University Students’ Attitudes Toward Seeking Psychological Help for Psycho-Social Problems in Two Selected Public Universities in Tanzania: A Mixed Methods Study

Universities worldwide have established psychological help services to help students deal with ever-growing psycho-social problems. However, evidence shows that students do not prefer using the available services. Nevertheless, the available evidence offers limited information about university students’ attitudes toward seeking psychological help in Tanzania. Thus, the present study examined university students’ attitudes toward seeking psychological help for psycho-social problems. Data were collected from 740 students using questionnaires and focus group discussions. Descriptive statistics were used to analyze students’ help-seeking attitudes. The independent sample t-test was used to determine the difference in students’ attitudes by age, sex, and year of study. Analysis of variance (ANOVA) was used to compare the means of attitudes by students’ field of study. Thematic analysis technique guided the analysis of FGDs data. The findings revealed that most university students had positive attitudes toward seeking psychological help for the studied psycho-social problems. The FGDs findings revealed that students had positive attitudes mainly because they could get relief from the problems they faced, the presence of confidentiality to information shared, and the perceived competence of help service providers. Furthermore, the findings indicated a statistically significant difference in attitude scores for female students (M = 40.56, SD = 3.78) and male students (M = 39.64, SD = 4.62; t (723) = 2.9, p = 0.004, two-tailed). Moreover, university students’ attitudes differed significantly by fields of study, F (3, 723) = 8.12, p < .001. Promoting positive help-seeking attitudes among students might improve their utilization of psychological help services.


Introduction
University education is very demanding in various intellectual, emotional, social, and moral aspects than any other phase of education because most students experience plenty of work pressures and challenges that may result in psychological, social, physical, and emotional difficulties (Bano & Iqbal, 2018).Research shows that students who fail to cope with these difficulties may be vulnerable to developing psychosocial problems (Bano & Iqbal, 2018).Psycho-social problems refer to the difficulties faced by young people in different areas of personal and social functioning (Timalsina et al., 2018).On the one hand, psycho-social problems are concerned with various psychological problems such as depression, sleep disorder, anxiety, learning difficulties, and alcohol and drug abuse (Timalsina et al., 2018; University of Dar es Salaam [UDSM], 2018b, 2021; Vannieuwenborg et al., 2015).On the other hand, they are concerned with social problems such as financial, housing, loss of loved ones, educational and romantic relationship difficulties, sexual harassment, and problems with social security (UDSM, 2018a(UDSM, , 2021;;Vannieuwenborg et al., 2015).
The prevalence of psychosocial problems, mainly depression, sexual harassment, and romantic relationship, have been reported among university students across country contexts.In particular, Mohammed et al. (2021) examined the prevalence of psycho-social problems involving 936 university students in Saudi Arabia.The findings revealed that the prevalence of psychosocial problems included depressive symptoms, as high as 41.1%, anxiety symptoms at 26.9%, and stress symptoms at 22.4%.In the United Kingdom, Connell et al. (2007) found that the common problems presented by university students were academic issues or concerns (41%), low self-esteem (43%), depression (54%), and interpersonal problems (57%).Asante and Andoh-Arthur (2015) reported that the prevalence of depressive symptoms among university students in Ghana stood at 39.2%, with 31.1% having mild and moderate depressive symptoms and 8% having experienced severe depressive symptoms.In Tanzania, a report by the UDSM established that the student population is experiencing various mental, psychological, and physiological challenges which necessitate counselling and rehabilitation services to help them achieve and maintain optimal functioning (UDSM, 2017).Pinchevsky et al. (2020) examined the prevalence of sexual harassment among college students in the USA.The findings indicated that about 9 out of 10 respondents reported having experienced sexual harassment, with a majority (74%) of them being female students.Bastiani et al. (2019) showed that the frequency of sexual harassment among university students in Italy was 38.3% among men and 44.2% among women in the last 12 months.The study also informed that students reported experiencing mental distress symptoms like panic symptoms while at the University.Sivertsen et al. (2019) examined the prevalence of sexual harassment among Norwegian university students pursuing higher education in Norway and abroad.The findings revealed that about 24.2% of students reported having experienced sexual harassment in their lifetime, and 16.7% reported having experienced sexual harassment within 12 months.Abe (2012) examined the prevalence of sexual harassment among Nigerian University students.The findings revealed that 54% of students were physically harassed, 43% were verbally harassed, and 5% experienced either rape and/or sexual assault.In Tanzania, the UDSM antisexual harassment policy and the counselling policy both acknowledge the prevalence of sexual harassment cases at the University of Dar es Salaam notably from male students to female students or from members of academic staff to students (UDSM, 2018a(UDSM, , 2018b)).Onditi et al. (2014) conducted a cross-sectional study on psycho-social stressors of help-seeking behavior among university students' teachers in Tanzania.Romantic relationship difficulties were one of the psycho-social problems examined.The findings revealed between 20 and 34% of students from the studied years of study reported to have experienced romantic relationship difficulties.Furthermore, it was reported that challenges experienced in a relationship by romantic partners might sometimes result in negative consequences, including homicide (Mtulya, 2009;Robi, 2009).The present study focused on psycho-social problems that combine mental health problems (depression) and social problems (romantic relationship difficulties and sexual harassment).This is because most of the previous studies in the area of help-seeking have focused mainly on investigating students' attitudes toward seeking psychological help for mental health problems and less focus on non-mental health problems.Furthermore, the three psycho-social problems were chosen because they are the most common problems among the student population at universities in western and non-western cultural contexts.Additionally, in Tanzania, there exists more evidence about the prevalence of these problems in the student population in some of the public universities (Onditi et al., 2014;UDSM, 2017UDSM, , 2018b)).
The prevalence of psycho-social problems in the university student population has prompted universities in Tanzania and elsewhere to establish student support services, including psychological help.This help is meant to support students in dealing with their problems and consequently achieve and maintain optimal functioning while undertaking their studies.Psychological help is conceptually defined as a voluntary service provided by educated and trained personnel to individuals experiencing various psycho-social problems to improve their psychological well-being (Wong, 1997).It comprises services sought from formal sources such as counsellors, psychiatrists, social workers, and clinical psychologists (Rickwood et al., 2005).Evidence shows that university students who use psychological help from formal sources tend to be better socially and emotionally adjusted (Destefano et al., 2001).They are also reported to be more successful in terms of achievement (Cholewa & Ramaswami, 2015) and are more likely to continue their studies (Sharkin, 2004).
The International Association of Counseling Services (IACS, 2011) reported that psychological help services that include counselling are an integral part of the mission of educational institutions and support the mission in several ways, including consultation, teaching, preventive and developmental interventions, and treatment.Within educational institutions, counselling services are critical in helping clients experiencing various moments of stress caused by academic and personal issues.Getachew (2020) further informed that changes occurring in the educational systems across the world, notably the increase of students' enrolment in universities and the influence of globalization, technological advancement, and the significant cultural changes thereof, necessitate the need for having counselling services in universities more than it used to be in the past.Furthermore, literature indicated that seeking formal psychological help is more satisfying than seeking informal help (McLennan, 1991) and could improve students' academic achievement and enhance a sense of personal development among students, especially when the service providers are qualified professionals (Oluremi, 2014).Moreover, psychological help plays a preventive role by helping students to remain at the University and identify and learn skills that can assist them in meeting their educational and life goals effectively (IACS, 2011;Turner & Berry, 2000).

