DISSERTATION CHAPTER 2 (continuation)

Submitted by

James Dada

A Dissertation Presented in Partial Fulfillment

of the Requirements for the Degree

Doctor of Philosophy

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]

GCU Proposal Template V8.3 01.18.18

© by Your Full Legal Name (No Titles, Degrees, or Academic Credentials), 2018 Comment by GCU: NOTE: This is an optional page. If copyright is not desired, delete this page. The copyright page is included in the final dissertation and not part of the proposal. Comment by GCU: For example: © by Jane Elizabeth Smith, 2012This page is centered. This page is counted, not numbered, and should not appear in the Table of Contents.

All rights reserved.

GRAND CANYON UNIVERSITY Comment by GCU: The Signature Page is only included in the final dissertation and not part of the proposal.

The Dissertation Title Appears in Title Case and is Centered Comment by GCU: If the title is longer than one line, double-space it. The title should be typed in upper and lowercase letters.

by

Insert Your Full Legal Name (No Titles, Degrees, or Academic Credentials) Comment by GCU: For example: Jane Elizabeth Smith

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 Comment by GCU: This page is only included in the final dissertation and not part of the proposal. However, the learner is responsible for ensuring the proposal and dissertation are original research, that all scholarly sources are accurately reported, cited, and referenced, and the study protocol was executed and complies with the IRB approval granted by GCU.

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).

_____________________________________________ ______________________

James Ayodele Dada Date Comment by GCU: This page requires a “wet signature.” Remove the brackets and type in the learner’s name. The learner needs to sign and date this page and insert a copy into the dissertation manuscript as an image (JPEG) or PDF text box. This page must be signed and dated prior to final AQR Level 5 review.

Abstract Comment by GCU: On the first line of the page, center the word “Abstract” (boldface) Style with “TOC Heading”Beginning with the next line, write the abstract. Abstract text is one paragraph with no indentation and is double-spaced. This page is counted, not numbered, and does not appear in the Table of Contents. Abstracts do not include references or citations.The abstract should be between 150-250 words, most importantly the abstract must fit on one page.The abstract is only included in the final dissertation and not part of the proposal.

Keywords: Abstract, assist future researchers, 150 to 250 words, vital information Comment by GCU: Librarians and researchers use the abstract to catalogue and locate vital research material.

Dedication Comment by GCU: The Dedication page is the first page in the dissertation with a Roman Numeral. In the final dissertation this is usually page vi, so we have set it as vi.The dedication is only included in the final dissertation, not the proposal.

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. Comment by GCU: If you cannot see the page break, click on the top toolbar in Word (Home). Click on the paragraph icon. ¶Show/Hide button (go to the Home tab and then to the Paragraph toolbar).

Acknowledgments Comment by GCU: See formatting note for DedicationThe Acknowledgements section is included only in the final dissertation, not the proposal.

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. Comment by GCU: If you cannot see the page break, click on the top toolbar in Word (Home). Click on the paragraph icon. ¶Show/Hide button (go to the Home tab and then to the Paragraph toolbar).Do not use section breaks!

Table of Contents List of Tables xi List of Figures xii Chapter 1: Introduction to the Study 1 Introduction 1 Background of the Study 6 Problem Statement 7 Purpose of the Study 10 Research Questions and/or Hypotheses 11 Advancing Scientific Knowledge and Significance of the Study 14 Rationale for Methodology 16 Nature of the Research Design for the Study 17 Definition of Terms 19 Assumptions, Limitations, Delimitations 21 Assumptions. 22 Limitations and delimitations. 22 Summary and Organization of the Remainder of the Study 24 Chapter 2: Literature Review 26 Introduction to the Chapter and Background to the Problem 26 Identification of the Gap 28 Theoretical Foundations and/or Conceptual Framework 30 Review of the Literature 32 Methodology and instrumentation/data sources/research materials 36 Summary 39 Chapter 3: Methodology 42 Introduction 42 Statement of the Problem 43 Research Questions and/or Hypotheses 44 Research Methodology 45 Research Design 47 Population and Sample Selection 48 Quantitative sample size 48 Qualitative sample size 50 Research Materials, Instrumentation OR Sources of Data 54 Trustworthiness (for Qualitative Studies) 58 Credibility. 59 Transferability 59 Dependability. 60 Confirmability. 61 Validity (for Quantitative Studies) 63 Reliability (for Quantitative Studies) 65 Data Collection and Management 66 Data Analysis Procedures 68 Ethical Considerations 72 Limitations and Delimitations 75 Summary 76 References 78 Appendix A. Site Authorization Letter(s) 83 Appendix B. IRB Approval Letter 84 Appendix C. Informed Consent 85 Appendix D. Copy of Instruments and Permissions Letters to Use the Instruments 86 Appendix E. Power Analyses for Sample Size Calculation (Quantitative Only) 87 Appendix F. Additional Appendices 88

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.

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.

87

This section describes what the researcher will investigate, including the research questions, hypotheses, and basic research design. The introduction develops the significance of the study by describing how the study is new or different from other studies, how it addresses something that is not already known or has not been studied before, or how it extends prior research on the topic in some way. This section should also briefly describe the basic nature of the study and provide an overview of the contents of Chapter 1. Learners and committee members should also note the following important information about dissertation topics:

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 Psychology 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 Psychology does not support clinically based research.  

The GCU Dissertation Template provides the structure for the GCU dissertation. The template provides important narrative, instructions, and requirements in each chapter and section. Learners must read the narrative in each section to fully understand what is required and also review the section criteria table which provides exact details on how the section will be scored. As the learner writes each section, s/he should delete the narrative and “Help” comments, but leave the criterion table, after each section, as this is how the committee members will evaluate the learners work. Additionally, when inserting their own narrative into the template, leaners should never remove the headings, as these are already formatted, or “styled.” Removing the headings will cause the text to have to be reformatted, that is, you will need to reapply the style. “Styles” are a feature in Word that defines what the text looks like on the page. For example, the style “Heading 1, used for Chapter headings and the List of Tables title, the List of Figures title, the References title, and the Appendices title, has set up to conform to APA: bold, double spaced, “keep with next,” Times New Roman 12. In addition, the automatic TOC “reads” these styles so that the headings show up in the TOC and exactly match those in the text.

The navigation pane in Word shows the first and second level headings that will appear in the Table of Contents. To access the navigation pane, click on Home in a Word document>View Pane. Learners should consult their course e-books for additional guidance on constructing the various sections of the template (e.g., Grand Canyon University, 2015, 2016, 2017a, 2017b).

Learners should keep in mind that they will write Chapters 1 through 3 as the dissertation proposal. However, there are changes that typically need to be made in these chapters to enrich the content or to improve the readability as the final dissertation manuscript is written. Often, after data analysis is complete, the first three chapters will need revisions to reflect a more in-depth understanding of the topic and to ensure consistency. Engaging in scholarly writing, understanding the criterion rubrics, and focusing on continuous improvement will help facilitate timely progression. Comment by GCU: Include one space after the final sentence puncutation in the dissertation.

To ensure the quality of both the proposal and final dissertation and reduce the time for AQR reviews, writing needs to reflect doctoral level, scholarly-writing standards from the very first draft. Each section within the proposal or dissertation should be well organized and easy for the reader to follow. Each paragraph should be short, clear, and focused. A paragraph should (1) be three to eight sentences in length, (2) focus on one point, topic, or argument, (3) include a topic sentence the defines the focus for the paragraph, and (4) include a transition sentence to the next paragraph. Include one space after each period. There should be no grammatical, punctuation, sentence structure, or APA formatting errors. Verb tense is an important consideration for Chapters 1 through 3. For the proposal, the researcher uses future tense (e.g., “The purpose of this proposed study is to…”), whereas in the dissertation, the chapters are revised to reflect past tense (e.g., “The purpose of this study was to…”). Taking the time to ensure high-quality, scholarly writing for each draft will save learners time in all the steps of the development and review phases of the dissertation process.

As a doctoral researcher, it is the learner’s responsibility to ensure the clarity, quality, and correctness of their writing and APA formatting. The DC Network provides various resources to help learners improve their writing. Grand Canyon University also offers writing tutoring services through the Center for Learning Advancement on writing basics; however, the writing tutors do not provide any level of dissertation editing. The chair and committee members are not obligated to edit documents. Additionally, the AQR reviewers will not edit the proposal or dissertation. If learners do not have outstanding writing skills, they may need to identify a writing coach, editor, and/or other resource to help with writing and editing. Poorly-written proposals and dissertations will be immediately suspended in the various levels of review if submitted with grammatical, structural, and/or form-and-formatting errors.

The quality of a dissertation is evaluated on the quality of writing and based on the criteria that GCU has established for each section of the dissertation. The criteria describe what must be addressed in each section within each chapter. As learners develop a section, first read the section description. Then, review each criterion contained in the table below the description. Learners use both the overall description and criteria as they write each section. Address each listed criterion in a way that it is clear to the chair and committee members. Learners should be able to point out where each criterion is met in each section.

Prior to submitting a draft of the proposal or dissertation or a single chapter to the chair or committee members, learners should assess the degree to which each criterion has been met. Use the criteria table at the end of each section to complete this self-assessment. The following scores reflect the readiness of the document:

0 = Item Not Present or Unacceptable. Substantial Revisions Are Required. Comment by GCU: Format with style “List Bullet.” Numbered or bulleted lists are indented .25 inch from the left margin. Subsequent lines are indented further with a hanging indent of .25” per the example in the text. Each number or bullet ends with a period. Bullet lists use “List Bullet” Style. Numbered lists use “List Number” Style.

1 = Item is Present. Does Not Meet Expectations. Revisions are Required.

2 = Item is Acceptable. Meets Expectations.

3 = Item is Exemplary. No Revisions Required.

Sometimes the chair and committee members will score the work “between” numbers, such as a 1.5 or 2.5. The important thing to remember is that a minimum score of 2 is required on each criterion on the prospectus, proposal and dissertation before one can move to the next step. A good guideline to remember is that learners are not finished with the dissertation until the dean signs the cover page.

Learners need to continuously and objectively self-evaluate the quality of writing and content for each section within the proposal or dissertation. Learners will score their work using the learner column in the criteria tables as evidence that they have critically evaluated their own work. When learners have completed a realistic, comprehensive self-evaluation of their work, then they may submit the document to the chair for review. Rating work as all 3’s will indicate that the learner has not done this. The chair will also review and score each section of the proposal and dissertation and will determine when it is ready for full committee review. Keep in mind the committee review process will likely require several editorial/revisions rounds, so plan for multiple revision cycles as learners develop their dissertation completion plan and project timeline. Notice the tables that certain columns have an X in the scoring box. As mentioned above, the chair will score all five chapters, the abstract and the reference list; the methodologist is only required to score Chapters 1, 3, and 4 and the abstract; the content expert is only required to score Chapters 1, 2, and 5 and the abstract. The chair and committee members will assess each criterion in their required chapters when they return the document with feedback.

Once the document has been fully scored and approved by the chair and committee, and is approved for Level 2 or 5 review, the chair will submit one copy of the proposal or dissertation document with the fully scored assessment tables and one copy of the document with the assessment tables removed for AQR review. Refer to the Dissertation Milestone Guide for descriptions of levels of review and submission process.

The background section of Chapter 1 describes the recent history of the problem under study. It provides a summary of results from the prior empirical research on the topic. First, the learner identifies the need for the study, referred to as a gap, which the dissertation study will address. Strategies learners can use to identify a need or gap include:

Using results from prior studies.

Using recommendations for further study.

Using societal problems documented in the literature.

Using broad areas of research in current empirical articles.

Using needs identified in three to five research studies (primarily from the last three years.

Next, the learner builds an argument or justification for the current study by presenting a series of logical arguments, each supported with citations from the literature. This need, called a gap, developed from the literature, is the basis for creating the problem statement. A local need is appropriate for a study. However, the learner needs to situate the “need” or problem by discussing how it is applicable beyond the local setting and contributes to societal and/or professional needs. The problem statement is developed based on the need or gap defined in the Background to the Study section.

Research problems are socially constructed, meaning that a problem may not be considered one until society recognizes it as a problem. For example, spousal abuse was recognized as a problem after women earned more rights. Research problems are not determined only by how much one knows about it, but by the need to investigate phenomena that affect people in order to improve their lives (Krysik & Flynn, 2013).

The Problem Statement section begins with a declarative statement of the problem under study, such as “It is not known if and to what degree/extent...” or “It is not known how/why…”

Other examples are:

It is not known _____.

Absent from the literature is______.

