ADVANCED NURSING RESEARCH
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ADVANCED NURSING RESEARCH
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Evidence Based Practice Grant Proposal
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Grant Proposal-Assessing the role of stigma towards mental
health patients in help seeking
Study problem
There are several studies that have shown that stigmatization
towards mental health patients have been present throughout
history and even despite the evolution in modern medicine and
advanced treatment. For example, Verhaeghe et al., (2014),
captures in a publication in reference to a study that he
conducted that stigmatization towards mental health patients has
been there even as early is in the 18th Century. People were
hesitant to interact with people termed or perceived to have
mental health conditions.
Stigmatization has resulted from the belief that those with
mental problem are aggressive and dangerous creating a social
distance (Szeto et al., 2017). Also, mental health-related stigma
has become of major concern as it creates crucial barriers to
access treatment and quality care since it not only influences
the behaviour of the patients but also the attitude of the
providers hence impacting help-seeking. Timmermann,
Uhrenfeldt and Birkelund (2014), have identified stigma as a
barrier that is of significance to care or help seeking while the
extent to which it still remains a barrier have not been reviewed
deeply. Therefore, this study will assess the role contributed by
stigma in help seeking in depth. 1. Purpose
The intention of the research study is to review the association
between stigma, mental illness and help seeking in order to
formulate ways in which the stigma that is around mental health
is done away with to enable as many people suffering from
mental health complications to seek medical help.2. Background

Mental health is crucial in every stage of life. It is defined as
the state of psychological well-being whereby the individual
realizes a satisfactory integration instinctual drive acceptable to
both oneself and his or her social setting (Ritchie &
Roser, 2018). The status of mental health influences physical
health, relationships, and most importantly day-to-day life.
Mental health problems arise when there is a disruption in
mental well-being.
The risk factors to mental health problems are not limited and
therefore everyone is entitled to the problem irrespective of
gender, economic status, and ethnic group. For example, data
shows that in America one out of five individuals experience
mental health problems annually; with mental disorders being
recognized as the leading cause of disability not only in the
United States but also globally (Ritchie & Roser, 2018). Mental
health disorders are seen to be complex and of many forms such
as anxiety, mood, and schizophrenia, among others.
Data shows that in 2017 about seven hundred and ninety-two
million people lived with a mental disorder. Challenges have
been identified with data presentation since mental health
disorders are under-reported worldwide (Ritchie &
Roser, 2018). World health organization data shows that mental
health disorders are not only determined by one’s ability to
manage their thoughts, behavior and interaction with others but
also economic, environmental and social factors. For example,
the on-going global financial crisis creates a macroeconomic
phenomenon that provides a significant opportunity for mental
health consequences with an increased rate of suicide and
harmful substance use.
Most research studies have shown that there exist many gaps in
relation to mental health problems. The gap ranges from
treatment interventions and effective use of the available tools
to reduce the issues of mental health. For example, there exists

a research gap on the interventions meant to reduce and
eradicate stigma which has been recognized as a determinant of
mental health problems and this spiked my interest.
Therefore, in order to fill this gap such question as a) what is
the association between stigma towards mental health patients
and help-seeking? b) To what extent does stigma constitute a
barrier to the search for help among mental health patients? And
c) Are there populations that are more deterred from seeking
help due to stigma? Have to be answered through research to get
the intended purpose.
Research objectives
a) To explore the impacts of stigma
b) To assess an association between the contributing factors of
stigma to help seeking
c) To assess the extent in which these factors of stigma
contribute to help seeking.
Research questions
How does the stigma around mental health complications
prevent those suffering from mental health complications from
seeking medical help?
Theoretical framework
Stigma has been described as a negative effect of a label and the
product of disgrace that makes a person to be apart from others
(Henderson et al., 2013). It is built upon distinct constructs
prejudice, discrimination, and stereotypes (Henderson et al.,
2013). For example, believing that those people diagnosed with
mental illness are dangerous leads to many people not wanting
to associate with those who are mental ill. In return, those with
mental health complications become unwilling to let people
know of their status to save themselves from discrimination and