Psychological Help in Tanzania's Context
Psychological help in educational settings in Tanzania started when the government incorporated counselling services in the education system during the national conference held in Arusha in 1984 (Biswalo, 1996).The main goal was to help students choose the courses to pursue for their future careers, a role that was placed in the hands of career masters and mistresses.Furthermore, counselling was further needed for students because the introduction of western education alienated them from their cultural norms, values, and beliefs (Sima, 2006).Such alienation from the cultural norms and values led to increased social, personal, and psychological problems among students; hence, counselling was needed to play an integral role in the educational system to address the challenges mentioned above (Sima, 2006).Moreover, counselling services in Tanzania started to gain much attention following the emergence of HIV/AIDS in the 1980s, when many people, including educationists, suggested that counselling should be made available to people infected or affected by HIV/AIDS (Sima, 2006).It is also worth noting that, though psychological help has recently started to gain attention in higher education in Tanzania, still some students are inhibited by their traditions from discussing their problems with counsellors; instead, they should seek help from traditional healers as some of the problems are associated to witchcraft (Rushahu, 2022).
The provision of psychological help is echoed in Tanzania's education and training policies at national and educational institution levels.Among the goals of the education and training policy (ETP) of 2014 is to have psychological help in the form of counselling services that meet the requirements of education and training.For instance, statement number 3.2.15 of this goal categorically stated that ''the government shall strengthen the provision of counselling services at all levels of education and training'' (Ministry of Education and Vocational Training [MOEVT], 2014).Furthermore, the Higher Education Development Programme 2010 to 2015 (MOEVT, 2010) and the Tanzania Commission for Universities (2019) indicated that all higher education institutions in Tanzania are encouraged to have psychological help services to support the university students' population and the wider university community.