While the literature indicates ____________, it is not known in (school/district/organization/community) if __________. Comment by GCU: Format bulleted lists using the style “List Bullet.” The preferences for this tyle are: Numbered or bullets are indented .25 inch from the left margin, subsequent lines are indented further to .25 inches. Each number or bullet ends with a period. These preferences have been set in this dissertation template.

This section then describes general population affected by the problem along with the importance, scope or opportunity for the problem and the importance of addressing the problem. Questions to consider when writing the problem include:

What is the need in the world or gap in the literature that this problem statement addresses?

What is the real issue that is affecting society, students, organizations?

At what frequency is the problem occurring?

What is the extent of human suffering that the problem produces?

Why has the problem received lack of attention in the past?

What does the literature and research say about the problem that can and should be addressed at this time?

What are the negative outcomes that this issue is addressing?

This section ends with a description of the unit of analysis, which is the phenomenon, individuals, group or organization under study. Specifically, at the conceptual level, the unit of analysis is the entity/thing (social organization, community, group, individual, social artifacts, policies/principles, or phenomenon) that the researcher wants to be able to say something about. It is the main focus of the study. The unit of analysis is that which the researcher is studying. At the implementation level, the unit of analysis gets determined and defined by the research question/problem statement.

The Purpose of the Study section of Chapter 1 provides a reflection of the problem statement and identifies how the study will be accomplished. It explains how the proposed study will contribute to the field. The section begins with a declarative statement, “The purpose of this study is….” Included in this statement are also the research design, target population, variables (quantitative) or phenomena (qualitative) to be studied, and the geographic location. Further, the section clearly defines the variables, relationship of variables, or comparison of groups for quantitative studies. For qualitative studies, this section describes the nature of the phenomenon/a to be explored. Keep in mind that the purpose of the study is restated in other chapters of the dissertation and should be worded exactly as presented in this section of Chapter 1. Comment by GCU: Note: Each paragraph of the dissertation must 3-5 sentences at minimum, and no longer than one manuscript page [3.08].

This section narrows the focus of the study and specifies the research questions to address the problem statement. Based on the research questions, it describes the variables or groups and their hypothesized relationship for a quantitative study or the phenomena under investigation for a qualitative study. The research questions and hypotheses should be derived from, and are directly aligned with, the problem statement and theoretical foundation (theory(s) or model(s). The Research Questions and/or Hypotheses section of Chapter 1 will be presented again in Chapter 3 to provide clear continuity for the reader and to help frame data analysis in Chapter 4.

If the study is qualitative, state the research questions the study will answer, and describe the phenomenon to be studied. Qualitative studies will typically have one overarching research question with three or more subquestions. If the study is quantitative or mixed methods, state the research questions the study will answer, identify the variables, and state the hypotheses (predictive statements) using the format appropriate for the specific design. For quantitative studies, the research questions align with the purpose statement. Quantitative studies will typically have three or four research questions and associated hypotheses; mixed method studies can use both, depending on the design.

In a paragraph prior to listing the research questions or hypotheses, include a discussion of the research questions, relating them to the problem statement. Then, include a leading phrase to introduce the questions such as: The following research questions guide this qualitative study:

RQ1: This is an example of how a qualitative research question should align within the text of the manuscript. Indent .25 inches from the left margin. Text that wraps around to the next line is indented using the Hanging Indent feature at .5.” Comment by GCU: Indent .25 inches from the left margin. Text that wraps around to the next line is indented using the Hanging Indent feature at .25.” The style for this is “List RQ.” Note: For the GCU template, the research questions and hypotheses are double spaced and do not follow the APA number or bullet list format for line spacing.

RQ2: Add a research question here following the format above. Additional research questions should follow the same format.

Or, for a quantitative study the research questions are formatted as below. The following research question and hypotheses guide this quantitative study:

RQ1: This is an example of how a quantitative research questions and hypotheses should align within the text of the manuscript. Indent .25 inches from the left margin. Text that wraps around to the next line is indented using the Hanging Indent feature at .5.” Comment by GCU: Use the “Style” called “List RQ to format the RQs and hypotheses.

H01: The null hypothesis that aligns to the research question is listed here. Comment by GCU: The null hypothesis is listed before the alternative hypothesis.

H1a: The alternative hypothesis that aligns to the research question and null hypothesis is listed here. Repeat this pattern for each quantitative research question and associated hypotheses.

The Advancing Scientific Knowledge and Significance of the Study section identifies the “gap” or “need” in the literature that was used to define the problem statement and develop the research questions. Further, it describes how the study will address the “gap” or “identified need.” The section describes how the research fits with and will contribute to or advance the current literature or body of research. Although this advancement may be a small step forward in a line of current research, it must add to the current body of knowledge and align to the learner’s program of study. The section also discusses the implications of the potential results based on the research questions and problem statement, hypotheses, or the investigated phenomena. Further, it describes the potential practical applications from the research. The section identifies the theory(ies) or model(s) that provide the theoretical foundations or conceptual frameworks for the study. Finally, it connects the study directly to the theory and describes how the study will add or extend the theory or model.

The Rationale for Methodology section of Chapter 1 clearly justifies the methodology the researcher plans to use for conducting the study. It argues how the methodological choice (quantitative, qualitative, or mixed methods) is the best approach to answer the research questions and address the problem statement. Finally, it contains citations from textbooks and articles on research methodology and/or articles on related studies to provide evidence to support the argument for the selected methodology.

For qualitative designs, this section states the research question(s) the study will answer and describes the phenomenon to be studied. For quantitative designs, this section describes the research questions the study will answer, identifies and describes the variables, and states the hypotheses (predictive statements) using the format appropriate for the specific design. Finally, this section includes a discussion of the research questions, relating them to the problem statement. This section should illustrate how the selected methodology is aligned with the problem statement, providing additional context for the study.

This section describes the specific research design to answer the research questions and why this approach was selected. Here, the learner discusses why the selected design is the best design to address the problem statement and research questions as compared to other designs. This section contains a description of the research sample being studied, as well as, the process that will be used to collect the data on the sample. The design section succinctly conveys the research approach to answer the research questions and/or test the hypotheses. This entails the learner describing the unit(s) of observation, which may be individuals, groups, documents, artifacts, databases, based on the data collection plan and instruments/sources. At the conceptual level, the unit of observation is the entity or thing (organization, individual, condition) the researcher will observe, measure and/or collect data on. The unit of observation is that which the researcher will collect data on. At the implementation level, the unit(s) of observation is/are determined and defined by the data collection approach(es).

The Definition of Terms section of Chapter 1 defines the study constructs and provides a common understanding of the technical terms, exclusive jargon, variables, phenomena, concepts, and technical terminology used within the scope of the study. Terms are defined in lay terms and in the context in which they are used within the study. Each definition may be a few sentences to a paragraph in length. This section includes any words that may be unknown to a lay person (words with unusual or ambiguous meanings or technical terms).

Definitions must be supported with citations from scholarly sources. Do not use Wikipedia to define terms. This popular “open source” online encyclopedia can be helpful and interesting for the layperson, but it is not appropriate for formal academic research and writing. Additionally, do not use dictionaries to define terms. A paragraph introducing this section prior to listing the definition of terms can be inserted. However, a lead-in phrase is needed to introduce the terms such as: “The following terms were used operationally in this study.” This is also a good place to “operationally define” unique phrases specific to this research. See below for the correct format:

Abbreviations. Do not use periods with abbreviated measurements, (e.g., cd, ft, lb, mi, and min). The exception to this rule is to use a period when abbreviated inch (in.) to avoid confusion with the word “in.” Units of measurement and statistical abbreviations should only be abbreviated when accompanied by numerical values, e.g., 7 mg, 12 mi, M = 7.5 measured in milligrams, several miles after the exit, the means were determined [4.27]. Comment by GCU: All terms should be styled as Heading 4 (level 4 headings).

Spaces. Do not use periods or spaces in abbreviations of all capital letters unless the abbreviation is a proper name or refers to participants using identity-concealing labels. The exception to this rule is that a period is used when abbreviating the United States as an adjective. Use a period if the abbreviation is a Latin abbreviation or a reference abbreviation [4.02]. Use standard newspaper practice when presenting AM and PM times, as in 7:30 PM or 6:00 AM.

Term. Write the definition of the word. This is considered a Level 4 heading., Make sure the definition is properly cited (Author, 2010, p.123). Terms often use abbreviations. According to the American Psychological Association [APA] (Publication Manual of the American Psychological Association, 2010), abbreviations are best used only when they allow for clear communication with the audience. Standard abbreviations, such as units of measurement and names of states, do not need to be written out. APA also allows abbreviations that appear as words in Merriam-Webster’s Collegiate Dictionary (2005) to be used without explanation [4.22-4.30]. Comment by GCU: It is vital to include page numbers with in-text citations: “p.” for a single page, “pp.” for more than one page (e.g., p.12, and pp. 123-124). NOTE: Page or paragraph numbers are included with a direct quote.

Time units. Only certain units of time should be abbreviated. Do abbreviate hr, min, ms, ns, s. However, do not abbreviate day, week, month, and year [4.27]. To form the plural of abbreviations, add “s” alone without apostrophe or italicization (e.g., vols, IQs, Eds). The exception to this rule is not to add “s” to pluralize units of measurement (12 m not 12 ms) [4.29].

This section identifies the assumptions and specifies the limitations, as well as the delimitations, of the study. Define the terms and then list the limitations, delimitations and assumptions. Provide a rationale for all statements.

1. It is assumed that survey participants in this study were not deceptive with their answers, and that the participants answered questions honestly and to the best of their ability. Provide an explanation to support this assumption. Comment by GCU: Formatting numbered lists: Use the style, set in this template, called “List Number.” It has been set up according to the following specifications:Indent .25 inches from the left margin. Text that wraps around to the next line is indented using the Hanging Indent feature at .5.” Each number or bullet ends with a period. Bullet lists use “List Bullet” Style. Numbered lists use “List Number” Style.

1. It is assumed that this study is an accurate representation of the current situation in rural southern Arizona. Provide an explanation to support this assumption.

2. The survey of high school students was delimited to only rural schools in one county within southern Arizona, limiting the demographic sample. Provide an explanation to support this delimitation. Discuss associated consequences for the generalizability and applicability of the findings.

This section summarizes the key points of Chapter 1 and provides supporting citations for those key points. It then provides a transition discussion to Chapter 2 followed by a description of the remaining chapters. For example, Chapter 2 will present a review of current research on the centrality of the dissertation literature review in research preparation. Chapter 3 will describe the methodology, research design, and procedures for this investigation. Chapter 4 details how the data was analyzed and provides both a written and graphic summary of the results. Chapter 5 is an interpretation and discussion of the results, as it relates to the existing body of research related to the dissertation topic. For the proposal, this section should also provide a timeline for completing the research and writing up the dissertation. When the dissertation is complete, this section should be revised to eliminate the timeline information. Comment by GCU: When it is necessary to divide a paragraph at the end of the page, two lines must appear at the bottom of the page (widow) and two at the top of the following page (orphan). This is called “widow/orphan” control, and has been set up on the Normal Style in this template.

This literature review will address the issue that some populations openly seek out mental health services as they have identified that they are at high risk of mental illness (Naslund et al., 2020). On the other hand, some populations reject mental health services regardless of whether they need it or not citing stigmatization and victimization (Sebastian & Richards, 2017). According to Laugharne et al. (2018), the need to understand the populations either accepting or rejecting mental health services stems out from the need to improve the mental health status of the nation.

The literature review seeks to reveal what is known as concerns the nation’s mental health. This literature review will address the topic of mental health services with special emphasis being placed on the availability of the service, the availability of infrastructure supporting the service and the perception of people towards the service. The review will analyze the populations that have readily accepted and are willing to seek mental health services as well as those that reject and are unwilling to seek mental health services. The review is based on the fact that not all people have embraced mental health services and on the fact that there is a gap in the delivery of mental health care services.

The chapter will be divided into seven sections. The seven sections are mental health infrastructure, populations that accept mental health, populations that reject mental health, populations that have access to mental health, populations that do not have access to mental health, reasons for the rejection of mental health and the reasons for the use of mental health services. All the sections will have three sub-sections. The subsections will include introduction of the section, themes in the section and synthesis of the sections.

