Formalizing the Research Prospectus

Dissertation Prospectus

Factors Influencing Individuals' Decision to not Utilize Mental Health in Fort-Bend County, Texas. Comment by Reviewer: James, Usually, we do not include the actual name of the county or state. Just say mental health services in one county located in a southern state. You need to make sure you establish that this problem exists outside of this one county in Texas. You need to include the sample in the problem, purpose and RQs. Cite the theory you are using from the seminal source, which would be Bandura or Vygotsky. I provided a problem, purpose and RQ. You need at least 2 questions. See comments.

Submitted by

James Dada

November 20, 2019

The Prospectus Overview and Instructions

Dissertation Prospectus

Introduction

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the Centers for Disease Control and Prevention (CDC) and the U.S. Department of Justice, every year in the United States, millions of people suffer from mental illness. The numbers are significantly high that it requires raising public awareness and start campaigning for a much better health care system. In 2018, 47.6 million people in the U.S. experienced mental illness. This means 1 in every 5 adults. 11.4 million adults between ages 25 and 35 had an episode of serious mental illness. In 2016, 7.7 million youths aged 6-17 experienced some sort of mental health disorder, while 9.2 million people were reported to have experienced substance use disorder (National Alliance on Mental Illness, 2019). Comment by Reviewer: Left justify your work. Comment by Reviewer: Read and revise Comment by Reviewer: Fragment.

The health sector in Texas has been applauded for the good work in health allocations and expenditures. Fort Bend county, which is located within Texas, has also been on the map for having the best medical services in the country. Despite all the expenditures and better services offered to the people living in the county, Mental health sector still faces challenges. Research has shown that many Asian and African American people living in Fort Bend has little to no access and utilization of mental health services within the region (Texas 2017). This has been attributed to a number of factors which hinder most people from accessing mental health services. The poor access to this medical help has led to many people dying and committing suicide as a result of poor utilization of mental illness health services. Comment by Reviewer: This is good information, but we also need to establish that the need for this study exists outside of this county and outside of Texas. Can you do that here? Comment by Reviewer: Is this a peer-reviewed research source? Please be sure and include results of at least 3-5 studies in this section to establish that a problem exists. Comment by Reviewer: Ok, this is contradictory. You just said that Fort Bend has the best services in the country?

Fort Bend County in Texas has been recognized as one of the counties where the utilization of mental health facilities is below the expected standards. Although the Fort Bend County is one of the areas with the highest and the best health facilities within Texas, the county still faces a lot of challenges on the number of children with mental health challenges. The study will be conducted on the affected people who the African Americans, Asian Americans and the Caucasian citizens of Fort Bend County, Texas. Comment by Reviewer: Ok, based on the results of what studies on the topic?

The high mental health cases in Fort Bend County in Texas is blamed on various factors. One of the factors is the lack of enough and well-trained mental health professionals within the county. Such has resulted to lack of utilization of the mental health facilities hence the rising number of mentally challenges children. Poverty levels in the county have also been blamed for the increased number of mentally challenges children. Most of the people in the Fort Bend County have low income and cannot afford insurance hence lacking the access to mental healthcare.

Care givers in the mental healthcare clinics in Fort Bend, agreed that many people in the county laced knowledge about the mental healthcare because of their low social status within the Fort Bend County. Also, they acknowledged that they lacked enough knowledge about the importance of mental healthcare.

This paper is aimed at discussing the factors influencing individuals' decision not to utilize mental health services in Fort-Bend County, Texas. The study is important in understanding the major reasons which limit utilization of mental health services in the county and recommending ways through which the issues can be resolved. Comment by Reviewer: This is a research study.

Background of the Problem

Previous research works have explored the field of health accessibility not only in Texas but throughout the country. When narrowing downne to Fort bend in Texas, research has shown a gap alignment of medical services and needs of the people living in the county. Children at Risk (2013) deliberates on various increasing children with mental disorders’ needs in the society. Most of these develop mental illness from birth. Though Fort Bend has been applauded for having the best health services, the area still faces a number of challenges which are a threat to the child-health. Access to mental health is a gap yet to be filled in Fort bend (Beatty, Wilson, Ciecior, & Stringer, 2015). This has been fueled by few mental health professionals in Texas which has led to poor infrastructure in the mental health sector. The sectors greatly affected are the juvenile systems and emergency facilities. Many people in the region are uninsured and also have lower income which makes it had for them to get mental health services. In addition, poor parenting was a great contributor of health illness. This calls for further research into the field to understand more factors which affect the utilization of mental-health services in the areas not only in children but all people of Fort bend in Texas. Comment by Reviewer: this is six years old.