prejudice.
Many studies have reported an existence of negative attitudes
with regard to mental health problem and social distance
(Henderson et al., 2013). This is because those persons with
mental problem are regarded as dangerous, a public nuisance
and aggressive. Some of the contributing factors include the
media which influences the society’s view, public perception
which is influenced by the level of understanding towards
mental health problems and the illness itself and also reluctance
to seek help which contribute to further stigmatization. Stigma
is therefore seen as barrier since it inhibits a person from
seeking help hence resulting to a treatment gap and
advancement in medical programs meant to reduce cases of
medical care (Szeto et al., 2017). Therefore, mental health-
related stigma is seen to influence help seeking by those
mentally ill.3. EBP Model
The EBP study will rely on the IOWA model that was developed
by the University of Iowa Hospitals and Clinics in 1990s. The
EBP study will incorporate five steps of the IOWA model. The
steps include evidence retrieval, grading of evidence, the
development of an EBP standard and the actual implementation
of EBP and the evaluation of the whole process.
Evidence retrieval will involve the reviewing of journal articles
that have evidence that support the change that is to be
proposed in the EBP project. Grading of evidence will involve
scrutinizing and rating the evidence that exists in support of the
proposed evidence-based proposal. In terms of developing an
EBP standards, the success of the propose change will be used
as a measure. The actual implementation of the EBP will be in
reference to the proposed change whereas the evaluation of the
EBP will be based on the success rate of the proposed change in
reducing the stigma around mental health complications.4.
Proposed Change
The proposed change is that mental illness and complications to

be equated to other common illnesses. As it stands, mental
health complications are considered to be more severe than
other diseases or health complications. Despite mental
challenges and complications being highly rated, their possible
effects on the human body are not as severe in comparison to
other health complications. For example, tuberculosis and
malaria cause more deaths than all mental health conditions
combined. Despite tuberculosis and malaria being bigger killers,
the stigmatization around both diseases is not as bad as the
stigmatization that is around mental health complications.
By having mental health complications equated as other
common illnesses it will be possible to break the stereotype or
misconception of mental health complications. By so doing, it
will be possible and easier for people to report to health centers
if they suspect their mental health. Ultimately, the proposed
change will lead to stigmatization around mental health
complications reducing if not ending.5. Outcomes
There are three possible outcomes that may result from
implementing the propose change. For starters, the stigma
around mental health will be done away with or reduced. This
outcome will be achieved if the results of the evidence-based
practice support stigma around mental health being done away
with or being reduced. Secondly, there will not be any changes
as concerns the stigma around mental health. The second
outcome is likely to happen if the proposed change does not
necessitate change around mental health stigmatization. Lastly,
the stigma around mental health will increase. By implementing
the proposed change, the researchers expect that the stigma
around mental health will be reduced if not done away with.6.
Evaluation Plan
The proposed plan will be evaluated main ways. The proposed
plan will be evaluated through monitoring the number of people
that seek medical assistance for mental health complications
after the proposed change has been implemented. An increase in

the number will signify that the proposed change is effective at
reducing if not doing away with the stigmatization that is
around mental health complications. A decline in the average
number of patients that seek medical assistance for mental
health complications will signify that the proposed change is
not effective at doing away with the stigma that is around
mental health complications.7. Dissemination Plan
There are seven journal articles that will be studied and
rationalized with the aim of supporting the proposed evidence-
based change. The seven articles, all touch on the stigma around
mental health. The articles as well list the methods that have
been tried on in terms of reducing stigma around mental health
complications. All the identified journal articles are recent in
terms of publication; they were published in the last five years.
The articles will provide evidence that supports why the
proposed change will be effective at reducing and eventually
doing away with the stigma around mental health
challengeTools to be Used
Peer reviewing of articles is an important duty for two main
reasons. First, it ensures only valid articles are published
thereby reducing inaccurate studies or forged findings.
Secondly, it facilitates the sharing of information that can
enhance studies and findings before they are published. There
are various peer-reviewing techniques for evidence-based
practices, however, the two most common are the use of surveys
and the use of questionnaires.
Peer review tools for the proposal
Surveys are easy to conduct and require little to nil expertise
(Atkinson et al., 2017). The technique will be crucial when
reviewing literature for the study as it will make it possible for
the research team to collect as much information as they want
without going into the details of the articles that are under