University Students' Attitudes Toward Seeking Psychological Help
Although universities provide psychological help for university students, previous evidence suggests that students' utilization of such services is low (Aroko, 2014;Kamunyu et al., 2016a;Onditi et al., 2014;Raunic & Xenos, 2008;Setiawan, 2006).Furthermore, studies show that most students prefer informal sources of help, such as friends and family members, for solving their problems (Koydemir et al., 2010;Topkaya & Meydan, 2013).Therefore, it is worth understanding university students' attitudes toward seeking psychological help for psycho-social problems.Attitude is chosen because it is the immediate determinant of behavioral help-seeking intentions (Ajzen, 1991;Kan & Fabrigar, 2017).Attitude is the extent to which a person has a positive or negative evaluation of a particular behavior (Ajzen, 1991;Kan & Fabrigar, 2017;Mesidor & Sly, 2014).It comprises cognitive, affective, and behavioral components (Garcia-Santillan et al., 2012;Rosenberg et al., 1960).According to the theory of planned behavior (TPB), an individual's attitude toward the behavior is the function of the perceived positive or negative consequence of carrying out the behavior (behavioral beliefs) and the positive or negative evaluation of the consequence respectively (outcome evaluation) (Ajzen, 2020;Kan & Fabrigar, 2017).
Various studies have examined attitudes toward seeking psychological help.Some of these studies have indicated that university students held positive attitudes toward seeking psychological help (Aldalaykeh et al., 2019;Alemu, 2014;C xebi, 2009;Mesidor & Sly, 2014;Pheko et al., 2013;Yelpaze & Ceyhan, 2020).In particular, Yelpaze and Ceyhan (2020) examined Turking university students' attitudes toward seeking psychological help.The findings revealed that students who use ''seeking social support and avoidance stress coping strategies'' have more positive attitudes toward seeking psychological help.In contrast, students who use ''keep to self-strategies'' have more negative attitudes toward seeking psychological help (Yelpaze & Ceyhan, 2020).Similarly, C xebi and Demir (2020) examined Turking university students toward seeking psychological help.The results showed the participants had positive attitudes toward seeking psychological help, implying that they had positive views toward seeking psychological help.However, the study by C xebi and Demir (2020) involved both formal and informal sources of help; hence it might not explain university students' attitudes toward seeking psychological help in contexts where formal sources are studied, such as the one in the present study.Mesidor and Sly (2014) examined the attitudes of International and American college students toward seeking psychological help for mental health problems.The findings revealed that students had positive general attitudes toward seeking psychological help.Though the study by Mesidor and Sly (2014) was conducted among university students, it did not specify the fields of study involved.Pheko et al. (2013) conducted a cross-sectional study on university students' attitudes toward seeking psychological help in Botswana.The findings also revealed that most students held positive attitudes toward seeking psychological help.While the findings implied that university students evaluated and considered seeking help beneficial, the study did not indicate the psychosocial problems that students regarded as beneficial for seeking psychological help.
Other studies have revealed that university students held negative attitudes toward seeking psychological help (Al-Darmaki, 2011;Krow, 2020;Masuda et al., 2009;Xien & Zakaria, 2022).Specifically, Krow (2020) examined American college students' attitudes toward seeking professional help for mental illness.The findings revealed that the respondents had negative attitudes toward seeking psychological help for mental health treatment from a professional provider.Masuda et al. (2009) examined the help-seeking attitudes among African American, Asian American, and European American students.The study found that African American and Asian American college students had less favorable attitudes toward seeking psychological help when compared to European American students.Similarly, Samuel and Kamenetsky (2022) reported that most undergraduate university students at a Canadian University relied on informal sources of help, such as friends and family members than formal sources of support available through on-or offcampus psychological help services.Negative attitudes toward seeking psychological have also been reported in the university student population (Al-Darmaki, 2011;Xien & Zakaria, 2022) and non-student population in Asia (Chen et al., 2020).
The variations in findings regarding attitudes toward seeking psychological help, as revealed across studies, could partly be attributed to the cultural point of view.For example, the studies cited above (Al-Darmaki, 2011;Chen et al., 2020;Masuda et al., 2009) involved participants from Asian culture.The evidence shows that people of Asia origin usually perceive psychological help as less useful and practical for addressing their problems (Mojaverian et al., 2013).Collectivist Asian people prefer to solve their psychosocial problems mainly by working on their own, which involves suppressing unpleasant emotional experiences related to particular psychosocial problems rather than reaching out for help (Yu et al., 2015).In contrast, people from individualist cultures are more likely to have positive attitudes toward seeking psychological help as they are encouraged to be independent, autonomous, and distinct from others, with personal goals superseding groups' interests (Kwan et al., 1997;Wang & Lau, 2015).Nevertheless, Tanzania is a collectivist society, and thus, one would expect Tanzania's university students to have negative attitudes toward seeking psychological help, as is the case in most collectivist societies (Choi, 2012;Choi & Miller, 2014;Mojaverian et al., 2013;Nater, 2013;Yu et al., 2015).However, there is also evidence that collectivist individuals may consider psychological help as a means of social support and thus have a positive attitude toward seeking it (Yakunina & Weigold, 2011;Yelpaze & Ceyhan, 2020).
Moreover, the issue of language as a part of culture might also explain variations in attitudes.For example, the negative attitudes toward seeking psychological help among Asian-American students in a study by Masuda et al. (2009) may be attributed to the lack of full mastery of the English language, which is a medium of communication across the U.S. (Kang, 2016).Nevertheless, University students in Tanzania have a full mastery of the Swahili language, which is a medium of communication in most of the psychological helpseeking settings across the country.Hence, the language issue might not be a barrier to their attitudes toward seeking psychological help.Moreover, the masculine ideologies in the societies may partly explain the differences in findings across studies.In particular, females are more encouraged to seek help and are more likely to know people who sought help.Conversely, males hold negative attitudes toward seeking psychological help because of attempts to comply with masculine ideologies that make them believe they are strong enough to deal with whatever compelling circumstances, including afflictions due to psychosocial problems (Kamunyu et al., 2016a;Vogel et al., 2007).Research further informed that traditional gender roles lead males to believe that if they seek psychological help, they would be considered failures, hence, increasing their negative attitudes toward seeking help based on their masculine self-esteem (Vogel et al., 2006).
The conflicting findings concerning attitudes toward seeking psychological help suggest that more studies are needed to investigate a similar scenario in a new country context.Moreover, most existing studies about university students' attitudes toward seeking psychological help have employed a single research approach, mainly quantitative.The use of mixed methods research might provide further elaboration about the attitudes held by university students regarding seeking psychological help.Additionally, there is limited research on the attitudes toward seeking psychological help for psycho-social problems among university students in Tanzania.Therefore, this study had two objectives.First, it examined the university students' attitudes toward seeking psychological help for psycho-social problems (depression, romantic relationship difficulty, and sexual harassment and the reasons for their attitudes).Second, it determined the difference in attitudes toward seeking psychological help by students' sex, age, year of study, and fields of study.

Research Questions
This study was guided by three research questions: 1. What are the attitudes of university students toward seeking psychological help for psychosocial problems?2. What are the reasons given by students to explain their attitudes toward seeking psychological help for psycho-social problems?3. How do students' attitudes toward seeking psychological help differ by age, sex, year of study, and field of study?

Design and Setting
The study employed concurrent embedded design.This design involves collecting quantitative and qualitative data with varying weights at roughly the same time and then merging them to interpret the overall results (Creswell & Creswell, 2018).The design was helpful as it enabled the collection of quantitative and qualitative data in a single data collection phase.Essentially, qualitative data were embedded in quantitative data to corroborate and elaborate on the survey results on attitudes toward seeking psychological help.
The setting of our study has been partly described in our previous publication (Daudi et al., 2023).In a nutshell, the study was conducted at the University of Dar es Salaam Mwalimu Julius Kambarage Nyerere Mlimani campus (UDSM-MJKNM) and the University of Dodoma.UDSM-MJKNM is located in the commercial capital city of Tanzania, Dar es Salaam (UDSM, 2021), and UDOM is located in the capital city of Tanzania, Dodoma (University of Dodoma, 2021).Both are the most prominent publicly owned universities with the highest annual enrolment rate of more than 20,000 students compared to other universities in the country.Additionally, the age of the two universities whereby UDSM is the oldest and could represent the previously established public universities, and UDOM is the youngest.It could represent the recently established public universities.

Sample
The procedures used in determining the sample size for the study have been partly explained in our previous publication (Daudi et al., 2023).Briefly, the procedures outlined by Cohen et al. (2018) were used to determine the study sample size.The targeted population for the present study was 2093.According to Cohen et al. (2018), the sample size for the population of 2093 is 322.However, they added that if the population is divided into different strata, the sample size will increase.The population of the present study was divided into four strata, that is, fields of study, namely, education, social science, business, and engineering.Following the procedure by Cohen et al. (2018), the sample size of the present study increased from 322 to 740.

Participants
The participants' socio-demographic characteristics has been partly described in our previous publication (Daudi et al., 2023).In a nutshell, a total of 740 students were conveniently selected to participate in the study.The participants were obtained from two public universities in Tanzania, the UDSM-MJKNM and UDOM, across the fields of Education, Social Science, Business, and Engineering.Females were 389; males were 349, and 2 students did not specify their sex.The University of Dar es Salaam (UDSM) had 53.6%, and the University of Dodoma (UDOM) had 46.4%.Among them, 54.2% were in the third year, and 45.8% were in the second year.The participants had an average age of 22.6 (SD = 2.4).Most of the respondents (87%) were aged between 18 and 24.Moreover, most of the participants were from the field of Education 32.2%, followed by Social Science 26.2%, and then Business 24.6%.The remaining 17% were from the field of Engineering.

