Running Head METHODS PAPER 1METHODS PAPER Dayana Lewa.docx

Running Head: METHODS PAPER 1
METHODS PAPER
Dayana Lewandowski
Florida International University
HSA 6717
March 3, 2020
METHODS PAPER 2
Background and Introduction
The National Health and Nutrition Examination Survey
(NHANES) program studies the
design and nature of the health and nutrition basis as allocated
to children and adults in the
United States of America. Data and data sets can be accessed
that align to statistics that are vital
in delivery of field of health care attention and are significant
measures of the health and
nutrition needs and requirements as needed. Disease prevention
and control concentrates on

unleashing the responsibility of the health and nutrition
delivered to patients and individuals in
access and distribution of health care. Health and nutrition are
delivered to individuals in special
programs that focus on the essential needs of the people and the
patients at large. Different
research designs have been examined to discover the impact and
importance of good health and
nutrition to individuals in the day to day encounters.
Statement of the problem
The United States of America and other nations face one big
problem of health and
nutrition which mainly focuses on altering the normal
operations and functioning of the
individuals in their work on daily basis. Bad health services and
awful nourishment bring down
the accomplishment of residents in the United States of America
which thusly expands the
medical issues and different issues experienced in everyday
experiences. Numerous individuals
are confronted with one significant issue of expanded wellbeing
and sustenance issues which
caution on expanded impacts, melancholy, stress, monetary

ineffectiveness among different
issues.
METHODS PAPER 3
Purpose of the study
The research is meant to discover and evaluate the importance
and implications of good
health and nutrition to citizens in effort to solve the social and
economic issues that arise from
deteriorated and reduced health and nutrition in the United
States of America. The study will
apply different designs that create alarm on the importance of
good health and nutrition as
uncovered and as provided by the National Health and Nutrition
Examination Survey
(NHANES). Bad health care and bad nutrition lowers the
success of citizens in the United States
of America which in turn increases the health problems and
other issues experienced in the day
to day encounters. Many people are faced with one major
problem of increased health and
nutrition issues which alarm on increased effects, depression,
stress, economic unproductivity

among other issues.
Literature review
According to the data and information reviewed from the
National Health and Nutrition
Examination Survey (2018), health and nutrition plays an
important role in the development of
every individual because total disease and other defects on the
nutrition normally affects the way
and manner in which the American citizens interact with one
another and how they deliver
unique deliverables in the daily encounters. National Center for
Health Statistics (US) (2014)
came out to be effective on the plan and implementation of good
health and nutrition which form
a basis for thriving national health and nutrition as a key
indicator of economic success and
dominance.
Mariceli Comellas Quinones
11810000000073509
The literature review must be extensive. This is not a literature
review.
METHODS PAPER 4

Research Methods
Qualitative and quantitative research methods will be applied to
sort and categorize the
data and data sets assessed which will be the primary basis for
the research and study. It is
important to determine the causes of reduced health and
nutrition as well as the repercussions of
the deteriorating health and nutrition in individuals which have
an impact on economic activities
and development.
References
National Center for Health Statistics (US). (2014). Plan and
operation of the third National
Health and Nutrition Examination Survey, 1988-94 (No. 32). US
Department of Health
and Human Services, Public Health Service, Centers for Disease
Control and Prevention,
National Center for Health Statistics.
National Health and Nutrition Examination Survey, (US).
(2014). Plan and operation of the third
National Health and Nutrition Examination Survey, 1988-94
(No. 32). US Department of

Health and Human Services, Public Health Service, Centers for
Disease Control and
Prevention, National Center for Health Statistics.
Mariceli Comellas Quinones
11810000000073509
This is incomplete and thus I cannot grade
Principles of Marketing Version 2.0
By
John F. Tanner, Jr. and Mary Anne Raymond
687922
Principles of Marketing Version 2.0
John F. Tanner, Jr. and Mary Anne Raymond
Published by:
Flat World Knowledge, Inc.
One Bridge Street
Irvington, NY 10533
This work is licensed under the
Creative Commons Attribution-Noncommercial-Share Alike 3.0
Unported License.
To view a copy of this license,
visit http://creativecommons.org/licenses/by-nc-sa/3.0/ or send

a letter to
Creative Commons, 171 Second Street, Suite 300, San
Francisco, California, 94105, USA.
Printed in North America
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Brief Contents
About the Authors
Acknowledgments
Preface
What Is Marketing?
Strategic Planning
Consumer Behavior: How People Make Buying Decisions
Business Buying Behavior

Market Segmenting, Targeting, and Positioning
Creating Offerings
Developing and Managing Offerings
Using Marketing Channels to Create Value for Customers
Using Supply Chains to Create Value for Customers
Gathering and Using Information: Marketing Research and
Market
Intelligence
Integrated Marketing Communications and the Changing Media
Landscape
Public Relations, Social Media, and Sponsorships
Professional Selling
Customer Satisfaction, Loyalty, and Empowerment
Price, the Only Revenue Generator
The Marketing Plan
Index
1
2
3
5Chapter 1
5
11
13
15
20
22

23Chapter 2
23
25
34
38
40
43
44
45Chapter 3
46
60
65
67
69Chapter 4
69
72
77
80
84
88
91
93
95Chapter 5
95
99
Contents

About the Authors
Acknowledgments
Preface
What Is Marketing?
Defining Marketing
Who Does Marketing?
Why Study Marketing?
Themes and Organization of This Book
Discussion Questions and Activities
Endnotes
Strategic Planning
The Value Proposition
Components of the Strategic Planning Process
Developing Organizational Objectives and Formulating
Strategies
Where Strategic Planning Occurs within Firms
Strategic Portfolio Planning Approaches
Endnotes
Consumer Behavior: How People Make Buying Decisions
Factors That Influence Consumers’ Buying Behavior
Low-Involvement Versus High-Involvement Buying Decisions
and the
Consumer’s Decision-Making Process
Endnotes

Business Buying Behavior
The Characteristics of Business-to-Business (B2B) Markets
Types of B2B Buyers
Buying Centers
Stages in the B2B Buying Process and B2B Buying Situations
International B2B Markets and E-commerce
Ethics in B2B Markets
Endnotes
Market Segmenting, Targeting, and Positioning
Targeted Marketing versus Mass Marketing
How Markets Are Segmented
110
114
116
118
119Chapter 6
119
125
128
131
135
136
139Chapter 7
140
146

155
156
157Chapter 8
157
164
169
173
176
180
182
183Chapter 9
185
189
194
198
201
202
203Chapter 10
205
212
229
231
233Chapter 11
233
238
Selecting Target Markets and Target-Market Strategies
Positioning and Repositioning Offerings

Endnotes
Creating Offerings
What Composes an Offering?
Types of Consumer Offerings
Types of Business-to-Business (B2B) Offerings
Branding, Labeling, and Packaging
Managing the Offering
Developing and Managing Offerings
The New Offering Development Process
Managing New Products: The Product Life Cycle
Endnotes
Using Marketing Channels to Create Value for Customers
Marketing Channels and Channel Partners
Typical Marketing Channels
Functions Performed by Channel Partners
Marketing Channel Strategies
Channel Dynamics
Endnotes
Using Supply Chains to Create Value for Customers
Sourcing and Procurement
Demand Planning and Inventory Control
Warehousing and Transportation
Track and Trace Systems and Reverse Logistics

Endnotes
Gathering and Using Information: Marketing Research and
Market
Intelligence
Marketing Information Systems
Steps in the Marketing Research Process
Endnotes
Integrated Marketing Communications and the Changing Media
Landscape
Integrated Marketing Communications (IMC)
The Promotion (Communication) Mix
240
243
245
252
254
259
260
261Chapter 12
262
267
269
270
271Chapter 13

271
277
282
287
290
295
298
299Chapter 14
299
304
310
315
320
321
323Chapter 15
323
326
330
337
338
339Chapter 16
339
341
350
355
358
359
Factors Influencing the Promotion Mix, Communication

Process, and
Message Problems
Advertising and Direct Marketing
Message Strategies
The Promotion Budget
Sales Promotions
Endnotes
Public Relations, Social Media, and Sponsorships
Public Relations Activities and Tools
Social Media
Endnotes
Professional Selling
The Role Professional Salespeople Play
Customer Relationships and Selling Strategies
Sales Metrics (Measures)
Ethics in Sales and Sales Management
Integrating Sales and Marketing
Outsourcing the Sales Function
Customer Satisfaction, Loyalty, and Empowerment
Customer Communities
Loyalty Management
Customer Satisfaction
Ethics, Laws, and Customer Empowerment
Endnotes
Price, the Only Revenue Generator

