has been low in the past years in spite of government measure to improve mental health in the state (The Rees-Jones Foundation, 2020). This reveals the critical need of improving mental health in all areas based on the capability of producing effective care for each affected person. Abi-Jaoude et al., (2020) performed a study that aimed to determine effect of social media use on the mental health of teens. The application of social media in the study was highly imperative since it offered insight into the current social environment whereby social media adaptation has been very high. The study focused on issues that result during use of social media platforms. The authors eliminated any type of bias by using different social media platforms and types of users. This offered effective guidance related to mental health improvement initiatives in the area. The study revealed that social media has a strong impact on the capability of the youth to develop. This is primarily due the fact that they spend a lot of time on the platform. Attention span to other aspects in society often dwindles and mental health issues develop to lack of collaboration with people who would provide suitable guidance. Aguirre et al., (2020) identified that adolescents often receive ineffective mental health improvement due to overreliance on each other to improve their statuses. The issues progress since the adolescents are in a stage in their lives whereby it is difficult to focus on other health improvement measures. It is possible to identify a barrier in this case since it is evident that lack of mental focus in the appropriate direction often affects capability of improving in a holistic way. The article by Aguirre et al., (2020) further revealed that every adolescent requires mental health improvement due to their vulnerable stage. Carbonell et al., (2020) elaborated on the fact that there are barriers that limit access of healthcare for every person. The study was effective since it performed factual analysis in respondents who could provide insight into the mental health department. It was discovered that mental health was underlying issues that often occurs unnoticed in some individuals. This has a negative effect on the majority of affected persons, especially those who do not realize they have mental health issues. The study further revealed that mental health issues affected the capability of affected persons’ families to offer improvement. The families experienced issues like finances, lack of motivation, and lack of proper guidance. Czeisler et al. (2020) identified that there were issues related to access to mental health in terms of the Covid-19 pandemic. This perspective is imperative in the study of mental health access since it is evident that the behavior of people in regard to adverse health conditions often change and cannot get managed without proper study. The authors identified the pandemic affected every personal on the planet in terms of their employment, mental wellbeing, and healthcare services. Czeisler et al. (2020) stated that in the year 2020, “40% of adults” encountered mental health related issues. The study is related to the study of environmental factors and how they have an effect on the mental aspect of every person. The loss of employment results in worsening of mental health in two ways: lack of funds to access care, and negative mental status due to lack of self-sustenance for affected persons. Inability to access any type of healthcare service has a negative effect on affected person. da Silva et al., (2020) reported that mental healthcare access often receives limited attention since the person are discouraged by stigma in healthcare institutions. The authors identified that mental emergencies do not often seem serious for some healthcare institutions. This occurs since emergencies related to bodily harm are the ones which strongly affect the wellbeing of people and their ability to have full body function. This is an ineffective approach according to the authors since mental health is the basis of proper full body functioning. It is ineffective to focus only on one aspect of a person’s wellbeing without having high regard for their mental health status. Evans-Lack et al., (2018) identified that there are issues related to the ability to mental health patients to receive required outcomes based on economic variations. The study confirmed the notion that the gap in mental health improvement industry is still growing yet the world receives socio-economic development. Mental health is often negative when affected persons lack a way of developing themselves regardless of external barrier to their treatment. In this regard, the study identifies the factual factors which is that mental health causes depression and anxiety when it does not receive suitable treatment. Fante-Coleman et al., (2020) identified that access of mental healthcare was very limited for black youth in the current environment. The study got conducted in Canada whereby it was discovered that black youth could not access positive healthcare improvement due to underlying issues. Fante-Coleman et al., (2020) explained that black youths received mental health improvement when they engaged with law enforcement agencies and only when they got into emergency conditions that required mental health improvement. This reveals that mental health improvement initiatives do not always get provided early in peoples’ lives. Dolezal & Lyons (2017) explained that shame is a negative barrier that limits mental health improvement. The authors performed qualitative study on some credible documents whereby it was revealed shame and feeling little self-worth is a negative barrier to access of mental healthcare. The articles used in the study were peer reviewed journal articles each one having undergone care scrutiny and connection to the topic. The research was factual since the authors demonstrated that people often feel shameful because they consider mental issues as a sign of cognitive imbalance which often indicates improper human being functioning. Synthesis Analysis of all the studies reveals that environmental factors play a critical role in the access of healthcare for all persons. According to factual evidence collected by (Goetzel et al., 2018; The Rees-Jones Foundation, 2020; Evans-Lack et al. 2018; Carbonell et al. 2020; Czeisler et al. 2020), it is evident that the issue of environment has a long-lasting impact on the wellbeing of every person. The studies identified that whenever a person gets exposed to areas whereby, they do not feel comfortable, the resulting effect is feeling anxious due to improper cognitive balance. Environmental factors also play a role in the ability of people to access healthcare since they may lack the economic capability to do so. Negative economic conditions impair every person’s capability of having proper mental balance and ability to improve their statuses. Studies by (Johnson et al. 2020; Dolezal & Lyons 2017; da Silva et al. 2020) revealed that mental health patients often encounter barriers in regard to their capability of feeling comfortable around the healthcare industry. The authors identified issues of shame, stigma, and fear of appearing as weak to be the main drivers of limited access to mental health services. The studies reveal that poor training of mental health providers are the main issues that reduce proper adherence mental health improvement initiatives. Mental health improvement awareness has frequently received improvement, yet people still display personal barriers towards access of proper care. Studies by (The Rees-Jones Foundation, 2020; Abi-Jaoude, 2020; Aguirre et al., 2020; Fante-Coleman et al. 2020) revealed that mental health improvement gets affected by limited improvement in interpersonal connections. This has a negative impact on the capability of producing positive outcomes since it becomes difficult for people with issues to receive suitable help. Another issue is connected to the problem of interracial connections whereby people form black communities do not receive mental health improvement as a result of systemic barriers. All the studies were strong because they contained factual evidence related mental healthcare improvement. The only weak study is by Fante-Coleman et al. (2020) since they were focused on a small number of black youths living in Canada. The issues of mental health among youths are critical and requires study of many of them to determine institutional, interpersonal, and intrapersonal barriers for improvement. Themes or Topics: Studies from a Social Perspective: Issues that Cause Limited Access of Mental Healthcare Introduction This section shall perform analysis of factors which reduce mental health care access for some people. The use of peer reviewed journal articles in this section is highly imperative since they contain analyses from credible sources that all connect to the expected outcome of the research. The issues of economic challenges create a barrier for mental healthcare access in terms of finances and lack of capability to remain self-sufficient (Sarikhani et al., 2019; McDaid et al., 2019; Ibrahim et al., 2020). Interpersonal issues also pose a challenge to adherence mental health improvement measures since people that rely too much on social media find it hard to cope with negative outcomes of environments such as Covid-19 (Abi-Jaoude et al., 2020; Alonzi & Silverstein 2020; Doran & Kinchin, 2019). Adverse economic conditions have a negative impact on the capability of people to receive mental health improvement. The study of mental health from the perspective of finances is critical since it offers improvements based on requirements of affordability of healthcare. It is difficult for any person to access healthcare when they do not possess medical insurance. The issues worsen when the affected persons do not register for medical insurance that can cover a variety of medical issues. In this way, negative economic environment can further impair the capability of affected persons to receive improvements based on the constraints of the financial environment (Sarikhani et al., 2019; McDaid et al., 2019; Ibrahim et al., 2020). The next perspective of studying issues which limit access to healthcare is connected to intrapersonal issues that limit a person’s desire to receive healthcare (Abi-Jaoude et al., 2020; Alonzi & Silverstein 2020; Doran & Kinchin, 2019). Whenever a person gets exposed to adverse social conditions, it becomes difficult for them to receive improvements based on their unique requirements. This is primarily due to personal barriers that each person possesses which limit their capability of accessing mental health services (Abi-Jaoude et al., 2020; Alonzi & Silverstein 2020; Doran & Kinchin, 2019). The studies reveal people are more predisposed to encountering mental health issues when they lack proper comprehension of their environment. Improper external environment factors result in an inability to increase positive outcomes for each person. Sarikhani et al., (2019) identified that low- and middle-income persons were more exposed to financial constraints of mental health improvement. The approach by the researchers included study of online databases which contained information related to mental health. It was evident that the issue had a wide impact since the scope of the study covering 2000 to 2019 and all mental health improvement through the years. It was discovered that mental health improvement is a critical factor that requires each person to take part in the development. The study by Sarikhani et al., (2019) was factual since they ensured to only use documents written in English and those with information including barriers to provision and utilization of mental health services. Sarikhani et al., (2019) identified that mental health improvement initiatives were ineffective to persons who could access of types of services. This is connected to financial impact whereby persons who undergo mental health issues may lack resources required for improvement of their outcomes. The authors further identified that interventions placed to improve mental health get exposed to constraints whereby it is difficult to cause long-term improvement without studying capability of each person to receive improvement. The majority of Americans in the nineteen years that the study covered often encounter limited access to health improvement measures. The desire of some persons to seek mental healthcare got destroyed due to inability to access proper resources that increase positive health outcomes. McDaid et al. (2019) performed research related to health improvement measures in regard to economic capabilities. The authors identified that the U.S. government had to spend approximately “$201 billion” to deal with mental health disorders. The authors identified that mental health improvement was costly since the government had to deal with costs of managing nursing homes for persons with mental health issues. From this perspective, it is evident that mental health improvement requires many professionals as well as providing facilities that can serve persons of all ages. Another issue that causes costly mental health improvement requirements is the setting up of psychiatric institutions (McDaid et al., 2019). A lot of costs are incurred due to requirements of equipment and availability of healthcare professionals. the next economic factor that causes costly mental health improvement is the requirement of governments to set up mental health improvement departments in prisons (McDaid et al., 2019). All these factors are connected to the inability of access to healthcare for the persons that need it most when the economic environment is unfavorable. Ibrahim et al. (2020) identified that many persons with mental health issues do not attempt to access care after growing up in environments that do not allow people to be open about their issues. The problem continues to develop since the affected persons fear disapproval from family and society if they attempt to seek mental healthcare initiatives. The researchers performed qualitative research on 341 persons who were all provided with questionnaires that posed question suitable to the topic of mental healthcare access. Analysis of the responses was in support of the fact that mental health improvement is limited if a person’s environment remains hostile. Ibrahim et al. (2020) explained that the issues of lack of access could not get solved by the affected persons themselves since they lack adequate financial and external influence to improve their wellbeing. The authors further identified that access to treatment was limited since some affected persons feared for their academic performance. The fact that mental health improvement requires a person to possess desire to change results in further limited capability of affected persons to receive improvement. Abi-Jaoude et al. (2020) identified that smartphones and social media have a negative impact on the mental wellbeing of many persons. The majority of youth own smartphones which get used for communication and access to variety of entertainment content. Social media use as been constantly growing ever since the platforms got created. The youth are more attracted to different social media platforms since they can use internet connections to communicate with their peers from different geographical locations. This often causes addiction since the youth spend a lot of time on the platforms. Abi-Jaoude et al. (2020) identified that mental health issues develop since the youth have limited face-to-face encounters and thus cannot receive positive wellbeing. Abi-Jaoude et al. (2020) stated that youths who are addicted to social media and their smartphones are predisposed to having depression and suicidal thoughts. Such mental issues result due to limited capability of connecting with people with good intentions who would be able to influence them to perform better. Mental health issues develop since the affected persons fail to connect with real persons that would offer emotional support. Alonzi & Silverstein (2020) identified that environmental issues pose a negative impact on the capability of people to receive mental health improvement. The authors performed studies on some mental health patients to determine the impact of Covid-19 on their wellbeing. Alonzi & Silverstein (2020) studied 103 patients who had been diagnosed with Covid-19 to determine how their mental health status had gotten affected. The researchers identified that “depression, anxiety, and post-traumatic stress” occurred for all persons who had been infected with the virus. This has a relationship with the study of mental health improvement measures since it is evident that all affected persons lack the capability of improving due to negative environment. It is difficult to improve the wellbeing of the persons without studying how other health statuses that they possess can impact their general health. Doran & Kinchin (2019) studied the economic impact of mental health illnesses whereby they discovered that the cost of mental health improvement was very high in the current environment, yet it was difficult for governments to handle the requirements. The authors identified that the Canadian government has gotten exposed to adverse mental health for their citizens which required more than 2.8 trillion of Australian dollars in future mental health improvement (Doran & Kinchin et al., 2019). Every government is responsible for their citizen. In this regard, it is imperative for government funds to get directed to mental health departments and improvement initiatives. The barriers often develop when governments lack adequate funds to provide these requirements and when the citizens do not receive news about government improvement initiatives. Summary Complete analysis of all studies reveals that issues that reduce access to healthcare are interpersonal, intrapersonal, and institutional. Interpersonal issues occur whereby affected persons do not receive proper external push to improve their mental health statuses. The studies by Sarikhani et al., 2019; McDaid et al., 2019; Ibrahim et al., (2020) were suitable in offering insight in to proper mental health assessment and how external issues cause intrapersonal issues of access to care. The persons who are affected often lack capability of adapting to adverse social conditions. The studies by Abi-Jaoude et al., 2020; Alonzi & Silverstein 2020; Doran & Kinchin, (2019) offered insight into mental health issues due to institutional barriers. Concepts such as economical barriers and worldwide pandemic were the focus of the studies. The only weakness identified is that the study by Doran & Kinchin (2019) was focused on limited sample size yet the metrics and topics in the study were broad. Issues for Persons with Access to Refuse Mental Healthcare Introduction The selection of this topic was imperative since it is connected to access to healthcare for persons who encounter barriers in their improvement. The topic is suitable for this paper since it is imperative to form a strong basis for mental health improvement initiatives. Identification of factors involved in health improvement initiatives is imperative since it would study how mental health issues worsen without proper study. There are persons who refuse to access healthcare since they are limited by personal issues or external issues. This section shall reveal such issues and their improvement methods. There are persons who have capability to access healthcare, yet they reject such measures due to personal constraints. It is imperative to study such constraints to determine how they have an impact on the overall outcome of mental health improvement measures. Analysis of issues that cause some people to refuse healthcare reveals that the barriers are stigma, feeling of low self-worth, and improper decision-making capabilities (AMA J Ethics, 2017; Staiger et al., 2017; Knaak et al., 2017). The three articles focused on intrapersonal barriers that affect each person’s capability of identifying that they have issues which require mental health solutions. Barriers of access to healthcare also develop due to inability of people to realize they possess addictions that are detrimental, improper social networks, and focus on only one aspect of cognitive balance (Kecojevic et al., 2020; Hagell et al., 2018; Glazzard & Stones, 2019). The articles have a strong connection to the topics mentioned since they focus on structural issues that people face. The majority of these structural issues limit the people’s desire to seek mental healthcare in any area of their life. It would be possible to develop suitable arguments based on the components a theoretical focus of each paper in the field of mental health improvement. The AMA J Ethics (2017) identified that there are personal barriers that limit the capability of access to mental healthcare. A case study was used as the basis of the research whereby it focused on some person who could not make proper decisions concerning their health. The study explained the fact that medical decision-making is imperative since it guides physicians on the type of care suitable for each patient’s situation. Issues occur whereby patients lack mental capacity to explain their issues to physicians. The treatment procedure can thus become confusing. The AMA J Ethics (2017) focused on ethical decision-making whereby it explains that it is the duty of physicians to perform ethics as well as professionalism in all their mental health improvement initiatives. There are barriers in this process since affected persons do not realize the level of seriousness of the mental conditions. This can influence them to give limited information for health improvement measures. This is type of barrier is highly detrimental since the treatment plan a physician prescribes may not suitable to the mental health patient. Staiger et al. (2017) focused on issues related mental healthcare access when the affected persons have low self-worth. The researchers conducted the study using interviews that were provided to persons who were unemployed between that ages of 18 and 63, and those who reported having stress. These metrics were suitable since they were connected to the research are of assessing mental health issues and the impact which reduced affected persons’ capability of seeking care. The study revealed that fifteen persons cited mental health issues due to lack of proper wellbeing. Staiger et al. (2017) performed a high-quality study since the interviews got conducted in a face-to-face manner. The outcome revealed that sudden employment was highly negative and resulted in issues in a person’s life since they could not focus of self-improvement. The issue of lack of proper wellbeing was connected to inability to access proper care for all persons. Such persons feared getting discriminated against due to lack of self-sustenance. Such feelings elevate the mental health issues since the affected persons do not receive the required support for their conditions. Knaak et al. (2017) identified that stigma is a common issue related to mental health improvement. The authors performed a study on the different areas whereby mental health patients get stigmatized. This was an effective approach since it was possible to discover barriers that occurred such as ineffective mental balance for affected persons. This had a negative impact on their capability to seek care from the appropriate healthcare department as they were afraid to reveal their condition which often gets considered as shameful and dehumanizing. Knaak et al. (2017) further discovered that mental health patients with issues related to behavioral disorders often shunned by healthcare providers. This issue causes such patients to limit their desire to access mental improvement since they become afraid of getting dehumanized. The issue of access also occurs for healthcare providers who display pessimism and consider some improvement aspects to be inefficient (Knaak et al., 2017). In this regard, it becomes difficult to provide care in the appropriate areas that require healthcare improvement measures. Patients would be afraid to seek care and physicians would be unavailable fully in terms of professionalism require to improve care. The issues of patients rejecting mental health improvement measures can also get studied in the aspect of structural issues that reduce healthcare provision. Glazzard & Stones (2019) identified the technology industry, particularly social media, caused some youths to refuse mental health improvement measures. The researchers identified that social media exposes the youth to cyberbullying that affects their capability of receiving required care. The authors performed qualitative study of some peer reviewed journal articles that they used to develop their argument. This formed an argument related to improper mental balance due to negative relationships formed on the platform. Glazzard & Stones (2019) explained that social media use allows young people to change their appearance using different types of filters. This is a negative factor on cognitive balance since the social media users may form mentality and relationships that are negative. 