DISSERTATION

Alignment Comment by Jennifer R. Seymour: If you agree with these changes then I will have James copy and paste them throughout the paper. We didn’t want to do all of that if you had more changes to make.

There is a gap in the research regarding the factors influencing why people utilize or reject mental health treatment (Lund Hall et al., 2018). The gap this study will specifically address is what mental health providers indicate are the strategies influencing individual decisions to utilize or reject mental health services at the beginning and when they are continuing treatment. Comment by Daniel Smith: Good! Comment by Daniel Smith: This is different than the prior gap statement: that concurrent impact of structural and attitudinal factors influencing behavior for mental health problems especially for treatment purposes.

The problem is that it is not known how mental health providers describe the strategies that influence individual decisions to utilize or reject mental health services at the beginning and when they are continuing treatment in south Texas. Comment by Daniel Smith: This is different than the prior gap statement: that concurrent impact of structural and attitudinal factors influencing behavior for mental health problems especially for treatment purposes. Comment by Daniel Smith: Good!

The purpose of this qualitative descriptive study is to examine how mental health providers describe the strategies that influence individuals’ decision to utilize or reject mental health services at the beginning and when they are continuing treatment in south Texas. Comment by Daniel Smith: There is some misalignment of your purpose statement. You also describe your purpose in another section as this: This study will address the challenges that affect healthcare providers and also parents of the underage mental health patients and The purpose of this qualitative descriptive study is to examine how mental health providers describe the factors influencing individuals’ decision to utilize or reject mental health services in south Texas. Comment by Daniel Smith: Good!

Use Mental Health

· RQ1: What reasons do mental health providers identify that patients use mental health services? Comment by Jennifer R. Seymour: I think we can delete this one.?????
· RQ 2: What strategies do mental health providers use to encourage patients to
begin
using mental health services? Comment by Daniel Smith: How do they identify strategies, or what are the startegies?
· Interview Question Examples: What strategy do you use to encourage when a patient begins services? (share the strategy)What were the reasons they were beginning? (share reasons) Are there any other strategies you want to share?

· RQ 3: What strategies do mental health providers use to encourage patients to
continue using mental health services?
· Interview Question Examples: What strategy do you use to address when a patient who has been in therapy for four weeks or more to encourage them to continue services? (share the strategy)What were the reasons they were using? (share reasons) Are there any other strategies you want to share?

Reject Mental Health

· RQ4: What reasons do mental health providers identify that patients reject mental health services? Comment by Daniel Smith: How or why?
· RQ 5: What strategies do mental health providers use to address when patients reject beginning to use mental health services?
· Interview Question Examples: What strategy do you use to address when a patient begins to reject services? (share the strategy)What were the reasons they were rejecting? (share reasons) Are there any other strategies you want to share?
· RQ 6: What strategies do mental health providers use to address patients who reject to continue using mental health services? Comment by Daniel Smith: Let’s discuss your research questions in a Zoom. Six is a lot of questions and not all of them align with your purpose statement.
·
Interview Question Examples: What strategy do you use to address when a patient who has been in therapy for four weeks or more start to reject services? (share the strategy)What were the reasons they were rejecting? (share reasons) Are there any other strategies you want to share?

Factors Influencing Individuals’ Decision to Utilize Mental Health in South Texas
Submitted by Comment by Daniel Smith: James – please see my feedback summary in the attached document. Dr. Smith

A Dissertation Presented in Partial Fulfillment
of the Requirements for the Degree
Doctorate of Education
(or) Doctorate of Philosophy
(or) Doctorate of Administration

Grand Canyon University
Phoenix, Arizona

[Insert Current Date Until Date of Dean’s Signature]
GCU Proposal Template V8.3 01.18.18

GCU Proposal Template V8.3 01.18.18

© by Your Full Legal Name (No Titles, Degrees, or Academic Credentials), 2018
All rights reserved.

