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Access to Mental Health Supports and Services in Rural Nova Scotia: Perceptions and Experiences of Young Women

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Access to Mental Health Supports and Services in Rural Nova Scotia: Perceptions and Experiences of Young Women Access to Mental Health Supports and Services in Rural Nova Scotia: Perceptions and Experiences of Young Women by Holly Mathias Submitted in partial fulfilment of the requirements for the degree of Master of Arts at Dalhousie University Halifax, Nova Scotia July 2018 © Copyright by Holly Mathias, 2018 Dedication This thesis is dedicated to the community of Pictou County, Nova Scotia, including the students, families, school administration, teachers and staff, as well as healthcare professionals, who work tirelessly to promote mental health in their work and personal lives. ii Table of Contents List of Tables ................................................................................................................................ vii List of Figures .............................................................................................................................. viii Abstract .......................................................................................................................................... ix List of Abbreviations Used ............................................................................................................. x Acknowledgements ........................................................................................................................ xi Chapter 1: Introduction ............................................................................................................... 1 Background ................................................................................................................................. 1 The Research Problem ................................................................................................................ 4 Context and Significance of Study ............................................................................................. 5 Purpose ........................................................................................................................................ 6 Overview of Study Design .......................................................................................................... 6 Key Terms ................................................................................................................................... 7 Mental Health.......................................................................................................................... 7 Rural ........................................................................................................................................ 9 Youth..................................................................................................................................... 10 Supports and Services ........................................................................................................... 10 Implications for the Field of Health Promotion ........................................................................ 11 Summary ................................................................................................................................... 12 Chapter 2: Literature Review .................................................................................................... 13 Understanding Mental Health ................................................................................................... 13 The Burden of Mental Illness ............................................................................................... 14 Applying the Social-Ecological Framework to Mental Health............................................. 15 Youth Mental Health............................................................................................................. 16 Youth Mental Health in Canada ........................................................................................... 18 Rural Canada and Mental Health .............................................................................................. 19 The Determinants of Rural Life in Canada ........................................................................... 19 The Relationship Between Mental Health and Rural Life .................................................... 20 The Importance of Access ........................................................................................................ 24 Youth Access to Mental Health Support and Services in Rural Canada .................................. 26 Physical Access to Care ........................................................................................................ 26 Community Belonging .......................................................................................................... 27 Socioeconomic Status ........................................................................................................... 29 Support of Family and Friends ............................................................................................. 29 iii Youth Access to Care in Nova Scotia ................................................................................... 30 School-Based Services .............................................................................................................. 31 Rural Schools ........................................................................................................................ 31 School-Based Services .......................................................................................................... 32 School-Based Services in Nova Scotia ................................................................................. 33 Summary ................................................................................................................................... 34 Chapter 3: Study Design and Methods ..................................................................................... 35 Conducting Qualitative Research ............................................................................................. 35 Grounded Theory .................................................................................................................. 36 Community Based Participatory Research ........................................................................... 37 Setting ....................................................................................................................................... 38 Researcher Reflexivity .............................................................................................................. 41 Participants and Recruitment .................................................................................................... 43 Study Population ................................................................................................................... 43 Inclusion and Exclusion Criteria ........................................................................................... 44 Sampling and Study Size ...................................................................................................... 44 Recruitment Strategies .......................................................................................................... 45 Data Collection ......................................................................................................................... 46 The Importance of Gathering Lived Experiences ................................................................. 46 Data Collection Setting ......................................................................................................... 46 Interview Process .................................................................................................................. 47 Data Analysis ............................................................................................................................ 49 Ethical Considerations .............................................................................................................. 50 Submitting to Ethics .............................................................................................................. 50 Risks and Benefits................................................................................................................. 50 Working with Vulnerable Populations.................................................................................. 51 Informed Consent.................................................................................................................. 52 Privacy and Confidentiality .................................................................................................. 53 Storage of Data ..................................................................................................................... 53 Conflicts of Interest............................................................................................................... 55 Research Team Roles ............................................................................................................ 56 Trustworthiness ..................................................................................................................... 56 Summary ................................................................................................................................... 57 Chapter 4: Results - Barriers and Facilitators of Access ........................................................ 59 Introduction to the Students and the Community ....................................................................
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