Goldman Robin & Chester (2018) argues that mental health accessibility is an issue of concern among the healthcare industry in Texas. The article carried a research to evaluate the factors which affect medical accessibility with specification of Hispanic and black Americans living in Texas. The results of the research indicated that lack of education in mental health was a major factor that affected the utilization of Mental health within the region. This has increased the deaths resulting from mental cases in the region. 56% of all the population received mental health treatment. Out of the total percentage women formed the highest number with those who had been sexually abused at their young age forming many of the women. However, due to poor education on mental health programs the treatment was under-utilized, and target groups were not sufficiently reached in the community. Comment by Reviewer: Ok, this is a research study. However, be clear that this was done with American Indian men and women. The company that sponsored this study was: Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, Rockville, MD, USA. So you are saying that this study was done in Texas? This was a quantitative study: This study investigated the effects of gender, number of lifetime psychiatric diagnoses, and childhood victimization on utilization of mental health and substance abuse treatment services in a Southwestern American Indian tribe. Correctly attribute your work. Comment by Reviewer: What region? I can’t access the full text of this study. Comment by Reviewer: Read your work carefully.

Similarly, in their 2015 research analysis, Augsberger, Yeung, Dougher, & Hahm (2015), analyzed the hidden barriers to accessing care and utilization of mental health for Asian American Women in the Fort-Bend County of Texas. It showed that 299 women representing 43% of the survey participants have suffered from symptoms of depression or have had suicidal attempts. It examined the mismatch between available services and cultural needs, contribution of Asian society to mental health and contribution of Asian family to the stigma of mental health. Comment by Reviewer: This study is not in your reference list. Comment by Reviewer: What was the purpose of the survey?

Hamilton, Desai, Hoot, Gearing, Jeong, Meyer, & Begley (2016), did research on the factors that affect mental healthcare access among African Americans. They identified one of the reasons to be low income and lack of awareness about the existing institutions that offer mental healthcare. Augsberger, Yeung, Dougher, & Hahm (2015), identified further issues that affect the accessibility of mental healthcare among Asian American women in Fort Bend County. Accordingly, the authors concluded in their research that the Asian American women are suffering from depression and often were faced with the thoughts of suicide. According to the authors, Asian American women were stigmatized because of the mental health issues, and most of them do not want to come out and seek treatment.

Misra, S. M., Guffey, D., Roth, I., & Giardino, A. P. (2017) in their article “Complementary and Alternative Medicine use in Uninsured Children in Texas”, the authors describe the concept relating to the use of complementary and alternative medicine (CAM) for mental health treatment among children in Southern Texas. According to the authors, CAM use among US children stands at 12%. According to the 2012 National Health Interview Study. The research suggests that there are a number of uninsured population due to their limited access to care, which resulted in higher CAM use. A survey of 250 uninsured patients at various pediatric facilities in a free mobile clinic program showed a very high use by Hispanic population, their rate of CAM use in the last 12 months was close to 50% among children and 60% among parents. Southern Texas has placed a lot of effort into improving the health care treatment of children; according to that 2012 research report conducted a study National Health Interview Study. Research study suggests that facilities that the services offered are inversely proportional to the allocation provided. Misra and the rest have concluded that this issue has raised a lot of concern since the mental health of the people remain to be very low despite the efforts implanted. Research showed that some institutions have released a lot of funds to run this sector. This research also showed that Sothern Texas receive the second largest allocation for mental health.

The gap identified for research in this paper is the factors that affect the utilization of Mental health facilities within Fort Bend County. Various people within the mental healthcare profession have done research on some factors that may deter people from receiving mental healthcare. The literature on the mental health gap in Fort Bend, Texas, has revealed major reasons as to why the gap exists. Stigmatization and low income are some reasons as to why the gap exists in Fort bend County, Texas. Comment by Reviewer: Ok, you need to better explain the factors... these studies do not necessarily do that .. build an argument for the need for the study.

Theoretical Foundations/Conceptual Framework and Review of the Literature/Themes

Theoretical literature

There is the need to understand the consequences of not utilizing mental health as it evolved historically. Mental health services in Texas has faced several challenges. Texas (2017) asserts that people suffering from mental illness still faces problems despite the huge costs that are directed towards the healthcare. Schwartz, (2017) in support of Texas argue that the increased growth-rate of populations in Fort Bend has impacted the health sector at large. The high population together with economic constrains has led to few medical insurances which limits access to health. The access and utilization to mental medical care for the populations living in Fort Bend has created a gap within the county (Children at Risk, 2013).