GRAND CANYON UNIVERSITY

The Dissertation Title Appears in Title Case and is Centered

by
Insert Your Full Legal Name (No Titles, Degrees, or Academic Credentials)

Approved

[Insert Current Date Until Date of Dean’s Signature]

DISSERTATION COMMITTEE:
Full Legal Name, Ed.D., DBA, or Ph.D., Dissertation Chair
Full Legal Name, Ed.D., DBA, or Ph.D., Committee Member
Full Legal Name, Ed.D., DBA, or Ph.D., Committee Member

ACCEPTED AND SIGNED:

________________________________________
Michael R. Berger, Ed.D.
Dean, College of Doctoral Studies

_________________________________________
Date

GRAND CANYON UNIVERSITY

The Dissertation Title Appears in Title Case and is Centered

I verify that my dissertation represents original research, is not falsified or plagiarized, and that I accurately reported, cited, and referenced all sources within this manuscript in strict compliance with APA and Grand Canyon University (GCU) guidelines. I also verify my dissertation complies with the approval(s) granted for this research investigation by GCU Institutional Review Board (IRB).

_____________________________________________ ______________________
[Type Doctoral Learner Name Beneath Signature] Date

Abstract
The abstract is required for the dissertation manuscript only. It is not a required page for the proposal. The abstract, typically read first by other researchers, is intended as an accurate, nonevaluative, concise summary, or synopsis of the research study. It is usually the last item completed when writing the dissertation. The purpose of the abstract is to assist future researchers in accessing the research material and other vital information contained in the dissertation. Although few people typically read the full dissertation after publication, 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 covers the purpose of the study, problem statement, theoretical foundation, research questions stated in narrative format, sample, location, methodology, design, data sources, data analysis, results, and a valid conclusion of the research. The most important finding(s) should be stated with actual data/numbers (quantitative) or themes (qualitative) to support the conclusion(s) 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, 6th 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, assist future researchers, 150 to 250 words, 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)

The abstract is typically read first by other researchers and is an accurate, non-evaluative, concise summary or synopsis of the research study. 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 analysis, and results, as well as, a valid conclusion of the research. Abstracts must be double-spaced, fully justified with no indentions. (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 data/numbers (quantitative) ~or~ themes (qualitative) to support the conclusion(s).

The abstract is written in APA format, one paragraph fully justified with no indentations, double-spaced with no citations, 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, uses correct punctuation, and uses correct 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
An optional dedication may be included here. While a dissertation is an objective, scientific document, this is the place to use the first person and to be subjective. The dedication page is numbered with a Roman numeral, but the page number does not appear in the Table of Contents. It is only included in the final dissertation and is not part of the proposal. If this page is not to be included, delete the heading, the body text, and the page break below.

Acknowledgments
An optional acknowledgements page can be included here. This is another place to use the first person. If applicable, acknowledge and identify grants and other means of financial support. Also acknowledge supportive colleagues who rendered assistance. The acknowledgments page is numbered with a Roman numeral, but the page number does not appear in the table of contents. This page provides a formal opportunity to thank family, friends, and faculty members who have been helpful and supportive. The acknowledgements page is only included in the final dissertation and is not part of the proposal. If this page is not to be included, delete the heading, the body text, and the page break below.

Table of Contents
List of Tables x
List of Figures xi
Chapter 1: Introduction to the Study 1
Introduction 1
Background of the Study 6
Problem Statement 15
Purpose of the Study 19
Research Questions and/or Hypotheses 21
Advancing Scientific Knowledge and Significance of the Study 22
Rationale for Methodology 25
Chapter 2: Review 31
Introduction to the Chapter and Background to the Problem 31
Identification of the Gap 34
Theoretical Foundations and/or Conceptual Framework 37
Review of the 41
Methodology and instrumentation/data sources/research materials 75
Summary 87
Chapter 3: Methodology 93
Introduction 93
Statement of the Problem 95
Research Questions and/or Hypotheses 96
Research Methodology 98
Research Design 101
Population and Sample Selection 105
Trustworthiness (for Qualitative Studies) 121
Data Collection and Management 125
Data Analysis Procedures 128
Ethical Considerations 134
Limitations and Delimitations 140
Summary 143
References ………………………………………………………………………………148
Appendix A. 181
Site Authorization Letter(s) 181
Appendix B. IRB Approval Letter 182
Appendix C. Informed Consent 183
Appendix D. Copy of Instruments and Permissions Letters to Use the Instruments 184
Appendix F 190