The Pricing Framework and a Firm’s Pricing Objectives
Factors That Affect Pricing Decisions
Pricing Strategies
Endnotes
The Marketing Plan
Marketing Planning Roles
Functions of the Marketing Plan
Forecasting
Ongoing Marketing Planning and Evaluation
Endnotes
361Index
Source: Photo by Lilly Tanner, used with permission.
About the Authors
JEFF TANNER
John F. (Jeff) Tanner, Jr., is professor of marketing at the
Hankamer School of Business,
Baylor University. He is an internationally recognized expert in
sales and sales manage-
ment. He is the author or coauthor of twelve books, including
two best-selling text-
books with McGraw-Hill—Selling: Building Partnerships and
Business Marketing: Con-
necting Strategy, Relationships and Learning. His books have

been translated into sever-
al languages and distributed in over thirty countries.
Dr. Tanner spent eight years in marketing and sales with
Rockwell International
and Xerox Corporation. In 1988, he earned his PhD from the
University of Georgia and
joined the faculty at Baylor University, where he currently
serves as the research direct-
or of the Center for Professional Selling.
In addition to writing and research, Dr. Tanner maintains an
active consulting and
training practice. Recent clients include IBM, Hillcrest Medical
System, and others. He
is the managing partner of Team Fulcrum, which conducts sales
training and market-
ing research, and he is a founder and research director of BPT
Partners, the premier
training and education company focused on advancing the skills
and competency of
professionals in the customer relationship management industry.
MARY ANNE RAYMOND
Mary Anne Raymond is a professor and chair of marketing at
Clemson University. Pri-
or to joining the faculty at Clemson, she served on the faculty at
American University
in Washington, DC, and helped coordinate the graduate
marketing program at Johns
Hopkins University. Previously, she was an invited Fulbright
Professor of Marketing at
Seoul National University in Seoul, Korea.
Dr. Raymond received her PhD from the University of Georgia.
She has extensive

industry experience doing strategic planning and acquisition
analysis, marketing re-
search, and investment analysis for Holiday Inns, Inc.; Freeport
Sulphur; and Howard,
Weil, Labouisse, Friedrichs. Dr. Raymond also does consulting,
seminars, and market-
ing training for multinational companies, which have included
organizations such as
Merit Communications in Seoul, Korea; the Conference Center
and Inn at Clemson
University; and Sangyong Group.
Her research focuses on strategy in domestic and international
markets, public
policy issues, and social marketing. Dr. Raymond has published
over one hundred pa-
pers appearing in journals such as International Marketing
Review, the Journal of Ad-
vertising Research, the Journal of Marketing Education, the
Journal of Personal Selling
and Sales Management, and the Journal of Public Policy and
Marketing, as well as nu-
merous other journals and international conference proceedings.
Dr. Raymond has also
received numerous awards and recognition for her teaching and
research. She received
the Professor of the Year Award from Clemson University
Panhellenic Association, the
Undergraduate Teaching Excellence Award from the College of
Business and Behavior-
al Science at Clemson three times, the Eli Lilly Faculty
Excellence Awards for Outstand-
ing Research and Outstanding Teaching, and the Eli Lilly
Partnership Awards, and re-
cognition for Leadership in Student Development from the Dow
Chemical Company.

Acknowledgments
The authors would like to thank the following reviewers for
their feedback, which helped shape the second edition:
< Stephen M. Berry, Anne Arundel Community College
< Bob Conrad, Ph.D., APR, Conrad Communications, LLC.
< Ted Lapekas, SUNY/Empire State College
< Donald G. Purdy, University at Albany
< Elizabeth F. Purinton, Marist College
< Kelly Sell, Bucks County Community College
< Richard L. Sharman, Lone Star College-Montgomery
< Gary Tucker, Northwestern Oklahoma State University
< Gregory R. Wood, Canisius College
< Anne Zahradnik, Marist College
The authors would like to thank Camille Schuster for her input,
examples, and feedback on the first edition chapters. The
authors
would also like to thank the following colleagues who have
reviewed the first edition text and provided comprehensive
feedback and
suggestions for improving the material:
< Christie Amaot, University of North Carolina, Charlotte
< Andrew Baker, Georgia State University
< Jennifer Barr, The Richard Stockton College of New Jersey
< George Bernard, Seminole Community College
< Patrick Bishop, Ferris State University
< Donna Crane, Northern Kentucky University
< Lawrence Duke, Drexel University
< Mary Ann Edwards, College of Mount St. Joseph
< Paulette Faggiano, Southern New Hampshire University
< Bob Farris, Mt. San Antonio College

< Leisa Flynn, Florida State University
< Renee Foster, Delta State University
< Alfredo Gomez, Broward College
< Jianwei Hou, Minnesota State University, Mankato
< Craig Kelley, California State University, Sacramento
< Marilyn Liebrenz-Himes, George Washington University
< Alicia Lupinacci, Tarrant County College
< John Miller, Pima Community College, Downtown
< Melissa Moore, Mississippi State University
< Kathy Rathbone, Tri-County Community College
< Michelle Reiss, Spalding University
< Tom Schmidt, Simpson College
< Richard Sharman, Lonestar College
< Karen Stewart, The Richard Stockton College of New Jersey
< Victoria Szerko, Dominican College
< Robert Winsor, Loyola Marymount University
Preface
Principles of Marketing 2.0 by Tanner and Raymond teaches the
experience and process of actually doing marketing—not just
the
vocabulary. It carries five dominant themes throughout in order
to expose students to marketing in today’s environment:
1. Service-dominant logic—This textbook employs the term
“offering” instead of the more traditional first P—product. That
is
because consumers don’t sacrifice value when alternating
between a product and a service. They are evaluating the entire
ex-
perience, whether they interact with a product, a service, or a
combination. So the fundamental focus is providing value
throughout the value chain, whether that value chain
encompasses a product, a service, or both.

2. Sustainability—Increasingly, companies are interested in
their impact on their local community as well as on the overall
en-
vironment. This is often referred to as the “triple bottom line”
of financial, social, and environment performance.
3. Ethics and social responsibility—Following on the
sustainability notion is the broader importance of ethics and
social re-
sponsibility in creating successful organizations. The authors
make consistent references to ethical situations throughout
chapter coverage, and end-of-chapter material in many chapters
will encompass ethical situations.
4. Global coverage—Whether it is today’s price of gasoline, the
current U.S. presidential race, or midwestern U.S. farming, al-
most every industry and company needs strong global
awareness. And today’s marketing professionals must
understand the
world in which they and their companies operate. Examples of
decisions relative to the global marketplace are discussed
throughout the text.
5. Metrics—Firms today have the potential to gather more
information than ever before about their current and potential
cus-
tomers. That information gathering can be costly, but it can also
be very revealing. With the potential to capture so much
more detail about micro transactions, firms should now be more
able to answer, “Was this marketing strategy really worth
it?” and “What is the marketing ROI?” and finally, “What is
this customer or set of customers worth to us over their
lifetime?”
In this second edition, you’ll also find more emphasis on omni-

channel marketing, social media in marketing, and the other
com-
ponents of the digital media revolution that are changing
marketing so rapidly. Examples, videos, illustrations, and more
reflect the
latest in how marketing gets done.
4 PRINCIPLES OF MARKETING VERSION 2.0
marketing
“The activity, set of
institutions, and processes for
creating, communicating,
delivering, and exchanging
offerings that have value for
customers, clients, partners,
and society at large.”
creating
In marketing, a term that
involves collaboration with
suppliers and customers in
order to generate offerings of
value to customers.
exchanging
The act of transacting value
between a buyer and a seller.

C H A P T E R 1
What Is Marketing?
What makes a business idea work? Does it only take money?
Why are some products a huge success and similar
products a dismal failure? How was Apple, a computer
company, able to create and launch the wildly successful
iPod, yet Microsoft’s first foray into MP3 players was a total
disaster? If the size of the company and the money
behind a product’s launch were the difference, Microsoft would
have won. But for Microsoft to have won, it would
have needed something it’s not had in a while—good marketing
so it can produce and sell products that
consumers want.
So how does good marketing get done?
1. DEFINING MARKETING
L E A R N I N G O B J E C T I V E
1. Define marketing and outline its components.
Marketing is defined by the American Marketing Association as
“the activity, set of institutions, and
processes for creating, communicating, delivering, and
exchanging offerings that have value for cus-
tomers, clients, partners, and society at large.”[1] If you read
the definition closely, you see that there are
four activities, or components, of marketing:
1. Creating. The process of collaborating with suppliers and

customers to create offerings that have
value.
2. Communicating. Broadly, describing those offerings, as well
as learning from customers.
3. Delivering. Getting those offerings to the consumer in a way
that optimizes value.
4. Exchanging. Trading value for those offerings.
The traditional way of viewing the components of marketing is
via the four Ps:
1. Product. Goods and services (creating offerings).
2. Promotion. Communication.
3. Place. Getting the product to a point at which the customer
can purchase it (delivering).
4. Price. The monetary amount charged for the product
(exchanging).
Introduced in the early 1950s, the four Ps were called the
marketing mix, meaning that a marketing
plan is a mix of these four components.
If the four Ps are the same as creating, communicating,
delivering, and exchanging, you might be
wondering why there was a change. The answer is that they are
not exactly the same. Product, price,
place, and promotion are nouns. As such, these words fail to
capture all the activities of marketing. For
example, exchanging requires mechanisms for a transaction,
which consist of more than simply a price
or place. Exchanging requires, among other things, the transfer
of ownership. For example, when you
buy a car, you sign documents that transfer the car’s title from
the seller to you. That’s part of the ex-
change process.