Socio-Demographic Characteristics of FGDs Participants
This section summarizes the socio-demographics of FGDs participants based on sex, age, year of study, and field of study.In particular, females were 20 and males were 27.All FGDs participants were aged between 18 and 30 years.Second year students were 23, and third year students were 24.In terms of field of study, 13 students were from education, 12 from social science, 17 from business, and 5 from engineering.

Procedures
This study was ethically approved by the two participating universities.Before data collection, the researcher informed all participants about the overall purpose and the benefits of participating in the study.The participants were verbally requested for their consent to participate in the FGDs and audio record their voices during the FGDs sessions.Their willingness to take part in the study and withdraw from the study was also explained to them.Students completed the written consent form, which was attached to the questionnaire.Furthermore, participants were assured that their information, names, and other identifiers would be kept anonymous and confidential.In particular, the participants were told not to write their names or identifiers on the questionnaire to ensure the anonymity of their responses.The FGDs participants were given numbers so as to hide their identities during the sessions.

Measures
Attitude toward seeking psychological help for psychosocial problems was measured using 12 items adapted from the attitude toward seeking professional psychological help scale (ATSPPH-SF; Fischer & Farina, 1995).The information about the use of this scale has been partly described in our previous publication (Daudi et al., 2023).Briefly, one of the adaptations made was using the term ''counselling and/or counsellor'' because it is the commonly used term in psychological helpseeking settings in Tanzanian universities, including the studied universities.The researchers invited experts from the Department of Educational Psychology and Curriculum Studies at the UDSM to review the attitude measure for validity checking.In addition, the measure was piloted by the researchers on a sample of 60 students from the UDSM-Mwalimu Julius Nyerere Mlimani Campus.However, during the actual fieldwork of this study, the participants involved in the pilot study were not included.The pilot study checked if there were ambiguities and misunderstandings in some of the items that constituted instruments for data collection.For example, when completing the pilot questionnaire, the participants were asked to note and report items and response options that were unclear and ambiguous.
Moreover, during the pilot study, the participants were asked to give their views about any items or questions they thought were important that deserved to be included in or omitted from the questionnaire.Half of the items were positively worded, while the other half were negatively worded.For example, ''If I were experiencing a depression at this point in my life, I would be confident that I could find relief by getting counselling,'' ''A person with a romantic relationship difficulty is not likely to solve it alone; he or she is likely to solve it through counselling,'' and ''Discussing a sexual harassment problem with a counsellor gives me a sense of relief.''The response option ranged from 1 (strongly disagree) to 4 (strongly agree).The scores were added together as a measure of students' attitudes toward seeking psychological help.The total scores were calculated after reversing the negatively worded items.The higher scores indicated better help-seeking attitudes.The original scale had acceptable reliability ranging from 0.82 to 0.84 (Fischer & Farina, 1995).The pilot study results showed that the internal consistency of the attitudes scale was 0.5.The Cronbach's alpha of the scale for the present study was 0.71.
Focus group discussions (FGDs).FGDs were conducted to corroborate and elaborate the questionnaire findings.A total of eight FGDs were conducted.In each FGD, the group participants ranged from five to seven.Fortyseven participants were conveniently recruited from those who filled out the questionnaire based on their availability and willingness to participate in the FGDs.The groups were comprised of participants based on sex and year of study across all fields of study in each University.The FGDs were conducted on the university premises that afforded maximum privacy to the participants and at a specific pre-arranged time, and considered convenient for all students to meet and hold the discussions.
The FGDs for second-year and third-year students were conducted separately in order to allow comfortability among study participants and avoid intimidation of junior students from the second year of study and by senior students from the third year of study.In addition, the researchers encouraged and asked each participant to give their views on the discussed issues.The FGD data corroborated and elaborated the questionnaire findings.On meeting days before the FGDs sessions, the researcher reintroduced himself and his position in the study and the overall purpose of conducting the study.Then, the researcher verbally requested the participants' consent to participate in the FGDs, including asking and obtaining permission to record the conversation to capture participants' own words and messages (voices) for data analysis.Afterwards, the researcher allowed the participants to introduce themselves and ask questions or express their concerns.The introduction and information in the conversations before the FGDs sessions helped build rapport between the researcher and participants.The researcher conducted the FGDs sessions by posing main and follow-up questions and responding to some comments or questions that were asked for clarification.The time for the FGDs sessions ranged between 45 to 60 minutes.The questions asked during FGDs were, are you aware of psychological help (counselling)?(Yes, No), meaning, availability at the University, places where they can access them, how did you get to know about psychological help services, do you think it is important to seek psychological help (counselling) for a psycho-social problems (e.g., depression, relationship, and sexual harassment)?Yes/No, why?

Data Analysis
The quantitative data were analyzed using the SPSS for windows software package.In particular, descriptive statistics were used to analyze university students' attitudes toward seeking psychological help.The descriptive analysis involved computing and reporting mean, standard deviation, and percentage.The independent sample t-test was used to determine the difference in help-seeking attitudes by age, sex, and year of study.Likewise, the one-way analysis of variance (ANOVA) was employed to determine the difference in students' attitudes by students' field of study.The management of qualitative data started from the field by ensuring that the data from FGDs were audio recorded along with the field notes that the researcher took.The data from FGDs were transferred from the audio recorder to the computer hard disk, external hard disk, and flash drive as backup copies.All the files with recorded data were labelled using codes containing details about actual dates, the time they were collected, and respective study participants.
Thematic analysis was conducted for qualitative data by following the usual thematic analysis steps, namely, familiarization with data, generating initial codes from the collected data, searching for themes by sorting the generated codes into potential themes, reviewing themes, defining and naming themes (Braun & Clarke, 2013).The inductive technique was used to identify themes.It is where the themes are identified and analyzed by linking them with the collected data and are not dictated by the theoretical stance of the researcher.In this regard, induction facilitated the identification of themes from the raw field data on attitudes toward seeking psychological help for the studied psycho-social problems (Braun & Clarke, 2006, 2013).

