USE THE CHAPTER 1 INTRODUCTION TEMPLATE. You will write your chapter 1/introduction which is 2-4 pages in length, and also include a title page, and a list of 10 reference articles. Include your research question in a separate Word doc.
2-4 INTRODUCTION PAPER TO CAPSTONE PROJECT. SEE INSTRUCTION WORD DOC.
CAPSTONE PROJECT TOPIC: Comparative Analysis of Access to Healthcare in Rural Communities within the United States.
USE THE CHAPTER 1 INTRODUCTION TEMPLATE. You will write your chapter 1/introduction which is 2-4 pages in length, and also include a title page, and a list of 10 reference articles . Include your research question in a separate word doc.
What do you believe your research question would be?
Or in other words, what do you want to learn that would help improve rural health in the US?
***PLEASE SEE POWERPOINT ATTACHED FOR GUIDANCE***
***USE TEMPLATE FOR CHAPTER 1 INTRODUCTION***
***SEE EXAMPLE ATTACHED****
CHAPTER 1. INTRODUCTION
Introduction to the Problem
The introduction section begins with a brief discussion of the area of interest and then presents the following sub-sections:
Background of the Problem
Description of the background of the problem (brief historical perspective and explanation of why the problem remains unsolved at this time).
Statement of the Problem
The problem is presented in statement form, e.g., “The problem is …”
Purpose of the Study
This section explains why the study is being conducted. It may be (but not be limited to) one of the following: (1) to effect a change; (2) to solve a real business problem for an existing business; (3) to predict future situations; (4) to compare and contrast (strategies, technologies); (5) to develop a specific marketing program; (6) to determine the feasibility of a marketing option; (7) to conduct a marketing audit and diagnosis of the client organization; or (8) to conduct a marketing analysis of a given project, product, new market or other change in the existing marketing program.
Hypotheses or Research Questions
Hypotheses are only used in quantitative (statistical) research studies. A hypothesis statement predicts a relationship between two variables. Writing a hypothesis should always precede any actual experiments and is an important part of the scientific method. Remember … a good hypothesis statement makes clear the relationship between the variables and is always testable. Research Questions, on the other hand, are used for either quantitative or qualitative studies. The Statement of the Problem should lend itself to translation into a research question that asks precisely what this study must answer in order to (1) solve the research problem, and (2) achieve its purpose. The research question is a conceptual question, indicating the exact scope of the study.
Significance of the Study
This section provides information concerning the importance of the study. A study may be significant because it adds to the body of knowledge of business in general or is critical to the business under study.
The purpose of this section is to present some of the factors the researcher is asking the reader to accept as conditions of the study. Some examples are (1) the sample is representative of the population, (2) the appropriate variables have been selected for examination, and (3) the measurement tools are valid and reliable. Also, identify your hypothesis statement here.
These are those factors or conditions that may affect the data and are out of the researcher's control. For instance, validity and reliable issues from any surveys completed.
The purpose of this section is to summarize Chapter 1 and introduce the remaining chapters, including applicable subsections within each chapter.
References should be double-spaced, with a double-space between entries. Use the ruler to create a hanging indent.
APPENDIX A. ADD TITLE
Attach your appendix item here. If no appendices are needed, then omit this page. If more than one appendix is needed, continue to the following page, place APPENDIX B (in all caps) centered at the top of the page, the title of the appendix (in all caps), then attach the applicable item (e.g., table, figure, graph, illustration, etc.). Continue the same process as necessary for all subsequent appendices.
CHAPTER 1. INTRODUCTION
Introduction to the Problem
Untreated mental health issues are a worldwide public health concern (Chelala, 2013,
June 14). Approximately 450 million individuals suffer from some type of mental condition,
placing it as one of the leading contributors to ill-health and disability globally (World Health
Organization [WHO], 2001, October 4). According to the WHO (2001, October 4), although
there are existing treatments available, about two-thirds of people with a mental disorder do not
seek assistance from traditional services due to barriers such as stigma, discrimination and
disregard for health, which may result from a lack of understanding of mental health.
