Posted: August 3rd, 2022
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Factors Influencing Utilization of Mental Health Services in South Texas
Dr. Hanadi Altawil
Dr. Briana Nicholson
July 10, 2022
Definition of Terms
Definition of Terms
Caregiver: A person trained to attend to the needs of a person suffering from short- or long-term illness including disability, illness, or injury (Evergood, 2021).
Healthcare Provider: A person with suitable medical training required to facilitate the suitable improvement of patients’ conditions, e.g., nurse, doctor, dentist, or clinical psychologist (Sinclair, et al., 2018).
Mental Health Acceptance : This usually needs to develop and evolve over time, and it should be appropriate to the different life stages of a person’s concern. This is the willingness of a person to accepting that they do have mental problems and that they are willing to get medical assistance (Cage et al., 2018).
Mental Health Disorders: A broad term that is used to refer to a range of conditions affecting one’s mood, thinking, and behavior. It is condition that could be occasional or chronic influencing one’s ability to function (Medline Plus, 2021).
Mental Health: This is a state of well-being where an individual understands their abilities, cope with normal stresses, works productively, and contributes to their community (World Health Organization, 2018).
Mental Health Literacy: A construct taken from health literacy, which refers to an individual’s knowledge, beliefs concerning mental disorders that usually affects their management, recognition, and prevention (Kutcher et al., 2016).
Mental Health Services: These are the specific services that are fully devoted to the process of treating mental illnesses and the improvement of mental health in people with mental problems (Abuse, 2013).
Mental Health Rejection: In mental illness, rejection can be referred to as the feeling of sadness, shame, or grief that people usually feel when other people do not accept them. In this research however, this term is used to refer to the fact that people who are mentally ill reject mental health services willingly or unwillingly (Rohner & Britner, 2002).
Literature Review: Background to the Problem
Mental disorders create a tremendous global financial hardship, even more than chronic diseases. Unfortunately, not seeking help could result in adverse ramifications. (Tan et al., 2020).
Research shows that there are multiple reasons why people do not participate in seeking mental health treatment (Lund Hall et al., 2018).
Some reasons for not participating in mental health treatment include cultural beliefs, stigma, perceived stigma, and healthcare providers’ attitude (Brown et al., 2019).
There is a gap in the research regarding why people utilize or reject mental health treatment (Lund Hall et al., 2018).
Vega et al. (1999) emphasized the need for further research related to the underutilization of mental health services and issues for the minority and vulnerable populations.
Literature Review: Problem Space
Velasco et al. (2020) investigated the issues limiting 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.
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. The author analyzed the hidden barriers to accessing care and utilization of mental health for Asian American Women in Southern Texas
Hamilton, Desai, Hoot, Gearing, Jeong, Meyer, & Begley (2016). Reviewed and analyzed how the likelihood of lower hospitalization was associated with the race of African Americans while increasing age was a key predisposing factor in increased likelihood of hospitalization in South Texas.
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.
Based on these Literature reviews:
It is not known how mental health providers and caregivers in South Texas describe the factors that influence utilization of mental health services.
Literature Review: Theoretical Foundations
Social Cognitive Theory
This qualitative descriptive study’s theoretical framework is based on Albert Bandura’s Social Cognitive Theory, a behavioral theory (Morin & Cherry, 2019).
According to Morin and Cherry (2019), the Social Cognitive Theory can be applied to the context of mental health promotion and prevention.
It helps to describe how motivations in health and behaviors are influenced by the interaction of people’s beliefs, environment, and behaviors (Lake, 2017).
Literature Review: Theoretical Foundations-2
Social Cognitive Theory
Research question 1 is connected to the fact that healthcare providers’ expertise is valid to ensure patients get served with preventative measures for mental health issues
Research question 2 is valid since healthcare providers use their high level of expertise to assist caregivers to produce effective mental health management strategies
Literature Review: Review of Literature
Theme 1: According to Higgins (2017), mental health utilization in the United States has declined in the last twenty years. He cites that suicide rates have increased two-fold from 1990. Furthermore, he cites that substance abuse, more so of opiates, has become an epidemic. Higgins claim that the disability award for mental disorders has also increased dramatically, a possible indication of the nation’s mental health dwindling. Therefore, this study is important in order to document strategies providers use to encourage treatment to manage the significant increase in the need for treatment that history has documented (Higgins, 2017).