The literature review in addition aims to compare the existing literature on mental health. The comparison is supposed to provide light on whether there are similar opinions and views on the subject. The comparison as well helps in the identification of the various divergent views on the subject matter. Seven sections organize this paper. The literature review is divided into seven sections so that to touch on all subjects that touches on mental health. The only subject that relates to mental health that is not touched on in the literature review is the treating of mental health. It is not touched on, as it is not the focus of the study. The first section is mental health infrastructure and it focuses on the availability of mental health infrastructure in the nation. A review of literature in the section is based on the knowledge that mental health services infrastructures are not well distributed to offer assistance to those in need of mental health services.

The second section is a section that focuses on the reasons for lack of access to mental health. The need to review related literature is driven by the knowledge that there are individuals that need mental health; however, they choose not to get it. The third section analyzes the population that has easy access to mental health services. The fourth section deals with the populations that use mental health services. The fifth section focuses on the populations that reject mental health services. The sixth section focuses on the reasons for the use of mental health services. The review is on the need to understand why people seek or do not seek mental health services. The seventh section focuses on the reasons for the rejection of mental health services.

The literature was conducted through a systematic review using the Scopus, Science Direct, PubMed, Cuiden, Cochrane, google scholar, ISI, and PsycINFO databases. The review was conducted using key terms related to the sections of the study. To make the study as relevant as possible, only studies done and published in the last five years were reviewed.

The problem of mental health has evolved historically overtime. According to Higgins (2017), mental health in the United States has declined in the last twenty years. He cites that suicide rates have increased twice fold from 1990. Furthermore, he cites that the substance abuse more so of opiates has become epidemic. Higgins claims that the disability award for mental disorders has also increased dramatically, a possible indication of the nation’s mental health dwindling.

The big societal problem is that people who have access to healthcare are not using it and it is unclear how to improve use. Previous research on reasons people do not use mental health therapy have included studies on those who lack access either because of lack of insurance (Bickman, 2020). Or other financial reasons including transportation as found out by Mistry (2020), and proximity to treatment (Shi et al., 2020).The trends in the past research have indicated majority of people who desire mental health services find it hard to get the services based on the unavailability of a mental health infrastructure near them as well as financial constraints. Comment by Dr. Seymour: Good job!

Current research lacks focus on why people who do have access either reject or accept treatment, and strategies to improve acceptance. Current research findings that have emerged from recent studies focus on availing mental health information to as many people as possible through education (Myers‐Walls, 2020). Other current research focuses on availing mental health infrastructure more so to populations that have been identified to need it the most as supported by Leider et al (2020). Some research has looked at why people with access reject therapy to provide insight on how to convince them otherwise.

The gap in the research is that there is not research looking at why people use or reject mental health treatment. According to King et al. (2018), tobacco abusers and depressed people seek mental health services to recover health. Ali et al., (2019) provides evidence that through seeking mental health services, young learners from poor backgrounds can access other health services. According to Orlowski et al., (2016), mental health services are being sought for currently than in the past as more people are aware of the value of mental health to the overall body health.

According to Carrara and Ventura, (2018), self-stigma and fear of discrimination are the primary reasons that people reject mental health services. Luitel et al., 2017 published that the fear of being perceived as crazy and weak made people fear and reject mental health services. According to Memon et al., (2016), the stigma around poor mental health affects negatively the perception of mental health services. Surprisingly, some individuals reject mental health services as they fear positive diagnosis can deny then income-generating opportunities. According to Staiger et al., (2017), the unemployed population rejects seeking mental health services for fear that negative mental health diagnosis can hamper their opportunities to get employment opportunities.

From the findings of research studies and evolution of recent literature on the topic, defines the problem statement for the study.

The findings discussed here reveal some of the reasons why people accept or reject mental health care but they do not address why people with access either reject or accept, and what strategies provider have for improving acceptance. The problem this study will address is (COPY AND PASTE HERE)

The theoretical foundation of this paper is based on the cognitive theory of psychopathology. The theory was suggested by Aaron T Beck and emphasizes that perception influences both positive and negative mental health status (DeYoung & Krueger, 2018). The model is ideal for the dissertation as it helps in describing how an individual’s perception of situations or spontaneous thoughts on situations influence their emotional, behavioral, and psychological reactions towards mental health services. The theory emphasizes that the distorted beliefs influence people’s understanding of themselves, their world, and the people that they interact with. Furthermore, distorted beliefs influence an individual’s information processing.

The theory focuses on perception considering that mental health is primarily perception and neural connections. If neural connections are right, then the other factor influencing individuals’ views on mental health services is their perception. Perception refers to the understanding of the interpretation of a phenomenon. Perception is influenced by past events, culture, values, present circumstances, education, and preconceived notions (Rosli & Goh, 2020). By understanding the influences of perception, it is possible to understand the view of people towards mental health services.

This theory is connected to this study with the concept of perceptions. A look at the difference in individuals’ acceptance and rejection of mental health services reveals that it is about individual perceptions. Overtime individual perceptions have been grouped together and consequentially, beliefs around mental health have been formed. For example, members of the LBGT community have beliefs that mental health services are meant to conform them to an identity that they do not agree to (Steele et al., 2017).The belief started with an individual’s perception and the perception grew into the belief that supports the rejection of mental health services. According to Knight et al (2018), perception is a cornerstone of people’s decisions to reject or accept mental health treatment. By basing the foundation of the study in the cognitive theory of psychopathology it is possible to come up with a reason that explains why there are individuals that openly accept mental health services as well as why there are individuals that reject mental health services. This is because the theory states that perception influences both positive and negative mental health status, which helps explain the role of perception in the seeking or rejection of mental health services.

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Mental Health Infrastructure

There are an estimated 11,682 mental facilities in the US and out of the total less than 2000 of the facilities are running 24/7. The above statistics indicate that the nation has limited mental health infrastructure and that is contributing to the poor access to mental health services.

According to Hester (2017), the lack of enough mental health institutions is causing a lack of access to mental health services amongst military personnel. Hester conducted a case study where he focused on finding out why so many military personnel are committing suicide after coming from active combat sites. The study was on the Army Study to Assess Risk and Resilience in Service members. To ensure no bias, he compared the data he found from the existing data on civilians collected by the American Mental Health Association. The findings of the study revealed that the mental health disparity is the most probable leading factor of high suicide rates amongst veterans more so those who have been exposed to traumatic experiences. Based on the findings, Hester concluded that more servicemen need to be screened for mental challenges before they return to civilian life and that can only be done by having more psychic units in the military. Furthermore, there needs to be a collaboration between non-profit mental health providers and public health providers.

A survey conducted by Tran and Ponce (2017), revealed that the majority of people in California that need mental health care services cannot access the services. Tran and Ponce reviewed survey data from 2011 and 2014 and were able to identify that California had a population of 82,706 adults with mental health needs. The researchers used Multivariable logistic regression analysis of the data that they collected. The results of the study indicated that 70% of individuals with mental health complications had either not received any mental health service or that the service that they received was inadequate. Further study of the data revealed that mental health stigma and the cost of treatment prevented Californians from seeking mental health; the infrastructure set in place could not be easily accessed.

According to (Kohn et al., 2018), based on community-based surveys carried out in Argentina, Brazil, The United States, Peru, Chile, Columbia, Canada, Mexico and Guatemala there are numerous factors have been identified as the reasons why people are unable to access mental health services. The study involved surveying 75,306 participants who were 15 years and above. The findings of the study revealed that mental health illness accounted for a tenth of the nations’ burden of diseases. Out of the identified population, more than a third cannot access mental health services due to high costs as well as poor infrastructure. Lack of insurance is one of the reasons why people cannot access these services. Poor socioeconomic status particularly for families in rural areas makes it difficult for them to access mental health services. Distance has also been found to be another reason as to why people are unable to utilize these services.

According to (Martin et al., 2016), based on a case study analysis and review, there are correctional centers that do not have mental health infrastructure, and this limits the availability of mental health services in correctional centers. The analysis involved going through data provided by the Department of Corrections where special emphasis was placed on going through the policy on the screening inmates’ mental health upon admission. The analysis revealed that between 10% and 15% of inmates are erroneously classified in terms of their mental health thereby reducing their chances of getting mental health services. The misdiagnoses are a result of poor mental health infrastructure in correctional facilities.

In reference to (Johnson et al., 2018), based on a discursive review that they conducted, hospitals that have psychiatric departments and units have their employees working long hours due to the unavailability of enough staff, an indication that resources allocated to psychiatric wards are limited. The articles that they reviewed were drawn from peer-reviewed journals, national reports, and surveys. The review established that the availability of mental health services is compromised. The researchers recommend that more psychiatric employees need to be deployed to improve the delivery of mental health services.

According to Mongelli, Georgakopoulos, and Pato (2020), based on an article review, the lack of transparency and trust in psychiatric treatment has caused many people not to access mental health services. The articles that they reviewed were drawn from peer-reviewed journals, national reports, and surveys. The researchers reviewed some of the barriers to behavioral healthcare. Based on the review it was established that the lack of transparency and trust has often led resources, and infrastructure allocated to mental health has been revoked or withdrawn. The revoking of the infrastructure has been triggered by the need to reduce wastage, but the effect of the revocation has limited access to mental health services in the nation.

According to (Machado et al., 2018), based on a robust multivariable negative binomial regression model on 5507 municipalities, the number of youth committing suicide due to mental health complications has been on the rise. The study focused on individuals aged 14 and 22 years. Further investigations of the study revealed that the mental health needs of those in low come municipalities are not being met as a result of poor mental health infrastructure.

In an ethnographical study by Ecks in 2016 revealed that mental health infrastructure in the world is limited compared to physical health infrastructure. The study focused on global mental health on policies not older than 25 years. The study revealed that physical health is prioritized over mental health shedding light as to why there are fewer mental health infrastructures in not only the US but globally. The study recommends that more attention needs to be given to mental health for global mental health to improve.

Karaye, Ross, and Horney in 2019 conducted a 12-item Short-Form Health Survey (SF-12) was administered online to a sample of 3030 residents. Multiple linear regression models were used to identify predictors of self-rated health among the respondents. The survey revealed that US gulf coast residents are using self-rating to assess their mental health as there are no facilities to aid in assessing their mental health. The study recommends that more mental health facilities need to be set up in the gulf considering the population at the US gulf coast is a high-risk population; their constant contact with typhoons, hurricanes have stigmatized many to the extent that their mental health has been compromised.

In reference to (Castillo et al., 2019), based on a review of community interventions geared at improving mental health, there are few effective community interventions to help with mental health. The research team reviewed the literature on seven topics: early psychosis, criminal justice, global mental health, collaborative care, school-based interventions, mental health promotion, and homelessness. Based on the review it was revealed that the majority of people in the US and Australia are calling for community interventions for mental health promotion as they cannot access mental health services easily. The review established that more mental health infrastructures need to be set up for mental health to improve.

Synthesis

The majority of the studies and reviews analyzed are similar in that they confirm that the likely cause of mental health is poor infrastructure. The study by Johnson et al., 2018; Martin et al., 2016 and Ecks, 2016 are of a similar view that poor mental health infrastructure is undermining the delivery of mental health services. The studies cite poor infrastructure, few mental health practitioners, and poor knowledge of mental health as the three main things hindering mental health service delivery.

The success of most health services is dependent on the availability of resources and infrastructure and mental health is not an exception to this. The majority of the studies and reviews analyzed in this section are similar in that they confirm that the likely cause of poor mental health services is poor infrastructure. Several studies (Ecks, 2016; Johnson et al., 2018; Martin et al., 2016) are of a similar view that poor mental health infrastructure is undermining mental health services. The study by Karaye, Ross, and Horney (2019) is a good example of a study that confirms that the mental health institutions, as well as infrastructures not only in the state but in the nation, are not sufficient enough to meet the mental health needs of the population.

Six of the studies reviewed claim that the lack of enough mental health infrastructure is hampering mental health service delivery. The study by Karaye, Ross, and Horney in 2019 is a good example of a study that confirms that the mental health institutions, as well as infrastructures not only in the state but in the nation, are not sufficient enough to meet the mental health needs of the population. There is also a divergent view that there are enough mental health facilities and that there are other factors that are hindering access to mental health services. The identified factors are stigma, lack of resources, and the abuse of drugs. The studies that are of the divergent view are (Machado et al., 2018; Kohn et al., 2018; Tran and Ponce, 2017).

The following studies were very strong because of their large sample size (Castillo et al., 2019; Ecks et al., 2016; Mongelli, Georgakopoulos, and Pato 2020). Other studies such as Tran and Ponce 2017 and Martin et al., 2016 were strong because they did not have researchers’ triggered biases. Several studies were weak because of limitations. For example, (Machado et al., 2018); Johnson et al., 2018 and Kohn et al., 2018) were weak because of the limitation of researchers’ triggered bias.