Background of the Problem
Great concern is seen with the mental health of Asian communities among developed
countries of North America (American Psychological Association [APA], 2016; Farah, Khanlou,
& Tamim, 2014). They are known to represent a vast population that is continuing to increase,
hold a prevalence of mental health issues, and are notably recognized to underutilize mental
health services (Leong, 2011). For example, the United States, known as a melting pot of diverse
cultures, has an Asian represents the fastest-growing race group with an estimated amount of
17.3 million residents (Hoeffl, Rastogi, Kim, & Shahid, 2014). As a result, 13% of the Asian
American and Pacific Islanders (AAPIs) in the United States – totaling 2.2 million people – are
diagnosed with a mental illness in a given year (Mental Health America, 2016). In fact, one-third
of this population size utilizes mental health services (Abe-Kim et al., 2007). Research has
analyzed different Asian cultures and their subgroups, reporting that many that go undiagnosed
and untreated (Bauer, Chen, & Alegria, 2010; Derr, 2016).
Canada is another country experiencing a significant growth in their population of Asians
with a reported 4.5 million people (Asian Pacific Foundation of Canada, 2016). Studies reveal
that 1 in 5 Canadians will experience a mental illness at some point in their lifetime (Canadian
Mental Health Association, 2016). More concern is seen among South Asians, which represent
the largest visible minority group (1.26 million) in that country alone (Farah, Khanlou, &
Tamim, 2014). In Canada, the highest rate of South Asian people with unmet healthcare
treatment needs who have a major depression disorder was reported at 48%, with 33% indicating
that they had experienced barriers to accessing mental health services when compared to five
other ethnic groups, including Japanese, Chinese, Koreans, Aboriginals, and Whites (Gadalla,
Studies analyzing Asian subgroups in their foreign countries have recognized various
barriers affecting their ability to access treatment, such as shame and stigma culture (David,
2010), lack of mental health literacy (Nguyen & Bornheimer, 2014), lack of health insurance
(Lee & Matejekowski, 2012), and immigrant status (Kim & Keefe, 2010). Identifying and
understanding these and other perceived barriers to mental health issues among the Asian
population is imperative in order produce better tailored interventions which, in turn, will allow
them to receive the most appropriate assistance (National Alliance of Mental Illness, 2011).
In order to facilitate solution efforts made by public health professionals and policy
makers, research should continue to address all factors impacting their access to mental health
services (Snowden & Yamada, 2005). Much of recent published research has studied barriers
either as a single factor (e.g., language proficiency, stigma, acculturation difficulties) affecting
one specific Asian group (e.g., Asian refugees, Asian elderly immigrants, Asian American
college students) (Lai & Surood, 2013; Leong, 2011; Shannon, Vinson, Cook, & Lennon, 2016)
or collectively with other ethnic minority groups (Abe-Kim et al., 2007). There have been few
reports which have offered summarized data on barriers to health care treatment (Kim & Keefe,
2010), but no comprehensive review of the issue. Recent relevant systematic reviews are specific
to access to treatment (Greenwood, Habibi, Smith, & Manthrope, 2015), language barriers
(Ohtani, Suzuki, Takeuchi, & Uchida, 2015) and the impact of mental health-related stigma
(Akutsu & Chu, 2006).
Statement of the Problem
Asian populations in developed countries of North America experience barriers to mental
health services. Research aiming to learn more about each of the individual Asian sub groups
will offer critical details to assist with development of personalized mental health interventions,
thereby providing each one with the essential support that result in decreasing the prevalence and
incidence of mental health issues (Leong & Kalibatseva, 2011). In fact, the “one size fits all”
method has been shown to have limited effectiveness over time (Betancourt, Green, Carrillo, &
Park, 2005, para. 18). Research has also identified how tailored approaches to health care, such
as cultural competency are found to improve health outcomes as well as the quality of care
(Health Policy Institute, 2004).
Purpose of the Study
Taking various forms, and experienced at different levels of intensity, mental illness is a
common health issue affecting many individuals not only in North America, but worldwide.
Several studies have examined barriers to mental health services among Asian subgroups
collectively, but there is very little research separating the separating them to gather their
similarities and differences in mental illness among them (Leong & Kalibatseva, 2011).
Therefore, the aim and scope of this systematic literature review is to provide a comprehensive
synthesis of barriers to mental health services found among Asian groups living in North
America. Furthermore, reveal which factors giving the most hindrance among Asian populations,
and identify barrier trends among the Asian subgroups.
