This document provides feedback on a dissertation prospectus from the dissertation chair, Robert Astur. Some key points made in the feedback include: 1) The prospectus does not clearly define what gap in research the study aims to address, as one cited study found no impact of patient-centered medical homes on expenditures or care. 2) More scientific citations are needed to support statements, rather than just websites. 3) Numerous grammatical and formatting errors need to be corrected before further review. The chair looks forward to discussing these issues further in their upcoming Zoom meeting and working with the student to strengthen the prospectus.

1. 36
Dissertation Prospectus Comment by Astur, Robert: Hi James,
Thanks for sharing this. I can see that you have worked hard on
this and that you have a passion for this field. We are going to
ZOOM tonight, so I want to get you back my first set of
comments before we talk. Going forward, you will need to
address a number of things:
1) It is not clear what the gap is. Why does this research need
to be done? What has been done so far and how will this
project help to close that gap? You cite one study by Bowdoin
which clearly stated that PCMH does not affect expenditures or
care. So, how is this a gap?
2) You need to provide scientific citations for your statements.
You cannot rely on CDC and other websites because they are
not peer-reviewed and are less reliable. Offhand, you have very
few citations to your work.
3) You need to proofread your work or have somebody else
proofread it. You have numerous errors throughout, and it is
not the role of me or the rest of the committee to fix these for
you. They detract from your overall writing.
I look forward to learning more from you over our ZOOM.
Thanks James!

2. Robert
Factors Influencing Individuals' Decision to Utilize Mental
Health in South Texas
The Prospectus Overview and Instructions
Prospectus Instructions:
1. Read the entire Prospectus Template to understand the
requirements for writing your prospectus. Each section contains
a narrative overview of what should be included in the section
and a table with required criteria for each section. WRITE TO
THE CRITERIA, as they will be used to assess the prospectus
for overall quality and feasibility of your proposed research
study.
2. As you draft each section, delete the narrative instructions
and insert your work related to that section. Use the criterion
table for each section to ensure that you address the
requirements for that particular section. Do not delete/remove
the criterion table as this is used by you and your committee to
evaluate your prospectus.
3. Prior to submitting your prospectus for review by your chair
or methodologist, use the criteria table for each section to
complete a realistic self-evaluation, inserting what you believe
is your score for each listed criterion into the Learner Self-
Evaluation column. This is an exercise in self-evaluation and
critical reflection, and to ensure that you completed all sections,
addressing all required criteria for that section.
4. The scoring for the criteria ranges from a 0-3 as defined
below. Complete a realistic and thoughtful evaluation of your
work. Your chair and methodologist will also use the criterion
tables to evaluate your work.

3. 5. Your Prospectus should be no longer than 6-10 pages when
the tables are deleted.
0
Item Not Present
1
Item is Present. Does Not Meet Expectations. Revisions are
Required: Not all components are present. Large gaps are
present in the components that leave the reader with significant
questions. All items scored at 1 must be addressed by learner
per reviewer comments.
2
Item is Acceptable. Meets Expectations.Some Revisions May Be
Required Now or in the Future. Component is present and
adequate. Small gaps are present that leave the reader with
questions. Any item scored at 2 must be addressed by the
learner per the reviewer comments.
3
Item Exceeds Expectations. No Revisions Required. Component
is addressed clearly and comprehensively. No gaps are present
that leave the reader with questions. No changes required.
Dissertation Prospectus
Introduction
Mental health is a major issue around the World. The United
Nations (UN, 2015), has identified the issue as one of its

4. Sustainable Development Goals. The UN expressed its
uncertainty regarding the extent at which major social
determinants of mental disorders is being addressed Worldwide
(WHO, 2015). Therefore, it is developing a conceptual
framework that will address the social determinants and aligns
it with its sustainable development goals so that it can
systematically review the evidences about the social
determinants and identify potential mechanisms and targets for
interventions (Lund, et.al, 2018). Accordingly, 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 this country, millions
of people suffer from mental illness. The high numbers
necessitate raising public awareness and start campaigning for a
much better health care system (Hamilton.et.al, 2016). In 2018,
47.6 million people in the U.S. experienced mental illness
which 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 Astur, Robert: Please can
you explain what this means? Comment by Astur, Robert:
Please can you break down this complex sentence into smaller
and more manageable sentences? Comment by Astur, Robert:
You have numerous grammatical errors in your prospectus.
Please correct them or have somebody else correct them. It is
not my role to do this, but it needs to be done. I will not
comment on this each time I see problems though, because there
are too many to comment on. Comment by Astur, Robert:
Please provide citations for these statistics.
According to Kohn, et. al, (2018), there are emphasis on the gap
in mental health treatment in the American Region when
examined through the prevalence of mental health disorders, use
of mental health services, and the global burden of disease.
Statistical data from community-based surveys of mental