List of Tables
Table 1. Correct Formatting for a Multiple Line Table Title is Single Spacing and
Should Look Like this Example 36
Table 2. Equality of Emotional Intelligence Mean Scores by Gender 66

Note: Single space multiple-line table titles; double space between entries per example above. The List of Tables and List of Figures (styled as Table of Figures) have been formatted as such in this template. Update the List of Tables in the following manner: [Right click Update Field Update Entire Table], and the table title and subtitle will show up with the in-text formatting. After you update your List of Tables, you will need to manually remove the italics from each of your table titles per the example above.

List of Figures
Figure 1. Correlation for SAT composite score and time spent on Facebook. 69
Figure 2. IRB alert. 73

Note: single-space multiple line figure titles; double-space between entries per example in List of Tables on previous page. Use sentence case for figure titles. After you update your List of Figures, you will need to manually remove the italics per the example above.

ix

Chapter 1: Introduction to the Study

Introduction
Mental health and its disorders are among one of the leading causes of global disability (Schnyder et al., 2017). The increase of these conditions creates substantial societal costs in the United States (Schnyder et al., 2017). Mental disorders are often treatable and possibly preventable (American Psychiatric Association, 2018). Despite the demand and raising societal awareness of its importance highlighted by the coronavirus-19 (COVID-19) pandemic, help-seeking remains deferred or absent (Schynder et al., 2017).
Multiple factors influence one’s help-seeking for mental health issues. The reasons include handling the problem themselves, lack of awareness, low mental health literacy, and financial are linked with decreased help-seeking (Magaard et al., 2017). Other literature, such as the National Alliance on Mental Health (2020); Hipes and Gemoets (2018), illuminated that mental health-seeking behaviors occur when self-awareness and self-discipline are sought. Fear of social stigmatization is another reason why a patient rejects treatment.
Prior research conducted by Kohn et al. (2018) and Lund et al. (2018) emphasized a gap between mental health patients requiring treatment and those successfully receiving help. The authors suggested a need to identify the social determinants of mental disorders, align them with sustainable development goals, and identify potential mechanisms and targets for interventions (Lund et al., 2018). Lund et al. (2018) expressed a need for further research on why people decide to utilize or reject mental health services. The use or rejection of mental health services depends on the collaborative nature of participating in treatment by the patient and the provider working together to make the therapy worthwhile. The purpose of this qualitative descriptive study is to examine how mental health providers describe the strategies that influence individuals’ decision to utilize or reject mental health services at the beginning and when they are continuing treatment in south Texas. The proposed study addresses the gap in the literature and contributes to advancing the science by exploring factors according to mental healthcare providers that influence an individual’s decision to utilize or reject mental health services. The mental health providers will be asked to encourage patients to accept and not reject treatment at the start of treatment and continuing treatment. The high numbers of individuals coping with mental health conditions necessitate raising public awareness and campaigning for a better health care system in providing care (Hamilton et al., 2016). Part of this effort is identifying the reasons why people choose to utilize or reject mental health support.
In the southern Texas region, there is an unequal number of adults experiencing mental health problems. The numbers have increased from 9.4% in 2015 to 11.8% in 2018 (Understanding Houston, 2021). It has been reported that a higher percentage of adults’ report 14 days or beyond of undergoing poor mental health (Understanding Houston, 2021). Unfortunately, the populations being the most affected are Blacks, Hispanics, and Asian-Americans. Many of this population affected are between 30-44 years of age (Understanding Houston, 2021). These statistics illuminate the need for this proposed study to address mental health providers’ perceptions regarding the factors that influence their patients to seek or continue mental health services.
Chapter 1 introduced the topic along with the background of the study. Other sections of the chapter include theoretical foundation using Bandura’s Social Cognitive Theory, problem and purpose statements. The research questions, advancing scientific knowledge, rationale for the methodology, and nature of research design will be discussed. The last few sentences of the chapter will provide a summary and insight into Chapter 2.