Review of the Literature

Empathic Approach: Emphasized the issues of underutilized mental health resources and non-institutionalized adults as behavioral risk factors in Southern Texas. Comment by Reviewer: Not following you here. What approach?

(Augsberger, Yeung, Dougher, & Hahm, 2015; Basu, Rehkopf, Siddiqi, Glymour, & Kawachi, 2016; De Luca, Blosnich, Hentschel, King, & Amen, 2016; Hamilton, Desai, Hoot, Gearing, Jeong, Meyer, & Begley, (2016).

Augsberger, Yeung, Dougher, & Hahm (2015) identified various issues such as the history of suicide thoughts and depression among the Asian American women, different cultural needs in Fort Bend County, Texas.

It was identified that there are certain factors that influence the underutilization of mental health services among Asian American women with a history of depression and suicide in Fort-Bend County. There is also a mismatch between available services and cultural needs, contribution of Asian society to mental health and contribution of families to the stigma of mental health. It concluded and recommended that mental health utilization should not be low among all the cultures, but rather extremely encouraged especially among women in the county (Augsberger, Yeung, Dougher, & Hahm, 2015).

Boyer, C., Greenberg, L., Chutuape, K., Walker, B., Monte, D., Kirk, J., & Ellen, J. (2017). Exchange of sex for drugs or money in adolescents and young adults: An examination of sociodemographic factors, HIV-related risk, and community context. Journal of Community Health, 42(1), 90-100. doi:10.1007/s10900-016-0234-2

The purpose of this article is to carry out an assessment on maternal health and the wellbeing of the child and how it contributes to long term mental health. It mainly focuses on the anal stage especially when the child is born. It lays an emphasis on ensuring an understanding of basic but critical pediatric care. It resulted that the hospital was able to ensure that it provides the pediatric care to the critical patients for 24 hours before and after birth. This is to make sure that young and divorced mothers know how to navigate and ensure the provision of proper mental care. Recommendations includes providing classes and courses that to the main practitioners on how to handle new parents and how to guide them into providing the required help to the children who are ill.

Goldman D., Robin R. W. & Chester B. (2018), Factors Influencing Utilization of Mental Health and Substance Abuse Services by American Health Institutions

The purpose of this article is to study the impact that gender, the number of childhood victimization and psychiatric diagnoses has on the utilization of mental health patients in the Southwestern American Indian community. In its outcome and recommendations, the article declares these factors as the main contributors in the utilization of the substance abuse and mental health when one is coming up with proper treatment interventions.

Schwartz, A. (2017). A report on the demographic changes and changing needs of fort bend county University of Texas at Austin. doi:10.15781/T2MC8RZ1M

Ariel and Peter give an analysis how population growth has affected the health status of people living in Fort Bend, Texas. There have been different studies conducted to indicate the mental status of individuals living within the country. In the outcome of the research, this article laid emphasis on the fact that many people in the population are uninsured, and that the economic challenges that the large population is experiencing is responsible in part for what is influencing individuals' decisions to not utilize Mental Health and the extent to which the community healthcare extends its services to every member. Recommendations include training and mentioning healthcare providers and caregivers on improvements that need to be done continually to ensure that the different needs of the growing population are met.

Literature Themes

Review of the literature review identified the following themes:

· Lack of proper mental health education and infrastructure has been the major factor affecting the utilization of mental health. Goldman Robin & Chester (2018) in his research found out that women who had been exposed to sexual abuse and drug abuse formed the high numbers of people who utilized mental health services among the Hispanic and non-white people in Texas. Augsberger, Yeung, Dougher, & Hahm, (2015) in support of this research argued that mental health services had been underutilized by Asian women living in fort-bend as a result of both cultural needs and mismatch of the services offered in the health facilities in Texas.

· Lack of medical insurance. Research has shown that many people due to poor economic status has left many people without health insurance as they cannot afford. This limits many average and lower-class families from accessing mental illness services (Children at Risk, 2013).

· Poor perception among the community members. Researchers reveals that many people who live in Fort Bend perceive child mental illness as a mere sign of hunger besides poor diets. This has left many people neglecting utilization of mental-healthcare in the community (Children at Risk, 2013).