Even the term product, which seems pretty obvious, is limited.
Does the product include services
that come with your new car purchase (such as free maintenance
for a certain period of time on some
models)? Or does the product mean only the car itself?
Finally, none of the four Ps describes particularly well what
marketing people do. However, one of
the goals of this book is to focus on exactly what it is that
marketing professionals do.
value
Total sum of benefits
received that meet a buyer’s
needs. See personal value
equation.
personal value equation
The net benefit a consumer
receives from a product less
the price paid for it and the
hassle or effort expended to
acquire it.
marketing concept
A philosophy underlying all
that marketers do, driven by
satisfying customer wants
and needs.
market oriented

The degree to which a
company follows the
marketing concept.
1.1 Value
Value is at the center of everything marketing does (Figure 1.1).
What does value mean?
F I G U R E 1 . 1
Marketing is composed of four activities centered on customer
value: creating, communicating, delivering, and
exchanging value.
When we use the term value, we mean the benefits buyers
receive that meet their needs. In other
words, value is what the customer gets by purchasing and
consuming a company’s offering. So, al-
though the offering is created by the company, the value is
determined by the customer.
Furthermore, our goal as marketers is to create a profitable
exchange for consumers. By profitable,
we mean that the consumer’s personal value equation is
positive. The personal value equation is
value = benefits received – [price + hassle]
Hassle is the time and effort the consumer puts into the
shopping process. The equation is a personal
one because how each consumer judges the benefits of a product
will vary, as will the time and effort he
or she puts into shopping. Value, then, varies for each
consumer.

One way to think of value is to think of a meal in a restaurant.
If you and three friends go to a res-
taurant and order the same dish, each of you will like it more or
less depending on your own personal
tastes. Yet the dish was exactly the same, priced the same, and
served exactly the same way. Because
your tastes varied, the benefits you received varied. Therefore
the value varied for each of you. That’s
why we call it a personal value equation.
Value varies from customer to customer based on each
customer’s needs. The marketing
concept, a philosophy underlying all that marketers do, requires
that marketers seek to satisfy custom-
er wants and needs. Firms operating with that philosophy are
said to be market oriented. At the same
time, market-oriented firms recognize that exchange must be
profitable for the company to be success-
ful. A marketing orientation is not an excuse to fail to make
profit.
production orientation
A belief that the way to
compete is a function of
product innovation and
reducing production costs, as
good products appropriately
priced sell themselves.
production era

A period beginning with the
Industrial Revolution and
concluding in the 1920s in
which production-orientation
thinking dominated the way
in which firms competed.
selling orientation
A philosophy that products
must be pushed through
selling and advertising in
order for a firm to compete
successfully.
selling era
A period running from the
1920s to until after World War
II in which the selling
orientation dominated the
way firms competed.
product orientation
A philosophy that focuses on
competing through product
innovation.
marketing era
From 1950 to at least 1990
(see service-dominant logic
era, value era, and one-to-one
era), the dominant
philosophy among

businesses is the marketing
concept.
value era
From the 1990s to the
present, some argue that
firms moved into the value
era, competing on the basis
of value; others contend that
the value era is simply an
extension of the marketing
era and is not a separate era.
one-to-one era
From the 1990s to the
present, the idea of
competing by building
relationships with customers
one at a time and seeking to
serve each customer’s needs
individually.
Firms don’t always embrace the marketing concept and a market
orientation. Beginning with the
Industrial Revolution in the late 1800s, companies were
production orientation. They believed that
the best way to compete was by reducing production costs. In
other words, companies thought that
good products would sell themselves. Perhaps the best example
of such a product was Henry Ford’s
Model A automobile, the first product of his production line
innovation. Ford’s production line made
the automobile cheap and affordable for just about everyone.
The production era lasted until the

1920s, when production-capacity growth began to outpace
demand growth and new strategies were
called for. There are, however, companies that still focus on
production as the way to compete.
From the 1920s until after World War II, companies tended to
be selling orientation, meaning
they believed it was necessary to push their products by heavily
emphasizing advertising and selling.
Consumers during the Great Depression and World War II did
not have as much money, so the com-
petition for their available dollars was stiff. The result was this
push approach during the selling era.
Companies like the Fuller Brush Company and Hoover Vacuum
began selling door-to-door and the
vacuum-cleaner salesman (they were always men) was created.
Just as with production, some compan-
ies still operate with a push focus.
In the post–World War II environment, demand for goods
increased as the economy soared.
Some products, limited in supply during World War II, were
now plentiful to the point of surplus.
Companies believed that a way to compete was to create
products different from the competition, so
many focused on product innovation. This focus on product
innovation is called the product orient-
ation. Companies like Procter & Gamble created many products
that served the same basic function
but with a slight twist or difference in order to appeal to a
different consumer, and as a result products
proliferated. But as consumers had many choices available to
them, companies had to find new ways to
compete. Which products were best to create? Why create them?
The answer was to create what cus-
tomers wanted, leading to the development of the marketing

concept. During this time, the marketing
concept was developed, and from about 1950 to 1990,
businesses operated in the marketing era.
So what era would you say we’re in now? Some call it the value
era: a time when companies em-
phasize creating value for customers. Is that really different
from the marketing era, in which the em-
phasis was on fulfilling the marketing concept? Maybe not.
Others call today’s business environment
the one-to-one era, meaning that the way to compete is to build
relationships with customers one at a
time and seek to serve each customer’s needs individually. For
example, the longer you are customer of
Amazon, the more detail they gain in your purchasing habits
and the better they can target you with
offers of new products. With the advent of social media and the
empowerment of consumers through
ubiquitous information that includes consumer reviews, there is
clearly greater emphasis on meeting
customer needs. Yet is that substantially different from the
marketing concept?
CHAPTER 1 WHAT IS MARKETING? 7
service-dominant logic
An approach to business that
recognizes that customers do
not distinguish between the
tangible and the intangible
aspects of a good or service,
but rather see a product in
terms of its total value.

service-dominant logic era
The period from 1990 to the
present in which some
believe that the philosophy
of service-dominant logic
dominates the way firms
compete.
offering
The entire bundle of a
tangible good, intangible
service, and price that
composes what a company
offers to customers.
communicating
In marketing, a broad term
meaning describing the
offering and its value to
potential customers, as well
as learning from customers.
Still others argue that this is the time of service-dominant logic
and that we are in the service-
dominant logic era. Service-dominant logic is an approach to
business that recognizes that con-
sumers want value no matter how it is delivered, whether it’s
via a product, a service, or a combination
of the two. Although there is merit in this belief, there is also
merit to the value approach and the one-
to-one approach. As you will see throughout this book, all three
are intertwined. Perhaps, then, the

name for this era has yet to be devised.
Whatever era we’re in now, most historians would agree that
defining and labeling it is difficult.
Value and one-to-one are both natural extensions of the
marketing concept, so we may still be in the
marketing era. To make matters more confusing, not all
companies adopt the philosophy of the era.
For example, in the 1800s Singer and National Cash Register
adopted strategies rooted in sales, so they
operated in the selling era forty years before it existed. Some
companies are still in the selling era. Re-
cently, many considered automobile manufacturers to be in the
trouble they were in because they work
too hard to sell or push product and not hard enough on
delivering value.
Creating Offerings That Have Value
Marketing creates those goods and services that the company
offers at a price to its customers or cli-
ents. That entire bundle consisting of the tangible good, the
intangible service, and the price is the
company’s offering. When you compare one car to another, for
example, you can evaluate each of
these dimensions—the tangible, the intangible, and the price—
separately. However, you can’t buy one
manufacturer’s car, another manufacturer’s service, and a third
manufacturer’s price when you actually
make a choice. Together, the three make up a single firm’s
offer.
Marketing people do not create the offering alone. For example,
when the iPad was created,
Apple’s engineers were also involved in its design. Apple’s
financial personnel had to review the costs

of producing the offering and provide input on how it should be
priced. Apple’s operations group
needed to evaluate the manufacturing requirements the iPad
would need. The company’s logistics
managers had to evaluate the cost and timing of getting the
offering to retailers and consumers. Apple’s
dealers also likely provided input regarding the iPad’s service
policies and warranty structure. Market-
ing, however, has the biggest responsibility because it is
marketing’s responsibility to ensure that the
new product delivers value.
Communicating Offerings
Communicating is a broad term in marketing that means
describing the offering and its value to
your potential and current customers, as well as learning from
customers what it is they want and like.
Sometimes communicating means educating potential customers
about the value of an offering, and
sometimes it means simply making customers aware of where
they can find a product. Communicating
also means that customers get a chance to tell the company what
they think. Today companies are find-
ing that to be successful, they need a more interactive dialogue
with their customers. For example,
Comcast customer service representatives monitor Twitter.
When they observe consumers tweeting
problems with Comcast, the customer service reps will post
resolutions to their problems. Similarly,
JCPenney has created consumer groups that talk among
themselves on JCPenney-monitored Web
sites. The company might post questions, send samples, or
engage in other activities designed to solicit
feedback from customers.

