Browsing by Subject "Mixed-methods"

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    Barriers to Rural Mental Health Care: A Mixed Methods Investigation of Mental Health Outcomes, Services, and Help-Seeking
    (2019-05) Jensen, Emily
    Existing rural mental research points to several concerns regarding symptoms and outcomes (e.g., mental health status, mental health symptoms, suicide rates). Research also identifies several barriers that inhibit rural residents from accessing quality mental health services (e.g., factors influencing the availability of services, accessibility of services, and acceptability of services). Investigations that compare rural mental health outcomes and help-seeking to urban counterparts are limited; what does exist points to mixed findings about differences between groups. The research presented here aims to elucidate the limited understanding of barriers to mental health care in rural communities via a two-study, mixed-methods investigation. Study 1 is an analysis of an existing dataset collected in eight counties in Northern Minnesota and Wisconsin in 2015. The survey includes questions about behaviors, outcomes, and social determinants of health and mental health and includes (N = 6,976) responses. Chi-square and logistic regression analyses were used to assess the impact of geographic location (measured by RUCA codes) on mental health symptoms, help-seeking behaviors, and specific barriers to seeking help. Demographic covariates – including age, education level, gender, and income – were also considered. Results reveal some variation between the chi-square and logistic regression analyses, and hypotheses for the disparities are discussed. Findings from the logistic regression analyses revealed no significant differences across rural and urban groups for indication of mental health symptoms, though age and gender did account for some variance. The rural group was more likely to indicate delayed or forgone help-seeking behaviors, and the urban group was more likely to indicate attitudinal barriers to seeking mental health care. Study 2 is a qualitative study that followed a Hermeneutic phenomenological design. The goal of this study was to increase understanding of barriers to rural mental health care via rich descriptions of lived experiences with those barriers. Thirteen (N = 13) family physicians who practice in the same geographic area as the dataset in Study 1 were recruited using convenience and snowball sampling techniques. Family physicians were chosen for these key informant interviews because existing research suggests that primary care often serves as the front line of mental health care in rural communities. Their ability to speak to their own experiences, and to the experiences of their patients, also facilitated the gathering of a range of perspectives and rich descriptions. Findings were organized into seven overarching themes; key ideas therein pointed to both the presence of structural and attitudinal barriers to mental health care, and to ideas physicians have for overcoming them. Implications from the two studies point to the need for continued investigation into the presence of barriers to mental health care for rural communities, and ideas for maximizing existing resources. Differences between structural and attitudinal barriers are discussed alongside findings from these two studies, and future research should continue to investigate the differences between these categories of barriers. Increased understanding of what prevents rural communities from accessing needed mental health care will increase the efficiency and efficacy of future interventions aimed at reducing barriers and increasing access to care.
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    Comparing The Impacts Of Community-Based Tourism Development On Local Livelihoods And Empowerment
    (2023) Legatzke, Hannah
    For decades, policymakers, scholars, and development practitioners have promoted community-based tourism (CBT) for sustainable development in socioeconomically marginalized rural communities. However, the mixed results of these initiatives warrant further study into the mechanisms through which community-management of tourism leads to local livelihood opportunities and community empowerment. This dissertation responds to this need through a comparative case study of CBT management models in the Maya Biosphere Reserve, Guatemala. Different trajectories of community tourism involvement in the three gateway towns to the most visited parks in the reserve make it possible to study the role of community-tourism management compared to tourism development in strictly protected areas and in the private sector, in the local livelihood and empowerment outcomes of tourism. During approximately 10 cumulative months of ethnographic field research in the Maya Biosphere Reserve, I applied the Sustainable Livelihoods Framework (SLF) and Community Empowerment Framework to compare the impacts of tourism and its role in residents’ livelihood activities. Through semi-structured interviews, focus groups, content analysis, participant observation, and 134 livelihood surveys with household heads across the three towns, I find that community-based management of tourism supports a wider distribution of local tourism income-earning opportunities and overall greater local empowerment than conventional growth-oriented, private sector led tourism development in strictly protected areas, in part through emphasis on training opportunities and recognition of the compatibility and tradeoffs between tourism and residents’ other livelihood activities. Nonetheless, difficulties achieving social unity and differential individual barriers to tourism participation make ensuring equitable tourism community-tourism development an ongoing challenge. Tourism becomes part of integrated household livelihood portfolios, rather than supporting households alone or replacing small-scale agricultural activities. Overall, this dissertation contributes to understandings of the role of CBT in sustainable development as well as a methodology for more closely analyzing and comparing the livelihood outcomes of tourism development.
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    Using behavioral and design science to reduce administrative burdens: Evidence from Minneapolis Public Housing
    (2020-12) Merrick, Weston
    While the behavioral and design sciences share an academic lineage, they have drifted toward different disciplines, picking up the methods of their adopted fields. This drift is unfortunate because design offers powerful tools to uncover the knowledge of system participants and make changes that fit an organization, while behavioral science offers a deep literature of techniques to understand human behavior, alter choice architecture, and measure the impact of that change. I explore the potential to integrate the two in a mixed-method study with Minneapolis Public Housing Authority. Through the partnership, I show how a design-based approach can help identify extant choice architecture and residents’ cognitive shortcuts that may be causing undesirable outcomes, mobilize participant knowledge to promote reflection that advances changing of existing structures, and experimentally test the resulting interventions’ ability to reduce eviction actions. I make the case that integrating these approaches in the context of new understanding about administrative burdens opens fertile theoretical and methodological ground for a behavioral design approach.