The articles included in this section are on several subtopics that include the numerous reasons why people cannot access mental health services such as lack of financial capability (Chisholm et al., 2019; Fleury et al., 2019; Kohn et al., 2018; Calear et al., 2017). Other articles focus on personal beliefs and fears (Reynolds et al., 2020; Vreeman, McCoy &Lee, 2017) while others focus on travel distance barriers (Calear et al., 2017), poor health systems, poor organization, and poor professionals (Fleury et al., 2019; Bartolomei, 2016), stigma (Vreeman, McCoy, & Lee, 2017) and low-income (Chisholm et al., 2019).

There are various reasons that people cannot access mental health services. Top on the list is the lack of financial capability. The review looks at the factors and the reasons that make the accessing of mental health services difficult or impossible. An analysis of the studies reviewed reveals that the majority of the individuals or populations that have challenges in accessing mental health services are unable due to forces or circumstances out of their control. Chisholm et al., 2019; Fleury et al., 2019; Kohn et al., 2018 and Calear et al., 2017 state that the lack of finances, poor resources, and poor infrastructure are the primary reason why accessing mental health services are difficult. Surprisingly, some individuals opt not to get to access mental health services based on reasons that they can control or that they can navigate. The study findings by (Reynolds et al. 2020) and (Vreeman, McCoy, and Lee 2017) state that access to mental health services is hampered by personal beliefs and fears which can be controlled.

Calear et al. (2017) conducted a two-arm, cluster-randomized, controlled trial in eight high schools with the focus being on male students in either 11th or 12th grade. The trial was conducted to establish why there is high suicide ideation amongst male adolescents compared to female adolescents. Data was collected pre-intervention, post-intervention and at three months follow up to establish whether the intervention suggested in the study was effective at reducing suicide rates and ideation. Based on the trial it was established that help-seeking stigma was the main reason as to why male adolescents were unwilling to access mental health services. The main limitation of the study was that it focused specifically on one gender. The overlooking of the female gender might have led to conclusions that do not necessarily represent society.

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 (Calear et al., 2017). 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 (Calear et al., 2017).

According to (Kohn et al., 2018), based on community-based surveys carried out in Argentina, Brazil, The United States, Peru, Chile, Columbia, Canada, Mexico and Guatemala there are numerous factors have been identified as the reasons why people are unable to access mental health services. The study involved surveying 75,306 participants who were 15 years and above. The data collected included the weighted median and the mean treatment gap of moderate and severe mental illness. The data collected was analyzed by comparing it to the Global Burden of Disease rating. The findings of the study revealed that mental health illness accounted for a tenth of the nations’ burden of diseases. Out of the identified population, only a third cannot access mental health services due to high costs as well as poor infrastructure. According to (Kohn et al., 2018), the survey data indicate that women are at the highest risk of developing mental health issues due to drug abuse and sexual abuse and it also indicated that more women compared to men seek mental health services.

In 2019, Fleury and three other researchers posted their findings on the barriers to mental health. The researchers through semi-structured interviews conducted on 49 emergency room stakeholders identified that the barriers to access to mental health services were poor health systems, poor organization, and poor professionals (Fleury et al., 2019). The main limitation of the study is that the researchers did not have measures in place to ensure that the interviewees answered truthfully. As a result, the findings might not be as accurate as they should be.

Another study by Bartolomei and his team of researchers in 2016, identified that the lack of professional training, inadequate resources, and poor infrastructure led to poor access to mental health services. The researchers published their findings in reference to a study that they had conducted using a Likert scale on 135 care workers and mental health caregivers. The main limitation of the study is that the population that was studied on was too small and therefore the replication of the results of the study is hard to make using a large sample size.

In 2017, Vreeman, McCoy, and Lee published their findings on a review study that they had conducted earlier. The trio had conducted individual searches on PubMed and Medline to assess the challenges that HIV-Infected adolescents went through in accessing mental health services. The researchers reviewed 11,501 articles and publications where they focused on keywords. The words were HIV-related stigma, measurement of mental health problems, depression, and anxiety amongst HIV positive adolescents. The trio identified that the stigma around both HIV and mental health led to few HIV-adolescents seeking mental health services.

Another study that was reviewed in an attempt to understand the challenges in access to mental health services was a study publication done in 2020. Through individual interviews of 15 adults aged between 61 and 81 years, Reynolds et al. (2020), identified why the access to mental health services is hard for the elderly. The researchers collected data through the audio-recordings of the interview sessions and analyzed the data through narrative methods. The researchers identified that the elderly were resistant to accessing the services due to the fear of being labeled psychotic, difficulty in understanding and navigating through the help-seeking process, and the lack of emotional knowledge on how to react to psychological treatment. The main limitation of the study was that the sample size was too small for it to be used as a representation of the elderly.

In 2019, Chisholm and six other researchers published their findings on a study that they had carried out in an attempt to understand the challenges in the accessing of mental health services amongst low-class individuals. The researchers used a multi-method approach that consisted of three phases; narrative and quantitative assessment and in-depth interviews of low-income individuals in six sub-Saharan Africa and South Asian nations (Chisholm et al., 2019). From the study, the researchers identified that poor financial position limited access to mental health services. In addition, mental health services received significantly less funding compared to other health services.

Synthesis

An analysis of the studies reviewed reveals that the majority of the individuals or populations that have challenges in accessing mental health services are unable due to forces or circumstances out of their control. (Chisholm et al., 2019; Fleury et al., 2019; Kohn et al., 2018 and Calear et al., 2017) state that the lack of finances, poor resources, and poor infrastructure are the primary reason why accessing mental health services is difficult. Surprisingly, some individuals opt not to get to access mental health services based on reasons that they can control or that they can navigate. The study findings by (Reynolds et al. 2020) and (Vreeman, McCoy, and Lee, 2017) state that access to mental health services is hampered by personal beliefs and fears which can be controlled.

The following study was very strong because they did not have the researchers’ caused bias (Chisholm et al., 2019).Other studies such as (Vreeman, McCoy, and Lee, 2017 and Kohn et al., 2018) were strong because they had large sample sizes. Several studies were weak because of limitations. For example, (Reynolds et al. 2020 and Bartolomei et al., 2016) were weak because of the limitation of the small sample size.

The articles included in this section are on several subtopics including domestic abuse victims, and women with access to mental health services (Karystianis et al., 2018; Knight & Winterbotham, 2020; Ferrari et al., 2016; Moreau et al., 2018; Brunner et al., 2019). Other articles focus on highly educated women (Moreau et al., 2018), women veterans (Brunner et al., 2019), and older adults from urban areas who can easily access mental health services (Knight & Winterbotham, 2020). I included this topic because this dissertation addresses individuals that can easily access mental health services.

Domestic abuse victims, primarily women have access to mental health services. According to Ferrari et al. (2016) based on a cross-sectional survey on 260 women, numerous facilities offer psychological help to women that have undergone domestic violence. The researchers collected data from the 260 women and used normal regression and logistic models for continuous and binary functions respectively. According to the study, the easy availability of mental services for women was since women were identified as a population at high risk of mental instability due to trauma associated with domestic violence. The main limitation of the study was that the sample size was small for conclusions that represent the society to be made.

Further studies by Karystianis et al. (2018), confirm the study findings of Ferrari et al. (2016). Karystianis and fellow researchers conducted a text mining study to establish whether it is possible to identify mental health disorders from unstructured text and in the process identified that individuals of domestic violence were slotted for mental health services once they reported abuse. The researchers used 200 domestic violence recorded events to arrive at the findings and the conclusions that they made. From the research, it was identified that depression was the most common mental disorder amongst victims of domestic violence.

According to Moreau et al. (2018), women who are conversant with telemental health services have easy access to mental health services. Moreau and his researchers conducted semi-structured qualitative interviews with 40 key stakeholders at veteran affairs medical centers. The researchers used transcripts to summarize key themes from the study. The researchers established that despite the telemental health services being open to all, it was women who accessed the services the most. The main limitation of the study is that the sample size was too small for conclusions that can be replicated all over to be made.

Another population that has easy access to mental health services is women veterans. According to Brunner et al. (2019), women veterans have easy access to mental health services based on the knowledge that they are a high-risk population of mental disorders based on that they are women who are exposed to tough and at times traumatic experiences. The researchers were able to make the above conclusion after they used survey data on 419 patients at the department of veterans’ affairs clinics. From the participants, 59% of women reported that they accessed mental health services as soon as they needed it.

Another population that has fair access to mental health services in urban older adults. Knight and Winterbotham in 2020 made a publication regarding a study that they had conducted. The duo used surveys, focus groups, and in-depth interviews to collect information from 94 older adults from urban, regional, and remote areas. The study team used thematic analysis to analyze the data collected. From the study, it was established that older adults from urban areas easily accessed mental health services unlike other older adults primarily due to easy access and better mental health discipline. The study sample was too small for conclusions that can be replicated in most areas to be made.

Synthesis

From the analysis, two groups are identified to have relatively easy access to mental health services. The first group is women and the other group is older adults. Based on the review, there are infrastructure and resources allocated to mental health to help out the identified groups due to their high vulnerability to mental illnesses or disorders. The above is evidenced by findings of studies done and published by (Karystianis et al. 2018; Knight and Winterbotham 2020; Ferrari et al. 2016; Moreau et al. 2018). Surprisingly, one article has a divergent view from the rest. Brunner et al. (2019) found out in their study that women veterans have access to mental health services due to the difficulty of the occupation. Surprisingly, male veterans have access to the same services, but they rarely utilize them in comparison to their female counterparts.

The following studies were very strong because they did not have researchers’ triggered biases (Karystianis et al. 2018 and Brunner et al. 2019). Several studies were weak because of limitations. For example, (Knight and Winterbotham, 2020; Moreau et al. 2018 and Ferrari et al. 2016) were weak because of the small study samples used.

Populations that Use Mental Health Services

The articles included in this section are on several subtopics including race (Chu et al., 2018), people with substance abuse issues (Gates et al., 2017). Others include prison inmates (Morrissey et al., 2016), and individuals with suicide ideation (Sareen et al., 2016). Other articles focus on individuals who are confused about their sexualities or sexuality challenges (Hughes et al., 2020) and abused children and women (Read et al., 2018); (Mengo & Gidycz, 2019). While another subgroup population includes military officers with traumatic experience (Russell et al., 2018). This topic is included because some populations have been identified to seek and use mental health services more than others.

According to (Chu et al., 2018), of all the races in the United States, the race that seeks out mental health services the most are white Americans. On the other hand, the race that rarely seeks out mental health services is the Asian race. The findings are based on the 2008 military survey data that focused on the reports made on post-traumatic stress, depression, and other mental health complications. By analyzing the data through the race criteria, the researchers identified that white and blacks were the most open to seeking mental health services. The main limitation of the study is that the researchers did not explore further why there is a huge difference between white Americans and the other minority races.

Some individuals seek mental health services because they have problems that they need help with such as substance abuse and suicidal ideation. Gates et al. (2017) studied individuals that are struggling with alcohol and substance abuse use mental health services. The above conclusion was made after a cross-sectional descriptive study was conducted on correctional facilities. The study examined the population of state prisons where n=10,998. The focus of the study was on the association between substance use disorder and mental health. The data for the study was collected from an electronic health record and an offender management system. The researchers used SAS 9.4 to conduct statistical tests on the collected data where they compared to race, gender, security levels, education, and types of mental health disorders. The findings of the study were that substance use and ill mental health were connected.

Further findings of the study revealed that inmates were open to seeking mental health services as the services were easily provided in correctional facilities. It was established that individuals struggling with substance use were open to mental health services. Another population that uses mental health services is people with suicide ideation (Sareen et al., 2016). Sareen and other researchers obtained data from 53477 respondents aged between 18 years and 60 years. The respondents consisted of civilians and military personnel. The researchers assessed the respondents’ lifetime and past-year prevalence of suicidal ideation. Based on the study, it was established, that majority of people that seek mental health services are individuals that have considered suicide or those that have attempted suicide. The identified population seeks mental health to help them reduce their ideation of suicide.

According to Hughes et al (2020), individuals who have identified that they have sexuality challenges use mental health services. Through a two-armed randomized controlled, open feasibility study comparing Sexual health promotion intervention, the researchers were able to identify that confusion of sexuality made people think that they have mental challenges. A nested qualitative study was used to obtain the views of 100 participants. A further study revealed that those who are not sure of their sexuality or sexual preference prefer seeking mental health services for them to achieve insight into their challenges. The main limitation of the study was that it utilized a small sample size and for that reason, the results do not represent society.