Theme 2: Appleton et al. (2020) conducted a qualitative study involving 15 young adults and 15 parents regarding why they do not seek mental health services. Two main themes emerged from this study a) systematic obstacles to care, b) problems with the quality of care received. The findings revealed that systematic barriers related to care were divided into three subthemes a) not being ill enough for mental health services, b) not receiving proper care while in mental health services, c) lack of communication between the services to provide continuity of care (Appleton et al., 2020).
Theme 3: Velten et al. (2015) research indicates that individuals’ lifestyle choices can influence people’s mental health status. This is linked to higher frequency of physical and mental activity, moderate alcohol consumption, non-smoking, a body mass index within the range of normal to overweight (not underweight or obese) and a regular life rhythm (Velten et al., 2015).
It is not known how mental health providers and caregivers in South Texas describe the factors that influence utilization of mental health services.
Healthcare Providers Vs. Caregivers
A healthcare provider is a person with suitable medical training required to facilitate the suitable improvement of patients’ conditions. Examples are nurse, doctor, dentist, or clinical psychologist
A caregiver is a person who is trained to attend to needs of a person suffering from short- or long-term illness. The issues can be due to a disability, illness, or injury
Research Questions and Phenomenon
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?
Phenomenon: Effective Utilization of Mental Health Services
Seminal sources describing qualitative methodology:
Qualitative methodology will be utilized to assist in offering actual evidences from the interview with participants. The interview will be based on previous studies that shows the main cause of low use of mental health services is due to the limitations of access to medical care (Augsberger, Yeung, Dougher, & Hahm, 2015).
Data collection operations will be performed using interviews and surveys to collect accurate information.
Information will be acquired to map the behavior of people who seek health care relating to mental health.
Literature supports the facts that issues of underutilized mental health resources and non-institutionalized adults is a behavioral risk factor in Southern Texas (Hamilton, Desai, Hoot, Gearing, Jeong, Meyer, & Begley, 2016). Seminal sources describing quantitative methodology:
Creswell (2014) described quantitative research as a deductive approach that is used to examine the relationship among variables in order to test theories.
Quantitative research requires a mathematical medium for data collection (Beuving & de Vries, 2015).
Quantitative research searches for facts (Barnham, 2015).
The goal of quantitative research is to examine relationships between variables and represent such relationships through statistical analysis (Creswell & Creswell, 2017).
Justification for Qualitative:
Qualitative research methodology is focused on non-numerical responses which provide information related to a topic getting studied by researchers (Aspers & Corte, 2019).
The methodology can get performed by using respondents, data, visual objects, or documents that all have connection to a 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 people used in the study (Herber et al. 2020). Justification against quantitative:
Quantitative is not the best methodology for this proposed study because it seeks to explore a phenomenon inductively, and there is no need to examine relationships between variables, search for facts, or use a mathematical medium for data collection.
The research methods are designed to collect numerical data that can be used to measure variables, which is not required for this research.
Quantitative data is structured and statistical in nature; its results are objective and conclusive.
It uses a grounded theory method that relies on data collection that is systematically analyzed. Because I do not need to draw general conclusions from my research and predict outcomes, hence it is not appropriate for this study
Design Definition Justification
(use /not use)
Qualitative Descriptive It is the suitable design since it provides data that is given by mental health providers who interact with patients in this field. It makes the information presented reliable and valid.
Literature review agrees with the argument that there is under usage of mental health resources. The State has a risk of having mentally ill people who have no access to care they require (Hamilton, Desai, Hoot, Gearing, Jeong, Meyer, & Begley, 2016).
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 improvement measures. A qualitative descriptive design is appropriate when a not complicated description is desired. It focuses on the details of what, where, when, and why of an event or experience.
Phenomenological Qualitative phenomenological research is appropriate when the goal is to describe lived experiences described by participants (Christensen et al., 2017; Creswell, 2014; Sloan & Bowe, 2014).
