Current trends in health care reform have emphasized access to health care for those in medically underserved areas (Streff, 1994). Often, these are rural environments. Thus, the health care provider who serves adolescents in rural areas needs to be familiar with their values and beliefs in order to better tailor interventions to meet the unique requirements of this population. Unfortunately, there is a paucity of information about perceptions of mental health in rural America, especially those of adolescents.
There are urban/rural differences in the way individuals view health. People living in rural areas tend to define health as the ability to be productive. They may resist help from outsiders and government agencies, especially those seen as providing welfare (Hanson et al., 1990). Instead, coping behaviors are learned from others in the family or from how people in the community handle problems. Even though they may be exposed to alternative ways of solving problems (e.g., through television and other media), there is generally not much support for attempts at new behaviors.
The rural population may deal with stress by ignoring it or seeking help from family, friends, physicians, or clergy. If a problem is unusual, there may not be anyone in the area to serve as a resource. Even when mental health services are available locally, they may not be accessed because of a perceived stigma associated with mental illness (Kenkel, 1986).
Coping patterns are often established during adolescence. Information regarding teenagers' views of such critical issues as drug abuse, family violence, and mental health, as well as how culture may influence their views, is therefore necessary for developing effective prevention and intervention strategies. The purpose of the present study was to explore the relationship between growing up in a rural or urban environment and perceptions of mental health and mental illness. The specific research questions were: (1) What are the attitudes and beliefs of high school students about selected behaviors representative of mental illness? (2) How similarly do rural and urban students classify these behaviors? (3) What demographic variables distinguish high school students' perceptions?
The questionnaire used for this research was devised based on a tool developed by Flaskerud (1980). In a survey conducted by the Joint Commission on Mental Illness and Health, Flaskerud used vignettes to elicit information about adults' attitudes concerning mental health. The present study's questionnaire contained nine vignettes describing behaviors that adolescents evaluated on a five-category Likert scale, with responses ranging from very healthy (1) to very unhealthy (5). Demographic information was also collected (a complete copy of the questionnaire is available from the authors).
The questionnaire was designed to have a sixth-grade reading level. Content validity was established by four experts - two specializing in rural health and two specializing in mental health. Test-retest reliability was determined using a subsample of 34 adolescents, with correlation coefficients for the vignettes ranging from .55 to .96 (only two were below .85). The first vignette read by the students, which described an incident of child abuse, had the lowest test-retest reliability. Students may have become more sensitive to the instrument's format with later vignettes. The vignette describing a situation in which parents were not able to set limits on a teenager's behavior, and she was getting into trouble, had the next lowest reliability (.75). Perhaps students' similarity to the teen in this vignette contributed to the variance in responses.
Consent to participate in the study was obtained from both the students and their parents. A researcher administered the questionnaire in students' classrooms. Confidentiality was assured; teachers did not have access to students' responses. …