Author ORCID Identifier

https://orcid.org/0009-0001-7301-736X

Date Available

8-20-2025

Year of Publication

2023

Document Type

Doctoral Dissertation

Degree Name

Doctor of Philosophy (PhD)

College

Nursing

Department/School/Program

Nursing

Advisor

Dr. Chizimuzo Okoli

Co-Director of Graduate Studies

Dr. Debra Moser

Abstract

Arabs in the United States (U.S.) are exposed to different stressors that place them at high risk of developing adverse mental health outcomes. Compared to other minority groups, Arabs in the U.S. have reported significantly higher levels of anxiety and depression. Researchers have found disparities between the need for mental health services (MHS) and actual utilization among Arabs in the U.S. Understanding the intrapersonal factors involved in MHS’ help-seeking behavior among Arabs in the U.S. is essential to reduce the burdens caused by untreated mental health disorders in this population. Therefore, the purpose of this dissertation was to enhance our understanding of MHS help-seeking intentions among Arabs in the U.S. Specific aims are to: 1) scrutinize and synthesize the research literature examining factors that impact MHS help-seeking behavior among Arabs; 2) test the psychometric properties of an instrument for assessing MHS help-seeking behavior among Arabs in the U.S.; 3) examine the effect of attitudes, subjective norms, and perceived behavioral control on Arabs’ intentions to seek MHS; and 4) develop and test a tailored web-based educational video addressing factors that may affect MHS’ help-seeking behavior among Arabs in the U.S.

Aim 1 was achieved by conducting a systematic literature review to identify factors affecting MHS help-seeking behavior among Arabs. Three databases (CINAHL, PubMed, and PsycINFO) were searched systematically for English peer-reviewed articles published before November 2022. Seventeen studies were included. Utilizing the Socio-Ecological Model, we identified different factors that manifest at different levels: intrapersonal level (mental health literacy, lack of resources, privacy and confidentiality, language barriers, mistrust of MHS, and misconceptions about mental health), interpersonal level (family support), and community level (role of religious leaders). Different forms of stigma, gender norms, and negative beliefs intersect across the three levels.

Aim 2 was achieved by conducting a psychometric analysis of the Mental Health Services Help-Seeking Behavior Questionnaire, a Theory of Planned Behavior (TPB) guided questionnaire. A cross-sectional study was conducted in the U.S. using data obtained through an electronic survey of a convenience sample of Arab and Arab American college students (N=102). The tested instrument consisted of 13 items measured on a 7-point Likert-type scale ranging from (1) strongly disagree to (7) strongly agree. The instrument comprised four subscales: attitudes, subjective norms, perceived behavioral control (PBC), and intentions to seek MHS. Cronbach’s alpha values were>0.8 for all subscales and the total scale. The factor analysis revealed that four factors were present within the scale, accounting for a total of 81.4% of the items’ total variance.

Aim 3 was achieved by conducting a quasi-experimental, pretest-posttest study to examine the effect of attitudes, subjective norms, and PBC on intentions to seek MHS and to test the impact of a tailored web-based video on MHS’ help-seeking behavior among Arabs in the U.S. The TPB was used to understand the trajectory of mental health-seeking intentions among Arabs in the U.S. Also, the development of the educational video was guided by this theoretical framework. A convenience sample of 154 Arabs and Arab Americans was recruited. Logistic regression analysis showed that, while controlling for sociodemographic, psychological distress, intrinsic and extrinsic religiosity, acculturation, public stigma, and self-stigma, individuals with higher attitude scores (OR = 4.876, 95% CI [1.71, 13.89]) and individuals with higher subjective norms scores (OR = 4.206, 95% CI [1.51, 11.73]) were significantly more likely to demonstrate a high intention to seek MHS. A Wilcoxon signed-rank test showed that the tailored web-based educational video elicits a statistically significant increase in intentions to seek MHS (Z = -8.600, p < 0.001), subjective norms (Z = -7.506, p < 0.001), and PBC (Z = -7.681, p < 0.001) among Arabs in the U.S.

In conclusion, this dissertation has filled an essential gap in the evidence of MHS help-seeking behavior among Arabs in the U.S. Their MHS help-seeking intentions are primarily influenced by their positive attitudes toward seeking MHS and the social pressure or expectations from significant others rather than their perceived ability to access MHS or control the behavior of seeking these services. Additionally, the preliminary evidence provided in this study suggests that a tailored web-based educational video targeting mental health help-seeking behavior can positively influence attitudes, subjective norms, PBC, and intentions related to seeking MHS among Arabs in the U.S. The next logical step in this line of research would be to include a randomized controlled study with a longitudinal follow-up to assess the impact of this intervention on intentions and actual help-seeking behavior.

Digital Object Identifier (DOI)

https://doi.org/10.13023/etd.2023.401

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Available for download on Wednesday, August 20, 2025

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