The theoretical model for the research gap is the Social Development Theory. The Social Development theory is a theory done by De Luca et. al. Within the theory, the authors propose that unfavorable social conditions and chronic health issues have a role that they play in promoting mental health issues within a certain category of people. The authors made a comparison between the utilization of the mental health conditions between the African Americans, Asian Americans and the Caucasians in the Fort Bend County, Texas. Comment by Reviewer: Hmmm. Why don’t you try Vygotsky.... use the seminal source. I could not find these authors. Plus, you have no date here, so it is hard to tell if this is a seminal source. Comment by Reviewer:

It is not known what is influencing individuals' decision to not utilize mental health in Fort Bend County, Texas. It is not known how mental health providers describe the factors influencing individuals’ decision to not utilize mental health in one county located in a southern state. The research topics seek to identify the key issues that prevent the people of Fort Bend County, Texas from utilizing the mental health services and facilities yet, although, there are increasing mental health cases among the children in Fort Bend County, Texas. Comment by Reviewer: Ok, you mentioned earlier that you were looking at a specific set of individuals. First, you need to show that they are not using health services in Texas.

This problem will target, address and serve as a model of investigating factors that affect utilization of mental health in the County ofThe population of interest is...

Fort Bend, Texas. The study plans to use qualitative-descriptive-research design in carrying out the study.

The purpose of this qualitative, descriptive study is to explore how mental health providers describe the factors influencing individuals’ decision to not utilize mental health in one county located in a southern state. The purpose of the study is to come with the factors that deter the people of Fort Bend County from accessing the much-needed mental healthcare. The study will employ a qualitative study that will target the specific people within Fort Bend County who have mental challenges and yet cannot utilize the mental facilities available at Fort Bend County.

Qualitative descriptive study aims at finding out the factors that affect mental health utilization in Fort bend, Texas. The study will go ahead to come up with recommendation on how to improve the mental health accessibility in the county.

The study is going to be a qualitative descriptive study that will involve psychiatrists, therapists, caregivers and service providers' descriptions of what and why they feel people are not accessing mental health services and what must be done to change their behavior towards accessing the services. It entails utilizing interviews to collect data and to understand how successful it will be if professionals are learning more about the Fort Bend communities, and how they can contribute to improved learning outcomes.

Research questions

How do mental health providers describe factors influencing individuals’ decision to not utilize mental health in one county located in a southern state?

· RQ1. How much higher is the cost for mental health care in the county compared to the rest of Southern Texas? Comment by Reviewer: these are not research questions. These are more items that you might cover in your literature review.

· RQ2. What is the average expenditure per adult enrollee in the area for mental health care?

· RQ3. Do the facilities offer state-of-the-art treatments using research and discoveries in the field of mental health?

· RQ4. What is the average number of mental health admissions and lengths of stay at behavioral hospitals?

· RQ5. Is there a statistically significant difference in the level of utilization of mental health among the different cultures?

· RQ6. Is there a statistically significant difference in the number of isolations of behavioral hospitals

The major objective of any health sector is to improve healthcare for the citizens regardless of the sickness. Fort Bend has devoted a large share of its finances towards healthcare which has seen it shine on the national map. Despite this effort, statistics show that mental health accessibility in the county is still very low. This has been evidenced by numerous research findings. Lack of Insurance, professionals, infrastructure and education has been theorized as major sources of the problem. This project through qualitative descriptive research aims at finding the factors that affect utilization of mental healthcare and recommend better ways through which mental health utilization can be improved in the county. Comment by Reviewer: How will the results add to the results of other studies? how will the results be of value to practitioners and society? How will results add to the knowledge of social learning theory?

The most appropriate methodology that will be used in answering the research questions, and which will also address the problem statement is a qualitative descriptive methodology (Colorafi, & Evans, 2016). The qualitative approach is very effective when a phenomenon that is being queried is properly and effectively defined, and this study has distinctly defined the phenomena of factors influencing individuals' decision to not utilize Mental Health in Fort-Bend County, Texas. The methodology is preferred as it is flexible when researching on health science topic to support various medical theories. This will support the research in finding and filling the gap in the study. Comment by Reviewer: No, it does not. See the classroom assessment technique I posted in class. I gave you all a list of criteria or attributes to use here.

The design for this piece of research work will be a qualitative descriptive study that is aimed at identifying the specific issues that are deterring utilization of mental healthcare facilities in Fort Bend County, Texas. This method applies the description of the factors in play and how they affect the outcome. This technique is best suited for the research as it will provide a description of factors limiting utilization of mental healthcare in Fort Bend. Comment by Reviewer: Missing the attributes of descriptive design and how they align with the problem.