Results
University Students' Attitude Toward Seeking Psychological Help for Psycho-Social Problems.The first objective of this study examined the attitudes of university students toward seeking psychological help in regard to three psycho-social problems.The psychosocial problems included depression, relationship difficulty, and sexual harassment.The descriptive findings showed that the majority (87%) of the participants had positive attitudes toward seeking psychological help regarding the aforementioned psycho-social problems.The results suggest that the majority of the participants valued seeking psychological help to address their psycho-social problems.Additionally, the study examined participants' attitudes toward seeking psychological help for depression, romantic relationship difficulty, and sexual harassment.The results of students' attitudes toward seeking psychological help for each of the three psychosocial problems are presented in Table 1.
Table 1 shows that the majority (92.2%) of the participants had positive attitudes toward seeking psychological help for sexual harassment, followed by depression and romantic relationship difficulty.This suggests that university students placed a high value on seeking psychological help for sexual harassment than on depression and romantic relationship difficulty.
The quantitative findings were corroborated and complimented with the qualitative findings collected through FGD.During FGDs, participants were divided on their views about the value of seeking psychological help.Some participants supported the idea of seeking psychological help for psycho-social problems, while others did not support it.However, generally speaking, it was evident that all participants involved in focus groups had positive attitudes toward seeking psychological help.In supporting their views, most participants with positive attitudes provided three reasons to support their position.These reasons are presented below.
Getting relief for the problems being experienced.The findings from FGDs uncovered that participants believed opening The participants' voices imply that most students hold a positive attitude toward seeking psychological help because of the perceived psychological relief obtained after visiting and talking about their problems to counsellors.
Other students also maintained that relief could be obtained when counsellors share similar problems that they may have gone through and also when they hear comforting words from the counsellor.This claim is supported by the following student' quote: Sometimes a counsellor may have passed through a similar painful experience.When they share it with you, you feel relieved that you are not the only one experiencing such a problem.(P52, male student) Correspondingly, another student added: Some students may experience depression for failing to pay the tuition fees that will allow them to sit for examinations.But comforting words from a counsellor, such as not sitting for exams now, is normal, and maybe you can postpone exams and do them some other times, which may relieve such students.(P40, female student) The above quotes suggest that talking frankly and openly about the problems, followed by hearing comforting words from the counsellor alongside hearing about similar painful experiences which others have also gone through, contributed to change in the view of help seekers about themselves as individuals and the actual psychosocial problem at hand.

Perceived
competence of the psychological help providers.Students also reported that seeking psychological help was influenced by the perceived competence of the psychological help providers.Participants uncovered that the counsellors possess the professional training and the practice experience they have developed through working with clients with psychosocial problems of various natures.The following excerpts support this argument: Counsellors are well experienced in helping people make correct decisions about their lives because of the training they received and their daily experience meeting such problems in their work.(P18, female student) One of the students maintained that: When I have any psycho-social problems, the only place I can go to get healed is to the counsellor because they are knowledgeable and experienced in attending to clients with problems.(P44, male student) Another student maintained that: Counsellors have plenty of training and experience due to problems they have encountered.They are likely to be wellpositioned to help you address what you might be going through as opposed to simply sharing your problems with friends.(P44, male student) These quotes from the participants attest to the importance of having trained and experienced psychological help service providers as a way of attracting students to support the utilization of such service since the qualified and experienced counsellors can be trusted because of their competence and have the legitimacy to attend to students' psycho-social problems.
Perceived presence of confidentiality.The third reason for students seeking psychological help was reported to be the perceived level of confidentiality and trustworthiness that students obtain from counsellors.They believed it safer and more secure to share their problems with professional counsellors than with relatives and friends.The following quotations support this argument I am confident about getting help from a counsellor for the sake of ensuring the confidentiality of what I am sharing with them.This is because counsellors cannot disclose your problems to others.(P6, female student) Supporting the argument, another student postulated that: You know counsellors are always trustworthy people who cannot divulge the information you have shared with them.(P9, male student) Another student added: I think counsellors are better because they can assure and maintain confidentiality to all my problems compared to friends and relatives.(P46, female student) These quotes imply that students supported the idea of seeking psychological help in circumstances where strict confidentiality of their information is maintained, as they cannot withstand the damage caused by the breach of their issues.
A few participants reported negative attitudes toward seeking psychological help mainly because of the perceived stigma associated with seeking psychological help, the presence of alternative sources of help, and previous negative help-seeking experiences.These reasons are explained below.
Perceived stigma of seeking psychological help.The results from FGD uncovered that from the students' perception, the perceived stigma of seeking psychological help involved both perceived self-stigma and social stigma.
Regarding the perceived self-stigma of seeking psychological help, participants' especially male students, reported that seeking psychological help would symbolically imply that they are not strong enough to deal with problems in contrast to what men are expected to be.This was evident in seeking psychological help for sexual harassment issues.The following statements support this: If a man experience harassment of any form, it becomes difficult to expose it to the counsellor and his friends.This is because doing so will mean that he is inferior, and it will be weak of him to seek external help.(P50, male student) Another student shared a similar view: For me seeking help after being sexually harassed will mean that I am a failure, and also that will be weak of me.(P19, male student) The two quotes reveal the perception that male students are naturally strong and expected to demonstrate strength by dealing with challenging situations without seeking help from others.This explains their negative attitudes toward seeking psychological help even if they have faced psychosocial problems that are beyond their control and would get help from providers of psychological help.
Regarding the perceived social stigma of seeking psychological help, participants expressed the fear of being negatively interpreted and judged by other students.Being perceived negatively includes being considered a sinner and at fault after experiencing a problem.Also, feeling shameful and considered weak by other people partly informed the perceived social stigma of seeking psychological help.The perceived social stigma was evident when the problem in which help should be sought was related to sexual harassment.The following quotations support this claim: Speaking of us ladies, when we experience sexual harassment, many of us believe that society thinks it is us (ladies) who are sinners or at fault.So we avoid seeking help from counsellors because we fear being labelled negatively by those around us. (P13, female student) Another student added: You know, in our society, the way it has been conceived is that when it comes to sexual harassment, it is a woman who gets harassed, and a man cannot be harassed.It is shameful for a man to seek help for that problem.(P47, male student) Similarly, one student remarked that: Many people feel embarrassed and fear being perceived as weak when others learn that they have been seeking psychological help.(P3, female student) The foregoing statements have two implications.The first is that male students have a sense of perceived social stigma toward seeking psychological help, especially on sexual harassment issues, because they feel ashamed of doing so since they believe that sexual harassment is for women and not for men; as a consequence, they evaluated the idea of seeking psychological help negatively.The second implication is that female students have a sense of perceived social stigma toward seeking psychological help for sexual harassment because of the fear of being labelled negatively by society, like being considered weak and being considered at fault for the negative incident that happened to them.
Perceived presence of alternative source(s) of help.Some students believed that they could use the experience and advice from their friends and relatives to address their concerns; thus, seeking psychological help from professionals was unnecessary.One student contended that: I know maybe my friend experienced depression or sexual harassment, and coincidentally you find that I am going through a similar experience.So, I will ask her how she addressed them and use her insights to deal with my own experience instead of going to the counsellor.(P13, female student) Supporting a similar view, the other student added: The tradition of seeking psychological help from a professional is tricky because we often use other people's experiences to solve our problems.We ask them to share with us the ways they used to solve their problems, and we use such ways to solve our problems.(P35, male student) The two suggest that students' negative attitude toward seeking psychological help was based on the view that there are always other students who have experienced similar psychosocial problems one might also be going through.Therefore, consulting peer students who have ever gone through similar psychosocial problems would be enough to get the kind of help needed as opposed to making efforts to look for help from counsellors.
Students also supported pursuing alternative sources of help since they may not freely share their problems with counsellors because they are not related and consider counsellors strangers to clients with whom it is hard to share personal issues.The following quotes justify this claim: It is hard to go to the counsellor's office with whom you are not related to seek help while you have people around you with whom you live and have a good relationship with them.So, I would instead go to familiar people than go to a counsellor whom I don't have any relationship with them.(P48, male student) Supporting the idea, another student narrated that: We have that mentality that problems are to be shared with people with whom we have close ties, such as friends and relatives.So why waste time going to a counsellor when I can ask my friend or a close relative to help me with my problem?(P36, female student) Previous negative help-seeking experience.Other students reported that some supporting staff or counsellors explicitly or implicitly scold some students who drop into the counselling offices to express their concerns for help.Additionally, some students reported that some of the talk or body language expressions in terms of gestures and facial expressions of some counsellors are not good.Such language expressions explicitly or implicitly propose or approach establishing a romantic sexual relationship with the same students who drop into the counselling office to seek help.The following statements illustrate: A year ago, I felt depressed because of some personal issues.So, I decided to go to the University counsellor to clear out my depression.But when I went there, the receptionist forced me to disclose my problem to her before seeing a counsellor.She even reprimanded me for no reason.(P13, female student) A similar view was shared by another student who claimed: Sometimes you may go to the counsellor, and you end up being sexually harassed.A counsellor may want to be sexually intimate with you.And even sometimes, how they talk or look at you can show that they are sexually interested in being with you.It annoys me because you wouldn't expect a counsellor to take advantage of your problem to meet his sexual desires.(P11, female student) Likewise, one of the students remarked: Some counselling offices are not welcoming; you may be yelled at the initial point of expressing your issues.So, I think the counsellors should not yell at the clients, and they should be generous so that clients may express their problems well and want to come back for counselling.(P37, male student) These statements suggest that some students held unfavorable attitudes toward seeking psychological help because they experienced an unwelcome atmosphere when they approached some of the supporting staff or the counsellor for help.They are judged negatively instead of being listened to with unconditional positive regard about their concerns related to the psychosocial problems afflicting them.They endure unpleasant or undesirable advances (unethical behaviors) from some of the counselling office bearers.