5. disorders in the various countries in America including
Argentina, Brazil, Canada, Chile, and the United States etc.
were utilized. The World Mental Health Survey published data
were used in estimating professional the treatment gap. For
Canada, Chile, and Guatemala, the treatment gap was calculated
from data files. The mean, median, and weighted treatment gap,
and the 12-month prevalence by severity and category of mental
disorder were estimated for the general adult, child-adolescent,
and indigenous populations. Disability-adjusted Life Years and
Years Lived with Disability were calculated from the Global
Burden of Disease study. Mental and substance use disorders
accounted for 10.5% of the global burden of disease in the
Americas (Kohn, Ali, Puac-Polanco, Figueroa, López-Soto,
Morgan, & Vicente, 2018). Comment by Astur, Robert: What
does this mean? Comment by Astur, Robert: This details is
not necessary here. Perhaps you can use this place to describe
what the pressing issue is? Comment by Astur, Robert: I am
not sure where you are going with this yet, but you will not be
able to use such global stats if you are going to focus on the
US. I am sure there are US stats that are more readily available.
But, I will read on to see what direction you take this.
Comment by Astur, Robert: Please revisit how to cite
articles by multiple authors.
Bowdoin, Rodriguez-Monguio, Puleo, Keller, & Roche, (2018)
emphasized that patient-centered medical home (PCMH) is a
model meant for improving health outcomes while at the same
time meant to contain the cost of care. Yet, the evidence is
inconclusive. This study aims at studying and examining the
links between care provided in consistent with the PCMH and
healthcare services utilization as well as expenditures for non-
aging citizens who are suffering mental illness in the United
States. A survey that was conducted which used self-reported
data of 6908 non-aging adults suffering mental illness
participated in the 2007-2012 Medical Expenditure Panel
Survey. Participants involved in the study on utilization of
healthcare services were compared with expenditures on care

6. consistent with the PCMH, other participants include non-
PCMH usual source of care (USC), and participants without a
USC. The outcome showed differences in utilization and
expenditures between participants who were provided with care
consistent with the PCMH and the volunteers who had a non-
PCMH USC showed non statistical importance for any
healthcare services category. The conclusion demonstrated that
there are consistencies in care received with the PCMH was not
significantly linked with differences in healthcare services
utilization or expenditures when compared to having a non-
PCMH USC. Comment by Astur, Robert: Please correct this
citation in your REFERENCE section. Comment by Astur,
Robert: Why do you say this? The Bowdoin study showed that
it did not have any reduction in expenditures? Are there
conflicting studies that show that it does reduce expenditures?
Comment by Astur, Robert: Which study? Yours ? Or
another one? Comment by Astur, Robert: I am not sure how
you are interpreting this. Comment by Astur, Robert: What does
this mean to you? It means that there are no observable
differences between the groups, correct?
This is a research study will examine how mental health
providers describe the factors influencing individuals' decision
to utilize mental health services in South Texas. The study is
important in understanding the major reasons for utilizing and
reasons that limit utilization of mental health services in the
State and recommending ways through which the issues can be
resolved. Comment by Astur, Robert: At this point, it is
unclear why this is important to research – or, put another way,
why this is a gap? Comment by Astur, Robert: These are
different issues, right? Understanding the reasons is one issues.
Recommending resolution is another.
Criteria
Learner Self-Evaluation Score
(0-3)
Chair Evaluation Score