40 The persons affected by this issue do not realize that they develop personality disorders. This is highly detrimental to their wellbeing as some even resort to cosmetic surgery to transform their appearance (Glazzard & Stones, 2019). The issue of mental health does not seem to bother such social media users since they always desire to progress with a trend instead of remaining true to their personality. Hagell et al., (2018) identified that structural issues in terms of social surrounding of people affects their capability of receiving effective mental health. The issue of peer and social groups often influence the ability of a person to seek mental health improvement. The authors identified that peers could result in negative outcomes for some people in terms of mental wellbeing. Peers often influence each other to engage in substance abuse since it may seem cool (Hagell et al., 2018). Issues often develop in this aspect since it is difficult to access mental healthcare when persons involved do not realize the gravity of their conditions. Hagell et al., (2018) performed analysis of peer reviewed journals which was effective in displaying the types of mental health improvement initiatives that have been developed. The authors identified that poverty level is a factor that causes mental health issues and limits the capability of affected persons to receive care. This is primarily due to the fact that persons how come from households exposed to poverty are involved in different types of requirements for their wellbeing. This social factor causes mental health improvement to appear of little worth in the improvement of affected persons. Kecojevic et al. (2020) identified that structural issues in terms of the healthcare industry cause people to have limited capability of accessing healthcare. The approach used by the authors was effective since they studied issues of Covid-19 pandemic and their relation to the education sector. The study used surveys that were provided for 450 students and each was required to responds to a rating scale for each question applicable in the research. This was an effective approach since it was connected to the efforts taken identify whether lack of focus created barriers for people seeking mental healthcare improvement. Kecojevic et al. (2020) performed the cross-sectional study which revealed that students who shifted to online learning were negatively affected by the shift and prevailing Covid-19 conditions. From this perspective, it is possible to identify that negative social environment is a factor that limits the capability of improving access to care. It is difficult for affected persons to realize that they need to transform their statuses when they have issues they ought to deal with. The fact that education improvement is a priority results in some affected persons to reject mental health improvement since it does not seem to have immediate negative outcomes. Summary The synthesis of information from the articles reveals that mental health improvement is required even though many persons reject evidence-based guidelines to solve mental health issues (AMA J Ethics, 2017; Staiger et al., 2017; Knaak et al., 2017). The articles are effective since the studies got conducted using survey, interview, and case study approaches that reveal factual information for mental issues. The desire to access healthcare was limited for some people since they could not receive favorable environments for their needs (Kecojevic et al., 2020; Hagell et al., 2018; Glazzard & Stones, 2019). The authors provided a commendable approach of mental health improvement from this perspective. The study by Glazzard & Stones (2019) was weak since it was based on issues on social media platforms for young people, yet it did not expound on how different platforms like Facebook, Twitter, or Instagram caused issues for users. Persons that Accept Mental Healthcare Access Introduction The study of people who accept mental healthcare improvement initiatives is imperative since it determines the appropriate knowledge related to the field of mental health improvement. This section of the paper shall study how different persons accept intrapersonal, interpersonal, and structural suggestions for mental health. The process of analyzing personal improvements in the field of healthcare is connected to the intrapersonal desire that each person possesses to enhance their comfort. Whenever have adequate mental capacity to realize that they have a problem, it becomes easier to adopt mental health improvement initiatives (Hemsley et al., 2018; Kemp et al., 2019; Lake & Turner, 2017). The researchers performed qualitative analysis and interviews as the main approaches use to improve knowledge in the field of mental health. It shall be possible to identify how mental health improvement is possible for different fields of healthcare using the unique study topics developed by the authors. The approach taken by (Hemsley et al., 2018; Kemp et al., 2019; Lake & Turner, 2017) is effective since it offers insight related to mental health improvement by current issues like social media and education improvement. The technique of seeking information form peer reviewed documents is effect since it is possible to determine how people get affected by certain issues in their external environment. The technique creates effective understanding in the field of mental health improvement since it is possible to discover how mentally ill persons react to improvement measures. Whenever people with mental health issues become aware of techniques of changing their wellbeing, they attempt to deal with their situations using any available measures. The process of seeking external help is connected to technological aspects, improvement of healthcare providers’ attitudes, and getting exposed to conducive environments (Abi Doumit et al., 2019; Naslund et al., 2020; Follmer & Jones, 2017). The authors performed these studies in relation to the capability of using analysis of peer reviewed articles, questionnaires, and research of topics related to mental health improvement. The ability to discover need for healthcare is the best approach in creating positive outcomes. People often encounter mental health conditions such as: “anxiety, mood, psychotic, eating, personality, addiction, obsessive-compulsive, and post-traumatic stress disorders” (Goldberg, 2019). All these have unique impacts on affected persons, and it is imperative to develop solutions in order to come up with effective outcomes. The studies by (Abi Doumit et al., 2019; Naslund et al., 2020; Follmer & Jones, 2017) offer proper solutions to mental health especially after each person discovers their issues. Hemsley et al., (2018) identified that persons with mental health issues can get improved once they are exposed to environments that provide them with balance and sense of belonging. Social media users often receive proper improvement since they connect with variety of people on the social networking platform (Hemsley et al., 2018). The authors offered benefits of social media use which contrasts with other articles that stated social media use causes development of anxiety (Karim et al., 2020). The approach by the authors is effective in handling mental health issues since the current environment has millions of people using social media platforms. There are approximately “3.1 billion monthly active users” on “Facebook, WhatsApp, Instagram, and Messenger” (Tankovska, 2021). In this regard, it is evident that people who use social media for positive outcomes can receive variety of improvements according to their needs. Hemsley et al., (2018) further explained that social media use is positive since is offers communication at any time that a person requires it. This is connected to the improvement of mental health whereby people suffering from different types of issues can get transformed once they receive proper connection with people they care about. Lake & Turner (2017) explained that people in the current environment have better capability of receiving mental healthcare because they are more exposed to health improvement initiatives. The authors identified credible data from the World Health Organization and European Union related to mental health assessment and techniques of providing people with required measures (Lake & Turner, 2017). The main outcome of the research was that identification of mental health issues is the basis of finding solutions. This creates an effective technique of discovering solutions to every individual’s issue. Lake & Turner (2017) performed qualitative analysis of some credible sources whereby it was possible to discover considerations that can improve healthcare. The need to improve personal issues can get addressed when the affected persons receive care that suits their issues. Creating conversations with healthcare providers forms the basis of treatment since they can decide whether patients require prescription drugs or therapy. The procedure of seeking medical care is effective for patients who aim to receive appropriate changes and possess self-will for transformation. It is possible for mentally ill persons to seek care when they meet healthcare providers who are caring (Lake & Turner, 2017). The outcome of the research analysis reveals constant improvements can cause more effective solutions. Kemp et al., (2019) identified that mental healthcare can get acquired once affected persons improve their resource acquisition capability. The authors performed interviews on 16 persons to seek information related to mental health improvements for persons with limited access to care. The interviews were performed for healthcare providers and program leaders to determine the possibility of offering global improvement in healthcare (Kemp et al., 2019). From this perspective, it is evident that health improvement is a procedure that has high possibility of providing improvement as each person realizes their responsibility. Kemp et al., (2019) identified that specialists have a high likelihood of providing care to mental health patients. This is a factual analysis since as mentioned above, mental health issues occur in different forms. People who discover the approach provided by the authors can receive proper improvement since it would be possible to identify specialists that are highly trained to handle mental health patients. People can use technology to access mental health services using the internet or through WhatsApp connections (Kemp et al., 2019). The possibility of gaining suitable physicians gets provided in this way. Naslund et al. (2019) identified that people can receive positive mental wellbeing when they get exposed to technological environments like social media which provide conducive mental status. The authors performed study and analysis of peer reviewed articles which offered appropriate information related to mental health improvement measures. The study revealed that use of social media is effective since it provides interactions and peer network suitable to a mentally ill person’s need. The approach by Naslund et al. (2019) was effective since it supported the proposal that social media usage is effective for developing conducive mental health. People would open accounts on the social media platforms and use the internet to search for data that can reduce their negative symptoms of mental health issues. Naslund et al. (2019) found data from credible sources which revealed that mental health improvement is possible once affected persons take part in different improvement initiatives. Once the sick persons discover areas and platforms that make them happy. It would be easier to issue effective changes. Abi Doumit et al. (2019) explained that transformation of patients’ attitudes towards healthcare is imperative for their growth. The authors performed a study using questionnaires distributed to 2289 respondents who got asked questions related to their mental health issues. It was possible to discover issues related to ability of people to seek mental healthcare regardless of environmental factors. The authors performed analysis of large communities to determine personal issues that limited their capability of seeking healthcare. The authors applied technological means to produce factual data whereby they performed quantitative analysis of data from the research process. Abi Doumit et al. (2019) discovered that attitude improvement forms an effective basis for mental health awareness. Attitude improvement can occur in an interpersonal, intrapersonal, and structural perspective. Whenever mentally ill persons become exposed to encounters that pose bad outcomes for other people, they feel it is their responsibility to change so that they receive proper interactions. This is an effective driving force in the field of mental health improvement since it has a capability of generating positive outcomes for all persons. Follmer & Jones (2017) identified that people who realize the negative outcome of mental illness on their work often attempt to find ways of fixing the issue. The authors researched on documents which contained information related to mental health in workplaces. The approach taken by the authors is commendable since it is possible to determine the appropriate mental health improvement initiative after identifying the types of professional environments that trigger negative outcomes. Every employee gets exposed to mental health issues due to the frequent stressful situations at work. The affected persons can seek healthcare by attempting to deal with interpersonal issues with their colleagues and lack of adherence to stakeholder expectations. In this way, it would be possible to seek improvement due to the capability of generating proper mental capacity to receive improvement. Summary The study of Kemp et al., (2019) has the weakness whereby it only focused on supervision of mental health providers to improve quality of care. The study limited its analysis to only low-resource areas whereby the possibility of gaining sufficient unbiased data was limited. The studies by (Abi Doumit et al., 2019; Naslund et al., 2020; Follmer & Jones, 2017) were effective since thy developed effective comprehension of how people can use common environmental issues to improve their capability of seeking access to mental healthcare. The research conducted was also uniquely positive since it was possible to reveal how environmental issues have a capability of generating problems and how affected persons can use their problems to seek solutions. Factors that cause Rejection of Mental Healthcare Access Introduction The topic got selected since it is highly suitable in the field of mental health. There are moments when people get affected by the types of social environments. This paper as already analyzed issues that cause limited access to mental healthcare. This section shall deal factors which cause people to reject already established mental healthcare initiatives. The main groups of people that this section shall study are LGBT community and religious groups. There are articles that study how mental health issues are connected to the religious sector. Ayvaci (2017) and Peteet (2019) performed research into the religious sector and discovered that mental health issues do not receive proper focus. The authors based their argument on the fact that religious settings often focus on a higher power. This influences their method of handling issues since it is difficult for affected persons to receive proper support suitbale to their mental health issues. The study of the peer reviewed journal articles by Ayvaci (2017) and Peteet (2019) shall reveal how the level of focus that each person display has an impact on their capability of receiving mental health improvement. Religious settings are often time-consuming and require all persons involved to provide undivided attention (Milner et al., 2020. The studies shall reveal whether it is possible to provide while adhering to requirements of religion (Paika et al., 2017). A study conducted by Estrada et al., (2019) was focused on assessing how religious education has an impact on the overall wellbeing of mental health status. The authors performed research on a variety of documents related to religious education and how it has an impact on adolescents (Sutherland, 2018). The authors identified that mental health issues develop due to overreliance on religion can cause some adolescents not to receive positive mental wellbeing (Van Herreweghe & Van Lancker, 2019). Estrada et al., (2019) stated that when adolescents who are not Christians engage with peers who are Christians, it is common to encounter stigma and discrimination that affects their mental health balance. This is negative issue of religion which can result in rejection of improvements as the affected persons fail to realize the proper institution to improve their wellbeing. Estrada et al., (2019) further identified that religion has a negative impact on the LGBTQ community since the members can get considered to be mentally ill by religion. Often, this is not the case causing affected persons to reject religion entirely. The rejection can progress towards any positive mental health improvements. The effect of religion is thus negative from this perspective. Ayvaci (2017) performed analysis of some peer reviewed studies related religion assessment and how people were drawn to religious activities based on societal structure. The authors analyzed surveys related to religion, for instance, it was discovered that many persons who were religious fail to inform psychiatrists of their religious affiliations (Ayvaci et al., 2017). This reveals that religion forms a barrier for people seeking mental healthcare and improvement. Another factor that causes rejection is the view that some psychiatrists have concerning religion. Patients may consider their issues not to be detrimental since they formed a concept of “religiosity” which seems positive in their perspective. Ayvaci (2017) assessed surveys that revealed how religious clergy are not properly aligned with mental health departments. This is a negative factor since it is evident that mentally ill persons realize this barrier and attempt to solve mental health issues on their own. Rejection of mental health improvement initiatives is thus detrimental since religion causes people to have a misguided view of their psychiatrics (Ayvaci, 2017). It is common to encounter misguided perspective of religion improvement initiatives. Peteet (2019) identified that the connection between religious beliefs and psychiatric symptoms can get confusing when the affected persons cannot tell a difference between positive or negative aspects of their personalities. The author’s research was based on analysis of peer reviewed journals and he also gave examples of some people who could not realize their need to receive mental healthcare. Persons who are mostly drawn to religion can get affected since it would be hard to separate religious ideas from real life issues. This can be detrimental for the capability of gaining positive aspects in any type of social environment. Peteet (2019) explained that religion can influence people with dangerous environments to receive improvements suitable to their issues. This can occur when persons affected by domestic violence, divorce, or substance abuse have misguided belief that their issues are parts of their lives and that they ought to persevere (Menegatti-Chequini et al., 2019; Mofatteh, 2021; Peteet, 2019). People who possess such beliefs can have limited desire to access of mental health improvement since they focus too much on religion and forget the need to improve their holistic aspects. Estrada et al. (2019) performed analysis of peer reviewed journal articles that connected religion to mental health improvement. The authors identified that religious beliefs can cause “depression, anxiety, and obsession” when the affected persons do not possess balance with other social aspects (Estrada et al., 2019). It is common for people who have too much obsession for religion to receive misguided view of their problems. Getting obsessed with religion often results in affected persons to fall deeper into depressions since they do not consider professional mental health improvement as a suitable solution (Salari et al., 2020; Sampogna et al., 2020; Salami et al., 2020). The mentally ill persons seek support from religion which can be positive but does not always in effective outcomes. Estrada et al. (2019) explained that religion is connected to the capability of people to realize that they can receive improvement for stressful situations. The authors identified that life has very many stressors that can get solved using positive aspects of religion. This has a negative connection with the mental aspect of life since people who fail to identify the dangers of life’s issues can have low regard for religious improvements. Whaibeh et al., (2020) identified that the LGBTQ community is highly disadvantaged due to society’s perception of their issues. The authors identified that many persons in the LGBTQ community experience suicidal thoughts, anxiety, and discrimination. The issue causes a majority of them to oppose mental health improvement initiatives which may appear insensitive to their choice of living. Whaibeh et al., (2020) explained how mental health departments consider LGBTQ persons to possess conditions that can push them to have misguided view of their sexuality. From this perspective, persons in the LGBTQ community do not receive appropriate improvement since they cannot develop properly while getting constantly segregated (Thomas et al., 2020). Whaibeh et al., (2020) performed study of how telepsychiatry can overcome issues related to requirement of improving mental health aspects of the LGBTQ community. It is possible to discover how people reject mental health improvement measures when they cannot get aligned with people who have similar issues as they do. The process of getting healthcare access can also cause rejection when persons in the LGBTQ community get divided from other people in society. Moagi et al. (2021) explained that persons in the LGTBQ community receive discrimination in different areas since their practices are unnatural in the majority of all areas of life. This perspective forms a rejection of persons in the community since they consider their choices as proper and that all persons in society should accept their choices. Moagi et al. (2021) used literature research and data evaluation methods to perform analysis of the connection between LGTBQ communities and mental health. The studies produced data related to mental health awareness that affects the capability of receiving treatment based on victimization, emotional issues, and stigma for the persons who identify differently in terms of their sexuality. Moagi et al. (2021) based their study on the fact that mental health improvement is a critical requirement in today’s society as more people “come out” and reveal their sexual identities. Rejection for mental health improvement is common in the studies is common as the affected persons desire to remain independent as they discover their new form of life and how it has an impact on their overall wellbeing. Nakkeeran & Nakkeeran (2018) identified that sexual orientation has an effect on the mental wellbeing of all persons. The authors’ research was mainly explanatory since they identified that the LGBTQ community was affected by a variety of issues which were related to mental health improvement initiatives. The process of forming gender identity is exposed to inaccurate concepts in regard to Accethe stigma that society creates on people. In this regard, the studies by the authors are effective as they depict how people reject mental health improvement measures and forget to correlate their capabilities to the standards set up by health improvement initiatives. Nakkeeran & Nakkeeran (2018) explained that the procedure that each person applies to form their identity often gets exposed to issues when they do not receive proper guidance. Rejection of mental health measures occurs since the affected persons cannot get proper guidance when they experience humiliation and low regard. The authors identified that the affected persons find it hard to transform their capabilities with societal expectations. Summary The articles presented by the authors (Estrada et al., 2019; Peteet, 2019; Ayvaci, 2017) were positive since it was possible to create connection with the religion sector and its impact on mental health improvement initiatives. The articles by (Whaibeh et al., 2020; Moagi et al., 2021; Nakkeeran & Nakkeeran, 2018) were effective in explaining how the LGBTQ community gets affected by social factors which reduce adoption of mental health improvement. The only weakness was that Moagi et al., (2021) based their analysis on the LGBTQ keyword