DNP 896 II Project Proposal Draft

DNP 896 II Project Proposal Draft

Identification of Problem and Clinical PICOT Question

Minority groups, especially ethnic groups in the United States, have significant disparities in mental health outcomes and access to mental healthcare (Cook et al., 2018). A majority of these mental health disparities are due to commonly observed barriers such as socioeconomic and geographic barriers. However, cultural views on mental health have led to the stigmatization of mental health disorders. Such cultural views and stigma are suspected to impact the recognition of an individual’s mental health issues and mental help-seeking behaviors (Schomerus et al., 2019). This DNP project is designed to explore how mental health stigmatization among ethnic minority groups impacts their health-seeking behaviors. It aims to provide a comprehensive review of sources and characteristics of mental health stigma, explore how stigma influences mental health-seeking behaviors, review the current status of cultural competence among practitioners, and design interventions to overcome stigma and promote mental healthcare utilization among ethnic minority groups.

The developed PICO question is: In ethnic minority groups (P), what is the impact of mental health stigmatization (I) compared to other barriers of mental healthcare (C) on health-seeking behavior and mental health (O)?

Clinical Significance to Advance Practice Nursing

The DNP project goes beyond the common barriers to mental health access and utilization among ethnic minority groups to focus on the influence of mental health stigma on help-seeking behaviors and mental health outcomes. It will, therefore, make mental health providers and researchers more aware of mental health stigma among ethnic minorities and help highlight how ethnic minority groups perceive mental health problems. Therefore, the DNP project will improve advanced practice nursing, especially in mental health practice, by highlighting specific cultural factors of mental health and mental healthcare utilization among ethnic minority groups to help them design and implement targeted and culturally sensitive interventions to improve mental health utilization and outcomes among these groups.

Review of Literature

Racial and Ethnic Disparities in Mental Health

A preliminary literature review shows that a majority of past studies on mental health disparities have focused on confirming the existence of such disparities in mental health access and outcomes and the major barriers to access, including barriers certain populations face. Studies like those conducted by Cook et al. (2018) and McKnight-Eily et al. (2021) confirm the existence of such mental health disparities, with Cook et al. (2018) noting that such disparities in access and outcomes are more prevalent among racial and ethnic minorities as a compared to their White counterparts. McKnight-Eily et al. (2021) note that such racial and ethnic disparities have been much more pronounced during the COVID-19 pandemic, highlighting their pre-existence prior to the pandemic.

Factors for Mental Health Disparities

The major causes of such disparities are social, economic, and systemic in nature. Based on a preliminary review of the literature, social and economic aspects of healthcare access and utilization, such as costs of care, levels of income, and area of residence, contribute to reduced access and utilization of mental healthcare services. Most minorities are more likely to be of low-income backgrounds, living in areas and conditions with a higher risk for mental health problems and lack of mental health support systems (Cook et al., 2018; Lu et al., 2021; McKnight-Eily et al., 2021). Other barriers to access are systemic. For instance, Edbrooke-Childs and Patalay (2019) link poor healthcare utilization among ethnic minorities to racially discriminative practices among practitioners. Others, such as Fante-Coleman & Jackson-Best (2020), note that racial minority groups such as Blacks and other racial minority groups receive inadequate or delayed care as compared to White populations. Such systemic challenges in access to mental healthcare are more likely to lead to poor help-seeking behaviors.

Stigma as a Barrier to Mental Health Access

Studies are further moving from the common barriers of access to focus on cultural views and mental health and care utilization. The stigma attached to mental health from a cultural perspective is viewed as a major factor in the delayed use of professional help among individuals from minority groups. However, stigma is a multi-component, multi-phased phenomenon (Ahad et al., 2023). It can either be understood from an individual perspective or a larger community perspective. For instance, Fante-Coleman and Jackson-Best (2020) and Lu et al. (2021) link internalized stigma and community stigma to poor seeking and use of professional assistance. Regardless of the strong link between mental health stigma and mental health behaviors, there lack of comprehensive information on mental health-related stigma in the individual and ethnic community (Eylem et al., 2020), including factors of internalized stigma (Alemu et al., 2023). This makes it difficult for a single initiative to address stigma and promote health-seeking behaviors among minority groups, necessitating a paradigm shift in mental health research and practice.