Another subgroup of people who seek mental health treatment is those who have been abused, often children and women. For example, the other major population that receives mental health services is children that have gone through abuse or that have been neglected (Read et al., 2018). Read and fellow researchers conducted Systematic Reviews and Meta‐Analyses using PsycINFO geared at establishing the main reason why adults sought mental health services. The researchers went through 42 999 medical files as part of their review where the search items were children who had been abused or neglected. From the review and analysis, the researchers identified those individuals who were abused or neglected as children the majority of the time sought mental health services as they believe that the abuse might have affected them psychologically.

The study revealed that adults who were abused seek mental health services actively. Just as abused children, women who have also been abused seek mental health services (Mengo & Gidycz, 2019). Mengo and Gidycz carried out a case study and reviewed cases on 154 women who were victims of intimate partner violence. The study revealed that such women were psychologically affected by the abuse to the extent that they sought mental health services. The women consider mental health services as a way of redeeming their mental status considering that they have been made to feel inadequate. The study revealed that women who have experienced intimate partner violence are likely to seek out mental health services as compared to men that are victims of intimate partner violence. The main limitation of the study was that it utilized a small sample size and for that reason, the results do not represent society.

There are locations where mental health treatment is offered such as prisons. According to Morrissey et al., (2016), recovering convicts also seek mental health services. Morrissey and his fellow researchers conducted a quasi-experiment on 895 inmates with severe mental illnesses. The outcomes were estimated via propensity-weighted logit models. The researchers were interested in confirming whether the expediting of Medicaid enrollments of inmates with mental illness helped to reduce recidivism. As the researchers conducted the study, they identified that inmates that thought they were mentally ill actively sought mental health services, an indication that they wanted to resolve any mental health complications that may have contributed to them committing crimes and offenses.

In reference to Russell et al., (2018), one of the large populations that seek mental health services is military officers who have suffered a traumatic experience in active combat. Russell and his team of researchers reviewed military data of officers who have taken part in active combat as far back as in World War II. According to the article, military personnel is exposed to stigmatizing events and situations and the situations often lead to mental health complications. The study as well revealed that over the years, military personnel has become aware of the effects of war to the extent that after they come out of active combat sites, they seek mental health services. The majority of military personnel seek mental health services for them to easily interact with civilians and for them to live normal lives. The main limitation of the study was that it did not utilize a control sample to assess whether the number of individuals that have undergone traumatic experiences and have never needed mental health services exceeded those that needed the services.

Synthesis

Seven studies have convergent views. The convergent view is that exposure to traumatizing events leads to certain populations to seek mental health services. According to Mengo & Gidycz, 2019, adults abused as children often seek mental health services for them to do away with the psychological harm caused by the abuse. Sareen et al., 2016, confirm the view that trauma leads people to seek mental health services. Studies by (Sareen et al., 2016; Mengo & Gidycz, 2019; Read et al., 2018); Hughes et al 2020), identified that individuals who had suicide ideation seek mental health services for them to gain control of their minds as they consider themselves unable to master their minds.

Surprisingly, based on three studies reviewed they are populations that do not seek mental health services to improve their health, but they do so improve their interactions with other society members. The three studies (Russell et al., 2018; Morrissey et al., 2016; Gates et al., 2017), emphasize that the populations that seek mental health services are populations that are seeking to improve their interactions with other society members. The three articles focus on populations exposed to harsh conditions. The population includes military personnel and convicts.

The following studies were very strong because they did not have researcher triggered biases (Morrissey et al., 2016; Sareen et al., 2016 and Gates et al. 2017). Several studies were weak because of limitations. For example, (Mengo & Gidycz, 2019 and Hughes et al 2020) were weak because of the small study samples used.

Populations that Reject Mental Health Services.

The articles included in this section are on several subtopics of those that reject mental health services including minorities such as the LGBT community (Su et al., 2016), transgender community (Rider et al., 2018). The Amish population (Miller-Fellows et al., 2018) and the immigrant population and refugees (Silove, Ventevogel & Rees, 2017) and (Bas-Sarmiento et al., 2017). Others reject mental health services due to high costs and poor insurance coverage barriers (Kohn et al., 2018) and (Calear et al., 2017). The other articles focus on athlete sponsorships (Moreland, Coxe & Yang, 2018) and adult trauma victims (Kantor, Knefel, & Lueger-Schuster, 2017).

In the United States, 42% of the population believes that cost and poor insurance coverage are the top barriers that prevent them from accessing mental health care (Kohn et al., 2018). While only 25% reported that they make decisions between using mental health treatment or paying for daily necessities (Calear et al., 2017). Calear and a team of researchers in 2017 conducted a two-arm, cluster-randomized, controlled trial aimed at establishing whether indeed males are less likely to seek mental health services compared to females or not. The study focused on young men aged between 11 and 18 years and it revealed that young men were not open to the idea of getting mental health services. Data was collected pre-intervention, post-intervention, and at 3-month follow-up on male students in either 11th or 12th grade in eight schools. The study findings revealed that stigma around mental health as well as the patriarchal structure made it harder for young men compared to women to seek mental health. The study revealed that young men are amongst the population rejecting mental health services.

According to Su et al., (2016), members of the Lesbian community are known to reject mental health services mainly due to stigma. The above results were realized through a survey conducted online from respondents who self-identified as bisexual, gay, lesbian, and/or transgender persons aged 19 years and above from Nebraska in 2010. The study relied on the information collected from 767 respondents of which 91 identified as transgender whereas the rest were non-transgender respondents. The study used multivariate logistic regression analysis, chi-square, or bivariate t-tests and to examine differences in reported depression symptoms, discrimination, suicide attempts, and self-acceptance of the LGBT community. According to the conclusions of the survey, lesbians fear rejection and victimization due to their sexual preference and as a result, avoid getting mental health services for both mild and severe mental complications.

Another population that avoids getting mental health assistance is the majority of the immigrant population (Bas-Sarmiento et al., 2017). Bas-Sarmineto and his term of researchers conducted a systematic review using the Scopus, Science Direct, PubMed, Cuiden, Cochrane, ISI, and PsycINFO databases. The quality of the articles was analyzed by using the Equator Guidelines. The researchers reviewed 817 studies and identified 21 that best fit the description of their study. Based on the findings of the study, the population rejects mental health services as mental health complications are not viewed as normal in the immigrant population. Due to the stigma around mental health complications, many of them are afraid and unwilling to seek mental health services for fear of victimization.

An analysis of the transgender community reveals that the majority of them reject mental health services (Rider et al., 2018). Rider and a team of researchers surveyed 80 929 respondents. Chi-squares and multiple analysis of covariance tests were used in the analysis of the data collected. The survey was intended on identifying the view of teenagers as concerns mental health services. The results of the survey revealed that teenagers that identified with the transgender community and those that did not conform to the gender they were born with were against mental health services. They rejected mental health services as they viewed the services would outwardly reject what they believed in. The study confirms that the transgender community rejects mental health services.

Another population known to reject mental health services is refugees, more so African refugees (Silove, Ventevogel & Rees, 2017). According to a review of mental health amongst refugees, refugees are against mental health services due to two main reasons. First, they fear that if they are found not to be mentally fit, they may not receive help from those helping them. Secondly, they fear the victimization that comes with mental illness or challenges.

According to Kantor, Knefel, and Lueger-Schuster (2017), adult trauma victims more so men are not welcome to the idea of seeking mental health services. According to a systematic review conducted by the research team of five online databases, individuals who have experienced traumatic experiences such as rape, and physical violence are against seeking mental health services. The search strategy was based on three main terms: barriers and/or facilitators, trauma, and MHS use. 1612 papers and studies were found to match the search criteria. A standardized eligibility assessment based on eligibility criteria was used in the review and analysis of the identified papers and studies. According to the findings of the studies, the situation is worse for men who completely shun from getting any kind of help. The majority of the time, adults reject mental health services due to shame. They are ashamed of sharing what they went through and how it has affected them psychologically.

Another group that refrains from getting mental health assistance is collegiate athletes for fear of losing their athlete sponsorships (Moreland, Coxe & Yang, 2018). The analysis used a socio-ecological framework, which considered how collegiate athletes perform and study. 21 articles were identified as they met the criteria of the study. Conceptualizations and operationalizations of mental health services utilization were carried out as well. Moreland, Coxe, and Yang carried out the case study analysis and the case revealed three main points. The first thing was that college athletes did not consider themselves to be under the threat of mental health complications. The second thing was that for athletes that felt that they were mentally unfit, they opted to hide out to secure their sponsorships. Lastly, college athletes opt for substance and alcohol abuse as a way to mask and deal with any mental complication that they may be going through.

According to Lipari and her team of researchers in a publication made in 2017, individuals that are diagnosed with substance abuse and alcohol abuse reject mental health services. The researchers combined the 2012–2014 National Survey on Drug Use and all state levels among adults aged 18 or older to conclude. According to the findings of the study, they mainly reject the services as the services would most likely indicate that their mental states do not allow them to consume alcoholic drinks (Lipari et al., 2017). The fear of being forced to stay away from alcohol causes them to reject any form of mental health service.

In a cross-sectional study conducted using 45 participants, it was revealed that young people are amongst the population that reject mental health services. The researchers used thematic analysis to analyze Qualitative feedback collected from the anonymous questionnaire that they administered that measured help-seeking preferences, psychological distress, and barriers to accessing help. From the study, four reasons were identified that make it hard for young people to seek mental health services. The first reason is the stigmatization beliefs (Salaheddin & Mason, 2016). The second reason is the preference for self-reliance. The third reason is difficulty in expressing concerns. The last reason is they have difficulty identifying with mental illnesses or complications. According to the recommendations of the study, there is a need to demystify mental illness. The study as well recommended that there should be more aware of mental health services more so targeting young people.

Synthesis

An analysis of the studies reviewed reveals two main things. The convergent view of most of the studies is that the populations that reject mental health services do so due to the stigma around mental complications. The majority of populations that reject mental health do it for fear of being victimized. Immigrants and refugees reject mental health services for fear of being victimized by their community members. The majority of immigrant communities and refugees view mental illness as anomalies not acceptable. It is for that reason that most of them reject mental health services. The studies that accept the above convergent view are Kantor, Knefel and Lueger-Schuster, 2017; Silove, Ventevogel & Rees, 2017; Bas-Sarmiento et al., 2017, Calear et al., 2017 and Miller-Fellows et al., 2018.

There is a divergent view that mental health services are rejected as they are intended to conform to those identified to need it. The above statement can be confirmed through the studies that state that the LGBT community and college athletes reject mental health status. For the LGBT community, they reject mental health services as they reject the view that sexuality is determined by one’s genes and not the state of mind.

They reject the services as they believe that they are meant to change their views on sexuality and sexual preferences. On the other hand, college athletes reject mental health status as it would rule them out of athlete scholarship opportunities as well as dent their future aspirations on sports. The studies that are in line with the divergent view include Moreland, Coxe & Yang, 2018; Rider et al., 2018, and Su, et al., 2016.

Several populations are known to outrightly reject mental health services. Some of the populations include minorities and members of the LGBT community. The below reviews studies on individuals and groups that reject mental health services with the primary aim of establishing why they reject the services. An analysis of the studies reviewed reveals two main things. The convergent view of most of the studies is that the populations that reject mental health services do so due to the stigma around mental complications. The majority of populations that reject mental health do it for fear of being victimized. The studies that accept the above convergent view are Kantor, Knefel and Lueger-Schuster, 2017; Silove, Ventevogel & Rees, 2017; Bas-Sarmiento et al., 2017, Calear et al., 2017 and Miller-Fellows et al., 2018.

Reasons for Use of Mental Health Services

The articles included in this section are on several subtopics focus on young people that are more receptive to mental health services (Lal, Nguyen, & Theriault, 2016) and (Orlowski et al., 2016). Other articles include involuntary mental health admissions (Smith et al., 2020). The remaining articles focus on those that have been incarcerated (Han et al., 2017), Adolescent with substance abuse issues (Ali et al., 2019) and (King et al., 2018).

To make the literature review possible, studies were searched on online databases. The databases that were searched included Scopus, Science Direct, PubMed, Cuiden, Google Scholar, Cochrane, ISI, GCU database, and PsycINFO. Six key phrases were used in the study and the key phrases are similar to the six subsections of chapter 2. The phrases were reasons for rejection of mental health services, reasons for lack of access to mental health, mental health infrastructure, reasons for use of mental health services, populations that reject mental health services, populations that use mental health services, people who have access to mental health.