Criterion

*(Score = 0, 1, 2, or 3)

Learner Score

Chair Score

Methodologist Score

Content Expert Score

Introduction

This section provides a brief overview of the research focus or problem, explains why this study is worth conducting, and discusses how this study will be completed. (Minimum three to four paragraphs or approximately one page)

Dissertation topic is introduced and value of conducting the study is discussed.

Note: The College of Doctoral Studies recognizes the diversity of learners in our programs and the varied interests in research topics for their dissertations in the Social Sciences.  

Dissertation topics must, at a minimum, be aligned to General in the Ph.D. program, Leadership in the Ed.D. Organizational Leadership program, Adult Instruction in the Ed.D. Teaching and Learning program, Management in the DBA program, and Counseling Practice, Counselor Education, Clinical Supervision or Advocacy/Leadership within the Counseling field in the Counselor Education Ph.D. program. 

If there are questions regarding appropriate alignment of a dissertation topic to the program, the respective program chair will be the final authority for approval decisions.  

Specifically, although the College prefers a learner’s topic align with the program emphasis, this alignment is not “required.” The College will remain flexible on the learner’s dissertation topic if it aligns with the degree program in which the learner is enrolled. The Ph.D. program in General does not support clinically based research.  

2

2

2

Discussion provides an overview of what is contained in the chapter.

2

2

2

Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.

2

2

1

*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:

Background of the Study
Mental disorders create a tremendous global financial hardship than chronic diseases (Tan et al., 2020). According to the Centers for Disease Control and Prevention [CDC] (2018), the disease has become a significant public health issue in the United States (U.S.) that is requiring immediate attention. The U.S.’s economic cost is approximately $2.5 trillion worldwide and is expected to double by 2030 (Tan et al., 2020). Unfortunately, many individuals not seeking help could result in adverse ramifications (Tan et al., 2020). There are many reasons for people not to participate in help-seeking towards mental health. Some of the reasons include cultural beliefs, stigma, perceived stigma, and healthcare providers’ attitude towards them (Brown et al., 2019).

Research shows that there are multiple reasons why people do not participate in seeking mental health treatment (Lund Hall et al., 2018). Furthermore, these patients tend to discontinue treatment before the physicians’ or healthcare providers’ specified date. 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. In this arena, healthcare providers could make a difference in how a patient continues or rejects mental health services. There is a gap in the research regarding why people utilize or reject mental health treatment (Lund Hall et al., 2018). This study will specifically address what mental health providers indicate are the strategies influencing individual decisions to utilize or reject mental health services initially and when they are continuing treatment.

Theoretical Foundation

This qualitative descriptive study’s theoretical framework is 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 describes how motivations in health and behaviors are influenced by the interaction of people’s beliefs, environment, and behaviors (Lake, 2017). It is important in determining the individual’s decision to utilize or reject mental health services.
The theory’s major components include reciprocal determinism, behavioral capability, observational Learning, reinforcements, expectations, and efficacy (Bandura, 2001). The first component, reciprocal determinism, is the foundation of the theory. It refers to an individual’s reciprocal interaction with a set of learned experiences, their environment, and their response to stimuli to achieve their goals (Bandura, 2001). Behavioral Capability describes the person’s ability to conduct a behavior via knowledge and skills (Bandura, 1994). An individual learns from the consequences of their behavior, affecting the environment they live (Bandura, 2001). Observational Learning ascertains that people can observe others’ behavior and model the behavior (Bandura, 2001). Reinforcements focused on the internal and external responses of a person’s behavior that could affect maintaining or suspending the behavior (Bandura, 2001). Expectations reference the expected consequences of an individual’s behavior. The outcomes could be health or non-health-related. The experiences are primarily the driving force of this component. Bandura (1994) stated self-efficacy is a person’s beliefs regarding their ability in a specific area.

Criterion

*(Score = 0, 1, 2, or 3)

Learner Score

Chair Score

Methodologist Score

Content Expert Score

Background of the Study

Minimum two to three paragraphs or approximately one page

The background section of Chapter 1 provides a brief history of the problem.
Provides a summary of results from the prior empirical research on the topic.