Mobile devices, like iPads and Droid smartphones, make mobile
marketing possible too. For ex-
ample, if consumers check-in at a shopping mall on Foursquare
or Facebook, stores in the mall can
send coupons and other offers directly to their phones and pad
computers.
F I G U R E 1 . 2
A BMW X5 costs much more than a Honda CRV, but why is it
worth more? What makes up the complete offering
that creates such value?
Source: Wikimedia Commons.
F I G U R E 1 . 3
Social media sites like Foursquare and Facebook have a location
feature that allows consumers to post their
location. Retailers can then use this to send coupons and other
special offers to the consumer’s phone or pad for
immediate use.
Source: Flickr.
Companies use many forms of communication, including
advertising on the Web or television, on bill-
boards or in magazines, through product placements in movies,
and through salespeople. Other …
Running Head: DEPRESSION 2

LITERATURE REVIEW 1
DEPRESSION
Effect of the Increased Rate of Depression in the United States
Florida International University
Dayana Lewandowski
HSA 6717
February 21, 2020
Background and Introduction
In the recent decade, depression has been termed as a modern-
day epidemic due to the increasing rate of depression cases in
the United States. Most people view depression as commonly
encountered chronic conditions in primary care, leading to an
increased rate of depression in the world since it remains
underdiagnosed and undertreated. People and healthcare
organizations tend to ignore the sign of depression as they term
it as a mere stressful mood or sad feeling that will go away with
time (Orgeta, Qazi, Spector, & Orrell, 2015). This does not
always happen as a small, sad feeling may advance to a more
severe problem, which has caused an increased rate of
depression in the United States.
Depression is a disease like other diseases that require
healthcare attention through treatment. It is a mental disorder
disease that presents with low self-esteem, stress, feeling guilt,
depressed mood, poor concentration, loss of interest, loss of

appetite, low self-worth, and disturbed sleep (El Bayoumi &
Ismail, 2015). Depression problem is usually brought by
lifetime events that face human being in their daily life where
some people are weak to handle the situation. This event may
include health issues, loss of loved one, relationship, loose of
something one holds closes to them. It may also be occurred due
to no apparent reasons like the one named above.
There is a different type of depression that vary on how an
individual’s depression sign and symptoms manifest themselves.
The major depression experienced by United States citizens and
all over the world is Major Depression Disorder (MDD) that is
characterized by a mood disorder (Albert, 2019). Other types
include premenstrual dysphoric disorder suffered mostly by
women.
In healthcare facilities, there is no laboratory test to diagnosis
depression, and the primary analysis is done id to evaluate the
cause of the depression. The diagnosis process is more of an art
than a science, and medical physicians generally depend upon
the patient's symptoms and signs. Currently, most of the doctor
depends on diagnostics and statistical manual of mental disorder
to provide a more detailed analysis of the disease.
According to Olfson, Blanco, & Marcus (2016), depression is
mostly experienced by more women than men, while
unemployed people are at high risk of being affected. Different
depression episodes may be characterized by varying signs and
symptoms depending on what triggered the events such as motor
retardation, sleep patterns, feeling of guilt or shame, fatigue,
among others.
Depression is increasingly being perceived as a global
healthcare problem due to increased mental health issues related
to depression in the world. The perspective of depression rate
perceived as a global health problem is widely covered by the
World Health Organization (WHO), providing evidence of
increased depression rates in the world. The world health
organization analysis shows that ten to twenty per cents of
internal medicine inpatient and outpatient suffer from

depressive illnesses. The same rate is experienced by the patient
suffering from chronical disease leading to a high percentage of
depression in the world.
In the United States, more than seventeen million adults suffer
from major depressive episodes. The rate continues to increase
as young people below the age of eighteen years have expressed
a high sigh of depression effects in the United States (Kuehner,
2017). Women are mostly affected by major depressive disorder
compared to men representing more than eight percent, while
men show five percent of the effect. The significant difference
between women and men affected by depression is high between
the age of eighteen and twenty-five years.
According to Olfson, Blanco, & Marcus (2016), the high
increased rate of depression in the world is because most of the
people with depression do not receive medical treatment for
their signs and symptoms until it is too late for them.
Approximately fifty percent of the adults have a major
depressive disorder in their lifetime medical history seek
medical attention and treatment in health care facilities. In
contrast, forty-eight percent do not receive mental healthcare
attention within a year. It shows the high risk of people
suffering from depression increasing due to a lack of access to
medical treatment, increasing the already existing depression
(Haddad & Boyce, 2017). This is because there no population
leaving the suffering population through the procedure, while
others continue to suffer from depression.
Another dominant perception that has led to an increasing rate
of depression is the belief by the American citizen and medical
physician that distress is chronically under-diagnosed among
people or in the society and therefore undertreated (Siu et al.,
2016). The views are evidence among public health institutions
as less than twenty-five percent of patients suffering from
depression globally have access to medical treatment. It has
contributed to the global problem of diseases discussed most in
the world.
The apparent increase in the depression rate in the world has

been caused by the change of the definitions of depression and
the diagnosis process under the new diagnostic statistic manual
that is widely used in the United States (Twenge, Joiner,
Rogers, & Martin, 2017). The method distinguishes mental
disorder according to patient patterns of signs and symptoms
usually used by a medical physician, policymaker, researchers,
and pharmaceutical companies. The process considers
depression disease as a minor reaction of mental distress
grounded in stress and anxiety. This fails to recognize
depressions as a condition by itself leading to many cases of
depression worldwide.
Diagnostic statistical manual receives significant criticism of its
validity and reliability of classifying and defining mental
disorders such as depression. It has set the threshold of
diagnosis of depression too law leading to confusion of the
causes and behavioral signs to distinguish it from normal
distress (Knapen, Vancampfort, Moriën, & Marchal, 2014).
There is a need for the appropriate classification of mental
disorder to clearly identify normal distress from depression
related signs and symptoms.
The medicalization of distress has contributed to a high rate of
depression in the United States (Twenge, Joiner, Rogers, &
Martin, 2017). Despite the benefits of overdiagnosis of
symptom-based classification of mental illness, the process had
experiences difficulties in the expansion of diagnostic criteria
for a mental disorder. Effective diagnosis of mental illness
helps in the development of treatment of depression, decreases
in the social stigma of mental illness.
The increasing rate of antidepressant prescription of depression
cases in the United States is used as a measure for depression
rate. In the recent decade, there has been an increase in the
antidepressant prescription that has become a normal prescribed
class of medication in the United States (Cusack et al., 2016).
The increased antidepressant use has led to and the new form of
treatment of depression that helps to determine the current
mental disorder in health service. Notably, increase use of

antidepressant prescriptions has led to unmet needs for
treatment for depression, which is a widely appropriate medical
response.
The effort to address the unmet needs, such as economic burden
societal problems by targeting the cause of under-diagnosis for
diagnosis and treatment of depression, helps to curb the rate of
depression. Increased overdiagnosis of the causes of depression
may result in a increased productivity, improved physical
health, reduced discrimination, reduced suicide rate, decreased
social stigma, and reduced mental illness. It also reduces the
problem associated with depression, such as drug and substance
use, alcohol abuse, and suicidal case.
According to Olfson, Blanco, & Marcus (2016), more harm is
caused to depression patients by failing to diagnosis severe
depression than overdiagnosis and its consequence. This is the
primary cause of the increased suicidal cases of excessive abuse
of alcohol by depressed people. It may lead to the use of
antidepressant drugs by patients who may not need them while
those in need fails to get the medicine.
Purpose of the Study
The primary purpose of the study is to evaluate the causes of
the increased rate of depression in the United States and come
up with ways to mitigate the high rate from expanding any
further. The increase rate of depression is alarming in the
United States and other parts of the world, leading to a
significant global health problem in the health sector
(Rosenbaum, Stubbs, & Vancampfort, 2018). The number of
people affected by depression is increasing daily due to a lack
of proper diagnosis and treatment of distress. It also to close the
existing knowledge gap on the recent cases of the high rate of
depression, method of preventing new trends in mental disorder,
future ways of dealing with diagnosis and treatment of
depression.
Research Question
1. To evaluate the causes of increased depression rates in the
United States.