Differences in University Students' Attitudes Toward Seeking Psychological Help Based on Demographic Characteristics
The second objective examined whether attitudes toward seeking psychological help differed based on students' demographic characteristics.Table 2 summarizes the independent samples t-test and ANOVA results on the differences in students' attitudes based on sex, age, year of study, and field of study.
The independent sample t-test results in Table 2 indicated a statistically significant difference in the mean score of attitudes toward seeking psychological help between female students (M = 40.56,SD = 3.78) and male students (M = 39.64,SD = 4.62), t (723) = 2.9, p = .003,h 2 = .01.This means that female students were slightly more positive about seeking psychological help than male students.Furthermore, the results showed that attitudes toward seeking psychological help did not significantly differ by students' year of study, t (725) = 1.737, p = .083,and students' age, t (713) = 2.49, p = .621.This means that students' age and year of study did not affect their attitudes toward seeking psychological help.
Furthermore, ANOVA results in Table 2 revealed that there was a statistically significant difference in attitude toward seeking psychological help by students' field of study, F (3, 723) = 8.12, p \ .001,partial h 2 = .03].The post hoc comparisons using the Tukey HSD test indicated that the attitude mean scores for education (M = 41, SD = 3.75) was significantly different from engineering (M = 38.78,SD = 4.83) and business (M = 39.79,SD = 4.17).Social science (M = 40.2,SD = 4.2) differed significantly from engineering.Furthermore, the business did not differ significantly from social science or engineering.The results suggest that education and social science students were more positive about seeking psychological help than engineering students.