7. (0-3)
Reviewer Score
(0-3)
Introduction
This section briefly overviews the research focus or problem,
why this study is worth conducting, and how this study will be
completed.
The recommended length for this section is two to three
paragraphs.
1. Dissertation topic is introduced along with why the study is
needed.
2. Provides a summary of results from the prior empirical
research on the topic.
3. Using results, societal needs, recommendations for further
study, or needs identified in three to five research studies
(primarily from the last three years), the learner identifies the
stated need, called a gap
4. Section is written in a way that is well structured, has a
logical flow, uses correct paragraph structure, uses correct
sentence structure, uses correct punctuation, and uses correct
APA format.
NOTE: This Introduction section elaborates on the Topic from
the 10 Strategic Points. This Introduction section provides the
foundation for the Introduction section in Chapter 1 of the

8. Proposal.
Reviewer Comments:
Background of the Problem
According to the Centers for Disease Control and Prevention,
mental health has become a significant public health issue in the
United States that requires immediate attention and must be
diagnosed at its early stages. Without an early diagnosis and
treatment, children and adolescents may experience problems in
the home, at school and among friends including issues with
forming friendships (CDC, 2018). Accordingly, researchers
have explored some barriers relating to the utilization of mental
health service, notwithstanding, there were other factors that
may also influence individuals' decision to not utilize mental
health. Comment by Astur, Robert: REF Comment by
Astur, Robert: Can you elaborate and with more scientific
referencing? Comment by Astur, Robert: REF?
Results indicates that experienced providers who encounter
some level of burden may likely utilize mental services than
others who do not experience any burden. Providers that
experience high level of burden will likely 15 times or more
utilize mental health services (OR =13.70; 95% CI 10.58-17.74,
p<0.001). Similarly, the caregivers that experience serious signs
of depression or anxiety in their child or adolescent (OR=1.55;
95% CI 1.21-1.98; p<0.05) will tend to use the services more
than the caregivers who experience mild or no sign of
depression or anxiety. The mental health status of the caregiver
is of no significance and has no influence on need and
utilization (Grayson, 2016). Comment by Astur, Robert:
REF? Do you mean providers? Or patients? Comment by
Astur, Robert: REF.
I am going to stop commenting on every sentence that requires
scientific citations. In general, if you are making a statement

9. that is not common knowledge, you need to provide a scientific
citation. For example, if you are citing stats, or effects, or
outcomes, etc. All need a citation. Please try to resolve this for
your paper.
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 this
Southern State County. 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. One
Southern State 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 this Sothern State receive the
second largest allocation for mental health. Comment by
Astur, Robert: Please revisit how to cite articles. Comment by
Astur, Robert: Which? Comment by Astur, Robert: How does
this contribute to your story? Comment by Astur, Robert: Why
do you use this terminology? Can you just name the state?
Based on the data collected, a gap was identified regarding the
factors that affect the utilization of Mental health facilities
within the county. Various people within the mental healthcare

10. profession have done research on some factors that may deter
people from receiving mental healthcare. The literature on the
mental health gap in the county has revealed major reasons as to
why the gap exists. Stigmatization and low income are some
reasons as to why the gap exists in the county.
Criteria
Learner Self-Evaluation Score
(0-3)
Chair or Score
(0-3)
Reviewer Score
(0-3)
Background of the Problem
This section uses the literature to provide the reader with a
definition and statement of the research gap and problem the
study will address. This section further presents a brief
historical perspective of when the problem started and how it
has evolved over time.
The recommended length for this section is two-three
paragraphs.
1. Includes a brief discussion demonstrating how literature has
established the gap and a clear statement informing the reader
of the gap.
2
2. Discusses how the “need” or “defined gap” has evolved
historically into the current problem or opportunity to be
addressed by the proposed study (citing seminal and/or current
research).
2
3. ALIGNMENT: The problem statement for the dissertation

11. will be developed from and justified by the “need” or “defined
gap” that is described in this section and supported by the
empirical research literature published within the past 3-5 years.
2
4. Section is written in a way that is well structured, has a
logical flow, uses correct paragraph structure, uses correct
sentence structure, uses correct punctuation, and uses correct
APA format.
2
NOTE: This Background of the Problem section uses
information from the Literature Review in the 10 Strategic
Points. This Background of the Problem section becomes the
Background of the Study in Note, this section develops the
foundation for Chapter 1 in the Proposal. It is then expanded to
develop the comprehensive Background to the Problem section
and Identification of the GAP sections in Chapter 2 (Literature
Review) in the Proposal.
Reviewer Comments:
Theoretical Foundations/Conceptual Framework and Review of
the Literature/Themes
Theoretical literature
There is the need to understand the consequences of both
effective utilization and non-utilization of mental health as it
evolved historically. Mental health services in this Southern
State 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 this Southern State argue that the
increased growth-rate of populations in one specific county