According to Smith et al., (2020), there has been an increase in the number of involuntary admissions to mental health facilities from 2008 to date. The researchers came to the above conclusion after they extracted publicly available data on involuntary admissions. The researchers used a regression analysis to compare predicted rates and observed admission rates. The explanation of the rise of admissions has been due to high substance abuse as well as many mental illness diagnoses. The articles' findings confirm that mental health services are sought to help those suffering from mental disorders as well as those with substance abuse challenges.

Another reason as to why there is the use of mental health services is because there is the availability of telemental health more so face to face mental health services. Orlowski et al., (2016), carried out a qualitative study that helped them reach the above conclusion. The researchers conducted semi-structured interviews with 10 people who were aged between sixteen and twenty-two years. The researchers analyzed the data they collected through inductive thematic analysis. Based on the studies, it was concluded that youth were accessing mental health services much more than before as they could do it at the comfort of their homes through technology that made it possible for a face to face remote clinic visits.

Another reason as to why mental health services are accessed is because they provide an opportunity for other forms of health services to be availed. Ali et al., (2019), used a multinomial logistic regression model to survey to understand the characteristics of adolescents that seek mental health services. The researchers used national data available from 2012 to 2015. The findings of the study revealed that the majority of the adolescents that sought mental health services in educational settings were adolescents that did not have any other health means other than public health. Through mental health services in schools, such learners could access other health services easily.

Through study findings published in 2018 by King and four other researchers, tobacco addiction and depression were the main reason that people sought mental health services. The researchers conducted an online survey that had 2370 respondents from eleven colleges in Virginia and North Carolina (King et al., 2018). They analyzed the data collected by comparing it using a depression score rating. Based on the findings it was established, that young adults seek mental health services when dealing with tobacco depression and when they are depressed.

Synthesis

Analysis of the populations that seek mental health services reveals that the population seeks mental health services because of love. The populations love themselves enough to want to secure their health. The populations love their loved ones and those around them enough to secure their health by securing their mental health. According to King et al. (2018), tobacco abusers and depressed people seek mental health services to recover health. Ali et al., (2019) provides evidence that through seeking mental health services, young learners from poor backgrounds can access other health services. According to Orlowski et al., (2016), mental health services are being sought for currently than in the past as more people are aware of the value of mental health to the overall body health. The desire to know whether mental health services are sought out for good only pushes the need for the below review.

An analysis of the studies under review reveals that the majority of the times that people seek mental health services is because they have poor mental health or that their general health is compromised. According to King et al. (2018), tobacco abusers and depressed people seek mental health services to recover health. Ali et al., (2019) provides evidence that through seeking mental health services, young learners from poor backgrounds can access other health services. According to Orlowski et al., (2016), mental health services are being sought for currently than in the past as more people are aware of the value of mental health to the overall body health. Lastly, according to Smith et al., (2020), there has been an increase of involuntary mental health admission due to poor mental health as well as substance abuse. Surprisingly, some individuals seek mental health services for abuse. According to Han et al., (2017), some individuals feign mental illness to access opioids for recreational use.

The following studies were very strong because they utilized large study sample sizes (King et al., 2018, Han et al., 2017 and Smith et al., 2020). One study was identified as weak because of a limitation. For example, Ali et al., (2019) were weak because of researcher triggered bias.

Reasons for Rejection of Mental Health Services

In this section, the articles included focus on several subtopics that include self-stigma and fear of discrimination (Carrara and Ventura, 2018) and (Luitel, et al., 2017); others focus on beliefs and perceptions of mental health (Choudhry, 2016), the unemployed population (Staiger et al., 2017) and the African-American minority communities (Memon et al., 2016),

According to Carrara and Ventura, (2018), self-stigma and fear of discrimination are the primary reasons that people reject mental health services. The duo reviewed 149 pieces of literature on mental health. Of the 149 articles, 9 were found to be the most ideal considering the researchers were studying the effects of stigma on mental health services. The findings of the study confirmed that stigma and fear of rejection caused people to stay away from seeking mental health services even when they needed it the most.

According to Staiger et al., (2017), the unemployed population rejects seeking mental health services for fear that negative mental health diagnosis can hamper their opportunities to get employment opportunities. The researchers conducted qualitative semi-structured individual interviews with 15 unemployed individuals. The analysis of the data collected was done using qualitative content analysis. Results from the study indicated that individuals perceived to have mental illnesses were treated significantly differently to other unemployed individuals when applying for employment.

In 2017, Luitel and four other researchers published that the fear of being perceived as crazy and weak made people fear and reject mental health services. In addition, the perception that mentally ill people are incapable of handling themselves as well as handling their finances makes people reject mental health services. The findings were a result of a quantitative study conducted on 1983 adults (Luitel et al., 2017). A three-stage sampling technique was employed for the study to determine why people were not open to seeking mental health services. The researchers compared the barriers to access to care with the effects of the barriers. In the end, it was established that the negative effects of confirmed mental illnesses drove people away from wanting to know their mental health status.

According to Memon et al., (2016), there are two main barriers to mental health services amongst blacks and other minority communities. The researchers conducted a Qualitative study in Southeast England. The researchers recruited 26 adults both male and female from the black and minority registry. They used thematic analysis to identify the key themes to the barrier of mental health services delivery. Based on the findings of the study, it was concluded that the inability to accept mental health challenges as a health concern caused the study group to reject mental health services. In addition, the stigma around poor mental health affected negatively the perception of mental health services.

Synthesis

Based on the analysis of the studies, it is possible to identify that the main reason that people reject mental health services is because of the stigma around mental illnesses. The majority of individuals believe that a positive diagnosis of a mental disorder makes a person a misfit that leads to rejection by community members. According to Carrara and Ventura, (2018), self-stigma and fear of discrimination are the primary reasons that people reject mental health services. Luitel et al., 2017 published that the fear of being perceived as crazy and weak made people fear and reject mental health services. According to Memon et al., (2016), the stigma around poor mental health affects negatively the perception of mental health services. Surprisingly, some individuals reject mental health services as they fear positive diagnosis can deny then income-generating opportunities. According to Staiger et al., (2017), the unemployed population rejects seeking mental health services for fear that negative mental health diagnosis can hamper their opportunities to get employment opportunities.

Not everyone is open to the idea of knowing their mental health status. Some individuals believe that mental illnesses are curses and for that reason would not subject themselves to tests that would implicate them. The majority of individuals believe that a positive diagnosis of a mental disorder makes a person a misfit that leads to rejection by community members. According to Carrara and Ventura, (2018), self-stigma and fear of discrimination are the primary reasons that people reject mental health services. Luitel et al., 2017 published that the fear of being perceived as crazy and weak made people fear and reject mental health services. To improve mental health, it is appropriate that the perceptions around mental health are known for them to be demystified. The review looks at the main reasons why mental health is rejected.

The following studies were very strong because they did not have researcher triggered biases (Luitel et al., 2017 and Memon et al., 2016). Several studies were weak because of limitations. For example (Staiger et al., 2017 and Choudhry et al., 2016) were weak because of small sample sizes.

In the mental health infrastructure section, there were four main methods used to conduct the studies under review. Three of the tools were used a similar number of times while one method was only used once. The first tool used was the case study method. Hester (2017) conducted a case study where he focused on finding out why so many military personnel are committing suicide after coming from active combat sites. Martin et al., 2016 conducted a case study analysis that involved going through data provided by the Department of Corrections where special emphasis was placed on going through the policy on the screening inmates’ mental health upon admission. Machado et al., (2018), conducted a robust multivariable negative binomial regression study on 5507 municipalities where the study focused on individuals aged 14 and 22 years. The

The second tool that was used was the survey method. Tran and Ponce (2017), reviewed survey data from 2011 and 2014 and were able to identify that California had a population of 82,706 adults with mental health needs. Kohn et al., (2018) Conducted a community-based survey of 75,306 participants who were 15 years and above. .Karaye, Ross, and Horney in 2019 conducted a 12-item Short-Form Health Survey (SF-12) that was administered online to a sample of 3030 residents.

The third tool that was used was the discursive review method. Johnson et al., (2018) conducted a discursive review of articles drawn from peer-reviewed journals, national reports, and surveys. Castillo et al., (2019) conducted a literature review of community interventions geared at improving mental health. Mongelli, Georgakopoulos, and Pato (2020) conducted an article review where the articles were drawn from peer-reviewed journals, national reports, and surveys.

The last tool that was used was the ethnography study method. Ecks in 2016 conducted an ethnographical study that revealed that mental health infrastructure in the world is limited compared to physical health infrastructure. The study focused on global mental health on policies not older than 25 years.

Based on the review, the case study method, the survey method, and the discursive review method are used widely in the study of mental health infrastructure.

Reasons for Lack of Access to Mental Health section

In the reasons for the lack of mental health section, there were five methods used to conduct the studies under review. The first tool used was the randomized controlled trial: Calear et al. (2017) conducted a two-arm, cluster-randomized, controlled trial in eight high schools with the focus being on male students in either 11th or 12th grade. The second tool used was the survey method: Kohn et al., (2018) conducted a community-based survey that involved surveying 75,306 participants who were 15 years and above; Bartolomei et al., (2016) surveyed 135 care workers and mental health caregivers.

The third tool used was the interview method: Fleury et al (2019) conducted semi-structured interviews on 49 emergency room stakeholders; through individual interviews of 15 adults aged between 61 and 81 years, Reynolds et al. (2020), identified why the access to mental health services is hard for the elderly. The fourth tool used was the literature review method: Vreeman, McCoy, and Lee (2017) conducted a review study where they reviewed 11,501 articles and publications where they focused on keywords.

The fifth tool uses was a mixed-method approach: in 2019, Chisholm and six other researchers used a multi-method approach that consisted of three phases; narrative and quantitative assessment and in-depth interviews of low-income individuals in six sub-Saharan Africa and South Asian nations in an attempt to understand the challenges in the accessing of mental health services amongst low-class individuals.

An analysis of the methods used reveals that the interview method is the most used when studying the reasons for lack of access to mental health.

People who do have access to Mental Health Section

In the people who have access to the mental health section, there were three methods used to conduct the studies under review. The first tool used was the survey method: Ferrari et al. (2016) conducted a cross-sectional survey on 260 women and used normal regression and logistic models for continuous and binary functions respectively in the analysis of the study; Brunner et al. (2019) conducted a survey on 419 patients at the department of veterans’ affairs clinics to establish which population access mental health services in the department; Knight and Winterbotham in 2020 used surveys, focus groups, and in-depth interviews to collect information from 94 older adults from urban, regional, and remote areas.

The second tool used was the text mining study method: Karystianis et al. (2018) conducted a text mining study to establish whether it is possible to identify mental health disorders from unstructured text and in the process identified that individuals of domestic violence were slotted for mental health services once they reported abuse. The third method used was the interview method: Moreau et al. (2018) conducted semi-structured qualitative interviews with 40 key stakeholders at veteran affairs medical centers.

An analysis of the method used reveals that the survey method is the most used in the study of people who have access to mental health.

Populations that Use Mental Health Services Section

In the population that uses the mental health section, there were six methods used to conduct the studies under review. The first tool used was the survey method: Chu et al., 2018 used 2008 military survey data that focused on the reports made on post-traumatic stress, depression, and other mental health complications to understand the populations that use mental health services; Sareen et al., (2016) surveyed 53477 respondents aged between 18 years and 60 years. The researchers assessed the respondents’ lifetime and past-year prevalence of suicidal ideation. The second tool used was the cross-sectional descriptive study: Gates et al. (2017) conducted a cross-sectional descriptive study on correctional facilities where the total population studied was 10,998.

The third tool used was the nested qualitative study: Hughes et al (2020), conducted a nested qualitative study to obtain the views of 100 individuals who had identified that they have sexuality challenges use mental health services. The fourth tool used was the mixed approach method: Read et al., (2018) conducted Systematic Reviews and Meta‐Analyses using PsycINFO geared at establishing the main reason why adults sought mental health services. The researchers went through 42 999 medical files as part of their review where the search items were children who had been abused or neglected.

The fifth tool used was the case study method: Mengo & Gidycz (2019) carried out a case study and reviewed cases on 154 women who were victims of intimate partner violence. The study revealed that such women were psychologically affected by the abuse to the extent that they sought mental health services; Russell et al., (2018) conducted a case study by reviewing military data of officers who have taken part in active combat as far back as in World War II. The sixth tool used was the quasi-experiment method: Morrissey et al., (2016) conducted a quasi-experiment on 895 inmates with severe mental illnesses where the researchers were interested in confirming whether the expediting of Medicaid enrollments of inmates with mental illness helped to reduce recidivism.