A descriptive phenomenological design focuses on correlating experience and perception, whereas hermeneutic phenomenology focuses on interpreting and finding meaning within the phenomenon (Sloan & Bowe, 2014). NOT FIT FOR RESEARCH:
This design was not chosen because the problem does not seek to correlate experience with perception.
Narrative Range (2019) described a qualitative narrative exploration as one that tells the story of an individual.
Narrative research is often written in a narrative chronology, and sometimes the researcher combines their own views with those of the participant in a collaborative narrative (Creswell, 2014). NOT FIT FOR RESEARCH:
This design was not chosen because this study does not seek to narrate the story of an individual.
Case Study Qualitative case studies are appropriate when the goal is to present a clear picture or overall understanding of a situation, program, or individual (Range, 2019).
Case studies are best when there is a need for an in-depth analysis of a case, bounded by time and activity, using a variety of data collection instruments and procedures (Creswell, 2014). NOT FIT FOR RESEARCH:
This design was not chosen because the focus is not on strangulating data, but instead focused on describing the experiences of participants within a phenomenon.
Grounded Theory Qualitative grounded theory research is most appropriate when the goal is to derive an abstract theory through multiple stages of data collection and analysis (Croswell, 2014).
NOT FIT FOR RESEARCH:
This design was not chosen because this study does not seek to derive an abstract theory, nor use comparative analysis.
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.
Population, Target Population, and Sample
Population Target Sample
United States Mental Health Providers and caregivers Mental health providers and caregivers in South Texas who are members of the Mental Health America (MHA).
Sample participants will come from Southern Texas, United States.
20 mental health providers and caregivers will be selected as the sample group.
Interviews: Minimum of 15 Mental Health providers
The participants will be sampled from the three closest mental health centers/hospitals in the region
Focus group 10-15 Caregiver
Instrumentation and Data Sources
Data Sources #1
Data Source #2
Data Source #3
Mental health providers with membership in Mental Health Associations will be the main participants in the study based on 5 years experience and the willingness to be interviewed
Data will be collected using interviews and questionnaires.
Interviews will be used to gather information.
The information will be collected by taking notes, making recordings and documenting the responses from the interviews.
15-20 participants will participate in the study
Interview with Mental Health Providers: Psychiatrists & Therapist recorded on tape
Semi-structured questionnaire with a focus group comprising of caregivers Providers would be selected to complete questionnaire forms that will include basic demographic questionnaire, which will be used based on their experiences
Consent form will be sent and obtained with signatures
The selected participants will submit the consent forms and complete the interview using Zoom.
Data will be Collected using a Google form
Mental health providers/participants names will be removed from the data
Descriptive statistics will be used in summarizing acquired data.
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
Data will remain stored on the researcher’s computer with password encrypted.
Information gathered will be summarized using Descriptive Statistics.
Questions posed will be addressed through coding.
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
Data Collection Steps: Slide 1
Data Collection Steps: Slide 2
Sampling Strategy and Sample Selection
Sampling Strategy Description The population will include mental health professionals who have specific characteristics that are of interest to the researcher.
Target population would include mental health providers such as psychiatrists, social workers, psychologists, and therapists. Target population would be from south Texas due to convenience and interest in this specific location given current statistics on mental health use.
Geographical location for the study- Southern Texas region. Minorities with poor access to primary care
Populations most affected are Blacks, Hispanics, and Asian-Americans.
Population affected: 30-44 years of age (Understanding Houston, 2021).
Sampling Steps Identify a list of mental health professionals to contact.
Formally request participation from the target population: 20-30 mental health professionals (interview, focus group and survey) by email.
If there are not enough participant responses, then the researcher will call or request participation in-person. Contact a potential participant based on other provider’s recommendation.
Formally request participation from the target population: If there are not enough responses, the researcher will request for participation in-person.
Researcher may also ask participants for recommend to other mental health professionals or providers to participate in the investigation.
Sampling Selection Criteria The sampling pool includes psychiatrists, caregivers, psychologists that and can be used in the data collection set.