Theoretical Framework

The DNP project is grounded on the Health Belief Model (HBM). The HBM points out that health behaviors, including health-seeking behaviors, are driven by an individual’s held beliefs on their susceptibility to health risk, the severity of the risk, benefits to action, perceived barriers to action, self-efficacy, and cues to action (Jones et al., 2015). The HBM supports the development of interventions to help individuals better understand health challenges, improve risk perception, and encourage behaviors that lead to actions to reduce or eliminate the risk while improving self-efficacy to sustain behavior changes (Green et al., 2020). The model will help the DNP project understand the views of ethnic minorities on mental health, the basis of stigmatization, and its relation to help-seeking behaviors, as well as help design appropriate interventions to manage and overcome stigma and promote increased utilization of mental healthcare services.

Methods

The DNP project combines both qualitative research and quantitative research methods. Both methods complement each other and allow interpretation of both types of data to support the generalizability of findings and develop specific recommendations to overcome the barriers of mental healthcare.

Participants

The DNP project focuses on racial and ethnic minority groups within the community served by Columbus Spring East and OSU Medical Center DODD Hall health facilities. These include groups such as African Americans, Hispanic groups, Asian, and Native American groups. Besides being a member of the focus groups, the inclusion criteria include individuals aged between 14 years and 65 years.

Setting

The research project will be conducted within community practice sites, including Columbus Spring East and OSU Medical Center DODD Hall clinics. Both clinics provide services within a community with diverse populations, including Whites and a large population of minority racial and ethnic groups, such as African Americans, Hispanics, and Asian communities. The clinics also utilize multidisciplinary teams, making it possible to support the study.

Intervention and Tools

The proposed research project utilizes the Attitudes Toward Seeking Professional Psychological Help Scale (ATSPPH) and a semi-structured interview that is based on the Health Belief Model for data collection. The ATSPPH will be adapted to the scenario of focus in order to comprehensively assess and understand the attitudes of racial and ethnic minorities towards mental health and seeking professional help for their mental health. A semi-structured interview tool will also be designed based on the Health Belief Model (HBM) to explore and understand an individual’s experiences and perceptions of mental health and how such experiences and perceptions influence their health behaviors.

The proposed interventions include establishing a digital mental health clinic targeting racial and ethnic minority groups aimed at improving accessibility and utilization of mental healthcare services, as well as mental health provider education on cultural, communication, collaborative competencies, and skills in practice.

Appropriate Permissions

The right permissions will be obtained before the project and research are implemented. After completion of the CITI modules, IRB approval will be obtained to ensure that all activities during and after the research meet the set ethical standards in mental health research. This includes obtaining participant informed consent, protecting participant privacy, and ensuring safety for all individuals involved in the research. The project team will also obtain permission from the administration of the two participating medical and mental health facilities to conduct the research. The research team will also utilize a validated questionnaire and evaluation scales for data collection, including seeking authorization to use the Attitudes Toward Seeking Professional Psychological Help Scale (ATSPPH). In addition, the entire research process will ensure it adheres to the best research protocols, including obtaining informed consent and permission to use any interview and data collection tools.

Evaluation Methods

The proposed project will be evaluated in three phases: the pre-project launch phase, during the project period, and the post-project phase. The proposed evaluation methods utilize qualitative and quantitative data. For instance, a pre-evaluation phase, including a pilot study, will be employed to test the appropriateness of the sample size, interview protocols, and questionnaires. Both quantitative and qualitative methods will be utilized to collect data, test, and identify the correlation between mental health stigmatization and poor health-seeking behaviors and mental health among racial and ethnic minority groups and to understand the experiences of the individual’s experiences related to mental health stigma and poor help-seeking behaviors, respectively.

The post-project evaluation will include measuring the outcomes of the intervention. This will include observing health-seeking behaviors in relation to mental health stigma, rates of mental healthcare utilization within six months of intervention, experiences within the mental healthcare system, and mental health outcomes among racial and ethnic minority groups within six months of intervention.

Plan For Sustainability of Project

Sustaining the project during and after research and implementing the selected interventions is a critical part of the research process that has been considered during the planning phase. The project will be sustained through various strategies, including integrating the entire research process, including data collection, sample observation, data analysis and interpretation, and implementation of the developed interventions into daily practice. This will include recruiting nurses and collaborating with other providers within the research settings to be a part of the project. According to Kuleto et al. (2021), nurses have a continuous presence at the bedside and within practice settings and have the capacity to provide unique perspectives that may help determine gaps in practice and research and help design, implement, evaluate, and implement evidence-based solutions. The project will also include significant partnerships with the local community, including community organizations, to promote community engagement in the research and further outcomes in the implemented interventions. Additionally, the plan for sustaining the project also includes continuously evaluating the progress of the project, including giving and receiving feedback. This will ensure the project remains focused on its core objectives.