An analysis of the review reveals that the most preferred study method in the study of the population that uses the mental health services section is the survey method.

Populations that Reject Mental Health Services section

In the populations that reject the mental health services section there were six methods used to conduct the studies under review. The first tool used was the randomized controlled trial: Calear et al., (2017) conducted a two-arm, cluster-randomized, controlled trial aimed at establishing whether indeed males are less likely to seek mental health services compared to females or not. The study focused on young men aged between 11 and 18 years and it revealed that young men were not open to the idea of getting mental health services. The second tool used was an ethnographic study: Miller-Fellows et al., (2018) conducted an ethnographic study that established that the Amish population in Ohio was not going for mental health exams as well as they were not open to mental health services.

The third tool used was a survey: Su et al., (2016) conducted an online survey on respondents who self-identified as bisexual, gay, lesbian, and/or transgender persons aged 19 years and above from Nebraska and they identified that members of the Lesbian community reject mental health services mainly due to stigma. Rider et al., (2018) conducted a surveyed on 80 929 respondents where the survey was intended on identifying the view of teenagers as concerns mental health services; Lipari et al (2017) combined the 2012–2014 National Survey on Drug Use and all state levels among adults aged 18 or older to conclude on the population that primarily rejects mental health services. The fourth tool used was a systematic review: Bas-Sarmiento et al., (2017) conducted a systematic review using the Scopus, Science Direct, PubMed, Cuiden, Cochrane, ISI, and PsycINFO databases. Based on the findings of the study, immigrants reject mental health services as mental health complications are not viewed as normal in the immigrant population; Kantor, Knefel, and Lueger-Schuster (2017) conducted a systematic review in an attempt to understand why individuals who have experienced traumatic experiences such as rape, and physical violence are against seeking mental health services.

The fifth tool used was an interview: Silove, Ventevogel & Rees, (2017) interviewed refugees in an attempt to understand why refugees are against mental health services. The sixth tool used was the case study analysis method: Moreland, Coxe & Yang, 2018 conducted a case study analysis to understand why college athletes avoid seeking mental health services even when they need it. The seventh tool used was the cross-sectional study method: Salaheddin & Mason (2016) conducted a cross-sectional study conducted using 45 participants where it was revealed that young people are amongst the population that reject mental health services.

An analysis of the review reveals that the most preferred study method for the study of a population that rejects the mental health services section is the survey method.

Reasons for the Use of Mental Health Services section

In the reasons for the use of the mental health services section, there were four methods used to conduct the studies under review. The first tool used was the thematic study method; Lal, Nguyen, and Theriault in 2016 conducted a thematic study where 17 participants aged between 21 years and 35 years were recruited for a thematic study on mental health.

The second tool used was the case study analysis method: Smith et al., (2020) conducted a case study analysis in an attempt to understand the number of involuntary admissions to mental health facilities from 2008 to date.

The third tool used was the semi-structured interview method: Orlowski et al., (2016) conducted semi-structured interviews with 10 people who were aged between sixteen and twenty-two years to establish the effectiveness of telehealth in mental health services provision.

The fourth tool used was the survey method: Han et al., (2017) surveyed 72,600 citizens who have never been incarcerated to establish the use of mental health services; Ali et al., (2019), used a multinomial logistic regression model to analyze survey data to understand the characteristics of adolescents that seek mental health services; King et al (2018) conducted an online survey that had 2370 respondents from eleven colleges in Virginia and North Carolina to understand the role of drugs in the accessing of mental health services.

An analysis of the review reveals that the most preferred study method for the reasons for the use of the mental health services section is the survey method.

Reasons for Rejection of Mental Health Services section

In the reasons for the rejection of the mental health services section, there were five methods used to conduct the studies under review. The first tool used was the literature review method: Carrara and Ventura, (2018), conducted a literature review of 149 pieces of literature on mental health. The second tool used was the systematic review and a meta-analysis of qualitative data: Choudhry et al., (2016) carried out a systematic review and a meta-analysis of qualitative data on beliefs and perceptions of mental health. The analysis involved going through 15 publications.

The third tool used was the semi-structured interview: Staiger et al., (2017) conducted qualitative semi-structured individual interviews with 15 unemployed individuals; Memon et al., (2016) conducted a Qualitative study in Southeast England. The researchers recruited 26 adults both male and female from the black and minority registry. The fourth tool was a survey: Luitel et al, (2017) conducted a quantitative study conducted on 1983 adults.

An analysis of the review reveals that the most preferred study method for the reasons for the rejection of the mental health services section is the interview method.

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Summary

An analysis of the literature review reveals that the majority of the times that people seek mental health services is because they have poor mental health or that their general health is compromised. The convergent view is that exposure to traumatizing events leads to certain populations to seek mental health services as well as the exposure to drug and substance abuse. From the analysis, two groups are identified to have relatively easy access to mental health services. The first group is women and the other group is older adults. Based on the review, there are infrastructure and resources allocated to mental health to help out the identified groups due to their high vulnerability to mental illnesses or disorders.

An analysis of the studies reviewed reveals that the majority of the individuals or populations that have challenges in accessing mental health services are unable due to forces or circumstances out of their control. An example of such circumstances is poor infrastructure. The study by Johnson et al., 2018; Martin et al., 2016 and Ecks, 2016 are of a similar view that poor mental health infrastructure is undermining the delivery of mental health services.

Further analysis of the studies under review reveals that the populations that reject mental health services do so due to the stigma around mental complications. The majority of individuals that reject mental health services believe that a positive diagnosis of a mental disorder makes a person a misfit that leads to rejection by community members. According to Carrara and Ventura, (2018), self-stigma and fear of discrimination are the primary reasons that people reject mental health services. According to Memon et al., (2016), the stigma around poor mental health affects negatively the perception of mental health services. Surprisingly, some individuals reject mental health services as they fear positive diagnosis can deny then income-generating opportunities. According to Staiger et al., (2017), the unemployed population rejects seeking mental health services for fear that negative mental health diagnosis can hamper their opportunities to get employment opportunities.

Theories and themes. Based on the literature review three main themes emerged. The first theme was on the negative perception of mental health services. The majority of the studies reviewed indicated that many people stayed away from getting mental health services for fear of being rejected and looked upon due to the stigma around poor mental health. The second theme was that there is a poor allocation of mental health infrastructure. Despite mental health being as valuable as either type of health’s, mental health had little infrastructure allocated to it as evidenced by a few public mental health institutions. The last theme was that mental health services were mainly accessed by the female gender. Due to the patriarchal society, the majority of men refrain from getting mental health services for fear of being termed weak and unhealthy.

Limitations of the literature review. The literature review had two main limitations. The first limitation was that close to half of the studies reviewed used small sample sizes and therefore the results of the studies were not accurate representatives of the society. The second limitation of the review was that it also relied on studies that had researcher triggered biased. Some studies were confirming the biases of researchers as opposed to offering information that would help the study of mental health grow.

Findings of the literature review. An analysis of the literature review reveals that the majority of the times that people seek mental health services is because they have poor mental health or that their general health is compromised. The convergent view is that exposure to traumatizing events leads to certain populations to seek mental health services as well as the exposure to drug and substance abuse. From the analysis, two groups are identified to have relatively easy access to mental health services. The first group is women and the other group is older adults. Based on the review, there are infrastructure and resources allocated to mental health to help out the identified groups due to their high vulnerability to mental illnesses or disorders.

An analysis of the studies reviewed reveals that the majority of the individuals or populations that have challenges in accessing mental health services are unable due to forces or circumstances out of their control. An example of such circumstances is poor infrastructure. The study by Johnson et al., 2018; Martin et al., 2016 and Ecks, 2016 are of a similar view that poor mental health infrastructure is undermining the delivery of mental health services.

Further analysis of the studies under review reveals that the populations that reject mental health services do so due to the stigma around mental complications. The majority of individuals that reject mental health services believe that a positive diagnosis of a mental disorder makes a person a misfit that leads to rejection by community members. According to Carrara and Ventura, (2018), self-stigma and fear of discrimination are the primary reasons that people reject mental health services. According to Memon et al., (2016), the stigma around poor mental health affects negatively the perception of mental health services. Surprisingly, some individuals reject mental health services as they fear positive diagnosis can deny then income-generating opportunities. According to Staiger et al., (2017), the unemployed population rejects seeking mental health services for fear that negative mental health diagnosis can hamper their opportunities to get employment opportunities.

Chapter 3 documents how the study is conducted in enough detail so that replication by others is possible. The introduction begins with a summary of the research focus and purpose statement to reintroduce the reader to the study. This can be summarized in three to four sentences from Chapter 1. This section also outlines the expectations for this chapter.

Remember, throughout this chapter, that verb tense must be changed from present or future tense (proposal) to past tense (dissertation manuscript). At the dissertation stage, all comments regarding “the proposed research” or “the proposal” must be removed and edited to reflect the fact that the research has been conducted. Furthermore, consider what happened during data collection and analysis. Sometimes, the research protocol ends up being modified based on committee, AQR review, or Institutional Review Board (IRB) recommendations. After the research study is complete, make sure this chapter reflects how the study was actually conducted.

This section restates the research problem for the convenience of the reader. Then, edit, blend, and integrate the problem statement into a narrative discussion that addresses how the problem statement addresses the gap in the literature, as described in the Problem Statement section in Chapter 1. Change future tense in proposals to past tense for dissertation manuscripts.

This section restates the research question(s) (qualiative and quantitative) and the hypotheses (quantiative) for the study from Chapter 1. For a quantitative study, it then presents the matching hypotheses and explains the variables. For a qualitative study, it then describes the phenomena to be understood as a result of the study. The section also briefly discusses the approaches to collecting the data to answer the research questions. For a quantitative study, it describes the instrument(s) or data source(s) to collect the data for each and every variable. The variables are described at the conceptual, operational and measurement levels. For example, a conceptual level of a variable in a school setting may be student achievement. The operational level of the variable may be student performance in social studies. The measurement level for the variable may be individual student scores on the high stakes test, or percentage of overall students passing the test (at the school level).

For a qualitative study, this describes the instrument(s) or data source(s) to collect the data to answer each research question. It also discusses why the design was selected to be the best approach to answer the research questions, test the hypotheses (quantitative), or understand the phenomena (qualitative). Remember to change future tense to past tense for dissertation manuscripts.

This section describes the research methodology for the study (quantitative, qualitative, or mixed) and explains the rationale for selecting this particular methodology. It also describes why this methodology was selected as opposed to the alternative methodologies. This section should elaborate on the Methodology section (from Chapter 1) providing the rationale for the selected research method (quantitative, qualitative, or mixed). This section may bring in additional arguments based on the empirical studies used in the Methodology section in Chapter 2. This section justifies why the selected methodology is better than the alternative methodologies. Arguments are supported by citations from articles and books on research methodology and/or design. It is also appropriate in this section to outline the predicted results in relation to the research questions and hypotheses based on the existing literature. Learners should refer to their course e-books, specifically the RES-866 e-book (Grand Canyon University, 2016), for more information on developing this chapter.

This section elaborates on the nature of the Research Design for the Study section from Chapter 1. It includes a detailed description of, and a rationale for, the specific design for the study and describes how it aligns to the selected methodology indicated in the previous section. GCU core designs for quantitative studies include descriptive/survey, correlational, causal-comparative, quasi-experimental, and experimental. GCU core designs for qualitative designs include case study, narrative, grounded theory, and phenomenological. Additionally, this section must describe why the selected design is the best option to collect the data to answer the research questions and test the hypotheses. Learners should refer to their course e-books (Grand Canyon University, 2015, 2016, 2017b), for more information on developing this section.

This section discusses the setting, the population of interest, target population, and study sample. Researchers should identify each of these explicitly within the section. The discussion of the sample includes the research terminology specific to the type of sampling for the study. This section should include the components listed in the criterion table.

1. State the computed minimum sample size, and

2. Provide the evidence, which would be one of the following:

a. G*Power output(s) of the sample size computation(s) for the statistical procedure(s) needed to answer the research questions;

This section fully identifies and describes the types of data that will be collected, as well as the specific research materials, instruments, and sources used to collect those data (tests, questionnaires, interviews, data bases, media, etc.). Discuss the specific research materials, instrument, or source to collect data for each variable or group for a quantitative study. Discuss the specific research materials, instrument(s), or source(s) to collect information to describe the phenomena being studied for a qualitative study. Use the “Instrumentation” heading for a quantitative study. Use the “Sources of Data” heading for qualitative research. Use the “Research Materials” heading is using materials for experiments other than instruments. Use appropriate APA level subheadings for each data collection instrument, sources, or research material and place a copy of all instruments and research materials in an appendix. For example, a subheading of “Sources of Data” might be “Interviews,” which should begin a new paragraph, and the term “Interviews” should be styled as Heading 3.