which only produced data matching the keyword. It was thus difficult to identify required development in the efforts of all members of the community and their mental health requirements. Studies on Related Mental Health Improvement Research: Importance of Mental Healthcare Improvement Introduction Mental health improvement is imperative in all areas of life since the mental status of people often affects their capability of functioning well in any type of environment. The process of generating effective outcomes is connected to mental health improvement measures whereby each person is required to receive conducive mental health in order to generate high-standard output. In this regard, the selection of the topic was imperative since it determined effective outcomes based on the possibility of generating positive improvement for all persons and their external environments (SAMSA, 2021). Adan et al. 2019; Doran & Kinchin, 2019; Petrie et al., 2018 all identified that mental health is imperative since it provides proper body functioning. The authors performed qualitative analysis of mental health improvement measures and some peer reviewed journal articles containing mental health improvement data. Studies by Petrie et al., (2018) and Adan et al., (2019) identified that mental health improvement is required for the effective outcomes of all aspects of society. This need is connected to the requirement of handling mental health related issues by persons who have the capability of creating change. The studies focused on the healthcare personnel and institutions who have the capability of generating effective outcomes. The study by Doran & Irina (2019) was focused on the fact that mental health improvement is required for economic development. The articles by (Guidry-Grimes, 2020; Bożek et al., 2020; Hernández-Torrano, 2020) were effective in developing positive outcomes for persons living with mental health issues. The articles involved study of persons affected by mental health problems and peer reviewed analysis of mental health improvement measures. The study by Hernández-Torrano, (2020) was effective since it was directed to analysis of “5,561” journal articles each having content related to mental health improvement measures. The article by Guidry-Grimes (2020) was focused on mental health assessment since it is a requirement of generating effective outcomes for persons with decision-making capabilities. The field of mental health improvement displays its effectiveness in this way as it is possible to identify areas that require critical study to ensure all mentally ill persons receive required improvement measures. The articles by (Guidry-Grimes, 2020; Bożek et al., 2020; Hernández-Torrano, 2020) were properly developed and all discuss how mental health is important for full functionality of members of the public. The process of identification of mental health improvement areas forms the basis of appropriate change. This section shall discuss different areas where mental health improvement can get applied. Adan et al. (2019) stated that mental health improvement is possible by provide nutritional advice for persons who experience mental health issues. The authors performed study of many peer reviewed journal articles that revealed that nutrition is an imperative factor in the process of creating positive mental health status for individuals. The authors identified nutritional deficiencies have a negative impact on mental health status of different persons. The main deficiencies identified are lack of vitamins cause weak cognitive capability, lack of vitamin B1 causes depression, lack of folic acid causes ineffective mental development for children, and lack of vitamin B3 can cause dementia (Ada et al., 2020). The authors identified this factual information that directed proper development for persons with mental health issues. The approach by Adan et al. (2019) identified that mental health development is required to ensure proper physical functioning. Further, the possibility of having positive physical functioning is possible using all variety of vitamins and nutritious foods. Having a proper diet is important for children since it allows them to receive proper body functioning as they are rapidly developing. Adan et al. (2019) identified that brain activities cannot function properly during stressful situations. It is thus imperative to incorporate diet that has foods like fermented foods and higher fiber diets just to mention a few have a capability of generating positive mental health status. Doran & Kinchin (2019) identified that mental health improvement is imperative since it has a connection economic capability of each person. The authors performed studies related to issues that mental health have on the majority of the environment. Doran & Kinchin (2019) explained that it is imperative to generate cognitive balance for people since it has an effect on their ability to improve in terms of education, professionalism, and general welfare. From this perspective, mental health is connected to the possibility of having conducive workplaces that would allow all persons to form positive relationships and to create connections which display possibility of producing growth for all persons. The importance of mental health is displayed by Doran & Kinchin (2019) whereby they studied data from Canada, and it was determined that mental health improvement would require 2.8 million Australian dollars in coming years. This displays how mental health has an impact on the economic sector. It is evident that mental health improvement has the possibility of empowering people to generate more income that would serve all their requirements. Petrie et al. (2018) identified that persons who are responsible for many subordinates require mental health improvement to ensure they influence positive connections. The authors applied questionnaires are the data collection procedure which revealed information related to the issues managers face at work. Petrie et al. (2018) performed their research by sending the questionnaires using emails to different types of respondents. The procedure applied was effective since it was to discover how mental health issues affected managers as they answered questions using a Likert scale. In this way, it was possible to discover how behaviors of employees influenced the management style applied. Petrie et al., (2018) identified that employees who performed well were the ones who could engage with managers. It was possible to discover how proper mental balance has a possibility of creating positive outcomes as the managers encouraged subordinates and provided them with resources that could produce positive output. The process of creating conducive mental health involves assessment of all persons to determine how they can get improved. In this way, it would be possible to generate high quality outcomes when the mental health enhancement initiative creates suitable goals. Guidry-Grimes (2020) identified that decision making process is imperative in all mental health improvement initiatives. The author identified that the most appropriate technique of generating accurate mental health improvement is using shared decision-making strategy. The technique is effective since it is connected to the possibility of generating positive outcomes for patients and healthcare providers (Mihailescu & Neiterman, 2019). Guidry-Grimes (2020) explained that mental health improvement is possible for all persons involved in a mentally ill person’s life. It is possible to generate effective development by creating shared decisions for persons who are affected by the illness as they assess areas that can receive improvement. Guidry-Grimes (2020) explained that shared decision-making can harness capability of mentally ill persons and enable them to generate positive improvements. This technique is effective since it does not focus on a single issue that mentally ill persons go through. The technique provides capability of generating effective outcomes since it is possible to think beyond a mentally ill persons’ issue. Bożek et al. (2020) elaborated on the fact that psychological improvement is possible by connecting the mentally ill person to environments that they are familiar with. The authors performed theoretical analysis of articles which explained how mental health improvement is important for all persons in professional environments. The use of religion is suitable in offering positive mental health status since it is possible for the affected persons to get improved as they are exposed to people that share in their beliefs. Bożek et al. (2020) explained that mental health enhancement is possible by assessing health-related behaviors and using that information to offer suitable improvements. The procedure would provide insight into best option for psychological wellbeing. The approach proposed has high likelihood of generating positive outcomes since it is possible to adopt spirituality, psychological improvement, and change in attitude of health-related behavior. The approach would produce persons whose status does not impair positive outcomes. Hernández-Torrano (2020) identified that mental health improvement is possible by seeking to improve social structure that each person engages themselves in. The authors performed analysis of “5561 publications” that were related to mental health improvement initiatives related to the proper analysis of all affected persons. The research was commendable since it was possible to discover how mental health can get improved using social work initiatives connected to treatment measures performed using evidence-based outcomes. The authors proposed that reduction of negative vices like substance abuse, engaging with immoral persons, and stigma for mentally ill persons can all contribute to creation of solutions. Hernández-Torrano (2020) proposed that mental health improvement would be possible by using education to improve cognitive balance of affected persons. The authors proposed that university students can engage with each other properly and use the knowledge they gain to generate improvements based on their social issues. In this way, it would be possible to produce positive mental wellbeing. Summary The articles by (Guidry-Grimes, 2020; Bożek et al., 2020; Hernández-Torrano, 2020) were effective since they provided information related to the importance of mental health improvement and how it has an impact on the whole society. The articles performed peer reviewed journal articles assessment and also qualitative research using interviews and surveys to produce data related to mental health assessment initiatives. The articles by (Adan et al. 2019; Doran & Kinchin, 2019; Petrie et al., 2018) were effective in producing information to mental health improvement in different sectors that surround people. The articles explained how mental development was required for employees, health workers, and members of the public to ensure proper development for all persons. Importance of Mental Healthcare Access Introduction The selection of the topic of mental healthcare access is imperative since it creates guidance on the reasons why access of healthcare is critical. The process of access of mental healthcare can get reduced when health departments focus on other types of issues (Hossain et al., 2020; Czeisler et al., 2021; Galea et al; 2020). This topic shall assess how medical care is performed for different types of issues and how it would be possible to offer improvements. The articles by (Hossain et al., 2020; Czeisler et al., 2021; Galea et al; 2020) are effective in assessing access of mental healthcare since they contain information related the healthcare industry in recent years. The articles are mainly focused on mental health problems in regards to the Covid-19 pandemic (Stephenson, 2020; Riffel & Chen, 2019). The fact that the pandemic has affected every person on the planet results in the need to study how mental health issues have developed during this period. The procedure of seeking help for persons with mental health issues was affected by Covid-19 since physicians had to put their focus on finding solutions for the pandemic. This had a negative impact on the capability of generating effective outcomes for all mentally ill persons since their conditions worsened due to the pandemic and more people developed mental illnesses as a result of the pandemic. The focus on mental health issues during adverse conditions like Covid-19 is the key agenda in the studies made by (Hossain et al., 2020; Czeisler et al., 2021; Galea et al; 2020) as they analyzed how affected persons can receive proper improvements. The fact that mental health issues can develop at any point when people get exposed to negative social encounters results in the focus on health improvement in the areas. 110 The studies performed by (Jacob et al., 2017; John et al., 2018; King, 2018) were related to mental health improvement based on the capability of generating conducive external environments for all affected persons. The studies analyzed how recovery procedures can get performed by forming a connection between all aspects which affect the improvements of people. In this way, it shall be possible to determine how interpersonal, intrapersonal, and systemic issues affect the capability of mental health improvement. The procedures applied in the studies were mainly analyses of peer reviewed journal articles that contained mental health improvement measures. This section shall perform assessment of the studies and offer guidance on how mental health access is possible using the current environmental capabilities. Hossain et al., (2020) performed analysis of peer reviewed journal articles involved with the effect of Covid-19 on the environment. The authors studied how “self-rating anxiety scale and self-rating depression scale” can get used to perform effective analyses of the mental health aspect of each person (Hossain et al., 2020). The authors discovered that mental health issues occurred for certain types of people since the pandemic had caused negative mental wellbeing in regards limited social connections and inability to access care initiatives. The fact that isolation was the main government requirement resulted in the limited capability of mentally ill persons to visit healthcare centers to receive treatment. Hossain et al. (2020) performed quantitative study that discovered how people that fit these criteria had been affected by negative mental health aspects: age, occupation, gender, education, mental health status, residence, and pre-existent mental health issues. According to the criteria of the study, it was possible to identify that mental health access is imperative to all kinds of people on all levels which affect their output in society. Czeisler et al. (2021) explained that the Covid-19 pandemic has impaired desire of people to seek care since they are instructed to stay at home. The authors performed cross-sectional survey on 5573 respondents who had all gotten affected by the pandemic. The research approach performed by the authors was effective since it was possible to identify that mental health issues like anxiety and anxiety. The fact that these issues got discovered did not increase desire of mental health since many respondents stated that they preferred to continue staying indoors to curb spread of the virus. From this perspective, the desire to seek mental health improvement initiatives becomes limited as each person gets limited infrastructure capability of reaching mental health centers. The study by Czeisler et al. (2021) provides insight into how inaccessibility to mental healthcare can occur as society provides more focus on one area of healthcare. The persons who suffer most are those with pre-existing mental health issues and those who developed anxiety and depression as a result of pandemonium in the entire earth. King (2018) elaborated on the fact that physical distances caused by pandemics result in negative mental aspects for all affected persons. The authors performed study of people during the Covid-19 pandemic which indicated that issues of loneliness, domestic violence, and substance abuse increased. This indicates how lack of mental healthcare has a negative impact on people’s lives and affects their capability of transforming the environments. The fact that the pandemic forced every person to have limited physical connection with other people in society resulted in more cases of mental health issues that not every affected person could deal with on their own. The issue of inability to access mental healthcare is evident further because social isolation measures put up by the government must get adhered to all times. This results in increase in mental health issues since when people move at any moment to other social settings they get discouraged to perform as accepted. It becomes difficult to engage with physicians since online communication methods are not as productive as the physical methods. Jacob et al., (2017) explained that the process of recovery from any type of mental health issue was lengthy and required collaboration with many areas of a person’s life. The authors performed literature review analysis of a variety of documents which contained information about mental health improvement for person that had undergone therapy sessions. The peer reviewed journal articles that the authors used for analysis had been developed using qualitative and quantitative research methods. This allowed acquisition of information related to mental health improvement whenever affected persons realize the gravity of their conditions. It is possible to identify the need for access to mental health improvement in this way since it is evident that step by step approach is required to improve holistic treatment for persons who are mentally ill. The concept of access to mental healthcare is required at all times in the life of patients since they can receive care that addresses their issues. Further care is required to provide them with strength that would prevent them from relapsing. John et al. (2018) identified that access of mental healthcare was dependent on capability of people to receive proper guidance from their peers. The authors used technique of online databases search which allowed acquisition of information suitable to the study since keywords got used to produce appropriate search results. The authors identified that university students, financial constraints, and institutional barriers caused limited capability to access healthcare. John et al. (2018) identified that it would be possible to create improvements for the affect persons by offering emotional support and social improvement that has the capability of generating effective outcomes. John et al. (2018) elaborated on the fact that mental health improvement is required to improve on the capability of generating effective outcomes for all persons. The importance of access to mental healthcare is connected to the possibility of generating guidance for mental healthcare providers to align the capabilities with requirements of the mentally ill persons. This would result in development since all affected persons would devise ways of gaining appropriate care. King (2018) explained that mental health improvement is required since it has an impact on the holistic functioning capability of each persons. The author identified that environmental conditions, mental health issues, and the development of society are all correlated since they have different areas that generate effective outcomes for affected persons. The author applied qualitative research method where they performed analysis of some credible documents that proved mental health gets affected by air pollution and urban designs (King, 2018). The author identified that depression and anxiety can develop for some people when they do not receive required effects from psychiatric medication. King (2018) explained that access to mental healthcare is important since it ensured people function well in all types of environments. From this perspective, it would be possible to develop positive outcomes since the mental health improvement procedure would influence all aspect of urban development that require people to improve their cognitive balance. The perception of external environment is required since it has an impact on the type of output that each person would generate. Summary The articles by (Czeisler, et al., 2021; Hossain et al., 2020; King, 2018) were commendable since the information provided has strong correlation to the current mental health improvement initiatives. The fact that the studies got conducted recently results in the focus on the current mental health department issues. The studies by (Jacob et al., 2017; John et al., 2018; King 2018) offered direction towards mental health improvement that is possible using external assessment. The only weakness is that the studies were only limited to mental health improvement for certain groups like students instead of focusing on the wide area that mental health improvement is needed. Studies on Instruments Used for Data Collection This section shall assess all research methods used to study the topic. The fact that the phenomenon getting studied was mental health resulted in the assessment of variety of documents found online by typing keywords during Google search. In this way, it was possible to determine how different articles got developed to offer guidance on mental health improvement initiatives. Analysis of all articles used in this section revealed that the authors cited applied case study, surveys, mixed-methods, interviews, questionnaires, literature review, and digital search assessment were the main methods used. The study of topic in this literature review section would reveal all research methods that got applied and how they generated positive outcomes. After study of all documents, the most widely used research method was literature of documents from credible sources. Issues that Cause Limited Access of Mental Healthcare The tool used by Sarikhani et al. (2019) was scoping review method that allowed study of different aspects of mental healthcare access barriers. The authors applied the scoping review method and developed five approaches that were identification, selection, collection, charting, and summarizing all the data involved the study. The scoping review method got conducted using articles on “PubMed, Scopus, Web of Science, Embase, ProQuest, Wiley online library, and Sciencedirect”. The tool used by McDaid et al. (2019) was literature review method whereby the study analyzed quality and peer reviewed journal articles that contained information related to access of mental health services. The authors also applied scoping review method that is connected to literature review of variety of articles. The articles was developed by the authors as they searched for keywords related to issues causing barriers for mental health access. The tool used by Ibrahim et al. (2020) was a survey conducted using 377 people as respondents who were selected from areas that had people exposed to mental health issues. The research method used data from the survey to perform mathematical analysis which revealed occurrence of mental health issues in terms of a percentage. The tool thus provided accurate and unbiased data since it was possible to receive first-hand information from all respondents. The tool applied by Abi-Jaoude et al. (2020) scoping review method as they performed study on some credible sources involved with issues related to mental healthcare. The study used mathematical analysis using percentages that depicted how changes were created in the environments that required mental health improvement. The next tool used was survey method that provided insight into how social factors affect mental health. This mixed method strategy is effective in developing proper information for the study. Doran & Kinchin (2017) applied technique of literature review as the main method of seeking information related to the topic. The tool enabled acquisition of data related to mental health issues and the authors used 45 documents connected to the topic. The literature review tool is effective since it provides data that is accurate and found from credible sources. The next tool used was a checklist that provided ability to select suitable documents. The tool used by Alonzi et al. (2020) was SPSS software that possessed accurate capability of generating knowledge related to the phenomenon of mental health issues. The software approach of performing research was effective since it allowed entry of keywords related to the topic getting studied. The other tool applied was survey of 616 persons who had all been affected by mental health issues. The tool used by AMA J Ethics (2017) was case study approach that was effective in producing information related to mental health improvement measures based on societal barriers. The authors applied mixed methods since they also used literature review method to perform analysis of different peer reviewed articles