Descriptive Survey By Drs. Montgomery Prescod and Staci McPhaul
Abstract Stigma within the diverse population, including that which exists in how one views the healthcare system, mental health providers, and help-seeking behaviors of psychological services, has been identified as a significant barrier to access treatment and recovery. What follows is a consideration of the literature on the primary sources of perceived stigma and personal stigma related to psychological services. There are impediments to quality psychological services and cultural stigma surrounding psychological care. These include clinicians' lack of awareness of cultural issues, bias, or inability to speak the client's language, and the overall client's fear and mistrust of treatment. To investigate constructs that may impact the utilization of psychological services within the diverse minority population, we designed a descriptive survey to expand on previous research and analyze these stigmas among a sample of 161 participants, primarily members of diverse minority populations and ages 18 years and older. To express a response as to why there is a stigma towards psychological services, participants completed an online survey questionnaire on stigma around mental health services utilization. Overall, participants reported more significant perceived personal stigma than public stigma, an effect that was particularly apparent for women and those who identified as African Americans. Most participants disagreed with the agree/disagree questions assessing public stigma. Since the survey revealed that most participants' occupation were in the health care field, participants essentially agreed with the agree/disagree questions that dealt with trusting the health care system, access to treatment, and sharing worries with a mental health provider. However, participants also agreed with the agree/disagree questions that dealt with the lack of diversity of mental health care providers and insurance coverage affecting their choice to seek mental health services. Findings will help us explore solutions and make recommendations to encourage the utilization of psychological services, improve patient-provider interactions and quality of care deliver to diverse minority populations.
Stigma within the Diverse Population: Survey Research Nations can draw strengths from their cultural diversity. The full potential of a nation's diverse, multicultural society cannot possess a realization until all populations, including racial and ethnic minorities, gain access to quality health care that meets their needs. Many studies have revealed that the diverse minority populations experienced barriers to utilizing psychological services, including the cost of care, societal stigma, and the fragmented organization of services. Additional barriers include clinicians' lack of awareness of cultural issues, bias, inability to speak the client's language, and fear and mistrust of treatment. The purpose of this survey was to identify specific factors that may significantly contribute to the underutilization of psychological services within diverse minority populations and aid in the development of effective public health strategies that can bridge gaps and improve utilization within diverse minority populations. The study's implications are salient to diverse minority populations who have shown to have significant personal and public stigmas to psychological services. This study utilized a descriptive survey analysis on 161 participants who responded to the study about utilizing psychological services within diverse minority populations. Literature Review Current literature has shown diverse minority populations to have a high prevalence of avoidance of formal treatments for their mental health challenges until mental disorders become incapacitating and heavy financial burdens on communities and governments (DeFreitas et al., 2018). However, Krep (2017) submits there is great promise to improve mental health outcomes among members of diverse minority populations. There are vital factors that can influence help-seeking behaviors and contribute to the low utilization of psychological services that increase mental health disparities (Mantovani et al., 2017). For instance, a recent study done by Subica and colleagues (2019) revealed that Native Hawaiians and other Pacific Islanders (NHPIs) would rarely seek formal mental health treatments, and for reasons that are minimally understood. Data compiled on mental health disparities in diverse populations by the (APA) American Psychiatric Association (2017) suggests that most racial and ethnic groups have similar mental disorders to Caucasians but
access far fewer services. More exposure to physicians and the integration of behavioral health increases the chances of detecting mental illness and reducing disparities in access (Santiago & Miranda 2014). Research has found that for various healthcare providers, it is only through the experience of receiving anti-stigma training that they develop an awareness of the subtle and unintentional ways certain attitudes and behaviors may have contributed to stigmatizing experiences among their clients (Caman et al., 2018; Nyblade et al., 2019). Materials and methods Participants/Sample Population. The study's data collection provided an understanding of the underutilization of psychological services from diverse minority populations in North America, whose mental health profile may have been impacted. Diverse minority populations were not limited to a specific group but rather, individuals who met the study's inclusion criteria, consisting of an individual who is a diverse minority population and ages 18 years and older. Those individuals who did not identify as part of a diverse minority population and younger than age 18 were excluded from the study. Procedures. Participating in the study was voluntary. An invitation message and link to survey were sent to potential participants that fit the study's criteria to complete the survey. Participants were given a survey form, with a series of questions, with a set number of responses for them to choose from. There were no limit to the number of participants to respond to the survey, but a cutoff date and time were established. Before the participants saw the survey, informed consent was obtained before data collection during the screening process for suitable participants. If a potential candidate did not consent to the study, he/she would not have been allowed to continue to respond to survey questions. Data Analysis Plan. The descriptive survey examined specific constructs that may significantly impact the utilization of psychological services within diverse minority populations. The small group of participants representing the diverse minority populations provides their opinion, attitudes, and previous experiences on the topic. The Survey Monkey platform facilitated questionnaire administration and data analysis.