This project aims to answer the following research question: What are the major barriers
preventing Asian populations from seeking mental health services?
Significance of the Study
According to data and findings collected from the Substance Abuse and Mental Health
Services Administration (SAMHSA), the Social Security Administration, and the National
Comorbidity Survey – Replication (NCS-R), the National Institute of Mental Health (NIMH)
estimates an excess of $300 billion of total annual expenses are related to serious mental illness
which affects about 6% of the adult population. Furthermore, the approximate total amount spent
on all items associated with mental illness is rooted from the direct expenditures (e.g., treatment,
mental health services), as well as indirect expenditures consisting of losses resulting from
disability related to the mental condition (e.g., lost earnings, disability support) (NIMH, 2016a).
Lost earnings alone for serious mental illness costs the U.S. about $193.2 billion per year (Insel,
2008). The objectives of this systematic literature review are to analyze a collection of numerous
studies published in the past 11 years, identifying barriers hindering Asian populations in the
U.S. and Canada from receiving mental health care services and to highlight the trending barriers
found among individual Asian subgroups.
The systematic literature review was conducted by a single author; therefore, the
assumption is that the validity of the results may be affected as there is a risk of bias during the
assessment of studies. It is further assumed that production of generalize results can be found as
majority of the research studies involved quantitative methodology involving large populations.
Lastly, the review can be replicated as it follows a step-by-step systematic process of collecting,
examining, and synthesizing data from research studies.
The review consisted exclusively of peer-reviewed articles published within an 11-year
timeframe. Credible online resources and books were not included as they posed potential
complications with coding and issues with data analysis. Due to these limitations, the review
may have not examined all pertinent articles. Although, there is certainty that the results may not
have differed significantly if there were more articles included. The majority of the studies were
conducted in the U.S. and a few from Canada. The review itself uncovered commonalities in
barriers to mental health services (e.g., stigma, strong cultural adherence among older
immigrants) between both Asian Americans and Asian Canadians which contributed more
knowledge of the Asian subgroups found in developed countries. Unfortunately, it does not
reflect all barriers found in populations located in other developed nations within North America.
In addition, bias may have occurred during the article selection process (e.g., setting of inclusion
and exclusion criteria) and the reviewing stages (e.g., coding) due to the examination being
conducted by one author.
There is scarce research examining the unique barriers to mental health services among
the individual Asian subgroups. It creates a challenge for public health professionals to develop
effective interventions for these people who have been identified as one of the populations
experiencing a high incidence of mental health issues in North America. The intention of the
systematic literature review is to provide a comprehensive synthesis of distinct barriers found in
each Asian subgroup and identify influences contributing the greatest challenge to seeking help
for their mental illnesses.
Chapter 2 consists of a literature review of past research providing its history and current
state, which will provide support to the given public health issue. Chapter 3 includes the
methodology of the systematic literature review consisting of the description of the participants,
as well as the inclusion and exclusion of studies selected. Chapter 4 discusses the data collection
procedures, analysis, and results. Lastly, the project closes with Chapter 5, which provides
further discussion, conclusions, as well as recommendations for future studies.
Abe-Kim, J., Takeuchi, D., Hong, S., Zane, N., Sue, S., Spence, S. S., . . . Alegria, M. (2007).
Use of mental health-related services among immigrant and US-born Asian Americans:
Results from the National Latino and Asian American Study. American Journal of Public
Health, 91(1), 91-8.
Akutsu, P. D., & Chu, J. P. (2006). Clinical problems that initiate professional help-seeking
behaviors from Asian Americans. Professional Psychology: Research and Practice,
Asian Pacific Foundation of Canada. (2016). Proportion of total population of major Asian
ethnic groups by selected metropolitan areas. Retrieved from
Bauer, A. M., Chen, C. N., & Alegria, M. (2010). English language proficiency and mental
health service use among Latino and Asian Americans with mental disorders. Medical
Care, 48(12), 1097-1104.
Betancourt, J. R., Green, A., Carrillo, E., & Park, E. R. (2005) Cultural competence and health
care disparities: key perspective and trends. Health Affairs, 24(2). 499-505.