12. located in a Southern State 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 to, and utilization of mental health care for the
populations living in this county has created a gap within the
State (Children at Risk, 2013).
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 utilize mental health
services among the Hispanic and non-white people in the
county. Augsberger, Yeung, Dougher, & Hahm, (2015) in
support of this research argued that mental health services had
been underutilized by Asian women living in this county, as a
result of both cultural needs and mismatch of the services
offered in the health facilities in this Southern State.
· 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 this county 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 this research gap is the Albert
Bandura, Social Cognitive Theory. The Social Cognitive
Theory: Examines the context of health promotion and disease
prevention. It helps to describe how motivations in health and
behaviors are influenced by the interaction people’s beliefs,
environment, and behaviors. It was advocated by famous
psychologists Albert Bandura (Morin, 2019).

13. Major components of the theory in relation to individual
behavior change include:
· Self-efficacy: The belief that an individual has control over
and is able to execute a behavior.
· Behavioral capability: Understanding and having the skill to
perform a behavior.
· Expectations: Determining the outcomes of behavior change.
· Expectancies: Assigning a value to the outcomes of behavior
change.
· Self-control: Regulating and monitoring individual behavior.
· Observational learning: Watching/observing outcomes of
others performance or modeled behavior.
· Reinforcements: Promoting incentives and rewards that
encourage behavior change (Eslami, Norozi, Hajihosseini,
Ramazani, & Miri, 2018).
Criteria
Learner Self-Evaluation Score
(0-3)
Chair or Score
(0-3)
Reviewer Score
(0-3)
Theoretical Foundations and/or Conceptual Framework
This section identifies the theory(s) or model(s) that provide the
foundation for the research. This section should present the
theory(s) or models(s) and explain how the problem under
investigation relates to the theory or model. The theory(s) or
models(s) guide the research questions and justify what is being
measured (variables) as well as how those variables are related
(quantitative) or the phenomena being investigated (qualitative).
Review of the Literature/Themes
This section provides a broad, balanced overview of the existing
literature related to the proposed
research topic. It describes the literature in related topic areas
and its relevance to the proposed research topic findings,

14. providing a short 3-4 sentence description of each theme and
identifies its relevance to the research problem supporting it
with at least two citations from the empirical literature from the
past 3-5 years.
The recommended length for this section is 1 paragraph for
Theoretical Foundations and a bulleted list for Literature
Themes section.
1. Theoretical Foundationssection identifies the theory(s),
model(s) relevant to the variables (quantitative study) or
phenomenon (qualitative study). This section should explain
how the study topic or problem coming out of the “need” or
“defined gap” in the as described in the Background to the
Problem section relates to the theory(s) or model(s) presented in
this section. (One paragraph)
1.5
2. Review of the Literature Themes section: This section is a
bulleted list of the major themes or topics related to the
research topic. Each theme or topic should have a one-two
sentence summary.
1.5
3. ALIGNMENT: The Theoretical Foundations models and
theories need to be related to and support the problem statement
or study topic. The sections in the Review of the Literature are
topical areas needed to understand the various aspects of the
phenomenon (qualitative) or variables/groups (quantitative)
being studied; to select the design needed to address the
Problem Statement; to select surveys or instruments to collect
information on variables/groups; to define the population and
sample for the study; to describe components or factors that
comprise the phenomenon; to describe key topics related to the
study topic, etc.

15. 1.5
4. Section is written in a way that is well structured, has a
logical flow, uses correct paragraph structure, uses correct
sentence structure, uses correct punctuation, and uses correct
APA format.
1.5
NOTE: The two parts of this section use information about the
Literature Review and Theoretical Foundations/Conceptual
Framework from the 10 Strategic Points.
This Theoretical Foundations section is expanded upon to
become the Theoretical Foundations section in Chapter 2
(Literature Review). The Theoretical Foundations and the
Literature Review sections are also used to help create the
Advancing Scientific Knowledge/Review of the Literature
section in Chapter 2 (Literature Review).
Reviewer Comments:
Problem Statement
It is not known what is influencing individuals' decision to not
utilize mental health in the United States. It is not known how
mental health providers describe the factors influencing
individuals' decision to utilize mental health services. While
there are increasing mental health cases among the children in
the county, the research topics seek to identify the key issues
that prevent the people of this county from utilizing the mental
health services and facilities.
Criteria
Learner Self-Evaluation Score
(0-3)
Chair or Score
(0-3)