review. The method will be used to interview other researchers
who have written on the same topic. The interview process will
allow the researchers to gather as much information as possible
as to what the researchers think of the study topic; the validity
of the topic. It will also allow the researchers to gather
information on how they can improve the study.
The research team will also use the method to collect
information from other researchers who have interacted or come
into contact with publications similar to the proposed research
topic. Throughout carrying out studies, researchers came into
contact with data or information that does not concern what
they are studying. By having sit-downs with other researchers,
it will be possible for the research team to tap from such
researchers and get ways to ensure that the study findings are
relevant.
The second peer-reviewing technique that will be used is the
use of questionnaires. The majority of times in evidence-based
practice, researchers utilize questionnaires since they utilize the
qualitative approach. Questionnaires allow researchers to gather
information from their study subjects as well as from non-
participants of studies (Panczyk et al., 2017). Two of the main
reasons as to why the researchers will use the questionnaire
peer review tool are that it will cut on costs and that it is simple
to administer. The team plans to use the questionnaire technique
to gather as much information from their peers on what they
think of the subject topic and the details of the topic. Also, it
will be possible for the researchers if there is previous literature
that concerns the study based on the response on the
questionnaires. Previous literature will help in the collection of
information that can validate the proposed study.
Peer reviewing is an important aspect of validating studies and
their findings. It allows other researchers or students to
scrutinize an article before it is published. It helps in the

validation of studies. For the proposed EBP, survey and
questionnaire peer review tools will be used to help in
validating the studies. The two methods are effective as they are
simple and cheap to administer. It will be possible to gather
information on how the research can be improved as well as
gather information on what people think of the study topic.
Grant Request
The research team is looking to get a grant of $5000 to aid in its
EBP. The details of the amount proposed are as below
Proposed Tasks
If the proposal is approved, it will be possible to perform three
main tasks. The three tasks will help in the implementation of
the proposed change.
Task 1: Case study- Reviewing existing literature on stigma
around mental health complications
The first part of the study will involve going through existing
literature on stigma around mental health complications. The
sources that will be reviewed are seven in total. Task 1 will take
a month and will be conducted by 5 researchers.
Task 2: Interviewing clinicians that have dealt with the study
topic
The second task will have the research team clinicians that have
dealt with the study topic. The clinicians will share what they
stigma and mental health complications and this will help shed
light on what caused the stigma. The interview task will
approximately take three weeks. The interview process will be
conducted by three researchers
Task 3: Interviewing patients of mental health
The last task will involve the research team visiting and

interviewing patients of mental health. The research team will
observe how the patients respond to questions that concern their
mental health and stigma around mental health. Five researchers
will be charged with handling task 3. It is expected that the task
will take a week.
Schedule
Tasks
Task 1
Task 2
Task 3
Analysis and compilation of data

Week 2
Week 4
Week 6
Week 8
Week 10Budget
Researchers
Hours
Rate per hour $
Cost $
Robert George
150hrs
10
1500
Chis Webber
150hrs
10
1500
Ross Janet
80hrs
10
800
Waeni Mwinzi
40hrs
10
400
Naomi Loved
40hrs
10
400
Miscellaneous

400
8. Appendicesa. Informed Consent
Overview
Please look through this form with care. You have been invited
to be in an investigation study of looking at the role played by
stigma or disgrace in influencing the mental health patients
from seeking help and how this has affected the measures or
programs created to help the mental health patients. You were
selected to be in this study because you have the information we
need. You are not eligible to participate if you are not
comfortable giving any kind of information. You may ask any
questions you have to any person you are comfortable with
before you decide to participate. You will be given a copy of
this consent sheet.
Intention of the investigation
The reason for undertaking this research investigation is to look
at how far stigma or disgrace has influenced mental health
patients from seeking help. This will be possible through
looking at the measures or programs that have been put in place
to help the patients and also finding out whether these programs
are being used and also by finding out if there are people that
more discouraged from seeking help due to stigma or disgrace.
What will take place in the investigation?
If you decide to participate in this research investigation, we
will require you to be present during the interview or give you
questions to fill. The task will take place over two days. It will
consist of two interviews and will take 30 minutes per

interview. During this period, we will either call you to come at
the scheduled place, Veteran Connection facility or come to you
at your convenience time and place.
Benefits
Your participation will help in finding the answer to the
research question. Also, the research could be used in the future
to address the issue of stigma. There will be a level of
awareness created especially among the participants regarding
what the study is trying to address. There are no expected direct
benefits to either the society or the participant.
Discomforts and risks associated with this Study
There will be no expected risks.
Payments
Your participation in this research will be voluntary and
therefore there will be no any incentives for participating in the
research investigation.
Costs
No cost will be used when participating in the research
investigation.
Choosing to participate and choosing to withdraw from the
investigation
You have a right to choose whether you will participate in this
research investigation. If you decide not to participate, it will
not impact your future or current associations with Regis. You
have a freedom to refuse to respond to any questions or
withdraw at any point, for any reason. There will be no penalty
for withdrawing or not being part of the study. Whether you are
a student or an employee, if you decide to participate or not will
not influence your academic or employment status. It is a right
to choose whether to participate or not and therefore there will
be no consequences if you withdraw at any moment.