2. To determine the diagnosis and treatment of depression
3. To determine the appropriate method to curb the increasing
depression rate in the United States.
Significance of the Study
The study is aimed at helping the health care sector, especially
the medical physician, in dealing with the problem of
depression in curbing the rate of mental illness. The study
identifies the causes of depression that have been a significant
hindrance in dealing with the depression case (Rosenbaum,
Stubbs, & Vancampfort, 2018). Most of the medical physician
face challenges in differentiating the cause of various mental
disorders such as depression, anxiety, distress, and sadness.
The study also helps in coming up with the best diagnosis
method and treatment that is effective in dealing with
depression rates. One of the major problems leading to a high
rate of depression is a lack of a problem method to diagnosis
depression and provide appropriate treatment that will be
covered in the study. It will also develop the best techniques to
deal with depression disorder in the United States to reduce the
economic burden of dealing with depression by the
government.
The study also contributes to the existing research knowledge
that assists the academic progress of the existing problem in
healthcare service. Other researchers and academics will use the
information in supporting their evidence as well as expanding to
the research.
Literature Review
Introduction
Depression is a major healthcare problem that affects the
majority of people at one time in their life. The increasing rate
of depression cases has classified the problem as an epidemic
facing the world with a high rate experienced in the United

States. This is because most people affected with depression in
the early stage view it as the chronical condition that will go
away on its own, hence remain underdiagnosed and untreated,
increasing the rate of depression in the world. Medical
physician tends to ignore the sign of depression in the early
days of the disease as they relate it with sadness and minor
stress that can go away with time.
The problem of depression is like other major diseases that
require high medical care and attention to reduce the effect of
depression in the world. It is a major mental disorder that leads
to poor concentration, loose of focus, low self-esteem, low self-
worth, loss of interest, stress, feeling guilt, and loss of appetite,
among others (Albert, 2015). It is highly contributed by a
lifetime event happening in one life where some people are
weak to handle the situation.
Major depression disorder is a highly experienced type of
depression in the United States. It is characterized by faulty
mood regulation, continually life circumstances, medical
problems, genetic vulnerability, and medication (Albert, 2019).
Most of these factors interact together to bring depression
conditions leading to the patient losing self-esteem and control
in life. Lack of established ways to determine depression in its
early stages through a medical process led to the increased rate
of depression that only come to the awareness of medical
physicians its critical conditions.
The increasing cases of suicide among patients suffering from
depression led to the need to reach the causes of the increased
rate of depression in the United States. More than fifty percent
of suicide death cause in the United States are a result of
depression (Albert, 2015). The figure rises to seventy-five
percent if it includes those who consume excess alcohol due to
depression and later leading to suicide. Another significant
effect is the increased case of mental illness, leading to rising in
depression in the United States.
The topic of the increasing effect of depression will offer some
of the lasting solutions to the major causes of depression. It

helps people who do not know about what is going on in their
body to seek medical and therapy help hence reducing the cases
of depression worldwide. It provides medical physicians and
healthcare organizations with ways to diagnose and treats
depression leading to significant improvement in the health care
services offered to the depressed patient. It easies the work of
health care centers since depression is treatable if identified
early. Still, the cause of depression must be identified first for
effective treatment, which is the most challenging part of the
medical staff. Identifying the cause and effect of depression
reduces cases of suicide and mental illness in the world since it
provides methods to curb the increasing rate of depression in
the United States.
The literature review will utilize the secondary source of
information that include peer reviews articles and case studies
that focus on the effect of increased depression rate in the
United States. The paper analysis existing literature based on
the research question. The primary objectives focus on the
impact of the increasing rate of depression in the United States.
The research question includes doing evaluate the cause of
increased depression rates, determining the analysis and
treatment of depression, and determining the appropriate
methods to curb the increasing depression rate in the United
States.
Overview of Characteristics
In the United States, depression disorder affects more than
seventeen million adults and approximately seven percent of the
United States population (Depression Statistics, 2019). Young
people and women are the most affect with depression compared
to men. More than two million children aged between thirteen
and seventeen are diagnosed with depression in
2018(Depression Statistics, 2019). Most of the adults suffering
from depression-related symptoms are at high risk of developing
other major problems such as coronary artery disease.
According to a survey done by Columbian University Mailman
School of Public health, depression has risen to a higher

percentage among young people aged twelve years and above
over the last decade (Columbia University's Mailman School of
Public Health., 2020). The rate of depression in the United
States has risen from six percent to seven percent between the
years 2005 and 2015. The high rapid increase was experienced
mostly for young people aged twelve years and seventeen from
eight percent in 2005 to twelves percent in 2015 (Columbia
University's Mailman School of Public Health., 2020). The
increase depressions rise in young people has dangerous
individual and societal consequences leading to increased
government, society, and health organization concern to way to
reduce the effect.
Columbian University Mailman School of Public health research
also found that depression has high among young and old
people. The group is vulnerable to significant causes of
depression, such as life, even or health conditions that affect
their health status (Columbia University's Mailman School of
Public Health., 2020). The rapid increase in depression also
experienced among white’s people compared to black people in
the United States.
Other groups that experience a high depression rate include the
lower income group, high-income group, and those with a
higher level of education (Columbia University's Mailman
School of Public Health., 2020). Most of these groups
experience a high depression rate due to an increase in pressure
to maintain their life in order, such as work land life-related
stress, balancing career, work, and income stress.
Depression is highly spread among women compared to men.
According to Albert (2015), 5.5 percent of women are suffering
from depression compared to 3.2 percent of men globally by the
year 2012. This is a rapid increase in women compared to men
due to biological sex differences (Albert, 2015). The risk is
high in young women aged fourteen-year to twenty-five-year-
old, which decreased with age. Young women are at high risk of
being affected by mental disorders and major depression due to
failure to take antidepressant treatment and therapy seriously

until their health worsen (Albert, 2015). At the age of sixty-five
years, women tend to experience the same rate of depression
with men of the same period.
According to França & McManus (2018), the frequency at
which hospitals and healthcare centers encounter depression
cases has increased overtimes. Most of the cases reported are
from women who have just had children within forty weeks
after delivery that accounted for more than three hundred
million of the collected sampled (França & McManus, 2018).
The study shows the high increase of depression among women
and the leading causes attributed to women being at high risk of
depression compared to men due to delivery issues and taking
responsibilities of the children after birth.
Review of the Increase in Depression Rate
Causes of Depression
The mood disorder is highly associated with increased cases of
depression that emerge as major clinical issues. According to
Robinson & Jorge (2016), the mood disorder is a significant
feature with a patient suffering from depression according to the
meta-analysis of various factor of causing depression and stroke
diseases. Mood disorder consists of mental health disorder that
disrupts the emotional balance in the person lead to increased
stress and sadness over life events.
Cognitive impairment and mood disorder are a significant
contributor to post-stroke depression (Robinson & Jorge, 2016).
Cognitive recovery is a vital process to reducing to impact of
dost stroke depression together with antidepressant treatment.
According to Gallagher, Kiss, Lanctot, & Herrmann (2018),
mild cognitive impairment act as a base for depression, and
Alzheimer's dementia that is mostly expressed by old people. It
contributes to high depression among elderly people aged sixty-
five years and above to low progress of the brain leading to
mild cognitive impairment and later depression (Gallagher,
Kiss, Lanctot, & Herrmann, 2018). People with a history of
depression at their young age increase the risk of developing
mild cognitive impairment leading to a high rate of depression

in the old days despite treatment at a young age.
According to the diathesis-stress theory, the impact of
continuous stresses in life increases the risk of the dependent on
the diathesis and vulnerability to depression (Colodro Conde et
al., 2019). Major depression disorder is highly correlated with
the stress that increases the susceptibility for depression and
other health conditions to the patient. Increased social life
events and social support lead to an increased rate of depression
in the United States (Colodro Conde et al., 2019). According to
Colodro Conde et al. (2019), the venerability of stress and the
high number of reported personal life events beyond individual
expectations are high contribute to depression in the United
States.
Anxiety with the relationship of other personal traits is the
primary cause of major depressive disorder. Depression is
highly associated with anxiety with other individual behavior
that leads to serious mental illness (Subica, Allen, Frueh, Elhai,
& Fowler, 2015). General stress, anxiety factors, and personal
dimension are highly correlated with depression leading to
personal traits such as suicidal behavior to patients. According
to Subica, Allen, Frueh, Elhai, & Fowler (2015), general stress
is the cause of depression and suicidal behavior if it goes
untreated for a long time.
Environmental factor performs an essential role in the
development of depression problem since they trigger stress in a
real-life situation. According to Córdova-Palomera et al.
(2016), environmental factor such as work-related stress, family
condition, and life situation among other lead to depression
vulnerability by alteration of the oscillatory neural activities
during a resting state of a human being. Life events and
circumstances that get involve human beings such as losing
close family members, involvement in an accident can trigger
the brain to react differently, causing depression in the long run
(Córdova-Palomera et al., 2016). Environmental factor leads to
low self-esteem, anxiety, loneliness, and anger, among others,
lead to increased stress in one life such that they do not go

