The Influence of Human Support on the Effectiveness of Digital Mental Health Promotion Interventions for the General Population.

Mental wellbeing amongst the general population is languishing-exacerbated by the Coronavirus Disease 2019 (COVID-19) pandemic. Digital mental health promotion interventions, that improve mental health literacy and encourage adoption of evidence-informed practical strategies are essential. However, attrition and non-adherence are problematic in digital interventions. Human support is often applied as an antidote; yet, there is a paucity of randomized trials that compare different human support conditions amongst general population cohorts. Limited trials generally indicate that human support has little influence on adherence or outcomes in DMHPIs. However, providing participants autonomy to self-select automated support options may enhance motivation and adherence.

Participant Perceptions of Facilitators and Barriers to Adherence in a Digital Mental Health Intervention for a Nonclinical Cohort: Content Analysis.

BACKGROUND: Digital mental health promotion interventions (MHPIs) present a scalable opportunity to attenuate the risk of mental health distress among nonclinical cohorts. However, adherence is frequently suboptimal, and little is known about participants' perspectives concerning facilitators and barriers to adherence in community-based settings. OBJECTIVE: This study aimed to examine participants' perceptions of facilitators and barriers to adherence in a web- and mobile app-based MHPI for a nonclinical cohort. METHODS: This qualitative study used inductive, reflexive thematic analysis to explore free-text responses in a postintervention evaluation of a 10-week digital MHPI. The intervention was administered using a web and mobile app from September to December 2018. Participants (N=320) were Australian and New Zealand members of a faith-based organization who self-selected into the study, owned a mobile phone with messaging capability, had an email address and internet access, were fluent in English, provided informed consent, and gave permission for their data to be used for research. The postintervention questionnaire elicited participants' perceptions of facilitators and barriers to adherence during the intervention period. RESULTS: Key factors that facilitated adherence were engaging content, time availability and management, ease of accessibility, easy or enjoyable practical challenges, high perceived value, and personal motivation to complete the intervention. The primary perceived barrier to adherence was the participants' lack of time. Other barriers included completing and recording practical activities, length of video content, technical difficulties, and a combination of personal factors. CONCLUSIONS: Time scarcity was the foremost issue for the nonclinical cohort engaged in this digital MHPI. Program developers should streamline digital interventions to minimize the time investment for participants. This may include condensed content, optimization of intuitive web and app design, simplified recording of activities, and greater participant autonomy in choosing optional features. Nonetheless, participants identified a multiplicity of other interindividual factors that facilitated or inhibited adherence.

Addressing the COVID-19 Mental Health Crisis: A Perspective on Using Interdisciplinary Universal Interventions.

Mental health is reaching a crisis point due to the ramifications of COVID-19. In an attempt to curb the spread of the virus and circumvent health systems from being overwhelmed, governments have imposed regulations such as lockdown restrictions and home confinement. These restrictions, while effective for infection control, have contributed to poorer lifestyle behaviors. Currently, Positive Psychology and Lifestyle Medicine are two distinct but complimentary disciplines that offer an array of evidence-based approaches for promoting mental health and well-being across a universal population. However, these strategies for improving mental health are typically used in isolation. This perspective calls for a new paradigm shift to create and rollout well-designed interdisciplinary universal multicomponent mental health interventions that integrates the benefits of both disciplines, and uses innovative digital mental health solutions to achieve scalability and accessibility within the limitations and beyond the COVID-19 lockdown and restrictions.

The Influence of Three Modes of Human Support on Attrition and Adherence to a Web- and Mobile App-Based Mental Health Promotion Intervention in a Nonclinical Cohort: Randomized Comparative Study.

BACKGROUND: The escalating prevalence of mental health disorders necessitates a greater focus on web- and mobile app-based mental health promotion initiatives for nonclinical groups. However, knowledge is scant regarding the influence of human support on attrition and adherence and participant preferences for support in nonclinical settings. OBJECTIVE: This study aimed to compare the influence of 3 modes of human support on attrition and adherence to a digital mental health intervention for a nonclinical cohort. It evaluated user preferences for support and assessed whether adherence and outcomes were enhanced when participants received their preferred support mode. METHODS: Subjects participated in a 10-week digital mental health promotion intervention and were randomized into 3 comparative groups: standard group with automated emails (S), standard plus personalized SMS (S+pSMS), and standard plus weekly videoconferencing support (S+VCS). Adherence was measured by the number of video lessons viewed, points achieved for weekly experiential challenge activities, and the total number of weeks that participants recorded a score for challenges. In the postquestionnaire, participants ranked their preferred human support mode from 1 to 4 (S, S+pSMS, S+VCS, S+pSMS & VCS combined). Stratified analysis was conducted for those who received their first preference. Preintervention and postintervention questionnaires assessed well-being measures (ie, mental health, vitality, depression, anxiety, stress, life satisfaction, and flourishing). RESULTS: Interested individuals (N=605) enrolled on a website and were randomized into 3 groups (S, n=201; S+pSMS, n=202; S+VCS, n=201). Prior to completing the prequestionnaire, a total of 24.3% (147/605) dropped out. Dropout attrition between groups was significantly different (P=.009): 21.9% (44/201) withdrew from the S group, 19.3% (39/202) from the S+pSMS group, and 31.6% (64/202) from the S+VCS group. The remaining 75.7% (458/605) registered and completed the prequestionnaire (S, n=157; S+pSMS, n=163; S+VCS, n=138). Of the registered participants, 30.1% (138/458) failed to complete the postquestionnaire (S, n=54; S+pSMS, n=49; S+VCS, n=35), but there were no between-group differences (P=.24). For the 69.9% (320/458; S, n=103; S+pSMS, n=114; S+VCS, n=103) who completed the postquestionnaire, no between-group differences in adherence were observed for mean number of videos watched (P=.42); mean challenge scores recorded (P=.71); or the number of weeks that challenge scores were logged (P=.66). A total of 56 participants (17.5%, 56/320) received their first preference in human support (S, n=22; S+pSMS, n=26; S+VCS, n=8). No differences were observed between those who received their first preference and those who did not with regard to video adherence (P=.91); challenge score adherence (P=.27); or any of the well-being measures including, mental health (P=.86), vitality (P=.98), depression (P=.09), anxiety (P=.64), stress (P=.55), life satisfaction (P=.50), and flourishing (P=.47). CONCLUSIONS: Early dropout attrition may have been influenced by dissatisfaction with the allocated support mode. Human support mode did not impact adherence to the intervention, and receiving the preferred support style did not result in greater adherence or better outcomes. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR): 12619001009101; http://www.anzctr.org.au/ACTRN12619001009101.aspx.