16. Reviewer Score
(0-3)
Problem Statement
This section includes the problem statement, the population
affected, and how the study will contribute to solving the
problem.
The recommended length for this section is one paragraph.
1. States the specific problem proposed for research with a clear
declarative statement.
1.5
Describes the population of interest affected by the problem.
The general population refers to all individuals that could be
affected by the study problem.
1.5
Describes the unit of analysis.
For qualitative studies this describes how the phenomenon will
be studied. This can be individuals, group, or organization
under study.
For quantitative studies, the unit of analysis needs to be defined
in terms of the variable structure (conceptual, operational, and
measurement).
1.5
Discusses the importance, scope, or opportunity for the problem
and the importance of addressing the problem.
1.5
The problem statement is developed based on the need or gap
defined in the Background to the Study section.
2

17. Section is written in a way that is well structured, has a logical
flow, uses correct paragraph structure, uses correct sentence
structure, uses correct punctuation, and uses correct APA
format.
1.5
NOTE: This section elaborates on the Problem Statement from
the 10 Strategic Points. This section becomes the foundation for
the Problem Statement section in Chapter 1 and other Chapters
where appropriate in the Proposal.
Reviewer Comments:
Purpose of the Study
The purpose of this qualitative descriptive study is to
examine how mental health providers describe the factors
influencing individuals' decision to utilize mental health
services in South Texas. The purpose of the study is to come
with the factors that either influence or deter the people in the
State from accessing the much-needed mental healthcare. The
study will employ a qualitative study that will target mental
health providers within the State who are service providers that
care for the mentally challenged, and compare factors impacting
utilization and non-utilization of mental services available in
the State. The study will make recommendation on how to
improve the mental health accessibility in the State. It identified
multiple factors that are associated with both the utilization and
under-utilization of specialty mental health services among the
people living in the State such as delays in observing and
recognizing the symptoms and how to seek help, the absence of
appropriate mental health providers, and lack of health
insurance.
Criteria

18. Learner Self-Evaluation Score
(0-3)
Chair or Score
(0-3)
Reviewer Score
(0-3)
PURPOSE OF THE STUDY
This section reflects what the study is about, connecting the
problem statement, methodology & research design, target
population, variables/phenomena, and geographic location.
The recommended length for this section is one paragraph.
1. Begins with one sentence that identifies the research
methodology and design, target population, variables
(quantitative) or phenomena (qualitative) to be studied and
geographic location.
1.5
: Defines the variables and relationship of variables.
: Describes the nature of the phenomena to be explored.
1.5
Section is written in a way that is well structured, has a logical
flow, uses correct paragraph structure, uses correct sentence
structure, uses correct punctuation, and uses correct APA
format.
1.5
NOTE: This section elaborates on information in the Purpose
Statement from the 10 Strategic Points. This section becomes
the foundation for the Purpose of the Study section in Chapter 1
and other Chapters where appropriate in the Proposal.
Reviewer Comments:

19. Research Questions
The following research questions will help to guide this
qualitative study:
· RQ1: How do mental health providers describe the influence
of self-efficacy on individuals’ decision to utilize mental health
services?
· H1: Self-efficacy influences individuals’ decision to utilize
mental health services.
· RQ2: How do mental health providers describe the influence
of behavioral capacity on individuals’ decision to utilize mental
health services?
· H2: Behavioral capacity influences individuals’ decision to
utilize mental health services.
· RQ3: How do mental health providers describe the influence
of expectations on individuals’ decision to utilize mental health
services?
· H3: Expectations influence individuals’ decision to utilize
mental health services.
Criteria
Learner Self-Evaluation Score
(0-3)
Chair Score
(0-3)
Reviewer Score
(0-3)
Research Question(s) and/or Hypotheses
· The recommendation is a minimum of two research questions
along with related hypotheses and variables is required for a
quantitative study.
· Also recommended is a minimum of two research questions
along with the phenomenon description is …