The researcher will strive to recruit diverse professionals from various content areas/backgrounds. Convenience sampling is generally used to choose focus group participants (Nagle & Williams, n.d).
The sampling pool that includes psychiatrists, caregivers, psychologists and counselors from one mental health facility can be used in the data collection set.
Sampling Methods Proposed for Strategies
The sample selection process shall involve healthcare providers who are already provided with sufficient education to deal with patients’ mental health issues.
The sampling process shall include subgroups of caregivers and physicians to determine how each of them is connected to patients’ care.
The sampling strategy applied for this research shall be stratified sampling since it allows division of population into different groups
Selection of group components or members with similar characteristics is the required technique to generate accurate population assessment for the groups called strata
Data Collection Steps: Slide 3
Collecting the Data
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
Thematic Analysis- According to Braun and Clarke (2006), the above procedures are recommended for thematic analysis.
Data Collection Steps: Slide 4
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 Analysis Steps: Slide 1
Data Source #2 – Analysis Strategy
Step 1:Individual interviews will be conducted, recorded, and transcribed verbatim. The Zoom program will transcribe the data automatically, and then it will be read and cleaned up for minor changes.
Step 2: The researcher repeatedly reading and listening to the content to get familiarized with it and gain deeper and better familiarization with the contents; he will also identify the answers to those questions asked as well as identify the themes.
Member checking will be conducted
Code defined and given to each participant to check for any misinterpretation by the researcher
Adjustments to coding will be made based on participant responses as needed.
Step 3: Each participant’s transcripts will be kept in a password protected folder on the researcher’s hard drive.
Transcripts will be uploaded into MaxQDA for analyses. The files will be saved in MaxQDA and backed up on the researchers’ hard drive in a password protected folder.
Data Analysis Steps: Slide 2
Data Source #2 – Analysis Strategy
Step 1: Data collected will be grouped into three categories.
The first category is the person from which data was collected.
The second category will be the method used for data collection.
The third category will be the contents of the data collected.
Step 2: Thematic analysis (Nowell et al., 2017) will be used to analyze the data collected. It emphasizes the identification, analysis and interpretation of patterns of meaning within qualitative data. MaxDQA will be used in organizing and visualizing data.
Step 3: This step involves defining and naming the themes after refining them (Nowell et al., 2017).
In the end, results of the themes identified for each of the research questions will be written in Chapter 4 by research question with explanations of themes and excerpts of transcripts to support the themes.
Feasibility – Slide 1
Resources for study:
The researcher is required to obtain written permission that will be created and distributed to participants.
Informed consent from twelve mental health facilities.
A recording device via zoom is needed to record interviews
Either phone/zoom or in person interviews will be conducted.
Semi-structured interview, surveys and focus group questions.
Incentives of $25 gift cards would be offered to participants for their time and participation.
Mitigating the risk for bias from the researcher/interviewer/participants is the main ethical concern.
Incentives for participants must be appropriate and represent the value of time spent (not more/not less).
Keeping interview, focus group, and observation data confidential is vital for the reliability and validity of the investigation.
There are no risks to the participants based upon the recommendations of the principles of Justice, Beneficence, and Equity contained within the 1978 Belmont report.
Feasibility – Slide 2
Study Alignment with Program (Identify Program of Study):
My program of study is Industrial/Organizational Psychology. Studying the factors influencing utilization of mental health services in South Texas.
The proposed study aligns with the overall degree program by exploring why there is poor utilization of mental health services and reasons why people refuse or accept mental health treatment
Research highlighted the importance further exploring strategies used by mental health professional to persuade individuals to accept treatment and follow-up treatment.
There will be various obstacles that the researcher will face in order to align, support, and justify the need for the proposed study. Additionally, there will obstacles in receiving approval from IRB in order to observe, interview, and meet with focus groups of mental health professionals.
It will be an obstacle in recruiting enough mental health providers to participate in the study. The researcher will make sure to have extra participants signed up to account for attrition.
The proposed study is feasible, but it is time-sensitive because most providers recently just returned to the in-person treatments, so it is important to begin research during this period. Otherwise, it will be more of a reflection of the post-COVID, which is also feasible, but will change some aspects of the investigation.
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