Being released from the research investigation
The investigator may discharge you from the investigation at
any point due to the following reasons: (1) if you are distressed
or have health issues (2) you have not obeyed the stated
instructions, or (3) if you have an emergency that must be
attended to.
Confidentiality
The information recorded will be kept with at most secrecy.
Any information collected from you will be put away. The
records will be put locked away and also any electronic records
will be protected using a password to ensure security. Apart
from the researcher, the research sponsor and the supervising
lecturer will also be able to view the records. Upon completing
the research fully, the records will be completely destroyed by
incineration and any electronic information will be completely
formatted. Instead of using names the information will contain
numbers and therefore the responses will be anonymous to hide
your identity. The responses will be combined with other
participants’ data and therefore the information gathered is for
the general participants. Also, in the case of publishing the
reports, no information will make it possible for your identity to
be revealed.
Questions and Contacts
The investigator doing this investigation is: MR, Jr. The
investigator will be present to respond to any questions about
the investigation at Ph. 786.389.2691 and [email protected] For
any concerns or questions concerning your rights, you can
communicate with the University Institutional Review Board
Chair:
Dr. Margaret, PhD, RN
781-768-0000
Certificate of Consent
Grownup Participant Informed agreement
I have looked at this sheet (or have had it translated to me). I

also have been urged to raise any questions. I have gotten
responses to my questions. I agree to be in this investigation. I
have gotten (or will get) a copy of this sheet. I recognize the
discomforts and risks related to the above investigation and
know that I may withdraw from the research investigation at any
point without consequences.
Signature or Date
[Grownup Participant Informed Agreement]
Printed Name for the Participant:
His or Her Signature:
Date:
[Translator for those not speaking English]
Translator Printed Name:
___________________________________
Translator Signature: ___________________________________
Date: __________
[Authorized Representative for the Participant]
Participant’s Name (Printed):
___________________________________
Authorized Representative’s Name (Printed):
___________________________________
Authorized Representative’s Signature:
___________________________
Date: __________
Eyewitness’ Name (printed):

___________________________________
Eyewitness’ Signature:
___________________________________
Date: _________b. Literature Matrix
APA Reference
Research Question
Type of Study
Research Design
Sample, Sample Size, and How Selected
Instruments Used, Reliability and Validity, Data Collection
Methods
Results (including statistical analysis
Consistent with other Literature)
Limitations
Verhaeghe et al., 2014)
“What is the association between stigma towards mental health
patients and help-seeking?”
Survey
Multi-stage Cluster sampling
The number of participants was 728 from Belgium. They were
selected randomly based on the number of inhabitants using the
multistage clustering method.
Interviews that were based on face to face interactions and
computer-assisted were used. The sampling design ensured the

participants selected were a representation of the whole
population under study which ensured validity. Also, validated
instruments were used to measure the variables which
facilitated validity.
488 respondents said that those who use former service are
looked upon by others while 357 agreed that most people
perceive receiving psychiatric treatment as a personal failure.
Therefore, the respondents with a higher level of self-stigma
perceive care provided by professionals as less important while
those with high levels of public stigma attached less importance
to informal help-seeking. Gender, ethnicity and
sociodemographic characteristics were seen to have a less
significant impact on help-seeking attitudes, and is supported by
(Subramaniam, 2018) who states that less preference to seek
informal help is associated with the ability to recognize a
mental illness correctly. Multiple linear regression models and
logarithmic transformation were used to assess distribution.
The study was limited by the insufficient amount of empirical
research, hence inadequate literature to aid in carrying out the
research, such as the role of aesthetic environment in patient’s
well-being, which provides better knowledge about the
relevance of the patient’s room in healing. Also, one of the
limitations is that it restricted the interpretation of the causal-
effect relationship. Secondly, the study was based on help-
seeking attitudes rather than help-seeking behavior which
limited the study scope hence creating a bias towards other
confounding factors. The limited number of participants affects
the ecological generalizability of the findings, especially in
larger sample sizes.
(Timmermann, Uhrenfeldt & Birkelund, 2014).
“How seriously ill hospitalized patients’ experience and assign
meaning to their patient room?”
Cross-sectional