away easily, causing depression at last.
Diagnosis and Treatment
According to Subica, Allen, Frueh, Elhai, & Fowler (2015), the
only to identify and treat depression is through general identity
stress early enough before it changes one personal behavior.
General distress is the structure for increased sadness, anxiety,
and depression among adults leading to a change of individual
personality traits. It is highly associated with self-harm, feeling
guilt, loneliness, and increased loss of focuses to typical things
in life that it goes untreated, the man leads to depression
(Subica, Allen, Frueh, Elhai, & Fowler 2015). This is the sign
and symptom that people and medical physicians should be
looking for to diagnose depression in its early stage instead of
waiting until it’s too late.
According to Olfson, Blanco, & Marcus (2016), the increase of
government activities to encourage depression patients to take
antidepressant treatment seriously, there has needed no improve
or little improvement toward adherence to the treatment among
the patient. The study proposal of the patient screen of
depression regularly as a means of diagnosing a patient who
tests positive for depression (Olfson, Blanco, & Marcus, 2016).
Following the identification of positive signs of depression, the
patient should be subjected to proper clinical treatment to
improve the health condition before it too late.
Psychological treatment is one of the recommended methods to
cure depression and reduce the rate of depression among adults.
According to Orgeta, Qazi, Spector, & Orrell (2015), a
psychological treatment that involved the development of
numerous guidelines has been proven for the treatment of
posttraumatic stress disorder for a long time. The evidence
supports the effectiveness of posttraumatic stress disorder
therapies together with cognitive behavior therapy and cognitive
processing therapy to moderate and reduce the effect of
depression (Orgeta, Qazi, Spector, & Orrell, 2015). It shows the
advantage of the consistency of posttraumatic stress disorder

therapies to ensure the effectiveness and efficiency of the
treatment.
According to Albert (2019), neuroplasticity is a depression
treatment that seeks to resolve the environmental factor leading
to depression to human beings. It develops a synaptic
reorganization in response to an environmental stressor as a
basis to understand, adjust, learn, and remember in the process
of treatment (Albert, 2019). It develops brain stimulus to
antidepressant medication hence able to achieve an effective
result at the end.
Methods to Curb Depression
According to Hall & Reynolds-III (2014), collaborative care
intervention should be adopted worldwide to support those with
depression. Patients with late-life stages of depression tend to
seek medication support but show poor treatment adherence
hence increasing the rate of depression. According to Hall &
Reynolds-III (2014), the effectiveness of collaborative care
incentives in preventing an increase in depression rate should
focus on equality of gender and ethnicity in reducing
stigmatization and deprivation of depression.
Besides the effective treatment of depression, the patient should
be put under the primary care system as a way of preventing
them from suffering again in their lifetime (Hall & Reynolds-
III, 2014). The increase rate of depression is experienced since
the antidepression has proven to be inactive to treatment as
most of the patients do not adhere to the treatment (Olfson,
Blanco, & Marcus, 2016). Therefore, there is a need for a
primary care system for the depressed patient to ensure they
adhere to medication and provide enough support in the life to
point the patient cannot go back to depression state. According
to Hall & Reynolds-III (2014), most of the patients entirely
treated off depression tend to regenerate the same problem of
depression while they are old.
In the United States, most depressed patients receive treatment
in the primary care system compared to mental illness
institutions but have proved to be ineffective in controlling the

rising increase in depression in the country. According to
Orgeta, Qazi, Spector, & Orrell (2015), the primary care system
should take a population-based approach treatment of
depression. The approach focuses on the whole well-being of
the patient by following a systematic approach to treatment and
full recovery (Orgeta, Qazi, Spector, & Orrell (2015). The
approaches focus on finding and diagnosis, treatment, patient
engagement, and treatment to ensure the patient does not go
back to the same state.
The primary care system should address environmental factor
lead to depression to curb the increasing rate of depression in
the United States. According to Orgeta, Qazi, Spector, & Orrell
(2015), behavioral health problems such as drug and substance
abuse, anxiety, low self-esteem are the major causes of
increasing depression in America. The ability to address the
issues among depressed patients leads to better recovery instead
of medical treatment. The primary care should be more of
therapies activities to help full patient recovery by addressing
the cause of depression.
Effect of Increased Depression
According to (Clark, Li, & Cropsey, 2016), depression is the
primary source of increased suicide rates in the world. Through
the research done on all suicidal cases including in jail and
prison, more than eighty percent of the cases are a result of the
long-term struggle with depression. The research aimed to
identifies the factor that increases suicide risk in the American
community that concluded a lack of proper mental and physical
health due to depression lead to suicidal. Family dysfunctions,
which are a leading cause of depression and stress, lead to
suicide.
According to Capron, Lamis, & Schmidt (2014), depression has
led to increasing suicide rates among young people. In the
United States, suicide has continued to increase for decades.
Depression distress act as amplifying to the suicide rate among
young people due to slack of anxiety sensitivity (Capron,
Lamis, & Schmidt (2014). Most young people face various

environmental factors and life events such as the divorce of the
parents or break up with girls/ boyfriends that are difficult to
handle.
Depression among college students lead to increased suicide
rate in the institution of higher learning. Most young people do
not seek medical attention when faces with minus stress issues
that tend to accumulate until they cannot handle it anymore.
According to Capron, Lamis, & Schmidt (2014), the role of
anxiety sensitivity cognitive concern decreases as one continues
to experience stress, anxiety, sadness, and loneliness, which
increases the risk of being suffering from depression. Young
people, mostly those in college, tend to handle things on their
own without involves other people that are close to them,
therefore at high risk of depression and suicide.
Mental illness is another significant effect of depressions that
leads to increased mortality in society. Most of the depressed
people in the community are highly associated with all kinds of
molarity due to the loss of their mental control (Brown et al.,
2015). Depressed people have associated with behavior high
addiction to alcohol and substance abuse that increases molarity
in the community. Comprehensive assessments of people who
drink alcohol regularly and uncontrollably tend to be suffering
from depression (Brown et al., 2015). It has set a bad example
into the community due to their unethical behavior in public
despite some of being a public figure to society.
Conclusion
The existing information provides the basis of the research
question and the main problem of the research. Most of the
authors and researcher has focused on the cause of the increased
depression in the United States and come up with substantial
information on what may be leading to a rapid increase in
depression. Most of the authors found out that mood disorder
and …

G U I D E L I N E S F O R T H E A D V A N C E D
H E A L T H S E R V I C E S M A N A G E M E N T A N D
R E S E A R C H S E M I N A R
M A S T E R O F
H E A L T H S E R V I C E S
A D M I N I S T R A T I O N
1
Guidelines
...............................................................................................
...................... 2
Professional Seminar 6930 / Advanced Research Seminar 6717
Research Overview .. 3

Advanced Health Services Management and Research Seminar
HSA 6717 Overview .... 4
Organization of the Research Proposal
......................................................................... 5
Introduction/Background
.......................................................................................... 5
Statement of Problem
...............................................................................................
. 5
Significance of Study
...............................................................................................
... 6
Literature Review
...............................................................................................
........ 7
Research Methods
...............................................................................................
...... 9
CONTENTS

2
A Masters degree contributes to the professional mastery of an
administrative career in health
services administration. The Masters in Health Services
Administration prepares students with
hands-on experience in conducting research and interacting with
leaders while working in an
administrative residency in health service administration. The
student conducts a research project
on a specific healthcare management problem and/or enroll in
the Administrative Residency. At
some point in the program, the student may choose enrollment
in research or the residency based
on their interest.
Typically students enroll in the Professional Seminar (HSA
6930) and the Advanced Research
Seminar (HSA 6717) where all students develop a research
proposal by the end of the semester.
The student has the choice to enroll in either the
Administrative Residency (HSA 6875) or the
Masters Research Project (HSA 6977). If the student chooses to
enroll in the HSA 6977 in lieu of
the HSA 6875, the student advances in their research project.
Students who completed their
research proposal during the Advanced Research Seminar may
continue to work in the final
portion of the research project to fulfill the requirements for
HSA 6977. Page 4 of this guide
describes the research project structure in detail.