Research Question, Hypothesis, Aims, and Objectives RQ1. What are the significant factors that contribute to the underutilization of psychological services among diverse minority populations? H01. There are no significant factors that contribute to the underutilization of psychological services among diverse minority populations. Ha1. There are significant factors that contribute to the underutilization of psychological services among the diverse minority populations. The study aimed to see what factors contribute to phenomenon of underutilization of psychological service among diverse minority populations, uncover the psychological services ignored by members, and find how we can reduce this stigma and encourage psychological services utilization. This study's objective was to focus on the need to reduce stigma among members of the diverse population to increase the use of psychological services in order to improve the mental health profile of members of the diverse populations. Discussion The results from participants’ response were summarized, and allowed researchers to draw conclusions, compared previous studies, and determine which constructs were significant factors that contribute to underutilization of psychological services among diverse minority populations. It was widely agreed that lack of diversity of mental health care providers, and insufficient insurance coverage were most significant constructs that affected their choice to seek mental health services. Current research on the general topic of help-seeking behaviors by minority populations has shown a negative rate of utilizations reflected in the mental health profile of minorities compared to the general population. Treatment modalities, protocols, and assessment tools that are culturally normed to include culturally oriented practitioners and clinicians should be heavily considered to increase the utilization of psychological services within the diverse population. Overall, participants reported more significant perceived personal stigma than public stigma. This effect was particularly apparent for women (78.8%), contrary to men (21.12%) and those who identified as African Americans(82.61%) contrary to (0.62%) of participants
identified as Native American or Alaska Native, (1.24%) of participants identified as Asian or Pacific Islander, (6.21%) of participants identified as Hispanic or Latino, and (9.32%) of participants identified as other. Most participants disagreed with the agree/disagree questions assessing public stigma that involved religious background, spouse/partner, culture, occupation, and opinion of others. Since the survey revealed that most participants' occupation is in the health care field, participants essentially agreed with the agree/disagree questions that dealt with trusting the health care system, access to treatment, and sharing worries with a mental health provider. However, participants also agreed with the agree/disagree questions that dealt with the lack of diversity of mental health care providers and insurance coverage affecting their choice to seek mental health services.
Clinical Application
From the study, participants’ responses indicated the economics (individual cost of insurance coverage) and lack of representation of culturally oriented mental health care providers were the most prevalent constructs that contributed to the decreased utilization of psychological services among diverse minority populations. Participants' responses provided potential directions for further research and initiatives that may prove useful in enlightening both procedural formulation and practical implication. Mental health care providers can aid and take specific steps to reduce these barriers.
Here are a few starting points to help increase the utilization of psychological services.
Implementing a sliding scale: Expanding one’s scope of practice to facilitate those that cannot afford such services.
Create or promote initiatives: Become advocates for programs that exist or create programs that offer fully or partial funded health services for those patients that cannot afford it.
Collaborate with not-for-profit organizations: Partner with not-for-profit organizations that will match what individuals can pay to obtain quality psychological services.
Endorse policy change: Mental health care coverage would significantly enhance the utilization of psychological services for diverse minority populations. Policies that ensure the best quality of care to improve access to services, improve treatments, and better outcomes for those with mental health conditions.
Promote cultural competency: There needs to be an understanding of providing culturally responsive treatments free of judgments, predispositions, and adverse attitudes towards diverse minorities. By promoting more culturally competent clinicians, one should be available to provide treatment to meet and address the patient's needs that come from marginalized groups by providing affordable care. Conclusion The descriptive survey aimed to investigate, among the diverse minority population, the barriers that hinder their use of psychological services. Research question was asked in this study, “What are the significant factors that contribute to the underutilization of psychological services among diverse minority populations?” The Survey Monkey Platform was used to answer the research question, as participants responded and provided their opinions towards help-seeking behaviors measured on a Likert scale with a series of questions, with a set number of responses for which they choose from, respectively: strongly disagree, disagree, neutral, agree, strongly agree. Mental health care providers have a role in improving their clients' lives, which entails considering significant factors/construct influences that may affect access to treatment for the diverse minority population. Perceived public stigma and personal stigma appeared to have a differential impact on attitudes, opinions, and experiences towards utilizing psychological services. There were positive associations towards the perceived importance of care; however, individuals' lack of insurance or underinsurance may hinder an individual seeking treatment. This study can be used to build awareness and resilience, and help understand how stigma affects help-seeking behaviors among members of a population, thereby reducing public and personal stigma to increase the utilization of psychological services.
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