If you are using an existing instrument, make sure to discuss the characteristics of the instrument in detail. For example, on a preexisting survey tool describe: how the instrument was developed and constructed, the validity and reliability of the instrument, the number of items or questions included in the survey, the calculation of the scores, and the scale of measurement of data obtained from the instrument. Learners must also obtain all appropriate use permissions from instrument authors. Please note that GCU does not recommend developing or modifying instruments for quantitative studies and permission to do so must be obtained from the Assistant Dean.

For quantitative studies, distinguish between the validated instruments and the questions added by the researcher. The latter have to be justified as (1) data for one or more variables of interest in the study (included in the analysis), or (2) data needed for the sample profile (must be relevant to the topic), or (3) combination of both. Separate appendices required for each instrument; the validated instruments (or watermarked samples thereof) have to be accompanied by authors' or vendors' permission to use. Information required for quantitative validated instruments: (1) number and labels of scales (and subscales); (2) number or items per scale (and subscale); (3) type of scale/data (e.g., Likert scales produce technically ordinal data—ONLY SOME have a format that allows for APPROXIMATION to continuous data—required justification of approximation, with references); (4) method of data aggregation (e.g., for continuous scales: sum vs. mean vs. other mathematical formula).

For quantitative studies, describe the method of instrument administration. All instruments will be administered together, in a single session via online survey. If different instruments are administered separately to different participants, generate separate data files, establish the unit of analysis and create an identification for that as the key variable that will be used to merge the files—make sure to collect data for the key variable from all participants (include the key variable in all instruments).

If using research materials for an experiment for a quantitative study, discuss in detail not only the materials, but also the structure of the experiment or study. Describe all materials and how they will be used. Describe how the participant(s) interact with the materials during the experiment. In psychology and business, an experiment can be run to collect data for experimental, correlation and causal comparative designs. If using psychology data collection software tools such as e-Prime, learners should provide a copy of the software contract showing they are licensed to use the software. Validity and reliability of the experiment and materials must be argued using literature and similar studies.

For qualitative and quantitative studies, the learner often uses data sources other than instruments. These data sources may include databases, journals, participant drawings, photographs, documents, artifacts, and media. Additionally, learners will most likely develop their own interview or focus group guide, observation checklist, or other protocol when conducting a qualitative study. Therefore, learners must describe in detail the process used to develop the instrument, including the research, literature, theory or expert in the field used to develop and justify the questions. Additionally, learners must describe how the validity and reliability of the instrument was established, which often include expert panel review, member checking, field testing and/or pilot testing.

This section describes the four key elements that together serve to produce confidence in the research procedures and results of a qualitative study. These elements constitute the overarching concept of “trustworthiness.” The four elements are credibility, transferability, dependability, and confirmability. Credibility and transferability are the qualitative version of validity, and dependability and confirmability are the qualitative version of reliability.

Learners can start this discussion by (1) defining the concept (e.g., credibility), (2) identifying the “threats” (biases or weaknesses) inherent in their methodology (design, sampling, data collection procedures and sources of data/instruments, and data analysis), and (3) describing how they will minimize such threats (e.g., reflexivity for subjective bias in qualitative data analysis). The following are steps taken by a qualitative researcher to ensure the research is trustworthy, and are from Shenton (2004, p. 73), based on Guba’s (1981) four criteria for trustworthiness. The researcher should address as many as are applicable to the design selected.

Adoption of a well-established data collection plan.

Fundamental knowledge of naturalistic inquiry, which is the essence of naturalistic inquiry is that research is conducted in natural settings, that is, in settings where the participants live or engage in activities that are relevant to the phenomenon under study. (Armstrong, 2010; Lincoln & Guba, 1985)

Deep engagement, which means sufficient time is given to listen, document, and achieve saturation of data.

Member checking, which increases the authenticity of the final transcript.

Narrative truth, which means the researcher represents the authenticity of participants’ reflections, comments, stories, and perspectives.

Negative cases and rival explanations, which include evidence that does not fit the pattern that emerges during analysis, and provide explanation.

Researcher reflexivity, which is how the researcher maintain awareness about how results unfold, documenting emerging patterns. The researcher’s positionality or “reflective commentary:” allows researcher to clearly state the lens through which the social world is interpreted and discuss how the researcher’s background influences data collection and analysis (Lincoln & Guba, 1985).

Thick description, which is the context(s) of the participants be described in a rich and detailed manner.

Triangulation via use of different data collection methods, different informants, different locations

Researcher experience, which includes a description of background, qualifications, and experience of the researcher (researcher positionality)

Thick description that provides background data to establish context of study and detailed description of phenomenon in question to allow comparisons of the context can be made to other contexts. The greater the detailed description of the phenomena, the more meaningful the results may be when informing another context.to be made.

Sampling sufficiency, which refers both to the sample size and to the appropriateness of the sample, so that the participants experience the phenomena so that the data collected from them provide insight into the phenomena.

Audit trail, which is documentation of the inquiry process.

Evidence, which includes full transcripts, careful documentation of data gathering sessions, media (audiotapes, videotapes, documents, photographs) Employment of “overlapping methods.”

An in-depth methodological description that provides a comprehensible record of how data were collected and analyzed. Meticulous description increases soundness of study that can be useful for future studies.

Records of the data analysis process, which includes codebooks, how coding schemes were developed, documentation of initial codes secondary codes, categories, with multiple examples from the dataset (interview transcripts, observational records, focus group transcripts, for example).

Clear alignment of gap, problem statement, research questions, methodology, research design.

Peer debriefing, which includes consulting with mentors or experienced qualitative researchers to discuss and receive feedback on the study, prior to, during, and after the completion of the study.

Test the strength of the analysis and interpretation, which includes checking analysis and interpretation against documents, records, recordings (the dataset).

Coding, which is clear and well defined; the naming of patterns identified in the data; patterns can include stories, ideas, specific participant-offered terms, and phrases.

Providing ample evidence to support claims.

Intercoder reliability. The extent to which two researchers, coding data based on the same codebook (an inductively developed list of codes and their definitions) code the data in the same way.

Rival explanations and negative cases. Identify examples that do not fit a pattern that is emerging. These might indicate an alternative organizing scheme, or may be the exception that proves the rule (Creswell & Miller, 2000; Patton, 1999)

Researcher reflexivity, which is how the researcher maintain awareness about how results unfold, documenting emerging patterns. The researcher’s positionality or “reflective commentary:” allows researcher to clearly state the lens through which the social world is interpreted and discuss how the researcher’s background influences data collection and analysis (Lincoln & Guba, 1985).

In-depth methodological description to allow integrity of research results to be scrutinized.

Admission or statement of researcher’s beliefs and assumptions.*

Recognition of shortcomings in study’s methods and their potential effects.*

*These are covered in the assumptions and limitations sections of the dissertation.

This section describes and defends the procedures used to determine the validity of the data collected. Validity refers to the degree to which a study accurately reflects or assesses the specific concept that the researcher is attempting to measure. Ask if what is being measured is what was set out to be measured. Researchers must be concerned with both external and internal validity. External validity refers to the extent to which the results of the study are generalizable (quantitative) or transferable (qualitative) to the population. Internal validity refers to the rigor with which the study was conducted (study design, theory instrumentation, measurements, etc.). For this section, provide specific validity statistics for quantitative instruments, identifying how they were developed. Explain specific approaches on how validity will be addressed for qualitative data collection approaches.

This section describes and defends the procedures used to determine the reliability of the data collected. Reliability is the extent to which an experiment, test, or any measuring procedure is replicable and yields the same result with repeated trials. For this section, provide specific reliability statistics for quantitative instruments, identifying how the statistics were developed. Explain specific approaches on how reliability will be addressed for qualitative data collection approaches.

This section details the entirety of the process used to collect the data. Describe the step-by-step procedures used to carry out all the major steps for data collection for the study in a way that would allow another researcher to replicate the study. Think of this section of Chapter 3 as a recipe, that needs to be carefully followed to produce the best possible study results (or “entrée”). Review the Criteria Table below for the exact requirements in this section. It is critical this section is clear, comprehensive, and details the exact steps used in the data collection process.

If you were to inset a table in this chapter, set it upas shown below. Refer to Table 1 for formatting instructions.

This section provides a step-by-step description of the procedures to be used to conduct the data analysis. The key elements of this section include the process by which raw data were prepared for analysis and then subsequently analyzed. Overall, be sure that the language used to describe the data analysis procedure is consistently used in Chapters 4 and 5.

Here is an example of a figure and its caption:

This section should demonstrate adherence to the key principles of the Belmont Report (respect, justice and beneficence) in the study design, sampling procedures, and within the theoretical framework, research problem, and questions. Learners should clearly discuss how data will be stored, safeguarded, and destroyed, as well as how the results of the study will be published. This section should also reference IRB approval to conduct the research, which includes subject recruiting, informed consent processes, and the voluntary nature of study. Please see the Figure 2 below regarding IRB approval requirements. Additionally, the learner should identify the potential risks for harm that are inherent in the study, in lieu of just listing what they are doing to ensure confidentiality. Finally, the IRB approval letter with the protocol number, informed consent/subject assent documents, site authorization letter(s), or any other measures required to protect the participants or institutions, must be included in the appendices.

IRB Alert

Please be aware that GCU doctoral learners may not screen, recruit, or collect any data until they receive Institutional Review Board (IRB) approval and obtain a signed D-50 form. IRB review occurs after the proposal is approved by AQR and the proposal defense is completed. Learners are responsible for knowing, understanding, and following the IRB submission and review processes. Screening, recruiting participants, and collecting data in advance of IRB approval is a serious research ethical violation, with legal and federal regulatory implications to the University. If a learner chooses to screen or recruit study participants, or collects data in advance of obtaining IRB approval (IRB approval letter and D-50 form), s/he will be subject to serious academic disciplinary action by the Institutional Review Board and Code of Conduct committee. This may include collecting new data or requiring the learner to start over with a new research study. In addition, the Code of Conduct committee will issue a disciplinary action that may include warning, suspension, or dismissal from the program.

Note: Learners should NEVER proceed with any aspect of participant screening, recruiting, interacting with participants, or collecting data in advance of receiving the IRB approval letter and the signed D-50 form. The chairs and committee members are trained on these requirements; however, the learner is ultimately responsible for understanding and adhering to all IRB requirements as outlined in the University Policy Handbook and Dissertation Milestone Guide.

While Chapter 1 addresses the broad, overall limitations and delimitations of the study, this section discusses, in detail, the limitations and delimitations related to the research methodology and design and potential impacts on the results. The section also describes any limitations and delimitations related to the methods, sample, instrumentation, data collection process and analysis. Other methodological limitations and delimitations of the study may include issues regarding the study design, sample in terms of size, population and procedure, instrumentation, data collection processes, and data analysis. This section also contains an explanation of why the existing limitations are unavoidable and are not expected to affect the results negatively.

This section restates what was written in Chapter 3 and provides supporting citations for key points. The summary should demonstrate an in-depth understanding of the overall research design and analysis techniques. The Chapter 3 summary ends with a discussion that transitions the reader to Chapter 4.

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This is a required Appendix for Level 2 and Level 5 Reviews.

For purposes of confidentiality, this will be removed prior to Dean’s signature and the following text will be inserted:

Site authorization(s) on file at Grand Canyon University.

This is not the D-form! Use the approval letter that you received upon IRB approval.

This Appendix is required in the full dissertation only.

This is a required Appendix. The text to the informed consent that will be provided to learners after IRB approval (at proposal stage), or the text of informed consent that was provided (without signatures) at dissertation stage, should be attached here.

This is a required Appendix.

Required for both proposal and dissertation:

Proposal must include the a priori computation of the sample size;

The dissertation must include the a priori computation of sample size, and, if the recruited sample size is smaller than the a priori sample size, it must also include a post hoc computation of the effect size at power level 0.80.

Include a screen shot (graphic image) of the G*Power output.

Additional appendices may include statistical results, interview transcripts, raw data (as appropriate), or other critical information pertinent to the dissertation. Consult with the chair on additional appendices appropriate for the dissertation.