Survey
The study focused on a sample size of nine (9) patients is three
Swedish hospitals.
The instrument used- questionnaire – is standardizes the data
collection process, which in turn validates the process by
measuring what was purported to measure. Also, the instrument
is highly reliable because it incorporates researcher
participation, thus giving it the confidence, it deserves as a data
collection instrument.
The study findings showed that viewing natural light in
patient’s room promotes positive thought for critically ill
patients (Timmermann et al., 2014). Other literature has
identified other related themes such as enhancing positive
thought by overriding negative ones, promoting hope and a
positive mood, and helps in bringing good memories.
Essentially, being admitted in the ICU deprives patients of the
freedom to go outside and experience the natural environment.
However, there are different other methods of experiencing this
when hospitalized. This could be an ambient light from a glass
windows, and doors that let in fresh air. Also, the chair can be
placed strategically next to the window so that the patient can
have an unhindered view of the outside environment.
The study was limited by the insufficient amount of empirical
research, hence inadequate literature to aid in carrying out the
research, such as the role of aesthetic environment in patient’s
well-being, which provides better knowledge about the
relevance of patient’s room in healing. Also, the limited number
of participants affects the ecological generalizability of the
findings, especially in larger sample sizes.
(Schnyder et al.,2017)

“What is the association between stigma towards mental health
patients and help-seeking?”
Meta-analysis and systematic review
Cross-sectional, longitudinal or quantitative surveys
Three electronic databases were searched to ensure the
eligibility and relevance of the topic. All the studies that met
the search criteria were screened to assess eligibility. A total of
27 studies were used having 31677 participants from the age of
fifteen.
The electronic databases used include PsycINFO, EMBASE, and
PubMed. These instruments ensured that information acquired is
peer-reviewed hence reliable and also multiple studies adopted
since 1990 were used to ensure validity by comparing their
information.
27 studies ensured the eligibility criteria were met. The
involved participants were seen to have a negative attitude
towards help-seeking. There stigmatizing attitudes towards
those with mental problems showed an association with less
active help-seeking. The main outcome was odd ratio which was
calculated to assess the impact of stigma on seeking help the
confidence interval was 95%. This is supported by Zartaloudi &
Madianos, 2010) who agreed that a stigma that is greater is
correlated negatively with a favorable attitude toward seeking
help.
The first limitation was based on missing some important
studies due to publication bias. Secondly, there was less
information about the exact operationalization of the stigma
measures in the undertaken analysis.
(Al Saif et al., 2019)

“To what degree does stigma constitute a barrier to the search
for help among mental health patients?”
survey
Cross-sectional
385 participated in the study. A convenience sampling method
that was carried out in two stages was used to select the
participants.
A self-report questionnaire was used. The validity of the study
was somehow affected by the type of sampling method used.
However, to ensure reliability, a review of other sources was
done.
The participants showed different stigma attitudes with regard
to the working environment. Those who embrace EBP had less
stigma towards those with mental illness.
The study was affected by the large general population of health
care providers.
Gulliver, Griffiths, & Christensen, 2010)
“Are there populations that are more deterred from seeking help
due to stigma?”
survey
Systematic review
22 relevant studies were chosen. The sample size ranged from 3
to 3746
Three electronic databases were searched, and the data varied
between September-October 2009. The study was reliable and
valid.
Young people were seen to be the most to avoid help-seeking
due to stigma.
The strategy used to search maybe did not capture all the
relevant studies. Also, only 1 researcher coded facilitators and

barriers into themes and hence prone to biases.
Salaheddin, & Mason, 2016)
“Are there populations that are more deterred from seeking help
due to stigma?”
Online survey
Cross-sectional
203 participated in the study. They were selected using
snowballing and convenient technique
Focus groups and questionnaire techniques were used. The
study was reliable and valid.
45 participants had mental or emotional difficulty and reported
to not seek any kind of help.
The was potential for selection bias due to the techniques used.
There was also under-representation of males.
(Olausson, Lindale & Ekberg, 2013)
“What is the impact of care and treatment in ICUs on the patient
recovery process and wellbeing?”
Cross-sectional
Survey
The study focused on a sample of twelve (12) patients – six men
and six women.
The data collection is standardized by the use of open-ended
questionnaires that provided the patients with the freedom to
answer questions to the best of their ability. The instrument use
is highly valid since it measures what was intended to do - to
evaluate …