The student who chooses to conduct a research project will
finalize the research project within
two semesters— during the Advanced Research Seminar (HSA
6717) and during the Advanced
Health Services Management and Research Seminar (HSA 6977)
course. Below there is a
description of the Masters Program structure with either of
these choices.
The first objective of this guidelines is to provide a roadmap
for the student on both the
Advanced Research Seminar and the Masters Research Project.
Students should know in advance
about the program research expectations. If a student decides to
continue on the research project
path, they have the opportunity to continue to work on the
research project in their interest area. To
ensure the student’s success, follow these guidelines in
preparation for your research project.
The second objective of this guide is to show students the
components for conducting
quantitative and/or qualitative studies depending on the type of
study design that best applies.
Students are responsible for ensuring the research paper is free
of errors in form, style, spelling,
and grammar. Students should follow the American
Psychological Association (APA) writing
format. For more information on the APA writing style consult
the 6th edition manual.
Guidelines

3
Professional Seminar HSA 6930 // Advanced Research Seminar
6717 Overview
WEEK 1-2: Topic Selection
o Students enrolled in the Professional Seminar HSA 6930 who
are interested in research, discuss
a research topic with the course instructor.
o Meet the course instructor to discuss potential topics (within
the first three weeks).
o Search the literature to narrow down a topic of interest.
o Develop and annotated bibliography.
o Select a feasible research topic within the first three (3)
weeks.
Note: Students who do not meet the topic selection deadline,
will be offered the opportunity to register
in the Administrative Residency HSA 6875.
WEEK 3-7: Develop Research Question and Purpose of Study
o Meet with course instructor to discuss the research progress
and proposed topic.
o Discuss a research proposal structure / plan
o Develop a research question
o Develop Introduction/Background, Statement of Problem,

Purpose, and Significance of
Research
WEEK 8-11
o Start the Literature Review: Continue to research and annotate
sources
o Start the methods section
WEEK 12-14
o Turn in a comprehensive research proposal including a list of
references
4
Advanced Health Services Management and Research Seminar
HSA 6717 Overview
WEEK 1-2: Choose and/ or revise the Methods

o Choose an appropriate method and outline a design approach
o Discuss the feasibility of the research methodology
Note: The Masters Research project is descriptive in nature. If
the student has a preference on a
specific research design, the student must consult the course
instructor for approval.
WEEK 3-7
o Discuss the research data analysis plan with the course
instructor
o Write the research methods (i.e. participants, research design,
procedures and data analysis
proposal)
o Finalize your methodology
WEEK 8-11
o Data collection
o Start to analyze data
o Meet with your course instructor to discuss preliminary data
analysis
o Finalize data analysis
WEEK 12-14
o Meet with course instructor to discuss the research results and
next steps
o Write the results
o Discussion, recommendations, conclusions and limitations

o Turn in final research paper
5
Organization of the Research Proposal
The research proposal allows the student to write a formal
written plan put forward for
consideration in the Professional Seminar.
When the student is writing the research proposal it is written
in the future tense, since the
research has not been conducted.
Example: ‘This research will explore…’
Title Page
The title page should include several sections: Project title,
name, name of the institution name
of the course instructor and date the proposal is submitted. Do
not include a running head on the title
page.
The title should be brief yet informative, providing the reader

with a description of the
proposed topic of the research study. The title should reflect the
identification of the problem the
research assesses.
Introduction/Background
The first section must capture the reader's interest, provide a
rationale for the study as a whole and
inform the reader about the research content and scope.
First, explain the research background starting from a broad
perspective (e.g. what is known about
the problem globally? What is the prevalence of the problem
nationwide? Second, describe the problem
at the local/state level.) Third, describe what is already known
about the research topic.
This section includes relevant references to support the
statements part of the background. The
references should be from reliable sources of information and
these should be accurate. References can
be found in peer reviewed literature (i.e. scholarly journals),
books, and other reliable sources.
Statement of Problem
The statement of problem lays the foundation for the issues
being explored in the research project.
This section details why the problem requires research. The

statement of problem section usually starts
by addressing why the student is pursuing this research topic. Is
it serious enough to warrant the study?
Next, place the problem and research question in perspective,
develop a narrative on the demographics
(introducing the population of interest), and location of the
problem (setting/geographical location) or
situation leading to the applied research. It is essential to
provide compelling evidence the problem
exists. This section should also be supported by evidence based
references / citations. Cite relevant
literature to support the topic of interest and the variables of
study.
Significance of the Study
6
This section narrates why the proposed research study is
relevant or meaningful and why the
study might be necessary. The use of literature is highly
recommended to describe the gaps in the
published literature, insufficient knowledge in the subject area,
or the need to validate the findings of
previous studies. Explain what is the benefit or contribution to
new knowledge.

Example: “This research is important to understand barriers to
access health care services for
South Florida residents with cardiovascular diseases. This study
is relevant to better understand
what the specific barriers are so that intervention tailored to this
population are implemented.”
Qualitative studies are exploratory in nature. An example of a
qualitative research is: Interviews of
clinical practitioners about the types of policies on a specific
health program or available therapies to
treat a disease. This type of research is recommended when a
researcher wants to understand the
population or area of interest from a behavioral or analytical
perspective. Interpretations of the answers
are required.
In qualitative studies there is a guide of topics/themes. Through
this design there is some flexibility to
explore the participant’s responses through a structured
interview process.
If a student decides to use a qualitative study as the design of
their research, he/she shows the study
findings’ using the research participants’ direct narrative quotes
that should support the study
conclusions.
Qualitative research question example: “What are the relevant
barriers for access to healthcare are

for South Florida residents with cardiovascular diseases.”
Quantitative Research
Quantitative studies use a structured variable-specific survey
questionnaire or secondary data
collection. When using this type of research design, the student
uses a representative sample of the
population of interest. The student should be cautious about the
type of questions when using
questionnaires and should consult with the course instructor if
they are planning to use surveys to collect
data. The survey question (s) should follow the research
question objectives.
In these types of studies, the student should be able to speak
about the data that supports the
conclusions. In quantitative research it is not be possible to
subjectively interpret any results as in the
case of qualitative research.
Quantitative research question example: “What are the most
prevalent barriers to access health
care services identified by South Florida residents with
cardiovascular diseases?”

7
Literature Review
The purpose of the literature review is to describe the related
and existent evidence about the topic of
interest. Creswell (2014) suggests that the literature review
shares with the reader the results of previous
studies, related to the one being proposed/conducted.
The literature review is a critical review and assessment of
current as well as previous research
studies or evidence in the field of study. This section compares
and contrasts previous studies related to
the topic chosen, combining and summarizing related studies.
The reader should be able to find a roadmap and a narrative
describing many aspects of the literature
on what is known about the topic. Start by explaining the
problem worldwide, nationwide, and explain
the varying results documented in the literature.
Provide a logical structure to the reader guiding them through
previous research studies and theories
supporting the proposed research, establishing the importance

of the topic.
Be critical and consistent. Provide an assessment of the
strengths and weaknesses of previous and
current studies.
Cooper (2010) & Creswell (2014) recognized four aspects of
literature reviews, described below:
1) Integrate research / evidence that others have done or said
2) Criticize scholarly work
3) Build bridges between related topics
4) Identify the principal issues in a field
Example of a research question for the example below: “What
are the barriers to access
health care services identified by South Florida residents with
cardiovascular diseases?”
Literature Example: “Access to health care seems to be
improving in the United States
(Clooney, 2017). However, some research has found significant
increases in chronic diseases such as
cardiovascular diseases in the state of Florida (Jones-Who,
2018). Therefore, more research is needed
to understand barriers for access to health care services
identified by South Florida residents with
cardiovascular diseases, since the prevalence is rising. A recent
study found positive effects on access
to health care and cardiovascular disease outcomes (Clooney &
Comellas, 2018). Clooney and

Comellas (2018) argued there is an increasingly aging
population in South Florida identifying
significant transportation barriers to access preventive care
services.”
According to Creswell (2014) (in quantitative research) the
literature review starts with an (1)
introduction section, followed by (2) topic 1 (the independent
variable) (3) topic 2 (the dependent
8
variable) and (4) topic 3 (studies that address both the
dependent and independent variable) and (5) a
summary highlighting the most important studies (Creswell,
2014, p. 47).
The literature review for a qualitative and quantitative study is
written as part of the research
proposal.
Note: Use current literature / evidence. Seek the input from

your course instructor.
Literature Review: Step by Step
Creswell (2014) suggests several different ways to work on a
literature review:
1) Identify key words to locate different materials in a library.
The key words may emerge from
the literature and it may allow for the identification of a topic.
2) Search journals, books, databases (e.g. FIU computer
databases: ProQuest, EBSCO,
PubMed, etc.).
3) Gather as many reports as possible that are related to the
research topic.
4) Skim though the articles. Creswell (2014) suggests that
throughout this process, it is
important to try to gain a sense as to whether the research will
make a useful contribution to
the understanding of the literature.
5) Begin a literature map.
a. This is a visual picture or groupings of the literature on the
topic illustrating how the
study will contribute to the literature.
b. Position the study within the larger body of research.
6) Begin to draft summaries of the most relevant articles. Start
critiquing the previous literature
and point out deficiencies and issues with the methods.