The study will utilize both unstructured and structured questionnaires in addition to face-face interviews for the research. Tools will be used in collecting primary data, while the selected group will be composed of schools besides hospitals. Furthermore, the research will take note of the factors that interviewees think can improve the mental health accessibility in the country. Comment by Reviewer: interviews.. and one questionnaire. What is the name of that questionnaire and what RQ will it address?

Approval from the University will be sought before starting the process of data collection. The dissertation will collect information from a selected group of patients to provide primary data. Data collection will only start after the candidates must have acknowledged and signed the consent form. It will be collected systematically in a way that begins with schools, interview with caregivers and service providers', interview with psychiatrists and therapists and hospitals. The process will be as follows: Comment by Reviewer: Site authorization? Informed consent? Field test of interview? How will you schedule the interviews? How will they get the questionnaire?

· Five respondents from 10 schools, hospitals, hospitals will be given questionnaires to fill be three researchers.

· Interviews will involve five respondents from every hospital and school within the county.

· Respondents will respond to both interviews and both types of questionnaires.

· Manual coding will be done to all collected data.

· Data will be checked for any errors by both parties before further processing.

· Data will be entered into SciLab for analysis.

Data Analysis Procedures

Data analysis will use descriptive analysis, and the data collected will first be manually coded in relation to the themes of the study. The coded themes will then be analyzed, and explanations given. The overall aim of the analysis will be to find factors influencing individuals' decision to not utilize Mental Health in Fort-Bend County, Texas. At the initial starting stage, individual interviews will be conducted, recorded and transcribed verbatim. This will be followed by the researcher repeatedly reading and listening to the content in order to get familiarized with it. As such, the researcher will be able to gain deeper and better familiarization with the contents; he or she will also identify the answers to those questions asked as well as identify the themes. The researcher will use the two theories selected to see if the themes from the interviews align with the theoretical framework. Comment by Reviewer: you need a research-based process. See Braun and Clarke.. again, see the discussion forum in class.. where I posted this procedure.

· Data will be collected and analyzed for the study.

· Descriptive statistics will be used in summarizing acquired data.

· Coding will be used to address the questions posed.

· A narrative summary will be developed.

The researcher may adopt the process notes and MAXDQA in organizing and visualizing data. Similarly, he or she can also adopt the Braun and Clarke’s (2006) six-step thematic analysis process in identifying the relevant patterns in the data

· Stage 1: Get familiarized with the data. At this stage, the researcher is expected to already get familiarized with the contents of the research and have a better understanding of it. This is because the researcher is the individual that will collect the data.

· Stage 2: At the second stage, the researcher is going to generate first codes regarding the significant ideas discovered in the data.

· Stage 3: This stage allows the researcher to start the search for themes through analysis and a review of the codes and to understand those that can be developed into acceptable themes.

· Stage 4: This provides the researcher the opportunity of reviewing and refining the themes and then determine whether there is any of them that needs to be removed, combined, or if they can be broken down into additional themes.

· Stage 5: The researcher is expected to define and name the themes after refining them.

· Phase 6: At this stage, the final report should be generated by the researcher.

Ethical Considerations

Before the commencement of the study, I will seek authorization form all the relevant bodies including the IRB for approval. The research will also seek authority from the University board for conducting the research. All the data collected will be purely used for research purposes and remain confidential. The data will remain free to withdrawal by respondents from the study. No personal name or organizational names which may bring conflict of interest in the research will be included. The research will remain in the custody of the University will all rights reserved. Additionally, only relevant data will be collected by the researcher and only for the sole purpose of the study. He or she must stay clear of any subjectivity in analyzing the data and must also be proactive at preventing anything that will be harmful to the participants.

References

Beatty, K. E., Wilson, K. D., Ciecior, A., & Stringer, L. (2015). Collaboration among Missouri nonprofit hospitals and local health departments: Content analysis of community health needs assessments. American Journal of Public Health, 105 Suppl 2(S2), S337-S344. doi:10.2105/AJPH.2014.3024

Children at Risk (2013), Fort Bend County Assessment, A Report on the Needs of the Community’s Children, The George Foundation and The Fort Bend Chamber of Commerce, pp. 23.

Colorafi, K. J., & Evans, B. (2016). Qualitative descriptive methods in health science research. HERD: Health Environments Research & Design Journal, 9(4), 16-25.

Goldman D., Robin R. W. & Chester B. (2018), Factors Influencing Utilization of Mental Health and Substance Abuse Services by American Indian Men and Women, pp. 1.