Author ORCID Identifier

https://orcid.org/0000-0002-9384-4549

Year of Publication

2022

Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation

College

Nursing

Department/School/Program

Nursing

First Advisor

Dr. Ana Maria Linares

Second Advisor

Dr. Kristin Ashford

Abstract

Attention deficit hyperactivity disorder (ADHD) is a mental health disorder commonly diagnosed in childhood. Underdiagnosis and undertreatment of ADHD can lead to the development of other mental illnesses and disruptions in social functioning in adulthood. Therefore, parents can play a crucial role in proactively seeking mental healthcare for children who are at risk for or who have a clear diagnosis of ADHD. Studies in the United Kingdom and the United States highlight many barriers that prevent parents from seeking mental healthcare for their children, such as negative attitudes towards the mental healthcare system and stigma towards mental illnesses.

Cultural differences exist in mental health seeking behaviors. In the Kingdom of Saudi Arabia (KSA), the prevalence of ADHD among children varies from 3.4% to 16.4%. Also, there is little research on parental mental healthcare seeking behaviors for their children, which, in turn, could improve the recognition of ADHD in children. Examination of mental healthcare seeking behavior among Saudi parents is warranted to improve recognition of ADHD in children. Therefore, the purpose of this dissertation was to identify Saudi children at risk for ADHD; and to examine the effect of attitudes, subjective norms, perceived behavioral control, and fear of mental health stigma on parents’ intention to seek mental healthcare for their children at risk of ADHD.

First, a systematic review was conducted to identify parental barriers in seeking mental health services for children at risk of ADHD worldwide. The electronic search strategy identified articles published in a peer-reviewed journal any time before Jul 17, 2020. Twenty-one studies were included. The studies were conducted in six different countries: the United Kingdom, Australia, Taiwan, India, Greece, Iran, and the United States. Parental barriers to seeking mental healthcare for children at risk of ADHD were identified at multiple levels of the socio-ecological framework. Themes that emerged classified parental barriers to seeking mental healthcare for their children based on the individual-, the interpersonal-, and the community-level.

Second, a psychometric analysis of the Parental Attitudes toward Psychological Services Inventory (PATPSI)-Arabic Version was performed. A sample of 202 parents was recruited from the KSA. Cronbach’s alpha was .87 for the attitude subscale, .90 for the stigma subscale, and .79 for the intention subscale. Factor analysis yielded a 3-factor structure as reported with the PATPSI-English version. As hypothesized, parents’ knowledge of ADHD was positively correlated with the PATPSI-Arabic Version total score. The PATPSI-Arabic Version is a reliable and valid tool to measure Arabic parents' attitudes, stigma, and intention toward seeking mental healthcare for their children.

Next, a cross-sectional study was conducted to identify Saudi children at risk for ADHD; and to examine the effect of attitudes, subjective norms, perceived behavioral control, and fear of mental health stigma on parents’ intention to seek mental healthcare for their children who are at risk of ADHD. In this study (N = 202), The theory of planned behavior (TPB) was used as a framework to understand the trajectory of mental health-seeking behaviors among Saudi parents. The concepts in the TPB are attitudes, subjective norms, perceived behavioral control, and intention to seek mental healthcare. Parents were recruited from different cities in KSA, from November 2020 to August 2021. Based on parent responses, almost 12.0% of children were at risk of ADHD symptoms. The multiple regression analysis results showed that attitudes, subjective norms, and perceived behavioral control were predictors of parents’ intention to seek mental healthcare for their children. However, parents’ stigma toward mental healthcare was not a predictor of parents’ intention to seek mental healthcare for their children.

In conclusion, this study has filled an important gap in the evidence of barriers that prevent Saudi parents from seeking mental healthcare for their children at risk of ADHD. Furthermore, the results indicate the need of psycho-educational interventions that aim to improve Saudi parents’ knowledge of ADHD, its treatment, and their attitudes, and intentions toward seeking mental healthcare for their children. It is critical to ensure that children who need treatment receive it as early as possible to prevent the development of future psychopathology and associated problems in Saudis’ children.

Digital Object Identifier (DOI)

https://doi.org/10.13023/etd.2022.009

Available for download on Thursday, January 04, 2024

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