Date Available


Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation




Educational, School, and Counseling Psychology

First Advisor

Dr. Joseph Hammer

Second Advisor

Dr. Jeff Reese


Appalachians face higher rates of mental health concerns, yet they are less likely to have access to quality treatment. Online counseling, counseling using videoconferencing technology, may provide a viable solution to narrow this gap. However, little is known about Appalachians’ intention to use in-person or online counseling. This study examined Appalachians’ (N = 490) intentions to use online and in-person counseling using the theoretical framework of Theory of Planned Behavior (TPB; Ajzen, 1991). Results from structural equation modeling supported the indirect model for online and in-person counseling, where the associations between distal help-seeking factors (i.e., self-stigma, perceived stigma of close others, distrust of providers, self-reliance, income, and Internet speed) and intention to seek counseling were mediated by the core TPB factors (i.e., attitudes, subjective norms, perceived behavioral control). Additionally, the majority of participants reported preferring in-person counseling, yet over 40% of individuals preferred some type of online treatment (videoconferencing counseling, therapist guided Internet-based treatment, or unguided Internet-based self-help treatment). Thus, online treatments may have the potential to reach individuals who otherwise would not seek traditional in-person treatment.

Digital Object Identifier (DOI)

Funding Information


James S. Brown Graduate Student Award for Research on Appalachia

University of Kentucky's Appalachian Center


Graduate Student Research Assistantship

University of Kentucky's Center for Equality and Social Justice