Using results, societal needs, recommendations for further study, or needs identified in three to five research studies (primarily from the last three years), the learner identifies the stated need, called a gap.
Builds a justification for the current study, using a logical set of arguments supported by citations.

The problem is discussed as applicable beyond the local setting and contributes to societal and/or professional needs.

2

2

1.5

Section is written in a way that is well structured, has a logical flow, uses correct paragraph structure, uses correct sentence structure, uses correct punctuation, and uses correct APA format.

2

2

1

*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

The problem is that it is not known how mental health providers describe the strategies that influence individual decisions to utilize or reject mental health services at the beginning and when they are continuing treatment in south Texas. Without an understanding of the reasons for use or rejection, it is unlikely that successful interventions would enable more people to utilize mental health services. Particularly among the minority population of Hispanic-Americans, African Americans, and Asian-American families. Economic data from the city shares that 68% of Hispanics face financial challenges due to a limited level of education that limits the job opportunities, contributing to most of them living on a low average income (Herzog et al., 2016). show that African and Hispanic-American minorities are traditionally known to have poorer primary care access than Caucasian-Americans (SAMHSA, 2018). Comment by Daniel Smith: Good!
While the pattern changed a little due to the Affordable Care Act (ACA), the disparity is still high. The Hispanics’ low-income level and occupational characteristics are associated with low rates of health insurance cover. According to research by the Texas 2018 Mental Health National Outcome Measures (NOMS): SAMHSA Uniform Reporting System, 21.6% of African Americans in South Texas lack healthcare insurance, while the Hispanic or Latino population’s access stands at 26.3%, the reason is directed to low-income levels (SAMHSA, 2018; Printz, 2015). Asian-Americans are considered under-represented in key government, and lack of representation positions contributes to poor healthcare access. Only 0.8% of Asian Americans access have healthcare insurance that helps them access medical care services, including mental health (SAMHSA, 2018; Gor et al., 2019). The demographic characteristics of persons served by the State Mental Health Authority indicate (Table 1).

Table 1.

Insurance rates for different ethnicities

Uninsured Population, Race and Ethnicity

Overall Rates of Uninsured, %

American Indian or Alaska Native

0.3%

Asian

0.8%

Black or African American

21.6%

Native Hawaiian or other Pacific Islander

0.1%

White

72.8%

Hispanic or Latino

26.3%

Source: https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/Texas-2018.pdf
The importance of addressing this problem is because an individual’s mental health depends on their use or rejection of mental health treatment. Knowing the positive reasons people take advantage of services may help bring additional people in need of mental health services. Knowing the barriers may lead to policies or programs that can overcome the obstacles. Lack of mental health treatment has dire implications in south Texas, including lost productivity, unemployment, job absenteeism, and lack of community involvement (Mental Health Workforce in Texas, 2016). This is of particular importance in south Texas because of a lack of sufficient mental health professionals to meet the need. Experts in the region state that insufficient local mental healthcare professionals contribute to the hardships being experienced by the police and medical professionals, which puts public safety at risk. Physicians believe that the number of mental health patients increases with time more than the current status and is attaining the level of a national epidemic (Albert, 2019). This is the trend as the number of people in need of mental healthcare services keeps increasing, the number of people qualified to provide help keeps declining (Scripps Media, 2020).
The study area is south Texas, and the target group is the mental health providers. The mental health providers include psychiatrists, psychologists, and therapists. The healthcare providers (study sample) are drawn from 12 clinics, and approximately 20 providers are targeted. The sample population involves 20 healthcare providers. The unit of analysis is the individuals providing direct patient care. The phenomenon being measured will be the causes of acceptance or rejection of mental health services from healthcare providers’ perspective based on the experiences with patients who either accept or reject mental health services. The results will be reported for the entire group and not individuals. The importance of addressing this problem is because people’s mental health depends on their use or rejection of mental health treatment. Knowing the positive reasons people take advantage of services may help bring additional people in contact with mental health services.
Understanding the barriers may lead to policies or programs that can overcome the barriers. Lack of mental health treatment has dire implications in south Texas include lost productivity, unemployment, job absenteeism, and lack of involvement in the community (Mental Health …