Canadian Mental Health Association. (2016). Fast facts about mental illness. Retrieved from
Chelala, D. (2013, June 14). Untreated mental health issues: A global reality. Movement for
Global Mental Health. Retrieved from http://www.globalmentalhealth.org/untreated-
Farah, I., Khanlou, N., & Tamim, H. (2014). South Asian population in Canada: Migration and
mental health. BMC Psychiatry, 14, 154.
Gadalla, T. (2010). Ethnicity and seeking treatment for depression: A Canadian society. Journal
of Health Social Behavior, 44(3), 233-245.
Health Policy Institute. (2004). Cultural competence in health care: is it important for people
with chronic conditions? Retrieved from https://hpi.georgetown.edu/agingsociety/
Hoeffel, E., Rastogi, S., Kim, M., & Shahid, H. (2014). The Asian population: 2010. U.S. Census
Bureau. Retrieved from https://www.census.gov/prod/cen2010/briefs/c2010br-11.pdf
Insel, T. R. (2008). Assessing the economic costs of serious mental illness. American Journal of
Psychiatry, 165(6), 663-665. Retrieved from http://dx.doi.org/10.1176/appi.ajp.2008.
Kim, W., & Keefe, R. (2010). Barriers to healthcare among Asian Americans. Social Work in
Public Health, 25, 286-295.
Lai, D.W., & Surood, S. (2013). Effect of service barriers on health status of aging South Asian
immigrants in Calgary, Canada. Health and Social Work, 38(1), 41-50.
Lee, S., & Matejkowski, J. (2012). Mental health services utilization among non-citizens in the
United States: Findings from the national Latino and Asian American study.
Administration and Policy in Mental Health and Mental Health Services, 39(5), 406-418.
Leong, F. (2011). Cross-cultural barriers to mental health services in the United States. The Dana
Foundation. Retrieved from http://www.dana.org/Cerebrum/Default.aspx?id=39458
Leong, T. L., & Kalibatseva, Z. (2011, March 23). Cross-cultural barriers to mental health
services in the United States. The Dana Foundation. Retrieved from
Mental Health America. (2016). Asian American/Pacific Islander communities and mental
health. Retrieved from http://www.mentalhealthamerica.net/issues/asian-americanpacific-
National Alliance on Mental Illness. (2011). Asian American teenage girls have highest rates of
depression. NAMI Releases Report. Retrieved from http://www.nami.org/Press-
Nguyen, D., & Bornheimer, L. (2014). Mental health service use types among Asian Americans
with a psychiatric disorder: Consideration of culture and need. Journal of Behavioral
Health Services and Research, 41(4), 520-528.
Shannon, P., Vinson, G.A., Cook, T. L., & Lennon, E. (2015). Characteristics of successful and
unsuccessful mental health referrals of refugees. Administration and Policy in Mental
Health and Mental Health Services Research, 43(4), 555-568.
Snowden, L., & Yamada, A. (2005). Cultural differences in access to care. Annual Review of
Clinical Psychology, 1, 143-66.
World Health Organization. (2001, October 4) Mental disorders affect one in four people.
Retrieved from http://www.who.int/whr/2001/media_centre/press_release/en/
The Capstone Project
Table of Contents
WHAT I FOUND
WHAT IT MEANS
Chapters are easier to read if they have a logical
internal sequence, for example
What is the problem?
What is to be done?
What is already known about the problem?
How did your project address the problem?
What did your project find?
What do the results mean?
Each section should lead logically to the next.
This section should
• Summarize what is established
• Discuss the significance of this work and identify the consequences of this work in the context of the capstone project
• Raise issues that follow from this, that remain to be addressed (leading to the conclusion, without actually stating it, that there is a need to extend the research further in a particular area).
• Provide a compelling justification for the work presented.
Identify the Health Issue
Illness, Death, Disability, Disorder
Example: Coronary Heart Disease in the United States
Justify its importance
Leading Cause of death, prevalence, incidence, trends, cost for both genders and most ethnic groups
Example: CHD is leading cause of death in the United States
Specific Aspect of Health Issue you will address
Reduce cholesterol levels, prevent falls in hospital
Example: Reducing cholesterol levels will lead to reduction in CHD deaths
Limit to 2-4 pages