References

Ahad, A. A., Sanchez-Gonzalez, M., & Junquera, P. (2023). Understanding and addressing mental health stigma across cultures for improving psychiatric care: A narrative review. Cureus, 15(5). https://doi.org/10.7759/CUREUS.39549

Alemu, W. G., Due, C., Muir-Cochrane, E., Mwanri, L., & Ziersch, A. (2023). Internalized stigma among people with mental illness in Africa, pooled effect estimates and subgroup analysis on each domain: Systematic review and meta-analysis. BMC Psychiatry, 23(1), 1–19. https://doi.org/10.1186/S12888-023-04950-2

Cook, B. L., Hou, S. S. Y., Lee-Tauler, S. Y., Progovac, A. M., Samson, F., & Sanchez, M. J. (2018). A review of mental health and mental health care disparities research: 2011-2014. Medical Care Research and Review, 76(6), 683–710. https://doi.org/10.1177/1077558718780592

Edbrooke-Childs, J., & Patalay, P. (2019). Ethnic differences in referral routes to youth mental health services. Journal of the American Academy of Child & Adolescent Psychiatry, 58(3), 368-375.e1. https://doi.org/10.1016/J.JAAC.2018.07.906

Eylem, O., Eylem, O., De Wit, L., Van Straten, A., Steubl, L., Melissourgaki, Z., Danlşman, G. T., De Vries, R., Kerkhof, A. J. F. M., Bhui, K., & Cuijpers, P. (2020). Stigma for common mental disorders in racial minorities and majorities a systematic review and meta-analysis. BMC Public Health, 20(1). https://doi.org/10.1186/S12889-020-08964-3

Fante-Coleman, T., & Jackson-Best, F. (2020). Barriers and facilitators to accessing mental healthcare in Canada for Black youth: A scoping review. Adolescent Research Review, 5(2), 115–136. https://doi.org/10.1007/S40894-020-00133-2

Green, E. C., Murphy, E. M., & Gryboski, K. (2020). The health belief model. The Wiley Encyclopedia of Health Psychology, 211–214. https://doi.org/10.1002/9781119057840.CH68

Jones, C. L., Jensen, J. D., Scherr, C. L., Brown, N. R., Christy, K., & Weaver, J. (2015). The health belief model as an explanatory framework in communication research: Exploring parallel, serial, and moderated mediation. Health Communication, 30(6), 566. https://doi.org/10.1080/10410236.2013.873363

Kuleto, V., Milena, I. P., Stanescu, M., Ranković, M., Šević, N. P., Păun, D., & Teodorescu, S. (2021). Extended reality in higher education, a responsible innovation approach for Generation Y and Generation Z. Sustainability 2021, Vol. 13, Page 11814, 13(21), 11814. https://doi.org/10.3390/SU132111814

Lu, W., Todhunter-Reid, A., Mitsdarffer, M. L., Muñoz-Laboy, M., Yoon, A. S., & Xu, L. (2021). Barriers and facilitators for mental health service use among racial/ethnic minority adolescents: A systematic review of the literature. Frontiers in Public Health, 9, 641605. https://doi.org/10.3389/FPUBH.2021.641605

McKnight-Eily, L. R., Okoro, C. A., Strine, T. W., Verlinden, J., Hollis, N. D., Njai, R., Mitchell, E. W., Board, A., Puddy, R., & Thomas, C. (2021). Racial and ethnic disparities in the prevalence of stress and worry, mental health conditions, and increased substance use among adults during the COVID-19 pandemic — United States, April and May 2020. MMWR. Morbidity and Mortality Weekly Report, 70(5), 162–166. https://doi.org/10.15585/

Schomerus, G., Stolzenburg, S., Freitag, S., Speerforck, S., Janowitz, D., Evans-Lacko, S., Muehlan, H., & Schmidt, S. (2019). Stigma as a barrier to recognizing personal mental illness and seeking help: A prospective study among untreated persons with mental illness. European Archives of Psychiatry and Clinical Neuroscience, 269(4), 469–479. https://doi.org/10.1007/S00406-018-0896-0

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You will write the project proposal in the format of your chosen journal. Pay attention to the suggested paragraph limits of each section so that the body of the paper is not too long (or too short).

Include a title page and reference list; use chosen journal format,*Refer to Chapter 12 in the textbook (Moran et al.) for details on the appropriate information to include in each section of the proposal noted on the rubric. Submit the proposal via assignments in Canvas, to be graded first by your course faculty advisor, and then approved by your practice mentor.