that have a connection to the field of mental health improvement. The mixed methods strategy allowed analysis of a lot of unbiased data. Staiger et al. (2017) used interviews as the main tools to analyze issues that posed barriers for persons with desire to receive mental health improvement. The use of interviews as the main tool produced effective outcomes and allowed development of transcripts that contained data related to mental health barriers. The next tool was literature reviews that contained information related to mental health improvement initiatives. The mixt method technique allowed access of data that improved the study’s strength. The tool used by Knaak et al. (2017) was systemic review since the authors created a question that sought data required to increase understanding of why stigma occurs in mental health improvement procedures. The systemic review was conducted for some articles that had performed surveys on persons affected by negative mental health. This reveals that mixed method analysis was performed in the study. The systemic review method applied development of different topics connected to the topic. The tool used by Kecojevic et al. (2020) was survey method that produced data related to mental health improvement using the persons that had been by such issues. The process of data collection in the survey method further led to use of multivariable regression analysis that provided analysis of data related to the responses produced in the research. The mixed method of survey and multivariable regression analysis techniques were positive and generated data suitbale to the study. Hagell et al. (2018) performed effective analysis of data using scoping review technique. This method produced accurate and valid data since it allowed study of information from credible sources that had a connection with barriers for mental health improvement. The review process was performed on online databases that all contained information related to mental health related issues. The tool was positive and generated suitable data. Glazzard & Stones (2019) used literature review method as the tool that generates effective knowledge since it is performed on documents from credible sources. The process of seeking information from mental health studies provided effective guidance in the study since it was possible to determine how different topics could get aligned with various aspects of literature reviews. The tool was appropriate as it generate high quality guidance using credible sources that were all cited. Abi Doumit et al. (2019) used cross-sectional study as the main tool of seeking insight from 2289 persons. The study was then analyzed using Reported and Intended Behavior Scale (RIBS), Mental Health Knowledge Schedule (MAKS), and Community Attitudes toward Mental Illness (CAMI) that performed quantifiable data from the cross-sectional study. The tool used by Naslund et al. (2020) was literature review method that produced data from a variety of peer reviewed journal articles. The technique produced factual and unbiased data related to the topic of mental health issues caused by prevailing social issues. The tool used by Follmer & Jones (2017) was systematic review process that sought data from a variety of peer reviewed journals. The review process involved study of different persons and produced data related to the topic of interest. Synthesis was the next procedure that identify data related to the topic. The tool used by Hemsley et al. (2018) was literature review of some credible documents prepared by some scholars. The data collection technique was highly effective since it was possible to synthesis information from the different topics and generate an argument for dangers of external environment on the mental wellbeing of people. The tool used by Kemp et al. (2019) was surveys and case studies on some people who had been affected by mental health issues. The next procedure was systematic reviews on the information collected form the case studies and surveys. The information collected was factual since it was possible to receive unbiased data from the supervision of respondents. The tool used by Lake and Turner (2017) was scoping review of journal articles that contained information related to mental health management measures. The study sought information from factual scientific documents related to the topic. Criterion *(Score = 0, 1, 2, or 3) Learner Score Chair Score Methodologist Score Content Expert Score Review of the Literature (Approximately 30 pages) The learner assures that this section of Chapter 2 should be approximately 30 pages. (Thirty pages reflects a typical literature review length and is a recommendation, not a rule). The purpose of the minimum number of pages is to ensure that the overall literature review reflects a foundational understanding of the theory or theories, literature and research studies related to the topic. A well-written comprehensive literature review that reflects the current state of research and literature on the topic is expected and will likely exceed 30 pages. Literature reviews are updated continuously. This is an ongoing process to dissertation completion. X Describes the phenomena being explored in the study discussing the prior research that has been done on the phenomena. X Themes or Topics: The learner discusses and synthesizes studies related to the dissertation topic. May include (1) studies focused on the problem from a societal perspective, (2) studies describing and/or relating the exploring related phenomena (qualitative),, (3) studies on related research such as factors associated with the themes, (4) studies on the instruments used to collect data, (5) studies on the broad population for the study, and/or (6) studies similar to the study. The themes presented, and research studies discussed and synthesized in the Review of the Literature demonstrates understanding of all aspects of the research topic, the research methodology, and sources of data. X The learner structures the literature review in a logical order, including actual data and accurate synthesis of results from reviewed studies as related to the learner’s own topic. The learner provides synthesis of the information not just a summary of the findings. X The learner includes in each major section (theme or topic) within the Review of the Literature an introductory paragraph that explains why the particular topic or theme was explored relative to the overall dissertation topic. X The learner includes in each section within the Review of the Literature a summary paragraph(s) that (1) compares and contrasts alternative perspectives on the topic and (2) provides a synthesis of the themes relative to the research topic discussed that emerged from the literature, and (3) identifies how themes are relevant to the dissertation topic and research methodology. X The learner provides additional arguments for the need for the study that was defined in the Background of the Study section. X The learner ensures that for every in-text citation a reference entry exists. Conversely, for every reference list entry there is a corresponding in-text citation. Note: The accuracy of citations and quality of sources is verified by learner, chair, and content expert. X The learner uses a range of references including founding theorists, peer-reviewed empirical research studies from scholarly journals, and governmental/foundation research reports. X The learner verifies that all references are scholarly sources NOTE: Websites, dictionaries, publications without dates (n.d.), are not considered scholarly sources and are not cited or present in the reference list. X The learner avoids overuse of books and dissertations. Books: Recommendation: No more than 10 scholarly books that present cutting edge views on a topic, are research based, or are seminal works. Dissertations: Recommendation: No more than five published dissertations should be cited as sources in the manuscript. (This is a recommendation, not a rule). X The learner writes this section in a way that is well structured, has a logical flow, uses correct paragraph structure, sentence structure, punctuation, and APA format. X *Score each requirement listed in the criteria table using the following scale: 0 = Item Not Present or Unacceptable. Substantial Revisions are Required. 1 = Item is Present. Does Not Meet Expectations. Revisions are Required. 2 = Item is Acceptable. Meets Expectations. Some Revisions May be Suggested or Required. 3 = Item Exceeds Expectations. No Revisions are Required. Reviewer Comments: Problem Statement While the literature indicates that mental health issues are prevalent, it is not known how mental health providers and caregivers in South Texas describe the factors that influence utilization of mental health services. All the barriers for mental health improvement discussed in the literature review section are clear indicators as to why the problem is prevalent and requires attention. The process of identification of the problem for research revealed that there are a variety of mental health issues each with unique impact on people. The most common mental health issues are “anxiety, bipolar, depression, eating, obsessive compulsive, paranoia, and behavioral disorders”. The procedure of identification of these disorders is intricate. The problem of mental health in Texas undergoes issues whereby there can be lack of collaboration between persons affected by mental health issues and members of the public (THHS, 2021). The issue progresses as it becomes difficult to manage the conditions without following proper guidelines for mental health improvement measures. The procedure of identification of mental health issues becomes of difficult in Texas since $1.4 billion gets spent for mental health emergencies and $650 million gets spend to manage mental health related issues by the local government in Texas (Texas Public Radio, 2017). The problem identification is accurate and provides guidance to determine the appropriate method of dealing with mental health related conditions. The process of selecting mental health issues from the public becomes difficult since issues arise when systemic, interpersonal, and intrapersonal barriers exist as people seek to improve their wellbeing (Qin & Hsieh, 2020; Santini et al., 2020). The process of seeking support also encounters issues since it becomes difficult to connect qualified healthcare providers to the persons who undergo mental health related issues. The population of interest is young people between age 12 and 17 who mostly engage in substance abuse and adults between age 18 and 65 who suffer from post-traumatic stress disorder and depression. Criterion *(Score = 0, 1, 2, or 3) Learner Score Chair Score Methodologist Score Content Expert Score Problem Statement (Minimum three or four paragraphs or approximately one page) The learner states the specific problem for research with a clear declarative statement. The learner describes the population of interest. The population of interest includes all individuals that could be affected by the study problem.. EXAMPLE: The population of interest might be all adults in the United States who are 65 or older. The target population is a more specific subpopulation from the population of interest, such as low-income older adults ( ≥ 65) in AZ. Thus, the sample is selected from the target population, not from the population of interest. The learner discusses the scope and importance of addressing the problem. The learner develops the Problem Statement based on what needs to be understood as defined in the Problem Space and the Review of the Literature. The learner writes this section in a way that is well structured, has a logical flow, uses correct paragraph structure, sentence structure, punctuation, and APA format. *Score each requirement listed in the criteria table using the following scale: 0 = Item Not Present or Unacceptable. Substantial Revisions are Required. 1 = Item is Present. Does Not Meet Expectations. Revisions are Required. 2 = Item is Acceptable. Meets Expectations. Some Revisions May be Suggested or Required. 3 = Item Exceeds Expectations. No Revisions are Required. Reviewer Comments: Summary The process of synthesis of all the data reveals that identification of mental health issues and having the desire to seek improvement are the main issues that cause problems in the mental health improvement department. Mental health improvement has undergone some issues related to limited access of the measures which can reduce negative wellbeing to people. The study in the literature review section revealed that the main issues in the mental health improvement field are limited capability of people to access care and rejection of mental health improvement. The studies provided by (Ayvaci, 2017; Peteet, 2019; AMA J Ethics, 2017; Staiger et al., 2017; Knaak et al., 2017) all have a connection to the mental health improvement initiatives that are existent in the current environment. Personal barriers for improvement often cause limited capability of gaining health improvement procedures. Religion often causes people to form a diverse view of their mental health conditions which results in limited capability of seeking professional help (Ayvaci, 2017 & Peteet, 2019). The personal barriers formed by people are often the worst when it comes to mental health improvement initiatives since it is difficult to receive care that can generate effective outcomes for all people. Affected persons often seek care from people that are not qualified to offer professional help. There are systemic issues and interpersonal issues which cause limited desire to access mental health improvement measures. The issues develop due to stigma in healthcare departments. da Silva et al. (2020) identified that there is stigma in mental health departments which causes people to reject the services. This forms a negative basis for health improvement initiatives becomes it is difficult to receive care when the affected persons do not get emotional support from trained persons. Criterion *(Score = 0, 1, 2, or 3) Learner Score Chair Score Methodologist Score Content Expert Score Chapter 2 Summary (Minimum one to two pages) The learner synthesizes the information from all prior sections in the Literature Review using it to define the key strategic points for the research. X The learner summarizes the problem space and the what still needs to be understood and how it informs the problem statement. X The learner identifies the theory(ies) or model(s) describing how they inform the research questions. X The learner builds a case (argument) for the study in terms of the value of the research and how the problem statement emerged from the review of literature. X The content of this section reflects that learners have done their “due diligence” in synthesizing the existing empirical research and writing a comprehensive literature review on the research topic. X The learner summarizes key points in Chapter 2 and transitions into Chapter 3. X The chapter is correctly formatted to dissertation template using the Word Style Tool and APA standards. Writing is free of mechanical errors. X All research presented in the chapter is scholarly, topic-related, and obtained from highly respected, academic, professional, original sources. In-text citations are accurate, correctly cited and included in the reference page according to APA standards. X The learner writes this section in a way that is well structured, has a logical flow, uses correct paragraph structure, sentence structure, punctuation, and APA format. X *Score each requirement listed in the criteria table using the following scale: 0 = Item Not Present or Unacceptable. Substantial Revisions are Required. 1 = Item is Present. Does Not Meet Expectations. Revisions are Required. 2 = Item is Acceptable. Meets Expectations. Some Revisions May be Suggested or Required. 3 = Item Exceeds Expectations. No Revisions are Required. Reviewer Comments: Chapter 3: Methodology Introduction The study of mental health in south Texas forms its basis on the argument that stigmatization, lack of access to health care and lack of social connections affects mental health status of people. The study will use a qualitative study since it forms a strong basis of analysis of contents used to manage the topic. The participants in the study would be mental health providers and caregivers within south Texas to understand and document provider strategies impacting utilization of mental services available in the state. The criteria for the study would be issues affecting improvement of health conditions of mental well-being of people in south Texas, availability of mental health improvement initiatives, and ability for each person to access the mental health improvement measures. Mental health issues affect many of the people living in south Texas. According to KFF (Kaiser Family Foundation) the issues of inability of mental healthcare access in Texas was prevalent as “839,000 adults in Texas” could not access care between 2017 and 2018 (KFF, 2021). The issues became more prevalent in the recent year since many people could not access care due to the Covid-19 pandemic. Anxiety disorders and depression were the main issues that progressed due to the pandemic and limited face-to-face connections with people. Analysis of the issues in Texas reveals that “40.1 %” of people living in the region were affected by the pandemic and developed anxiety and depression. The issues resulted in worse conditions as the government had to focus on dealing with the prevailing conditions instead of the mental health conditions of people. Inaccessibility of mental healthcare results in issues in regard to the public’s desire to receive professional help. KFF (2021) stated that in 2020, 21.4 % of Texas residents could not receive therapy and counselling yet they had reported having mental issues. Altiraifi & Rapfogel (2020) identified that the issue of inaccessibility of mental healthcare had always been common even before the pandemic. The authors explained that it was difficult to access mental healthcare due to racism and unfair distribution of resources to other persons. The fact that mental disorders were different and unique in their own ways results in the limited capability of handling the prevalent mental health conditions. The limiting factors result in more issues since it is difficult to manage their conditions on their own while still getting exposed to negative social life. Mental health issues increased in south Texas due to substance abuse. According to KFF (2021) the abuse of opioid and dependence between 2017 and 2018 was “0.4%” of persons aged 12 and above in south Texas. The next abuse was alcohol that was “1.3 % for adolescents and 4.8 % for adults” between 2017 and 2018 (KFF, 2021). These types of abuse created mental health disorders especially since some people got addicted and could not handle their conditions (Ondersma et al., 2017; Octavius et al., 2020). Beeber (2018) explained that mental health issues develop since the affected persons find it hard to handle their conditions with limited physical capability of receiving treatment. This occurs since smoking, opioid use, alcohol abuse, and marijuana are the main substances that people use to manage stressful situations (Beeber, 2018). This causes worsening of mental health issues. There are institutional issues that cause limited access for mental healthcare in Texas, and they are mainly expensive care without insurance and lack of adequately trained personnel. According to KFF (2021) Texas residents could not receive care between 2017 and 2018 whereby “1287000, 401000, and 272000” with mild, moderate, and serious mental illnesses, respectively could not access required care. This forms a dangerous gap between health improvement measures and the possibility of provided effective care. Further analysis revealed that 377000 persons in Texas could not receive care since the mental health treatment expenses were very high (AFF, 2021). The issue of lack of insurance in the region is adverse since there were “5 million uninsured persons in the state” in the year 2018 (Every Texan, 2021). From this perspective, it is imperative to perform this study to gain more insight into the issue of being uninsured. The proposed study is suitable since it is connected to mental health improvement initiatives that are required in the current environment. Chapter three of the study shall apply a research design that connects to qualitative methodology as the main technique used to generate valid information. The organization of this chapter shall be systematic and provide guidance on effective analysis of credible sources with mental health improvement initiatives. The research questions section shall provide questions suitable to the study of mental health issues in south Texas. The qualitative methodology section will produce data related to the step-by-step approach used to generate valid data for the study. The rationale for research design section will generate information related to factors influencing utilization of mental health services in south Texas and mental health improvement initiatives and the reason why the research method is the most suitable. In the sources of data section, it would be possible to generate information related to topic from credible sources. The data analysis procedures shall get discussed to determine how they are suitable to the research design and topic getting studied. Criterion *(Score = 0, 1, 2, or 3) Learner Score Chair Score Methodologist Score Content Expert Score Chapter 3 Introduction (Minimum two to three paragraphs) The learner begins by restating the Purpose Statement for the study. X The learner provides a re-orienting summary of the research focus from Chapter 2 and outlines the expectations for this chapter. X The learner writes this section in a way that is well structured, has a logical flow, uses correct paragraph structure, sentence structure, punctuation, and APA format. X *Score each requirement listed in the criteria table using the following scale: 0 = Item Not Present or Unacceptable. Substantial Revisions are Required. 1 = Item is Present. Does Not Meet Expectations. Revisions are Required. 2 = Item is Acceptable. Meets Expectations. Some Revisions May be Suggested or Required. 3 = Item Exceeds Expectations. No Revisions are Required. Reviewer Comments: Purpose of the Study The purpose of this qualitative descriptive study is to examine how mental health providers and caregivers in south Texas describe the factors that influence utilization of mental health services. The study of mental health in south Texas forms its basis on the argument that stigmatization, lack of access to health care and lack of social connections affects mental health status of people. The study is using qualitative research methodology as it provide insight into the topic using different valid and peer-reviewed journal and articles. The problem that shall be focused on is the main factors that influence use of mental health services in south Texas. This issue is strongly connected to the problem that each person is exposed to while the attempt to access care suitable to their issues. Mental health issues in south Texas affect adults and children and the issue worsens as the state has millions of people fitting the criteria getting studied. The study shall analyze how interpersonal issues have an effect on the desire of people to seek mental healthcare and the influence of negative connections and its capability of resulting in worse mental health status. From the interpersonal perspective, it shall be possible to determine how physicians have an impact on the capability of their patients to receive suitable treatment. The purpose of the study is to further seek insight into how intrapersonal issues result in limited capability to receive care for different types of mental health conditions. This study will focus on this issue and the external driving forces that cause this. The study shall also provide insight in the systemic perspective to determine how mental health institutions and the local government in Texas have an impact on health improvement measures. Study of private organizations involved in mental improvement initiatives is critical and shall get performed to determine how full improvement can get provided for all affected persons. Criterion *(Score = 0, 1, 2, or 3) Learner Score Chair Score Methodologist Score Content Expert Score Purpose of the Study (Minimum one or two paragraphs) This section begins with one sentence that identifies the research methodology, design, problem statement, and geographic location. This is presented as a declarative statement: "The purpose of this qualitative [ design] study is to … [ include the Problem Statement] at a [setting/geographic location]." The learner introduces how the study will be carried out. The learner writes this section in a way that is well structured, has a logical flow, uses correct paragraph structure, sentence structure, punctuation, and APA format. *Score each requirement listed in the criteria table using the following scale: 0 = Item Not Present or Unacceptable. Substantial Revisions are Required. 