The Liebelt Attitudes, Knowledge, and Engagement Scale: The development and validation of a psychometric test between rural and urban adults

Philadelphia, PA

INTRODUCTION: While the prevalence of mental illness is comparable between rural and urban populations, adults in rural locations receive mental health treatment on a less frequent basis, and when received, the care offered is of lower quality relative to urban adults. Underutilization of mental health services in rural areas is a serious, well-documented problem and has been attributed to several possible factors, including geographic inaccessibility, reduced access to appropriate or culturally competent providers, lack of anonymity when seeking treatment, and reluctance to seek help due to discrimination and stigma. However, rural individuals may also remain reluctant to initiate treatment, possibly due to their long-standing acquired attitudes about psychotherapy, lack of help-seeking engagement behaviors, or absence of accurate knowledge about psychotherapy. OBJECTIVES: This study generally aims to identify barriers that prevent rural individuals from seeking mental healthcare, with the ambition to ultimately inform how to frame psychotherapy for this group and, ultimately, inform strategies to ameliorate interfering factors. First, using best practices in psychometrics and test development and employing factor analysis, this study aims to develop a brief, reliable, and valid measure, The Liebelt Attitudes, Knowledge, and Engagement (Health Seeking) Scale (LAKES), designed to evaluate rural individuals’ attitudes toward, knowledge of, and engagement in help-seeking behaviors related to psychotherapy. Second, the study aims to compare rural and urban samples on such identified factors (the LAKES’ overall score and three subscale scores) to differentiate rural from urban participants on attitudes, knowledge, and engagement in seeking mental healthcare. Further, exploratory analyses will examine the impact of demographic variables, including age, gender, race, and political affiliation, on the overall total scale score and the three proposed subscale scores. Finally, the relationship between the LAKES subscale and total scores to stigma will be examined. METHODS: Participants who meet inclusionary criteria will complete an online demographic questionnaire, the LAKES, and a measure of stigma. In a cross-sectional correlational and a between-subjects survey design, the hypotheses predicted are as follows: H1: the LAKES will comprise three distinct subscales (attitudes, knowledge, and engagement behaviors); H2: the overall total scale and three subscales will demonstrate coefficient alphas of at least .80; and H3: a standardized score on a valid, reliable measure of stigma will be inversely related to attitudes, knowledge, and engagement behaviors. RESULTS AND DISCUSSION: Findings from this study could be useful in informing and designing more nuanced methods for increasing the attractiveness of psychotherapy and soliciting participation in it and more culturally appropriate treatment recommendations. Likewise, it would be beneficial to investigate how the information gleaned would be useful in correcting misconceptions and misinformation, fostering more adaptive attitudes, stimulating interest, and facilitating more accurate beliefs among the rural population.