Discussion
The findings revealed that most students had positive attitudes toward seeking psychological help for the three psycho-social problems, namely, depression, sexual harassment, and relationship difficulty.This shows that students perceive it would be useful to seek psychological help because of its associated benefit, which includes solving the psycho-social problems encountered during their stay at the University.
The findings of the present study supported those of previous studies conducted in other contexts that also found that university students had positive attitudes toward seeking psychological help (Aldalaykeh et al., 2019;Alemu, 2014;Andoh-Arthur et al., 2015;Bohon et al., 2016;Mesidor & Sly, 2014;Pheko et al., 2013).For example, studies conducted in Jordan and U.S. revealed that most university students held positive attitudes toward seeking psychological help for depression (Aldalaykeh et al., 2019;Bohon et al., 2016;Mesidor & Sly, 2014).Similarly, studies conducted in Ghana, Ethiopia, and Botswana indicated that most students supported seeking psychological help specifically for depression (Alemu, 2014;Andoh-Arthur et al., 2015;Pheko et al., 2013).However, the previous studies mentioned above largely reported the findings on positive attitudes toward seeking psychological help, mainly for mental health problems.The present study extended the existing literature by specifically revealing that most students had positive attitudes toward seeking psychological help for sexual harassment and romantic relationship difficulty, as well as depression which is part of mental health problems.Consistently, it is asserted in the helpseeking measurement framework that it is important to be specific regarding the kind of problem to which the help-seeking process is directed instead of grouping a wide range of problems together (Rickwood et al., 2012).This, in turn, could make it easy to compare studies on different types of problems (Rickwood et al., 2012).
The findings of the present study differ from those in previous studies that revealed that most of the students had negative attitudes toward seeking psychological help.For example, studies conducted in America (Krow, 2020;Masuda et al., 2009), Canada (Samuel & Kamenetsky, 2022), United Arab Emirates (Al-Darmaki, 2011), and Malaysia (Xien & Zakaria, 2022).One of the plausible explanations for the differences in findings with regard to attitudes toward seeking psychological help, as revealed in this study and those in previous studies, could be partly attributed to the cultural point of view.For example, some studies cited above (Al-Darmaki, 2011;Masuda et al., 2009;Xien & Zakaria, 2022) involved participants from Asian culture.The existing evidence shows that people of Asia origin usually perceive psychological help as less useful and practical for addressing their problems (Mojaverian et al., 2013).Asian people prefer to solve their psychosocial problems mainly by working on their own, which involves suppressing unpleasant emotional experiences related to particular psychosocial problems rather than reaching out for help (Yu et al., 2015).
Furthermore, many studies show that individuals from Asian collectivistic cultures have negative attitudes Daudi et al.
toward seeking psychological help (Choi, 2012;Choi & Miller, 2014;Mojaverian et al., 2013;Nater, 2013;Yu et al., 2015).Thus, Tanzania being a collectivist society, it would be expected that Tanzania's university students would have negative attitudes toward seeking psychological help, as is the case in most collectivistic societies.However, this was not the case because there is evidence that indicates that collectivist individuals may consider seeking psychological help as a means of social support and thus have a positive attitude toward seeking it, as was the case for students in the present study (Yakunina & Weigold, 2011;Yelpaze & Ceyhan, 2020).
Nevertheless, the present study has extended the existing limited literature about positive attitudes toward seeking psychological help among individuals in collectivist cultures.Moreover, language as a component of culture might also facilitate or inhibit an individual from seeking psychological help.For example, a study by Kang (2016) revealed that Asian students who were studying in the U.S. could not seek psychological help because they lacked full mastery of the English language, which is a medium of communication across the U.S. Nevertheless, students in the present study did not cite language as a barrier to their attitudes toward seeking psychological help because all of them had the full mastery of Swahili language which is the medium of communication across the counselling centers in Tanzania.Moreover, the findings of this study also indicated that female students were more positive toward seeking psychological help than their male counterparts.The implication is female students perceived seeking psychological help to be more beneficial than male students.The findings of this study supported those of previous studies that informed that female students were more likely to have more positive attitudes toward seeking psychological help for their problems than their male counterparts (C xebi & Demir, 2020;Chandrasekara, 2016;Figueroa et al., 2020;Kuo et al., 2006;Kamunyu et al., 2016a).The masculine ideologies in the societies may partly offer a possible explanation as to why female students are more likely to be more positive toward seeking psychological help than male students.In particular, females are more encouraged to seek help and are more likely to know people who sought help.Conversely, males hold negative attitudes toward seeking psychological help because of attempts to comply with masculine ideologies that make them believe they are strong enough to deal with whatever compelling circumstances, including afflictions due to psychosocial problems (Kamunyu et al., 2016a;Vogel et al., 2007).The ANOVA results also revealed that engineering students held less favorable attitudes toward seeking psychological help than students in the fields of education and social science.The finding suggested that education and social science students perceived seeking psychological help to be more beneficial in addressing their psycho-social problems than engineering students.The results of this study are consistent with a study by C xebi (2009) revealed that education, arts, and social science students had more favorable helpseeking attitudes than engineering students.One of the plausible explanations for this similarity is that overall, in this study, there was a higher proportion of male than female students in the engineering field.The same was the case in the study by C xebi (2009).The assumption is that the fields of study with a high proportion of female students than male students will have more positive helpseeking attitudes compared to fields of study with few female students and many male students.
The findings from the focus group discussions indicated the three reasons why most students had positive attitudes toward seeking psychological help for psychosocial problems.The first reason was obtaining relief from the problem being experienced.The findings of this study are in line with those of previous studies that revealed that students supported the idea of seeking psychological help because of the general relief obtained after opening up problems to counsellors who are effective listeners (Busiol, 2016;Yelpaze & Ceyhan, 2019).The present study extended the existing literature by showing that students' relief was associated with the fact that psychological help settings are comforting, safe, and welcoming.Such settings would allow them to open up freely about their problems without being judged.
Perceived competence of psychological help providers was a second reason reported by students for their positive attitudes toward seeking psychological help.The findings indicated that students see help service providers as experts who have acquired enough professional training and practical experience through working with clients with various problems.The findings of this study are in line with those in previous studies that revealed that university students who believed that psychological help service providers were experts and knowledgeable were more likely to develop positive attitudes toward seeking psychological help (Figueroa et al., 2020;Yelpaze & Ceyhan, 2019).However, the present study partly added to the existing literature by showing that the competence of help service providers was, to a part, linked to their day-to-day encounters of meeting clients with different kinds of problems.
The third reason for students' positive attitude toward seeking psychological help is the perceived presence of confidentiality in the individuals and their working premises involved in providing helpful services.Students perceived that information related to personal issues they share with psychological help service providers would not be disclosed to others and would remain confidential between the client students and the help service providers.A study by Yelpaze and Ceyhan (2019) put that students perceive professional psychological services as an important opportunity to talk about problems they would otherwise not have the courage to discuss with friends and family members.Studies by Setiawan (2006) and Topkaya (2015) revealed that strict confidentiality in psychological help-seeking leads students to trust counsellors and consequently develop positive attitudes toward seeking psychological help.Therefore, the findings of this study and those in other previous studies indicate that students supported the idea of seeking psychological help in contexts where they are guaranteed confidentiality of their private information.
The findings from the focus group discussions revealed a few students had negative attitudes toward seeking psychological because of the perceived self and social stigma of seeking psychological help, the presence of alternative sources of help, and previous negative help-seeking experiences.
Regarding self-stigma, the findings indicated that the self-stigma of seeking psychological help was explicit among male students who disapproved of seeking psychological help for sexual harassment because they felt that doing so would imply that they were weak and inferior.This is because, in the Tanzanian context, male students hold biased beliefs through socialization which consider that seeking help implies inferiority.Male students' negative view toward seeking psychological help might be attributed to the culture of masculine mindsets that made them believe that they are naturally strong and expected to demonstrate strength by dealing with their problems without reaching out for help (Kamunyu et al., 2016a).The findings of this study supported the findings by Vogel et al. (2014), who found that men who embrace higher masculine beliefs have less favorable attitudes toward seeking psychological help for psychological problems.A study by Allen et al. (2016) indicated that men reported greater self-stigma as they were less comfortable sharing their struggles with psychological help providers as they assumed they could resolve their problems on their own.The present study extended the existing literature by showing that male students' selfstigma in seeking psychological help was more prone to sexual harassment issues than other problems such as depression and relationship difficulties.
Furthermore, the perceived social stigma of seeking psychological help among students was explicit when they feared being labelled by society that they were not strong enough to address their problems and judged as being at fault and sinners when they experience problems.These findings are in line with those of previous empirical studies that indicated that a higher social stigma is associated with negative attitudes toward seeking psychological help (Boyd et al., 2011;Bullard & Hosoda, 2015;Busiol, 2016;Komiya et al., 2000;Shea & Yeh, 2008;Topkaya, 2015).However, the students in this study interpreted the perceived social stigma of seeking psychological help in terms of feeling ashamed, labelled as weak, at fault, and sinners by society after experiencing a problem.The participants in other previous studies interpreted perceived social stigma in terms of being labelled as mentally ill people (Topkaya, 2015;Yelpaze & Ceyhan, 2019), being considered idiots as well feeling ashamed when others learn that they have been seeking psychological help (Boyd et al., 2011;Bullard & Hosoda, 2015) as well as considered as being seen as crazy (Busiol, 2016).
The presence of alternative sources of help was another reason for students' negative attitudes toward seeking psychological help.The findings revealed that students did not see the value of seeking psychological help from professionals since they could rely on their close friends and family members who have gone through a similar experience for psychological support when they experience problems.The findings of this study are consistent with previous studies, which revealed that having other sources of help, especially friends and family members, was associated with negative attitudes toward seeking psychological help from professional providers (Bullard & Hosoda, 2015;Goodman et al., 1984;Kamunyu et al., 2016b;Kuhl et al., 1997;Setiawan, 2006;Yelpaze & Ceyhan, 2019).Arguably, seeking psychological help from friends and family members is exemplary.Still, it is unreasonable to avoid seeking psychological help from professionals even in circumstances where friends and family members are not available or the problems in which help should be sought is beyond the capability of friends and relatives to address (Setiawan, 2006).
Finally, the previous negative help-seeking experience was also provided by those students who held negative attitudes toward seeking psychological help.The present study extended the existing literature by revealing that the previous negative help-seeking experience associated with negative attitudes toward seeking psychological help involved being yelled at, not welcomed well, and being sexually seduced.In contrast, students previous negative help-seeking experiences reported in the findings of previous studies included not finding what students were looking for and knowing others who sought psychological help but could not benefit from it (Yelpaze & Ceyhan, 2019), counsellor smoking a cigarette inside the counselling room that made students uncomfortable (Figueroa et al., 2020).It is established that if young people have a negative experience of seeking psychological help, they may be at greater risk of not seeking it again (Gulliver et al., 2010).Therefore, young clients (university students) must perceive psychological help as something they would be prepared to re-engage in when needed while considering the recurring nature of psycho-social problems among them (Gulliver et al., 2010).