1 = Item is Present. Does Not Meet Expectations. Revisions are Required. 2 = Item is Acceptable. Meets Expectations. Some Revisions May be Suggested or Required. 3 = Item Exceeds Expectations. No Revisions are Required. Reviewer Comments: Research Questions The phenomenon getting studied is mental health issues that affect the majority of residents living in Texas. The process of forming the research questions shall use current data involved in mental health improvement initiatives which is imperative since many people have been experiencing anxiety and depression due to the Covid-19 pandemic (Newby et al., 2020; Mullet et al., 2020; Moreno et al., 2020). The technique of creating research questions would also generate effective outcomes since the issue of mental health in Texas has been prevalent and exists for millions of the residents. Inability to access care due to external constraints and influence from the environment shall also get addressed. The following research questions will be used to generate suitable information related to the factors influencing utilization of mental health services in south Texas. · RQ1: How do mental health providers describe the factors influencing utilization of mental health services? · RQ 2: How do caregivers describe the factors influencing patient’s utilization of mental health services? The research questions will also be used to develop the rationale for qualitative research. It shall be possible to determine the types of respondents suitable to the topic getting studied. The research method chosen for this topic shall be qualitative method since it has the best approach of seeking first-hand information from respondents. The data collection techniques suitable for the research shall be focus groups and interviews. The use of focus groups is imperative since it offers study of people with similar conditions to the topic of study. The focus groups shall go hand in hand with interviews since it shall be possible to acquire valid information for the study’s direction. The interviews shall allow data collection from persons suitable for the research. The interviews would get explained to respondents to determine how they get affected by mental health. The interviews would involve questions for the participants whereby it would be possible to acquire data suitable to mental health related issues. The interview shall get developed using open ended questions which would be highly effective in producing unbiased data. The questions shall get created based on the research questions and participants selected to take part in the study. Each participant would be asked questions depending on their age and type of mental health disorder and symptoms displayed by patients. The focus groups shall involve study caregivers and then collecting data based on observations their responses. The focus group procedures shall get developed using questions that would guide the participants. Criterion *(Score = 0, 1, 2, or 3) Learner Score Chair Score Methodologist Score Content Expert Score Research Questions (Minimum one to two pages) The learner establishes the research questions, and defines the phenomenon/a X The learner describes the nature and sources of necessary data to answer the research questions (primary versus secondary data, specific people, institutional archives, Internet open sources, etc.). The learner describes the data collection methods, instrument(s) or data source(s) to collect the data for each research question. X The learner writes this section in a way that is well structured, has a logical flow, uses correct paragraph structure, sentence structure, punctuation, and APA format. X *Score each requirement listed in the criteria table using the following scale: 0 = Item Not Present or Unacceptable. Substantial Revisions are Required. 1 = Item is Present. Does Not Meet Expectations. Revisions are Required. 2 = Item is Acceptable. Meets Expectations. Some Revisions May be Suggested or Required. 3 = Item Exceeds Expectations. No Revisions are Required. Reviewer Comments: Rationale for a Qualitative Methodology The research methodology chosen for this study is qualitative methodology since it has the best approach of dealing with data that involves respondents. The research method is not focused on numerical analysis since it is possible to acquire data based on personal accounts as respondents provide non-numerical responses. Qualitative research methodology is focused on non-numerical responses which provide information related to the topic of the research (Aspers & Corte, 2019). The methodology can get performed by using respondents, data, visual objects, or documents that all have connection to the phenomenon getting studied (Poucher et al., 2019). The methodology also provides directions for any topic since it is possible to determine a research approach that has capability of generating future study of a similar phenomenon. The first-hand data collected using qualitative research would provide accurate accounts from participants in the study (Herber et al., 2020). The topic of mental health related issues and factors affecting their adoption would get studied effectively using qualitative approach since the initial requirement would be to select professionals who have firsthand information on individuals affected by mental health. The qualitative approach would produce data from the respondents, and it would be possible to create positive outcomes based on interviews and focus group research procedure. The phenomenon getting studied is connected to desire of understanding the factors influencing utilization of mental health services in south Texas. It is also connected to health departments to produce mental health providers who are trained effectively to handle patients’ issues. The findings from this type of study would produce effective outcomes since it would be possible to acquire data that does not include assumptions. Each participant would get instructed to produce accurate responses and the interview and focus groups methods would be the best in generating valid responses. Therefore, qualitative methodology will be helpful at addressing the problem statement, and problem space. In addition, it will answer the research questions as it focuses on the mental health providers and caregivers’ perspectives regarding the factors influencing individuals’ decision to utilize mental health services. Criterion *(Score = 0, 1, 2, or 3) Learner Score Chair Score Methodologist Score Content Expert Score Expanded Rationale for a Qualitative Methodology (Minimum one to two pages) The learner defines and describes the chosen methodology. X The learner provides a rationale for choosing a qualitative methodology, based on what still needs to be understood from the problem space, problem statement, and research questions. X The learner provides a rationale for the selected the methodology based on empirical studies on the topic. X The learner justifies why the methodology was selected as opposed to alternative methodologies. X The learner uses authoritative source(s) to justify the selected methodology. Note: Do not use introductory research textbooks (such as Creswell or internal GCU research course e-books) to justify the research design and data analysis approach. X The learner writes this section in a way that is well structured, has a logical flow, uses correct paragraph structure, sentence structure, punctuation, and APA format. X *Score each requirement listed in the criteria table using the following scale: 0 = Item Not Present or Unacceptable. Substantial Revisions are Required. 1 = Item is Present. Does Not Meet Expectations. Revisions are Required. 2 = Item is Acceptable. Meets Expectations. Some Revisions May be Suggested or Required. 3 = Item Exceeds Expectations. No Revisions are Required. Reviewer Comments: Rationale for Research Design According to the phenomenon getting studied, the research design that is most appropriate is qualitative descriptive. There are other designs that are applicable, like narrative and phenomenology that provide insight into some studies. The designs are strong since it is possible to study a topic based on its effect on many respondents. Regardless, qualitative descriptive methodology is the most approach since it provides insight into a phenomenon and how it affects the normal functioning of affected persons. The main purpose of this research is to determine intrapersonal issues that cause limitations to mental health utilization, interpersonal issues that limit possibility of gaining treatment, and systemic issues that cause barrier between mental health departments and persons who require care. According to Augsberger et al. (2015) qualitative descriptive design is appropriate for this study as it has the best approach of dealing with data that involves respondents. The authors emphasizes that it assists in offering actual evidence from the interview with participants (Augsberger, Yeung, Dougher, & Hahm, 2015). Qualitative descriptive design offers proper analyses of healthcare departments since it displays their characteristics mainly instead of focusing on required data (Bradshaw et al., 2017). The design method allows analysis of a phenomenon based on the respondents and their daily activities that are connected to the expected positive outcomes. In the case of the mental health departments in Texas it would be possible to generate data that is connected to mental health improvement and awareness. A qualitative descriptive design provides a strategy and offers guidance on how the research process shall be conducted (Kim et al., 2017). The qualitative descriptive design process would generate effective knowledge in regard to the personal barriers that each person possesses in regard to the availability of mental health utilization as described by the participants. Kim et al. (2017) stated that a qualitative descriptive design gets studied in its natural state. This approach is suitable to the study that this project is based on since its aim is to study mental health related issues that affect people in south Texas. The application of a qualitative research design is proper since it would analyze the naturally occurring mental health issues which affect desire of people to receive care. The study of natural state of phenomena is proper since it reveals how external factors influence the development and progression of issues related to the naturally occurring phenomenon (Kim et al., 2017). The study of mental health disorders in south Texas would be factual and provide proper insight into how the state’s residents get affected by external issues. Kim et al. (2017) also explained that qualitative descriptive design is high-quality since it does not focus on theoretic approaches and only deals with aspects of a research process that are flexible and can suit the direction the researcher prefers. This paper is based on the study of factors influencing utilization of mental health services, interpersonal, intrapersonal, and systemic factors that influence desire of mentally ill persons to acquire the appropriate treatment. The study would get aligned with the qualitative descriptive design since it would be possible to control direction of the research. The design shall allow data acquisition from participants response to questions during focus groups sessions and interviews. Bradshaw et al. (2017) explained that qualitative descriptive design is high quality since it is applicable in healthcare improvement initiatives. The authors stated that research would involve participants who are providers and caregivers who have firsthand knowledge of mental health issues. The next consideration would be the development of interventions based on the issues identified during the research (Bradshaw et al., 2017). From this perspective, qualitative descriptive design process is highly accurate in the study of mental health related problems in south Texas. The study would acquire unbiased data from respondents and use the information to provide insight into the healthcare department in Texas. The authors explained that qualitative descriptive design is effective since it analyzes who is involved, where it occurred, and why some events occurred. Seixas et al. (2018) explained that qualitative descriptive design is based on an interpretive technique of analyzing phenomena. The design focuses on reality since the issues related to a research area would get analyzed based on how they occur and the effect they have on external participants. In the study of mental health improvement issues, qualitative descriptive design has the possibility of generating data suitable to improvement of the daily operations of professionals in the field. An element of qualitative descriptive design is sampling that enables data collection using proper methods and acquisition of information related to factors influencing utilization of mental health services and mental health improvement measures. The observers involved in the research will be able to generate outcome that is connected and closely related to intended message. Seixas et al. (2018) elaborated on the technique that qualitative descriptive design applies, which is using contextualizing to find data that closely engages with the research method. It is possible to generate interview questions and to create focus groups which produce information related to the natural phenomenon’s improvement initiatives. In the case of this study, factors influencing utilization of mental health services, qualitative methodology is the most appropriate method that will be used because it is mainly exploratory (Leedy & Ormrod, 2014). The information found will provide the researcher with a better understanding of the factors that influences utilization of mental health services. Consequently, the findings of this study might help in developing hypotheses for potential quantitative research (Leedy & Ormrod, 2014). This study will also be using semi-structured techniques that includes interviews and focus groups. Data collection operations will be performed using interviews and questionnaires to collect accurate information. While information will be acquired to map the behavior of people who seek health care relating to mental health. The literature thus supports the facts that issues of underutilized mental health resources and non-institutionalized adults is a behavioral risk factor in Southern Texas Criterion *(Score = 0, 1, 2, or 3) Learner Score Chair Score Methodologist Score Content Expert Score Research Design (Minimum one to two pages) The learner identifies the research design for the study. The learner provides the rationale for selecting the research design supported by empirical and methodological references. X The learner justifies why the design was selected as the best approach to collect the needed data, as opposed to alternative designs. X The learner uses authoritative source(s) to justify the design. Note: Do not use introductory research textbooks (such as Creswell) to justify the research design and data analysis approach. X The learner writes this section in a way that is well structured, has a logical flow, uses correct paragraph structure, sentence structure, punctuation, and APA format. X *Score each requirement listed in the criteria table using the following scale: 0 = Item Not Present or Unacceptable. Substantial Revisions are Required. 1 = Item is Present. Does Not Meet Expectations. Revisions are Required. 2 = Item is Acceptable. Meets Expectations. Some Revisions May be Suggested or Required. 3 = Item Exceeds Expectations. No Revisions are Required. Reviewer Comments: Population and Sample Selection Population of Interest The population that this study shall address are United States Mental Health Providers and caregivers practicing in south Texas who have firsthand information on individuals affected by mental health related issues. The selection of these professionals and caregivers living in Texas is effective since there is a lot of data from credible sources which relates to prevalence of mental health issues in the area and the need to improve mental health of all residents. According to the Kaiser Family Foundation (KFF) (2020), there were “40.1% of adults in Texas” who were involved in a study and they revealed that they had issues such as anxiety and depression. This data was very high compared the reports by all adult in the U.S. who stated that they encountered similar symptoms and the prevalence was for “37.7% of them” (KFF, 2020). Target Population The target population for this study shall be Mental health providers and caregivers in south Texas who are members of the Mental Health America (MHA) and have been in practice in south Texas. All the participants shall be persons who had been living in south Texas even before the pandemic and had based their livelihood and daily operations to the social structure displayed in south Texas. Analysis would be effective since they have an impact on the capability of providing mental health care services. The target population shall also involve mental health providers who highly qualified to provide care and who had been working in Texas or other states in the U.S. Study Sample Sample participants will come from Southern Texas, United States, that comprises of 20 mental health providers and caregivers who will be selected as the sample group. Interviews with a minimum of 15 mental health providers The participants will be sampled from the three closest mental health centers/hospitals in the region. In addition to focus group that will comprise of 10-15 caregiver. These participants would involve people from the target population who would have volunteered to take part in the study. All the volunteers would be set up at a single location or their residences since the research shall get conducted via Zoom. The volunteers would be mental healthcare providers spread across the state of Texas. Qualitative Sample Size The process of creating a sample size involves selection of mental healthcare providers and caregivers living in Texas with prior experiences dealing with individuals affected by mental health disorders. The sample size will be generated after performing qualitative study of the State Mental Health Authority (SAMHSA) which displays data related to issues of persons living in south Texas (SAMHSA, 2019). The use of 100 respondents from members of the public would be effective and provide unbiased data. Emails will be used as a communication tool that would provide insight into the operations performed by the 20 mental healthcare providers working at 7 healthcare institutions. The providers would be psychologists, psychiatrists, nurses, and caregivers who have engaged with mentally ill persons face to face. Basic Measures Occurrence in South Texas, % Penetration Rate per 1,000 population 18.18 Community Utilization per 1,000 population 17.65 State Hospital Utilization per 1,000 population 0.47 Employment Status (percent employed) State Hospital Adult Admissions 57 Community Adult Admissions 23 State Hospital LOS Discharged Adult patients (Median) State Hospital LOS Resident Adult patients (Median) Percent of Client who meets SMI definition Adults with Co-occurring MH/SA Disorders Children with Co-occurring MH/SA Disorders 0.96 1.95 46.00 66.00 76 26 5 Source: https://www.samhsa.gov/data/sites/default/files/reports/rpt27977/Texas%202019%20URS%20Output%20Tables/Texas%202019%20URS%20Output%20Tables Recruiting and Sampling Strategy The procedure of recruiting persons for the research would get conducted online and each participant shall get identified using their initials. Information from the participants would get stored online on the cloud and using the computer’s hard drive for safeguarding. The strategy would ensure only suitable persons by selecting healthcare providers and caregivers with the desire to improve mental health care. Sampling Procedures The sampling technique shall be convenience and purposive sampling. It would involve providers and caregivers have internet access from their residences. Convenience would be possible since the sites are all in south Texas. In terms of purposive, it would be possible to acquire data since the interview procedure would involve factors influencing mentally affected persons in the interpersonal, intrapersonal, and systemic perspectives. The researcher shall send emails to the potential participants which would contain informed consent document, description of the study, and requirements for each participant. The interview procedure would get conducted online using Zoom. The data collection procedure would be highly effective since each of the 7 sites would involve a minimum of 100 respondents among which 20 will be selected. The interviews and focus groups would thus provide suitable data for the study. Sample Frame The approach of this study is to focus on assessing why residents in south Texas underutilize mental health services or have inability to access care. The involvement of mental healthcare providers shall strengthen this argument and offer better direction for the study. The selection of 20 respondents from the 7 locations would be highly effective since it would be possible to collect a lot of unbiased and first-hand information for the study. Primary Plan The main plan is to seek data from participants that would accept to use the Zoom platform for communication. The participants would be allowed to only share their audio during the meetings if they do not want to expose their faces. The recruitment plan shall also involve creation of a social media account and hashtag posted on Facebook, Twitter, and Instagram in order to identify providers who are experienced in mental health issues (Tankovska, 2021). The persons interested in the study would access a link that allows them to fill a form and to provide their names and emails. Further communication shall then get conducted using emails. If this first plan fails, the second plan shall involve selecting fewer recruits from less sites who would accept the study’s contents. Criterion *(Score = 0, 1, 2, or 3) Learner Score Chair Score Methodologist Score Content Expert Score Population and Sample Selection (Minimum one to two pages) The learner defines and describes the population of interest (the group to which the results of the study would be generalized or applicable) (such as police officers in AZ). The learner defines and describes the target population from which the sample ultimately is selected (such as police officers in AZ who belong to the police fraternal association). The learner defines and describes the study sample, who are the individuals who will volunteer or be selected from the target population and are the final source of data, and the final group from whom complete data will be collected. NOTE: There is no such thing as a sample population, there is only a “sample.” that is taken from the target population or the population. X The learner describes the required sample size to secure adequate qualitative data as based on the literature related to the design indicated in the previous section and provides the rationale for how this size was derived. X The learner defines and describes the sampling procedures (such as convenience, purposive, snowball, etc.) supported by scholarly research sources. For a purposive sample, the learner identifies the screening criteria (“purposes”) and how the participants will be screened (e.g., demographic questionnaire, expert knowledge of topic, screening questions such as years of experience in a position). The learner defines and describes the sampling strategy and the process for recruiting individuals to comprise the sample. The learner provides a compelling argument that the target population is large enough to meet the target sample size by defining the “sample frame” (the subset of the target population from which the sample will be drawn). X The learner discusses the primary plan to obtain the sample (plan “A”) as well as two back up plans to use if plan “A” does not provide the minimum target sample size. X The learner describes the process used to obtain site authorization to access the target population and sample frame. This includes the information required to obtain this authorization, such as a description of confidentiality measures, the limits of study participation requirements, and geographic specifics, for example. The learner includes evidence of site authorization in an appendix prior to submission for peer review. If public data sources or social media are used to collect data, and no site permission is required, the learner provides a rationale and evidence for why these sources can be used without this permission. X The learner writes this section in a way that is well structured, has a logical flow, uses correct paragraph structure, sentence structure, punctuation, and APA format. X *Score each requirement listed in the criteria table using the following scale: 0 = Item Not Present or Unacceptable. Substantial Revisions are Required. 