7) Assemble the literature review. Structure the literature
thematically (use headings).
The literature review conclusion should suggest how the
proposed research may contribute to the
current literature and could address gaps in the current
literature.
9
Research Methods
This section provides a description about participant selection,
the data collection the research
procedures and data analysis.
This section starts with a description of the study design (i.e.
qualitative and/or quantitative
design). The methods section includes the following:
1. Introduction. This section includes a reiteration of the

statement of problem and research
question.
2. Participants. This section includes the study population and
sample selection (quantitative) or
a description of study participants (e.g. males and/or females,
age range, ethnicity, or other
demographical characteristics). Describe how the participants
will be chosen (qualitative),
recruitment procedures, the estimated number of participants,
and reimbursement or monetary
compensations are given to participants (if any) should be
specified.
3. Procedures for data collection. This section includes detailed
descriptions of procedures
(quantitative or qualitative) used/to be used to collect the data.
Anticipate how data will be
collected. Explain why each procedure was chosen. It is also
important to describe how the
procedure will address the research questions.
4. Data Collection. In this course, data collection will be done
mainly through secondary data
(data collected by others, not the principal investigator).
Provide a rationale for the procedures,
using arguments based on its strengths and weaknesses, costs,
data availability and/or
convenience.
Qualitative Research
When conducting qualitative research, the aim is to address

people’s experiences, needs, and
different perspectives. Qualitative research aims at
understanding and observing attitudes, life
circumstances, beliefs, opinions, behaviors and a processes in
depth.
Data is collected by interviewing people and recording the
responses as well as observing and
documenting participant body language. The common
approaches for facilitating interviews are:
a. In-depth interviews: These are one on one interviews.
Researchers are interested in
understanding individual experiences or opinions.
b. Focus groups interviews: The researcher attempts to discuss
or explore participants’
opinions in a group setting.
c. Telephone mediated interviews: The researcher interviews
participants by phone.
d. Online mediated interviews: These are one on one interviews
conducted online.
e. Observation: This is an approach often used as a supplement
to recording participant’s
responses.

10
When conducting quantitative research, data is often gathered
using surveys either in person or
through the Internet. If the information is collected through a
survey questionnaire it usually has three
sections: (a) inclusion/exclusion criteria, (b) demographic
information and (c) the questions assessing the
study variable (s) of interest.
Sample and Population
In qualitative research designs, the researcher purposely
identifies the individuals (usually between
5 to 10 study participants) for the proposed study (Creswell,
2014). He/she should have in mind the
research problem and which population (s) are affected by the
problem.
This section of the paper describes the selection of study
participants, explains the characteristics
of the participants and describes the proposed number of
participants. It also includes the inclusion and
the exclusion criteria for including the research population.

As is the case with qualitative research designs, this section
describes the selection of participants
(e.g. data), explaining the demographic characteristics and
describing the proposed number in the
sample being studied. It also includes the inclusion and the
exclusion criteria for selecting the research
sample. Sample sizes may vary based upon the research
aim/question (s). Large sample sizes (e.g. ≥
100), often leads to increased accuracy in estimates about the
population.
Note: Students are encouraged to ask their course instructor for
recommendations on sample sizes.
Data Collection
It is common to develop structured and semi structured
questions and record each participant’s
responses. The interview research question should map to the
main research question.
When conducting qualitative research, an interview/discussion
guide is developed to conduct the
interviews. These questions address the main research problem.
Other data collected during the
interviews could include participant demographics (e.g. age,

sex, race/ethnicity, income for descriptive
statistics).
Note: The student interviewer informs the research participant
the location, day and time of the
interview. The interviewer ensures the participants have the
interviewer contact information in
case they get lost, are delayed, or have other problems prior to
the interview.
During and prior to the interview:
11
a) Provide an informed consent form indicating the research is
voluntary
b) Remind the research participants that they will be recorded
c) Remind the research participants that there are no right or
wrong answers during the
interview session (promote open and honest communication)
d) State name and the goal of meeting with the participants
e) Ask each participant to introduce themselves, state their
names or initials so that you can
later distinguish each participant responses
f) Do not redirect or interpret the respondent answers, or judge

g) Know the interview guide and questions
h) Do not bring any knowledge to the table
i) Be comfortable with silence
Note: Use probes as needed. For example – be silent, repeat the
statement they said and then
continue neutrally (“I see, uh…”), direct (“Tell me more”), and
clarify (what, where, when,
what).
This section describes how many questions are going to be used
(even if it is secondary data
collection) and how the survey that led to the data collection
was developed.
Example: “The data used in this research is from the
cardiovascular diseases questionnaire used in
research conducted by the National Center for Health Statistics
of the Centers for Disease Control and
Prevention. This is a national cross-sectional research study
representative of the U.S. population. The
interviewers were elderly persons and minorities to provide a
full representation of the U.S population.
Note: If the student plans to use a survey or other form of data
collection, consult the course
instructor for guidance.
Procedures

This section describes the participant’s recruitment process as
well as the methods used while
conducting the interviews (e.g., notes, audio tape recording, and
video tape recording). Discuss how the
group (if a focus group) will have a discussion in a quiet,
comfortable place to ensure everyone
speaks/participate. Describe the development of a topic guide.
A topic guide is used in the interview
process to guide and discuss key questions the interviewer
would like to cover, including useful prompts
to encourage discussion.
Include an explanation about transcribing the interview once the
participant’s interviews/discussions
have ended. After transcribing, the student reads the interviews
(i.e. the data) and start coding it.
Note: Coding is an approach used to organize the data by
grouping pieces (categorizing the
data) and writing a word representing a category (Rossman &
Rallis, 2012; Creswell,
2014, p. 198). In qualitative research, data is primarily in the
form of words derived from
the participant’s expressions on a subject matter.

12
The data should be organized into categories of themes.
Describe how the validity occurs in the
research process to validate the findings of the proposed study.
Describe one or more strategies for establishing the
accurateness of the findings. Some of the
commonly used strategies are described below:
a) Triangulation: Search for different data sources and use these
to build the justification of
themes (Creswell, 2014). If the researcher finds that the themes
are established based on
converging several sources of data or participant perspectives,
then this would add to the
validity of the study.
b) Member checking: Taking the emergent themes back to the
participants and asking them if
they feel the themes are correct.
Note: To check the reliability, researchers may cross-check the
results with an independent
person who can check the codes used by the researcher. Consult

the course instructor for
more information on this methods.
In this section the student documents the participant’s
recruitment process (e.g. consecutively, using a
snowball approach, randomly, or other procedure that is free
from bias). The student must always
provide informed consent and specify the research is voluntary
to all participants prior to starting the data
collection process. Therefore, the student must describe the
informed consent process in the methods
section (if administering a survey).
This section describes the processes used while collecting the
research data. It documents all the
processes for gathering data, selecting participants (or sites),
providing copies of the consent form (if
applicable).
Describe the study variables, the parameters established for the
variable (s) of study (e.g. optimal
health risk scores are defined as ≥10”) and how these data
collected was collected.

13
Data Analysis
This section explains how the data analysis section would be
organized. It also describes the data
analysis plan, how to code (assign numbers to the verbal
answers obtained from the participant).
Describe the study variables and the specific statistics that will
be used (e.g. counts, percentages, means)
as applicable.
Tips: Propose to use a software for data organization and
management:
a) Microsoft Excel can be used to organize the narrative data
collected.
b) For the demographical data (organize it in Microsoft Excel).
c) If using Microsoft Excel, create headings in each column
with the themes (type the
questions you asked in your interviews) for classifying themes
and units of analysis.
d) Quantify your themes and report its frequencies
e) Always refer back to the research question, asking “Was the
research question

answered?”
This section explains how the data analysis section is organized.
Present the data analysis plan in
sequential order. The analysis plan should include: (1)
Descriptive statistics of the data (e.g. frequencies
and percentages, the reporting average and counts).
After discussing the descriptive statistics, describe how the
variables will be measured on the survey
instrument. How the data will be handled (e.g. continuously or
categorically)? Discuss which of the
questions in the survey instrument answer the research question
(s).
Describe other statistical data plans on how to handle the data
(e.g. missing variables, outliers,
normality of the data).
Explain that the results will be shown using tables, graphs,
figures, or other form.
This section ends with a discussion of the implications for
practice of the study. Typically discusses
theoretical and practical consequences once the study is
completed.

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