Implications of the Findings
The study established that university students held positive attitudes toward seeking psychological help, suggesting that they believe that seeking psychological help is beneficial for addressing their problems.Thus, attitudes can be targeted by psychological help service providers in Tanzania and other similar country contexts.Targeting attitudes should be on having competent psychological help service providers, creating awareness about the benefits and effectiveness of psychological help services to university students and the general population, so much so that to increase utilization of such services.Further, as it was revealed in the findings that stigma is one of the causes for not seeking help, the government and universities should put in place psycho-education programs regarding psychological help to reduce the stigma associated with seeking help.
Moreover, confidentiality was also indicated as a reason for positive and negative attitudes, where the presence of it led to positive attitudes, and the absence of it led to negative attitudes.Thus government policies and psychological help providers in universities should put in place strategies that will make students understand how the information they share will be kept.This would, in turn, increase trust among help seekers toward help providers.Again, the previous negative help-seeking experience was also shared as a reason for those with negative attitudes.Thus, government policies and universities may put in place strategies that will make students understand how they will be received and treated during counselling process and what counsellors expect from them as well as what they should expect from counsellors.The outcome is that positive attitudes toward seeking psychological help will lead to higher utilization of psychological services offered within and outside the University.

Limitations of the Study and Directions for Future Study
Using convenience sampling in recruiting the participants may limit generalizations to a broader population of university students.Thus, the results could only be generalized to the population with similar characteristics to the one used in the current study.Second, the current study involved participants from two public universities; whether or not the results can be applied to other universities remain unknown.Future research may explore help-seeking attitudes by involving students from private universities for comparison purposes.Despite these limitations, the current study contributes to the existing body of knowledge on university students' attitudes toward seeking psychological help in a different sociocultural context.

Conclusion
This study provided an understanding of university students' attitudes toward seeking psychological help in the Tanzanian context, where there was no published evidence of the same phenomenon.The findings indicated that most university students had positive attitudes toward seeking psychological help for their psycho-social problems.Based on these findings, it can be concluded that promoting positive help-seeking attitudes is imperative for increasing students' utilization of psychological help services.Therefore, awareness of the benefit of psychological help (getting relief to problems being experienced), having competent psychological help service providers, and assuring a sufficient level of confidentiality in psychological help-seeking settings could partly promote positive help-seeking attitudes among university students.

Table 1 .
University Students' Attitudes Toward Seeking Psychological Help by Category of Problems.When you are depressed and talk to a counsellor, it helps you get a sense of relief and feel better as you open up about your depression to another person.(P8, male student)

Table 2 .
Independent Samples t-Test and ANOVA Results on the Differences in University Students' Attitude by Demographic Characteristics.
cF-values from one-way ANOVA.