1 = Item is Present. Does Not Meet Expectations. Revisions are Required. 2 = Item is Acceptable. Meets Expectations. Some Revisions May be Suggested or Required. 3 = Item Exceeds Expectations. No Revisions are Required. Reviewer Comments: Sources of Data The process of generating data shall involve assessment of interview participants and creating a connection between them and the topic getting studied. The data for this methodology section shall mainly come from the participants in the study. Data will be collected using interviews and questionnaires. Interviews will be used to gather information. The interview questions and focus group questions would get aligned to the research questions involved in the study. The information will be collected by taking notes, making recordings, and documenting the responses from the interviews with 15-20 participants who will be mental health providers with membership in Mental Health Associations in the study based on 5 years’ experience and the willingness to be interviewed. Semi-structured questionnaire will be used with a focus group comprising of caregivers. Research Data Research Data Source #1. Zoom meetings shall be used to enable connection between participants in the study who are mental health providers. The use of zoom meetings would be effective since no permission is required from the developers to use the platform. The only requirement is for users to create new accounts and to have stable internet connection that would not interfere with transmission. The mental health providers based in south Texas and those from other institutions in the United States would find a suitable platform for communication using Zoom meetings. The data source would provide information on mental health providers, and it would be possible to identify how they connect to the proposed research questions. Providers would be selected to complete questionnaire forms that will include basic demographic questions, which will be used based on their experiences. Consent form will be sent and obtained with signatures and the selected participants will submit the consent forms and complete the interview using Zoom. Research Data Source #2. Data will be collected using a Google form. The names of mental health providers and caregivers who will be the main participants in the study will be removed from the data. The Google forms shall be used to register participants interested in the study. The use of google forms is effective since no permission is required to use them for any research project. The forms can get developed by simply accessing google forms option on the google drive of a registered user. This method would be suitable since the forms would contain these fields: name, email, age, gender, and years in practice, as well as phone contact details. The google forms would be suitable since this research is based on seeking respondents from different areas in south Texas and communicating with them using online mediated communication methods. Research Data Source #3. Information gathered will be summarized using Descriptive Statistics and will be used in summarizing acquired data. While coding will be used to address questions posed and the transcribed interviews and coded data will also be stored on a backup USB thumb drive. The data will remain stored on the researcher’s computer with encrypted password. A narrative summary will be developed. Survey monkey will be used to collect data. Questions will be developed in part from: · National Institute of Environmental Health Sciences Mental Health Questionnaire · Agency for Healthcare Research and Quality (AHRQ) Mental Health Quality Measures Questionnaire The 3 channels that comprises of Zoom meetings, Google Forms, and Emails are selected since they all are freely accessible using internet connection and have capability of generating valid data from respondents. The use of social media would also be effective in the research process since it would be possible to find providers that will be interest in taking part in the study. There are more than one billion active social media users on “Facebook, Messenger, and Instagram” (Tankovska, 2021). This provides a large platform and source of data for participants living in south Texas since the majority use social media and have internet connections. Additional Data Additional Data Source #1. Emails shall get used to communicate with respondents in an official manner and to generate valid data from mental healthcare providers. The use of emails would create an official communication technique that shall get used to connect with mental health providers and caregivers. The communication process before the study begins will all get recorded on the emails and it shall be possible to find valid data that generates required output for the study. The requirements for emails as an instrument would only be email accounts from any providers that would be freely accessible and only require internet connection. The emails would contain required communication between all participants and ensure delivery of required information. The emails will also offer back up communication since even if one party deletes their email, it shall still be possible to produce a copy from another receiver and study the communication. Additional Data Source #2. Social media shall get used to find persons interested in the research process. The fact that use of social media is free and only requires account creation and internet connection results in the suitability for the research. It would be possible to generate proper data since respondents would find the google form links easily on the social media platforms. Creation of a hashtag on social media will draw attention to the purpose of the research and offer recruitment of required participants. Any person interested in the research will provide their details. Criterion * (Score = 0, 1, 2, or 3) Learner Score Chair Score Methodologist Score Content Expert Score Sources of Data (Minimum one to three pages) The learner provides a detailed discussion of the sources to be used to collect the research data that will be used to address the research questions. The required details include: 1. How the instrument was developed and constructed. 2. Interview questions must be aligned with the research design and collect the information to address the research questions and problem statement. X If the learner’s research data will come from an electronic database (archival, or secondary data), they provide the following information: 1. Identify the database and indicate exactly how the data will be obtained or accessed. 2. Confirm that the database actually contains data on the phenomenon or case that are needed to address the research questions. 3. Identify the source of the data (e.g., agency, website, etc.), and indicate how the data will physically be obtained and in what format. The learner includes an outline of the structure of the database in Appendix E, e.g., labels for the rows and columns. If permission to use the database is required, evidence of this permission also is included in Appendix E. X The learner provides a detailed discussion of the instrumentation and/or research materials to be used to collect any additional data, such as data to be used for participant screening/selection and/or demographic data. For screening/selection instruments, the learner explains how the instruments work, and exactly how the information obtained relates to participant selection. For demographic data, the learner describes why it is necessary and how it will be used. The main use of demographic data is to provide a profile of the sample, and the specific demographic information collected will be relevant to the proposal topic. X The learner includes a copy of all instruments, questionnaires, surveys, interview protocols, observation protocols, focus group protocols, or other research materials in Appendix E. For any instruments or research materials that require “permission to use,” Appendix E includes evidence of having obtained such permission. A protocol for data collection such as an interview or focus group or observation is more than a set of interview questions, It should provide the detailed process the learner will use to collect the data including their introduction and description of the process, the location, the physical set-up, the technologies to be used for holding and recording the meeting, the interview questions, additional probing questions, and/or facilitation and data collection techniques used in these approaches. A detailed protocol enhances the learner’s ability to defend the study. X The learner writes this section in a way that is well structured, has a logical flow, uses correct paragraph structure, sentence structure, punctuation, and APA format. X *Score each requirement listed in the criteria table using the following scale: 0 = Item Not Present or Unacceptable. Substantial Revisions are Required. 1 = Item is Present. Does Not Meet Expectations. Revisions are Required. 2 = Item is Acceptable. Meets Expectations. Some Revisions May be Suggested or Required. 3 = Item Exceeds Expectations. No Revisions are Required. Reviewer Comments: Trustworthiness The process of developing trustworthiness for a research is effective and ensures the data involved is factual and can get used for future analyses. Trustworthiness in research applied when finding data from different types of sources since there are many online sources that contain different types of data. Ameen (2017) explained that trustworthiness is required to generate high-quality data during research. It is possible to ensure trustworthiness in research by including data form valid, suitable, easily accessible, and sources that provide consent, and those that do not legally require consent to get used in other areas. Nyirenda et al. (2020) explained that trustworthiness in research is possible by setting suitable parameters that the study can have an impact on. This study shall acquire trustworthiness by using an external quality assurance person who already has knowledge of research procedures. The external persons shall be a psychiatrist who has practiced the profession before and was in involved in development of a peer reviewed study of mental health issues. The research would get documented to ensure trustworthiness since every task would get recorded and provide valid data. All communication would get recorded and stored on a repository to ensure acquisition of valid data. The emails, zoom meetings, google form data, and responses from interviews and focus groups would all get recorded and stored on a single hard drive and on the cloud to ensure a backup is available for analysis. Credibility Credibility of research refers to the technique of producing valid data that can get relied to produce suitable information (Forero et al., 2018). The data collection procedure will involve mainly digital instruments that offer suitable communication platform for the persons involved in the study. This technique shall ensure consistency of the data and alignment with required research parameters. The main threat is that the persons involved in the study. The main requirements are persons who have gotten affected by different types of mental health conditions and professionally trained mental health providers. There can be bias since it is possible that only certain types of mental health disorders would get addressed and the mental health providers can provide personal perception of the mental health sector. This threat would get addressed by ensuring sessions with respondents focus on factors causing rejection and inaccessibility of mental health improvement initiatives. Dependability Dependability refers to the capability of findings from research to generate the required guidelines for a study (Forero et al., 2018). A dependable study is one that had limited bias and conforms to expected outcomes. The main threat of dependability of research is inability to remove all types during data collection. This study shall address the issues by selecting persons with integrity to take part in the research. Transferability Transferability refers to the capability of research findings to get used in other healthcare departments and topics (Langtree et al., 2019). The study would ensure that the findings can display different aspects of mental health issues that can get applied to diverse persons in the mental health improvement initiative. The threat to transferability can be failure to disclose data collection procedure and types of data that got selected (Langtree et al., 2019). The solution for this issue would be to ensure data collection procedure gets performed properly and does not interfere with the research procedures. This would ensure the outcome of the research would be positive and produce expected outcomes. Confirmability Confirmability refers to the capability of using data that can get confirmed from a reliable source (Langtree et al., 2019). This would ensure the research process is capable of generating required guidelines and produce the proper direction for solution of mental health issues. The only threat would be using sources where the respondents had been coerced to take part in the research. It is possible to remove the threat by ensuring credible persons get used and would get involved in any future procedure of confirming validity. Criterion * (Score = 0, 1, 2, or 3) Learner Score Chair Score Methodologist Score Content Expert Score TRUSTWORTHINESS (Minimum two to four paragraphs or approximately one page) 1. Defines the concepts of credibility, transferability 2. Credibility: discusses how the study represents the participants’ experiences 3. Transferability: discusses how the study’s findings may be applicable to policy, practice, future research X 1. Describes the threats to the credibility and transferability of the study inherent in the study design, sampling strategy, data collection method/instruments, and data analysis 2. Addresses how these threats will be minimized X Defines concepts of dependability and confirmability X Dependability: discusses how the study documents research procedures. Provides detailed research protocols. X Confirmability: discusses how the study could be confirmed or findings corroborated by others. X Describes the threats to dependability and confirmability of the study inherent in the study design, sampling strategy, data collection method/instruments, and data analysis. Addresses how these threats will be minimized. X Appendices must include copies of instruments, materials, qualitative data collection protocols, codebook(s), and permission letters from instrument authors (for validated instruments, surveys, interview guides, etc.) X Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, sentence structure, correct punctuation, and APA format. X *Score each requirement listed in the criteria table using the following scale: 0 = Item Not Present or Unacceptable. Substantial Revisions are Required. 1 = Item is Present. Does Not Meet Expectations. Revisions are Required. 2 = Item is Acceptable. Meets Expectations. Some Revisions May be Suggested or Required. 3 = Item Exceeds Expectations. No Revisions are Required. Reviewer Comments: Data Collection and Management The data collection procedure would involve a step-by-step process to ensure production of high-quality outcomes for the research. The first step would be to communicate with the dean using a letter in order to receive authorization to conduct the research. The next process would be to submit the letter to the Institutional Review Board (IRB) that would provide authorization. After authorization, it would be possible to select participants for the research procedure. The selection process would involve these persons: psychiatrists, psychologists, and caregivers who have engaged with mentally ill persons. All selected participants would get provided with consent forms to ensure they provide full cooperation. Data management shall begin in this initial stage since it would be possible to engage with suitable persons and to record their details. The data collection procedure would involve interviews and focus groups as proposed for the research procedure. The focus groups would involve 10 respondents who would be healthcare providers based in south Texas. There would be respondents from other members of the public who are caregivers. The interview procedure would be explained to all participants to ensure they would be available at the time the interview is set to take place. The procedure for the focus groups would be explained to the participants to ensure they produce valid information for the interview procedure. Every participant would be expected to respond to all questions presented in the interview procedure to ensure they produce valid data involved in the study. The interviews and focus group sessions would all be conducted via Zoom platform that would ensure production of valid data for the research procedure. The consent form for the study would get developed using DocuSign which would ensure every respondent provides data that is suitable for the research. The use of DocuSign would involve an electronic signature that each participant would be required to provide in order to take part in the study. The interview proceedings using Zoom platform would all get recorded and used for later data analysis. MaxQDA shall be used for the qualitative data analysis procedure since it would be possible to acquire data and perform the data analysis procedure. Recordings for the meetings would be used as transcripts to provide analysis and they shall be stored on an external hard drive and on the cloud for safety backup. Data Management and Storage · Data will be stored on Zoom cloud along with a thumb drive type of equipment. · Data will be stored for a minimum of 3 years. · Data will be backed up on an additional web-based/cloud-based storage system such as Last Pass which allows for encryption. · Data will be permanently deleted from cloud storage systems whenever it is deemed appropriate. Data Source #1 – Analysis Strategy · Step 1: Knowing the Data: Ensure that researcher is familiar with the data by reading through the data and looking for patterns · Step 2: Creating Codes: Creation of initial codes & creation of categories · Step 3: Searching for Themes: Develop a detailed description of the phenomenon from the synthesis of the data · Step 4: Review Themes: For statistical significance for the secondary data and the additional data elements collected through interviews · Step 5: Defining and naming themes · Step 6: Produce the report Criterion * (Score = 0, 1, 2, or 3) Learner Score Chair Score Methodologist Score Content Expert Score Data Collection and Management (Minimum one to three pages) The learner describes the procedures for the actual data collection at a level of detail that would allow execution of the study by another researcher. This will include (but not be limited to) how each instrument, measurement technique, or data source will be used, how and where data will be collected, and how data will be recorded. The learner includes a sequence of actions or step-by-step procedures to be used to carry out all the major steps for data collection. This includes a workflow and corresponding timeline, presenting a logical, sequential, and transparent protocol for data collection that would allow another researcher to conduct the study. Data from different sources may have to be collected in parallel (e.g., paper-and-pen surveys for teachers, corresponding students, and their parents AND retrieval of archival data from the school district). Provides detailed description of data collection process, including all sources of data and methods used, such as field tests, interviews, member checking, observations, surveys, and expert panel review. Note: The collected data must be sufficient in breadth and depth to answer the research question(s) and interpreted and presented correctly, by theme, research question and/or instrument. sequence is acceptable. X The steps include acquisition of site authorization documents, IRB approval, and the procedures for obtaining participant informed consent and protecting the rights and well-being of the participants. The learner includes copies of the relevant site authorizations, participant informed consent forms, recruitment announcements/materials (e.g., posters, e-mails, etc.) in appropriate appendices. X The learner describes the data management procedures for paper-based and/or electronic data. This includes, for example, data security procedures and how and when data will be destroyed. X The learner writes this section in a way that is well structured, has a logical flow, uses correct paragraph structure, sentence structure, punctuation, and APA format. X *Score each requirement listed in the criteria table using the following scale: 0 = Item Not Present or Unacceptable. Substantial Revisions are Required. 1 = Item is Present. Does Not Meet Expectations. Revisions are Required. 2 = Item is Acceptable. Meets Expectations. Some Revisions May be Suggested or Required. 3 = Item Exceeds Expectations. No Revisions are Required. Reviewer Comments: Data Analysis Procedures The problem statement involved in this study is that: It is not known how mental health providers and caregivers in south Texas describe the factors that influence utilization of mental health services. There is prevalence of mental health issues in south Texas that requires to get studied to determine the rationale for underutilization of mental health in the region and how residents get adversely affected by their conditions. The research would study key participants to determine the exact the factors influencing utilization of mental health services in the region. According to the Texas Association of Counties (TAC), there was allocation of “$476 million” for mental health improvement initiatives in the state. The county government contributed “$371 million of the $476 million” used in mental health improvement procedures (TAC, 2020). This reveals that a lot of government funds get used to conduct mental health initiatives in the state. The research is thus valid in south Texas since it would be possible for the local government to come up with health improvement initiatives once the root causes of issues get discovered. The data analysis procedure would involve analysis of the root cause of poor utilization of mental health services and seek improvement measures. The participants involved in the study would all be mental health providers and caregivers as they produce trustworthiness for the entire research process. The study shall offer guidance on proper government allocation of funds to ensure capability of directing taxpayers’ money to the proper department (Vaesen & Katzav, 2017). The data analysis process would offer guidance on development of policies that are capable of generating suitable information for the improvement of mental health departments. It would be possible to discover the type of mental disorder that people suffer from and to guide mental health providers on the direction to take while treating patients. The fact that there is poor utilization of mental health services that results in the need to study how mental health providers can connect with patients to improve utilization of the services. The research process shall involve participants who are qualified mental health practitioners to ensure they all provide data suitable to real mental health issues which affect people in south Texas (Lee et al., 2018). The mental health department in south Texas already facing issues of inaccessibility since it is hard for person who cannot afford care to receive appropriate treatment. Hence, the issues of health improvement progress since it is hard to acquire treatment without insurance (Koons & Tozzi, 2019). This issue is connected to the need of gaining health measures for every person regardless of financial constraints. The fact that there are more economic requirements to enable each person to remain self-sufficient is another factor that influences this study’s development (Chen et al., 2019). The high rate of uninsured persons in south Texas result in the need to study barriers that influence mental health utilization, which may cause limited capability to generate mental health improvement in future studies. Inaccessible healthcare improvement techniques would get addressed in the data analysis stage to determine how each person can eliminate barriers to the status improvement. The data analysis process shall produce high-quality and suitable data required for mental health improvement. This would be possible after addressing each of the following research questions: · RQ1: What is the process involved in identifying the need of a person to receive mental healthcare? This question would be directed to mental health providers to determine how they can conclude that a person suffers from mental health issues. · RQ2: How do mental health providers describe the factors influencing utilization of mental health services?? This research question shall be directed to professionally trained mental health providers to understand why the people living in Southern Texas are not effectively utilizing mental health services. · RQ3: How do caregivers describe the factors influencing patient’s utilization of mental health services?? This research questions shall reveal why individuals living in south Texas utilizes very low budget allocation on funding of mental health care · RQ4: How do mental health providers determine the root cause of mental health related issues? This research question shall provide direction on how mental health providers assess patients to determine background issues that would have led to their present condition. This research question shall be directed towards mental health improvement that has a capability of using valid knowledge to provide effective improvement. As mentioned before, qualitative descriptive analysis is the best procedure to use to develop effective outcome for the research process. The data collection procedure shall be performed for the interview sessions and focus group sessions. The collection procedure would involve putting data into the sections involved in the topics related to identification of the problem in south Texas. The unique topics are all provided in the literature review section and have a possibility of generating required insight into mental health related issues in south Texas. The data collection procedure for the interviews would involve verbatim to ensure the recording and back up procedure involved trustworthiness. After collecting the data, it would be possible to generate valid responses by frequently listening to the interview processes. The procedure would involve effective analysis of the responses to ensure the study gets performed using required direction for the improvement of mental healthcare. The analysis procedure of this study shall be thematic analysis which has a capability of generating suitable topics based on the study’s direction (Nowell et al., 2017). Thematic analysis is suitable since it can produce required direction and research questions can get used to produce required topics. The data analysis procedure shall use MaxQDA as proposed, and it would be possible to connect with all elements of the research in this way. Once data gets recorded, the resulting procedure would involve generating topics based on the data to determine validity for the research. The research questions shall then be used to develop topics based on responses from the participants. Identification of different themes would be possible in this stage since it would be possible to generate valid topics for the study. After development of the topics, it would be possible to conduct quality assurance to determine the only topics and data suitable for the study on mental health improvement and accessibility. The last procedure would involve naming the themes to ensure the validity for the research process. Criterion * (Score = 0, 1, 2, or 3) Learner Score Chair Score Methodologist Score Content Expert Score Data Analysis Procedures (Minimum one to three pages) The learner restates the problem statement or purpose statement, along with the research question(s) X Describes how raw data are prepared for analysis (i.e., transcribing interviews, conducting member checking, how all sources of data will be organized. and checking for missing data). Describes (for both paper-based and electronic data) the data management procedures adopted to maintain data securely, including the length of time data will be kept, where it will be kept, and how it will be destroyed X Describe evidence of qualitative analysis approach, such as coding and theming process, which must be completely described and include the analysis /interpretation process. Clear evidence from how codes were combined or synthesized to create the themes must be presented. X Provides evidence that quantity and quality of data is sufficient to answer the research questions. X The learner provides description of how the results will be reported. X The learner writes this section in a way that is well structured, has a logical flow, uses correct paragraph structure, sentence structure, punctuation, and APA format. X *Score each requirement listed in the criteria table using the following scale: 0 = Item Not Present or Unacceptable. Substantial Revisions are Required. 1 = Item is Present. Does Not Meet Expectations. Revisions are Required. 2 = Item is Acceptable. Meets Expectations. Some Revisions May be Suggested or Required. 3 = Item Exceeds Expectations. No Revisions are Required. Reviewer Comments: Ethical Considerations The process of seeking direction in this research would involve accessing IRB approval as mentioned before. This shall the initial ethical consideration that shall offer guidance for the research process. The next department required for approval is the university council. This is imperative since it would ensure acquisition of any material for the research. The participants would have confidence in the research since it would be possible to ensure privacy for all the information, they provide in the research procedure. The participants for the research shall get recorded and their contact information shall get stored in a selected folder. The research process shall use initials for the process to ensure confidentiality of all respondents in the research process. Another ethical consideration for the research shall be acquisition of informed consent for the research procedure. The fact that this study is based on data collection from human subjects result since in the mandatory need to conform to the guidelines provided for human subjects in research (Manti & Licari, 2018). The use of human subjects would require human subjects’ protection and education. It would also be imperative to acquire IRB approval since the human subjects’ participants for the research would be persons that are unfamiliar to the persons undertaking the research. Collection of information from such participants would require connection with the appropriate respondents and adherence to the guidelines to ensure the research process does not waste the time and resources spent. The considerations for the informed consent shall be to protect participants from any type of psychological harm during the research. This is imperative for the research process since the topic getting studied is mental health. It is imperative to ensure all participants are capable of producing required outcomes for the research by ensuring they are aware of the direction the research is supposed to take. Protection of privacy is the next ethical consideration that ought to be the basis of the research process. This would ensure responds are capable of generating the required connection with volunteers for the research. Informed consent acquisition is a step-by-step procedure that is capable of generating proper guidance and improvement for research (Manti & Licari, 2018). Language is the initial requirement for the informed consent since it would ensure all participants would respond to the questions and provide valid answers. The study shall get performed in english and all communication would get performed using english since it is the national language that is spoken by the majority of all residents in the U.S. The informed consent document would also ensure all participants take part willingly in the research (Manti & Licari, 2018). This would eliminate any kind of coercion and ensure the research process uses suitable respondents. Full disclosure of the research would get performed before the research process to eliminate any confusing issues that might arise during the research process. The task is critical since it ensures every participant of the research is capable of generating their own understanding of the topic (Manti & Licari, 2018). After this step, it would be possible for the research questions and selected questions for each research direction to engage with all participants of the research. The procedure is a critical ethical consideration since the topic is critical and involves a lot of people. The fact that this study shall use DocuSign to generate valid data from respondents results in a basis of ethical considerations. The duration of the research should also get explained to the participants to ensure they are aware of their requirements. This is a critical consideration in research that ensures validity with the topic getting studied. During the research, it is possible that a different direction might get taken depending on respondents of the research. This can also occur if it becomes difficult to generate the appropriate topics and themes that would offer valid data. As such, it would be imperative to develop a research direction that is capable of generating effective outcomes and using it as plan B. The recruitment process should inform the participants of this possibility to ensure the research generates valid information. The research shall get developed to suit different types of respondents’ expectations. This would involve providing the research for White, African American, Hispanic, Pacific Islanders, and Native Americans that all suit the criteria of participants for the research. The use of respondents of different races would also get performed for the mental healthcare providers in the study. In this way, it shall be possible to gain unbiased data that is capable of generating effective outcomes for the research process. The respondents from the different races would also be involved in generating effective outcomes since it would be possible to gain insight on the mental health issues affecting different races in South Texas (Narkhede, 2020). The next ethical consideration is to ensure no external persons will take part in the research. This is imperative since it ensures privacy and confidentiality of all persons in the research process. All data collection procedures including the Zoom meetings, Google forms, and Emails would get accessed only by authorized persons. In this way, it would be possible to ensure the research process generates the required guidelines that will be able to impact many people in the study. It would be possible to ensure the research procedure involves the required persons would not expose the study’s contents until completion. In this way, it would be possible to perform proper data analysis procedure and to come up with a valid outcome of research. The ethical consideration in ensuring high quality research is creation of publications that are suitable for the research procedure. This is a critical consideration since the outcome of the research has the capability of producing proper insight into mental health improvement initiatives. The research will involve mental healthcare centers in Texas which will provide valid data for the study. It would be possible to engage with persons that are directly affected with mental health issues. The next ethical consideration for this research is conformity to code of ethics that is capable of producing the most effective outcome for improvement of mental health status of individuals in Texas. The code of ethics shall involve “responsible publication, confidentiality, integrity, honesty, openness and ability to be careful” in all the areas of this research. Code of ethics ensure the research process is effective and is capable of generating required outcomes. Every participant in the research would receive procedures that would not harm them in any emotional or physical way. All data collection procedures will remain confidential and all the data would get stored on a hard drive and on the cloud using login credentials known solely by the researcher. Criterion * (Score = 0, 1, 2, or 3) Learner Score Chair Score Methodologist Score Content Expert Score ETHICAL CONSIDERATIONS (Minimum three to four paragraphs or approximately one page) Provides a discussion of ethical issues, per Belmont Report and IRB guidelines, related to the study and the study population of interest. Includes citations. Explains which principles / issues are relevant to the study. Identifies the potential risks for harm that are inherent in the study. X Describes the procedures for obtaining informed consent and for protecting the rights and well-being of the study sample participants. Includes statement in Informed Consent on who has data access including chair, committee members, IRB and peer reviewers, college representative. X Addresses key ethical criteria of anonymity, confidentiality, privacy, strategies to prevent coercion, and any potential conflict of interest. X Describes the data management procedures adopted to store and maintain paper and electronic data securely, including the minimum 3-year length of time data will be kept, where it will be kept, and how it will be destroyed. Explains plan to implement each of the principles/issues that are relevant the study data management, data analysis, and publication of findings. Note: Learners are required to securely maintain and have access to raw data/records for a minimum of three years. If asked by a committee member, IRB reviewer, peer reviewer or CDS representative, learner must provide all evidence of data including source data, Excel files, interview recordings and transcripts, evidence of coding or data analysis, or survey results, etc. No dissertation will be allowed to move forward in the review process if data are not produced upon request. X Includes copy of site authorization letter (if appropriate), IRB Informed Consent (Proposal) and IRB Approval letter (Dissertation) in appropriate Appendices. All approvals, consent forms, recruitment, and data collection materials are mentioned in the Data Collection section and included in appropriate appendices (with appropriate in-text references). X 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. X *Score each requirement listed in the criteria table using the following scale: 0 = Item Not Present or Unacceptable. Substantial Revisions are Required. 1 = Item is Present. Does Not Meet Expectations. Revisions are Required. 2 = Item is Acceptable. Meets Expectations. Some Revisions May be Suggested or Required. 3 = Item Exceeds Expectations. No Revisions are Required. Reviewer Comments: Assumptions, and Delimitations The study of mental health issues in Texas is bound to have some limitations that must get addressed. Assumptions The assumptions that this shall experience are: 1. The data collection can get exposed to untruthful data since the respondents would not be physically available for the study. The use of online platforms would result in this issue since the participants would not receive supervision that is valid for mental health improvement. The issue would get solved by instructing the respondents to remain as truthful as possible by informing them of the seriousness of the research. 2. The use of online platforms can result in interruptions for the research since it would be difficult to ascertain that internet connection would always be provided. There can be issues during transmission and the videos or audios can get interfered with during transmission. This would cause the transcribing process to be exposed to inaccurate data. It would be possible to solve this issue by instructing the respondents to install internet from reliable internet providers and to ensure their machines are in proper condition for transmission. 3. An issue can occur when the mental health providers would produce responses that are biased based on their personal requirements for the research. This can result in issues of connection with the research questions. This issue can get addressed by ensuring use of participants with credible credentials which would ensure they produce high-quality responses. Delimitations The following delimitations shall get involved in the study: 1. The initial sample size of the study for mental health providers was large. To ensure more generalized and suitable data, the use of minimum of 50 participants for all mental health providers and the mentally affected persons would be suitable. 2. Use of persons affected by mental health issues and only those residing in Texas would produce limited data for the research process. Transferability would be difficult for the research process since the use of Texas resident may affect data and mental health issues affecting other persons in the U.S. This issue would get addressed by ensuring the participants get exposed to the appropriate environment that can impact their possibility of produce transferable data. Criterion *(Score = 0, 1, 2, or 3) Learner Score Chair Score Methodologist Score Content Expert Score Assumptions, Limitations, and Delimitations - Methodological (Minimum three to four paragraphs) The learner provides a separate subsection for assumptions and delimitations. X The learner states the assumptions being accepted for the study and provides a rationale for making each assumption. The learner also discusses associated consequences for the transferability and applicability of the findings. X The learner identifies the methodological delimitations of the study and provides a rationale for each delimitation. The learner discusses associated consequences for the transferability and applicability of the findings. X The learner discusses strategies to minimize and/or mitigate the potential negative consequences of methodological assumptions, limitations, and delimitations. X The learner writes this section in a way that is well structured, has a logical flow, uses correct paragraph structure, sentence structure, punctuation, and APA format. X *Score each requirement listed in the criteria table using the following scale: 0 = Item Not Present or Unacceptable. Substantial Revisions are Required. 1 = Item is Present. Does Not Meet Expectations. Revisions are Required. 2 = Item is Acceptable. Meets Expectations. Some Revisions May be Suggested or Required. 3 = Item Exceeds Expectations. No Revisions are Required. Reviewer Comments: Summary Mental health issues such as depression and anxiety are constantly increasing as many adverse conditions occur in society (Legg, 2018). The issue forms the basis for the majority of negative mental health wellbeing. This study has identified that mental health issues develop in people due to interpersonal, intrapersonal, and systemic issues. The issue of prevalent more so because it is difficult to offer mental healthcare for people who possess personal barriers that limit desire to improve. Issues occur further because it is difficult to generate a solution without studying root cause of mental health issues. This study’s main is to find the validity of the identification procedure involved in the research. Mental health improvement is required for all members of the public since it affects their capability of having a conducive environment (Lindert et al., 2017). This perspective formed an issue for the research since it would generate the required guidance and offer proper connection with valid respondents. The rejection of mental health improvement is a prevalent issue that must get addressed to ensure effective solution. The fact that many people regardless of age reject mental health improvements results in the use of digital methods of communication that would be familiar to the majority of respondents (Liverpool et al., 2020). The study shall use technological means since they are familiar to many people and have capability of producing suitable responses for the research process. The application of qualitative research methodology would ensure effective outcomes for the research since it would be possible to acquire data from credible sources. The procedure of literature review involved qualitative research methodology since it allows study of peer reviewed journal articles suitable for the topic. The process of identifying treatment gaps was effective since it revealed the guidelines required for mental health improvement (Luitel et al., 2017). The population used for the research is adults living in South Texas and mental health providers who have worked in the area. In this way, it was possible to acquire generalized information that would get used to create valid research. The data analysis procedure used qualitative descriptive research design which is effective in producing suitable analysis of research topic. The next chapter is chapters 4 and 5 that shall involve application of all research methods proposed in this paper. Criterion * (Score = 0, 1, 2, or 3) Learner Score Chair Score Methodologist Score Content Expert Score Chapter 3 Summary (Minimum one to two pages) The learner summarizes key points presented in Chapter 3 using authoritative, empirical sources/citations. Key points include (for example): · Methodology/design · Population · Sample size/selection · Instrumentation/Sources of Data · Data collection · Data analysis X The learner concludes Chapter 3 with a transition discussion to focus for Chapter 4. X The learner writes this section in a way that is well structured, has a logical flow, uses correct paragraph structure, sentence structure, punctuation, and APA format. X *Score each requirement listed in the criteria table using the following scale: 0 = Item Not Present or Unacceptable. Substantial Revisions are Required. 1 = Item is Present. Does Not Meet Expectations. Revisions are Required. 2 = Item is Acceptable. Meets Expectations. Some Revisions May be Suggested or Required. 3 = Item Exceeds Expectations. No Revisions are Required. Reviewer Comments: References Abi Doumit C, Haddad C, Sacre H, Salameh P, Akel M, Obeid S, et al. (2019) Knowledge, attitude and behaviors towards patients with mental illness: Results from a national Lebanese study. PLoS ONE 14(9): e0222172. https://doi.org/10.1371/journal.pone.0222172. Ackerman, C. E. (2020). Psychoanalysis: A Brief History of Freud's Psychoanalytic Theory. 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Uses a range of references including founding theorists, peer-reviewed empirical research studies from scholarly journals, and government/foundation research reports. The majority of all references must be scholarly, topic-related sources. Websites, dictionaries, and publications without dates (n.d.) are not considered scholarly sources and should not be cited or present in the reference list. In-text citations and reference list must comply with APA 7th Ed. Ensures that for every in-text citation a reference entry exists. Conversely, for every reference list entry there is a corresponding in-text citation. NOTE: The accuracy of citations and quality of sources must be verified by learner, chair and committee members. X X Uses a range of references including founding theorists, peer-reviewed empirical research studies from scholarly journals, and government /foundation research reports. X X Verifies that approximately 75% of all references are scholarly sources within the last 5 years. The 5-year time frame is referenced at the time of the proposal defense date and at the time of the dissertation defense date. This is a recommendation, not a requirement. Note: Websites, dictionaries, publications without dates (n.d.), are not considered scholarly sources and are not cited or present in reference list. X X Avoids overuse of books and dissertations. Books: Recommend a maximum of 10 scholarly books that present cutting edge views on a topic, are research based, or are seminal works. Note: when a book is cited this implies the learner has read the entire book. Dissertations: Recommend a maximum of 5 published dissertations. Note: dissertations are not considered peer -reviewed; and therefore, should be cited judiciously. X X Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, sentence structure, punctuation, and APA format X X *Score each requirement listed in the criteria table using the following scale: 0 = Item Not Present or Unacceptable. Substantial Revisions are Required. 1 = Item is Present. Does Not Meet Expectations. Revisions are Required. 2 = Item is Acceptable. Meets Expectations. Some Revisions May be Suggested or Required. 3 = Item Exceeds Expectations. No Revisions are Required. Reviewer Comments: Appendix A. Ten Strategic Points Ten Strategic Points The ten strategic points emerge from researching literature on a topic, which is based on, or aligned with a defined need or problem space within the literature as well as the learner’s personal passion, future career purpose, and degree area. The Ten Strategic Points document includes the following key points that define the research focus and approach: Strategic Points Descriptor Learner Strategic Points for Proposed Study 1. Dissertation Topic- Factors Influencing Utilization of Public Mental Health Services in South Texas · Topic comes out of the problem space supported by the literature, not the learner’s head or personal agenda · Aligned to the learners’ program of study, and ideally the emphasis area · Researchable and feasible to complete within the learners’ doctoral program, including extension courses as needed. · Focused 2. Literature Review - (Theoretical Framework (Theory) Gaps Themes All Citations Gaps Basu, Rehkopf, Siddiqi, Glymour, & Kawachi (2016). According to the authors, there is a gap here in the changes being experienced in social policies in recent years. It has created a gap among women with low income in South Texas. Accordingly, the authors used the determination of the differences in income to understand the relationships between health outcomes and welfare reforms as it impacts the less privileged women in comparison to the most affected women. Ly, A. (2019). This study focused on the factors that influence the utilization of mental health among Vietnamese Americans and the barriers to seeking help in Texas. The study had 12 participants including providers and community leaders who were familiar with the target population. The findings of the study indicated that there is a gap here in cultural acceptance of mental health treatment (Peteet, 2019). Hence the need to culturally specify mental health intervention to improve mental health utilization in the community. However, the study was limited by the small sample size; therefore, the findings cannot be generalized. Further studies should include more cultural groups to validate the findings of this research. Kwan, P. P., Soniega-Sherwood, J., Esmundo, S., Watts, J., Pike, J., Sabado-Liwag, M., & Palmer, P. H. (2020). The authors of this study aimed to evaluate the facilitators and barriers to mental health utilization among Pacific Islanders. Semi structure interviews were used to collect information from 12 pacific islanders. Trained community leaders recruited eligible candidates for the study. The study was limited by the small sample size. Five themes arose from the study. There is a gap here in regard to cost of healthcare, mental health stigma and language and culture barriers, which were the themes that emerged concerning barriers affecting the utilization of mental health services. The researchers indicated the need for future studies to include a larger sample size to enable generalization of the findings. Volkert, J., Andreas, S., Härter, M., Dehoust, M. C., Sehner, S., Suling, A., . . . Schulz, H. (2018). The aim of this study was to evaluate various aspects of the utilization of mental health services among the elderly. The study had 3,142 participants aged between 65-84 years. Logic regression approach was used to analyze predisposing, enabling, and need factors among the participants. Similarly, the study found that there is a gap in the factors influencing elderly people to utilize mental health services because they felt they could deal with their situations. The study indicated that more research is needed to validate the results of this study. Theoretical Foundation The theoretical foundation of this research will be based on the cognitive theory of psychopathology that was suggested by Aaron T Beck. It states that individual perception is influenced by positive and negative mental health status (DeYoung & Krueger, 2018). This model fits directly into the dissertation because it is helpful at describing how individual’s perceptions of situations including spontaneous thoughts on events influence people’s emotional, behavioral, and psychological reactions in relations to mental health services (Picco et al., 2017). The theory emphasizes that the distorted beliefs influence people’s understanding of themselves, their surroundings, and their interaction with others. As such, distorted beliefs influence the way individuals process information. Similarly, the theory focuses on perception in consideration that mental health is primarily a perception and has neural connections (Cherry & Morin, 2019). Where a neural connection is right, then, the other factor that influence individuals’ views on mental health services is their perception. Perception is the understanding of interpretations of a phenomenon, which is influenced by an experience an individual has lived, prior events, culture, values, present circumstances, education, and preconceived notions (Rosli & Goh, 2020). Through the understanding of influences of perception, people’s views regarding the utilization of mental health services is understandable. Furthermore, this theory connects to the study of mental health utilization through the concepts of perception. A research of the difference in individuals’ utilization of mental health services shows that it is about individual perceptions. Over time, as individual perceptions were grouped together, consequentially, their beliefs about utilizing mental health will be formed. Using example of the LBGT community, their beliefs about utilizing mental health services conforms to an identity that is not agreed upon (Steele et al., 2017). In their view, an individual’s perception grows into the belief that supports non-utilization of mental health services. Knight & Winterbotham (2020), states that perception is an understanding of individual’s decisions to either utilize or not utilize mental health treatment. The use of cognitive theory of psychopathology as the foundation of this study, will provide the possibility of understanding the rational why certain people openly utilize mental health services and why others do not utilize the services. This is because the theory emphasizes that perception can either influence positively or negatively people’s mental health status, which helps in explaining the role of perception in the utilization of mental health services. Through an understanding of perceptions in the study, it is possible to explain why individuals have different opinion about mental health. Therefore, it will contribute significantly to the knowledge under investigation about mental health utilization and how individuals seek mental health services (Eslami et al., 2018). Using the cognitive theory of psychopathology, it is possible to extend the theory to the study of mental health. The theory is now built on the research questions. It is used for the study because it provides a framework that considers past studies on mental health with specific emphasis on the seeking behaviors of mental health services. Literature Review 1. Empathic Approach: The problems of underutilization of mental health services and non-institutionalization of adults has been emphasized as behavioral risk factors. According to Kohn et al. (2018) there is a gap in utilization of mental health services in the United States among the individuals that require treatment and those that actually receive the treatment. Therefore, there is the need to establish and understand what the social determinants of mental disorders are, and align them with the sustainable development goals, and to establish the potential mechanisms and targets for interventions (Seixas et al., 2017; Kohn et al., 2018). Lund et al., (2018) also expressed the same gap in mental health utilization in Southern Texas, stating that there is need to conduct further research on why individuals utilize or chose to reject mental health services. The authors assert that the number of mental health patients seeking treatment and medication are fewer than those that are actually suffering from the illness (Lund et al., 2018). Professional Development: Job Satisfaction: With some recent issues in the country that have been linked to mental health issues, there is an emergence focus on mental health as a critical area of interest. Problems of mental health has been sidelined for many years, but now, there is the realization to understand the reasons why people utilize or reject treatment. While this is being extensively studied, more attention should be focused been to the patients. According to De Luca et.al. (2016), most chronic health conditions and terminal illnesses tend to result in mental disorders in patients. For various reasons, mental health is now among the priorities of medical practice (De Luca et al., 2016). Kohn, et al. (2018), examined recent prevalence of mental health disorders including lack of utilization of its services. The outcome was that about 43% of children and adolescents in the country suffer from mental illness, the treatment gap in the group was 64%. Utilizing or rejecting the services is dependent on collaboration of participating in treatment, while both patients and providers work together to make the therapy valuable. (Kohn, et al., 2016). 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 (Roslee & Goh, 2020). 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). 3. Problem Statement It is not known how mental health providers describe the factors that influence utilization of public mental health services 4. Sample and Location · Location – South Texas. USA · Participants will include people who are members of Mental Health Organizations including: · Mental Health America (MHA) · National Alliance on Mental Health (NAMI) · Target Population: · Mental Health Providers Sample: 20 samples that will comprise of interviews with 10 Mental Health Providers and 10 Caregivers. 5. Research Questions · RQ1: How do mental health providers describe the factors influencing utilization of public mental health services? · RQ 2: How do mental health providers describe strategies of encouraging patients to utilize public mental health services? · RQ 3: How do caregivers describe the factors influencing patient’s utilization of public mental health services? · RQ4: How do caregivers describe strategies of encouraging patients to utilize public mental health services? 6. Phenomenon (qualitative) or Define Variables/Hypotheses (quantitative) To understand factors that influence utilization of public mental health services · Lack of mental health utilization in Texas. · High rate of mental health conditions is reported in Southern Texas Texas is reported as poorly utilizing its allocated budget funding of mental health care 7. Methodology and Design Qualitative Descriptive Study Rationale for Methodology Qualitative methodology is justified for my research because it is effective at providing rich data and is neither restrained nor bound by limitations (Bradshaw et al., 2017). In addition, it is most appropriate because it is going to provide real life evidences based on interviews with participants who will be healthcare providers and caregivers that have difference experiences at giving primary data (Colorafi & Evans, 2016). Furthermore, Ondersma, et al., (2017)’s comments on Kim et al. (2017)’s topic “Staying Focused on Non‐Treatment Seekers,” described qualitative methodology as appropriate because data can be obtained in order to determine the health seeking behaviors (Ondersma, et al., 2017). This is applicable to my study as I try to determine individuals’ behavioral patterns and why they choose to either utilize or reject mental health treatment. Qualitative methodology appropriately addressed the problem statement that tries to understand how mental health providers and caregivers describe the contributing factors to individual’s decision to utilize or reject mental health treatment because the methodology will be flexible and effective when collecting data and gathering information from the participants (healthcare providers and caregivers) based on their experiences. Most of the previous studies that sought to determine the factors influencing health seeking behaviors among people experiencing mental conditions used quantitative research methodology. As a result, the findings of those studies did not explain important relationships and those associated with mental health utilization (Kapadia et al., 2017). Such studies focused extensively on the numerical and statistical elements of the study overseeing important relationships. As a result, this study will use a qualitative methodology to unearth the underlying relationships and themes that have not been studies before. The aim of the research is to determine factors that influence utilization of public mental health services. A quantitative methodology will not be the most appropriate approach to this study. The findings of a quantitative study may be generalized as information is drawn from random sources (Rahman, 2017). On the other hand, the findings of qualitative research can be generalized as they are drawn from specific sources. In addition, researchers using the quantitative approach operate under assumptions and as a result the information obtained may be biased (Ackerman, 2020). On the other hand, qualitative research has little assumption to nil assumption. Quantitative studies are carried out in unnatural environments that make the respondents uncomfortable and therefore cannot provide the appropriate information (Savela, 2018). As a result, these limitations make quantitative methodology inappropriate for the present study. 8. Purpose Statement The purpose of this qualitative descriptive case study is to understand how mental health providers describe the factors that influence utilization of public mental health services 9. Data Collection Approach · Informed & signed consent by participants · Visits to mental health providers and mental health facilities · Interview with mental health providers & caregivers recorded on tape · Interviews will involve 20 respondents from within Texas. · Focus group with subset of 6. · Sampling Method: Purposeful Sampling Sources: Interviews, Questionnaires & Focus Group Discussion 10. Data Analysis Approach · Informed & signed consent by participants · Visits to mental health providers and mental health facilities · Interview with mental health providers & caregivers recorded on tape · Interviews will involve 20 respondents from within Texas. · Focus group with subset of 6. · Sampling Method: Purposeful Sampling Sources: Interviews, Questionnaires & Focus Group Discussion Appendix B. Site Authorization This is a required Appendix for Level 2 Proposal Review; Level 4 IRB Review and Level 5 Dissertation Review. If no site authorization is required, provide a statement stating that, and explain why not site authorization was needed. Preliminary Site Authorization. At the proposal development stage, preliminary site authorization as evidenced by an email from the appropriate organizational personnel is acceptable, until a formal site authorization letter is obtained. Site authorization letters must be on letterhead of the organization providing permission and signed by the individual authorized to grant such permission per requirements below. Formal Site Authorization. Prior to IRB submission the learner must obtain formal site authorization to include: Written on organization letterhead Dated within the last 12 months Signed by an authorized representative of the site Clearly indicate activities for which researcher has obtained authorization. This is very important. The authorization should clearly indicate EXACTLY what authorization is being granted. For example: recruiting by email during work hours, interviewing primary teachers during their planning hours, distributing an electronic survey to staff members, granting access to email, etc. Site authorization information aligns exactly with recruitment materials, informed consent document, and the IRB application To review sample site authorization letter template please refer to GCU’s IRB Research Center on the DC Network: ( https://dc.gcu.edu/documents/irb_documents__iris/irb_forms_templates_updated_jan_2018 ) For purposes of confidentiality, site authorization letters will be deleted from this appendix by the Form and Format reviewer (Level 7 Review - just prior to dean’s signature) and the following text will be inserted: Site authorization(s) on file at Grand Canyon University. Appendix C. IRB Approval Letter This is a required document for Level 5 Review and published in the final dissertation manuscript. When you receive IRB approval for your study, you will receive a determination (or approval) letter to move forward with data collection. Download (from iRIS) then copy/paste a copy of the determination (approval) letter you received from the IRB in this appendix prior to submitting for Level 5 peer review. This letter must be the actual copy issued from IRB, not something the learner types up themselves. Appendix D. Informed Consent INFORMED CONSENT FORM INTRODUCTION The title of this research study is, “Factors Influencing Utilization of Public Mental Health Services in South Texas” I am a student at Grand Canyon University who shall perform a qualitative descriptive study involving mental health improvement in South Texas. I would appreciate it if you took part in this study since it is imperative for mental health improvement. KEY INFORMATION This document defines the terms and conditions for consenting to participate in this research study. · How do I know if I can be in this study? · You can participate in this study if you are: · Competent individual 18 years of age and above · You cannot participate in this study if you: · A minor below 18 years · What am I being asked to do? If you agree to be in this study, you will be asked to: · What is required is to provide information related to your mental health status and how it gets affected by external issues. You shall provide barriers of mental health improvement initiatives in your area. · When you receive the questions, you shall be required to answer them within an hour and to submit the response. · Where there is no other communication platform, social media platforms shall get used. · How you shall be required to answer all interview and focus group questions Audiotaping: (If applicable) I shall use a voice recorder device to for the whole research. You should accept to take part only if you allow recording of your voice. Videotaping: (If applicable) I would like to record the zoom meeting if you are okay with that since it would display the true emotions and reaction to some interview questions. · Who will have access to my information? (myself and members of the dissertation chair.) · Any possible risks or discomforts? There shall be no risks connected to this study. · Any direct benefits for me? No. · Any paid compensation for my time? There shall be no compensation for participation. · How will my information and/or identity be protected there shall be no sharing of personal information like names or contact information. PRESENTATION OF INFORMATION COLLECTED The information shall get displayed according to frequency distribution technique. NEW INFORMATION If there shall be development of any new information, it shall get included in the study. ADDITIONAL COSTS FOR ILLNESS OR INJURY Treatment during this study shall get performed by : (Better Health clinic Austin). TERMINATION OF PARTICIPATION Cancellation of participation can occur at any time if there is discovery of issues related to the study’s contents. PRIVACY AND DATA SECURITY · Will researchers ever be able to link my data/responses back to me? this shall not occur due to the privacy agreement · Will my data include information that can identify me (names, addresses, etc.)? No. · Will researchers assign my data/responses a research ID code to use instead of my name? Yes · If yes, will researchers create a list to link names with their research ID codes? “N/A” · If yes, how will researchers secure the link of names and research ID codes? How long will the link be kept? Who has access? Approximate destroy date? “N/A” · How will my data be protected (electronic and hardcopy)? Where? How long? Who will have access? Approximate destroy or de-identification date? The data shall get stored at the university’s computer and destroyed after three years. Only the research participants shall have access. · Where and how will the signed consent forms be secured? The forms shall get stored in folders and placed safely. FUTURE RESEARCH Any future research will involve picking new research participants or those willing to take part in the study again STUDY CONTACTS Any questions you have concerning the research study or your participation in the study, before or after your consent, will be answered by ( Jdada@my.gcu.edu) If you have questions about your rights as a subject/participant in this research, or if you feel you have been placed at risk, you can contact the Chair of the Human Subjects Institutional Review Board, through the College of Doctoral Studies at IRB@gcu.edu; (602) 639-7804. VOLUNTARY CONSENT PARTICIPANT’S RIGHTS · You have been given an opportunity to read and discuss the informed consent and ask questions about this study. · You have been given enough time to consider whether or not you want to participate. · You have read and understand the terms and conditions and agree to take part in this research study; · You understand your participation is voluntary and that you may stop participation at any time without penalty. Your signature means that you understand your rights listed above and agree to participate in this study ____________________________________________________ ____________________________ Signature of Participant or Legally Authorized Representative Date INVESTIGATOR’S STATEMENT "I certify that I have explained to the above individual the nature and purpose, the potential benefits and possible risks associated with participation in this research study, have answered any questions that have been raised, and have witnessed the above signature. These elements of Informed Consent conform to the Assurance given by Grand Canyon University to the Office for Human Research Protections to protect the rights of human subjects. I have provided (offered) you a copy of this signed consent document." (Your signature indicates that you have ensured the participant has read, understood, and has had the opportunity to ask questions regarding their participation) Signature of Investigator______________________________________ Date_____________ Appendix F. Interview Questions Demographics of the participants Sample Population 14 Mental Health Providers in United States Questionnaire Minimum of 70 Interviews Minimum of 10 Mental Health providers in South Texas Interview Questions · RQ1: What is the process involved in identifying the need of a person to receive mental healthcare? 1. Is there a step-by-step approach to find out reasons a person requires mental health assessment? 2. What is the root barrier to mental healthcare in this area? 3. What is the issue that prevents people from having the desire to access mental healthcare services? 4. Is it possible for mental healthcare providers to influence people to desire mental health assessment? · RQ2: How do healthcare providers determine the type of mental health disorder that a person suffers from? 1. What is the procedure to identify the type mental health disorder a person suffers from? 2. How mental health providers form a connection with patients to determine the type of issue and enable them to open up? · RQ3: What is the procedure involved in managing mental health disorders once they get identified? 1. What treatment is involved next after identifying mental health disorders? 2. How do physicians detect rejection in people to access mental healthcare requirements? 3. What influences people to reject mental health improvement? · RQ4: How do mental health providers determine the root cause of mental health related issues? 1. What type of connection is required to generate effective outcomes from respondents? 2. What is the result of mental health assessment? · RQ5: How does age of patient influence their capability of receiving appropriate treatment? 1. How do mental health providers determine age requirements for care? 2. What social factors influence mental health issues due to age? · RQ6: How do mental health providers’ attitude influence desire of patients to receive care? 1. How can mental health providers develop conducive environment for treatment? 2. What is the impact of negative provider attitude on patients? · RQ7: How do mental health providers connect with patients regardless of their barriers to receive care? 1. What strategies are involved in providing care? 2. What strategies are used to break barrier for health improvement? Appendix G. Focus Groups Questions · RQ1: How do mental health providers identify barriers of receiving care in patients? 1. What is the most effective method of providing suitable treatment? 2. What expertise do mental health providers use to provide high quality care? · RQ2: How do mental health providers determine the types of barriers whether intrapersonal, interpersonal, or systemic and their relation to mental health improvement? 1. What strategies can get used to develop intrapersonal barriers to care? 2. What strategies can get used to develop interpersonal barriers to care? 3. What strategies can get used to develop systemic barriers to care? · RQ3: How do mental health providers identify solutions to rejection of mentally ill patients to the existent treatment? 1. What is the procedure of developing interventions? 2. How do mental health providers create achievable goals? QUALITATIVE GCU Dissertation Template V9.0 8-10-2020
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