A Web- and Mobile App-Based Mental Health Promotion Intervention Comparing Email, Short Message Service, and Videoconferencing Support for a Healthy Cohort: Randomized Comparative Study.

BACKGROUND: The rapid increase in mental health disorders has prompted a call for greater focus on mental health promotion and primary prevention. Web- and mobile app-based interventions present a scalable opportunity. Little is known about the influence of human support on the outcomes of these interventions. OBJECTIVE: This study aimed to compare the influence of 3 modes of human support on the outcomes (ie, mental health, vitality, depression, anxiety, stress, life satisfaction, and flourishing) of a 10-week, Web- and mobile app-based, lifestyle-focused mental health promotion intervention among a healthy adult cohort. METHODS: Participants were recruited voluntarily using a combination of online and offline advertising. They were randomized, unblinded into 3 groups differentiated by human support mode: Group 1 (n=201): standard-fully automated emails (S); Group 2 (n=202): standard plus personalized SMS (S+pSMS); and Group 3 (n=202): standard plus weekly videoconferencing support (S+VCS), hosted by 1 trained facilitator. Participants accessed the intervention, including the questionnaire, on a Web-based learning management system or through a mobile app. The questionnaire, administered at pre- and postintervention, contained self-reported measures of mental well-being, including the "mental health" and "vitality" subscales from the Short Form Health Survey-36, Depression Anxiety and Stress Scale-21, Diener Satisfaction With Life Scale (SWLS), and Diener Flourishing Scale. RESULTS: Of 605 potential participants, 458 (S: n=157, S+pSMS: n=163, and S+VCS: n=138) entered the study by completing registration and the preintervention questionnaire. At post intervention, 320 out of 458 participants (69.9%; S: n=103, S+pSMS: n=114, and S+VCS: n=103) completed the questionnaire. Significant within-group improvements were recorded from pre- to postintervention in all groups and in every outcome measure (P≤.001). No significant between-group differences were observed for outcomes in any measure: mental health (P=.77), vitality (P=.65), depression (P=.93), anxiety (P=.25), stress (P.57), SWLS (P=.65), and Flourishing Scale (P=.99). Adherence was not significantly different between groups for mean videos watched (P=.42) and practical activity engagement (P=.71). Participation in videoconference support sessions (VCSSs) was low; 37 out of 103 (35.9%) participants did not attend any VCSSs, and only 19 out of 103 (18.4%) attended 7 or more out of 10 sessions. Stratification within the S+VCS group revealed that those who attended 7 or more VCSSs experienced significantly greater improvements in the domains of mental health (P=.006; d=0.71), vitality (P=.005; d=0.73), depression (P=.04; d=0.54), and life satisfaction (P=.046; d=0.50) compared with participants who attended less than 7. CONCLUSIONS: A Web- and mobile app-based mental health promotion intervention enhanced domains of mental well-being among a healthy cohort, irrespective of human support. Low attendance at VCSSs hindered the ability to make meaningful between-group comparisons. Supplementing the intervention with VCSSs might improve outcomes when attendance is optimized. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR): 12619001009101; http://www.anzctr.org.au/ACTRN12619001009101.aspx.

Factors predicting the mental health of adolescents attending a faith-based Australian school system: a multi-group structural equation analysis.

Background: Adolescents attending Seventh-day Adventist schools (Adventist) in Australia tend to experience good health and exhibit better health behaviors than national norms, however few studies have investigated factors predicting their mental health.Aims: The aim of this study was to explore the complex network of factors that predict the mental health status (MHS) of adolescents attending Adventist schools in Australia.Methods: A survey instrument was used to collect data from 1527 secondary school students attending Adventist schools across Australia. Structural equation modeling was employed to examine concomitantly the direct and indirect effects of childhood experiences, present attitudes and selected health behaviors on MHS.Results: Childhood family dynamics had the strongest association with MHS (ßtotal = 0.33) followed by a sense of meaning and purpose (ßtotal = 0.27), perceived social misfit status (ßtotal = -0.19), and school academic performance (ßtotal = 0.18). Multi-group analysis found significant pathway differences in the model for gender with regards to the association of meaning and purpose, physical activity and sleep quantity with MHS.Conclusions: The outcomes of the study highlight the importance of early positive childhood family dynamics and the discovery of meaning and purpose during adolescence to promote positive mental health among adolescents.

The association between self-rated health and social environments, health behaviors and health outcomes: a structural equation analysis.

BACKGROUND: The factors shaping the health of the current generation of adolescents are multi-dimensional and complex. The purpose of this study was to explore the determinants of self-rated health (SRH) of adolescents attending a faith-based school system in Australia. METHODS: A total of 788 students attending 21 Seventh-day Adventist schools in Australia responded to a health and lifestyle survey that assessed SRH as well as potential determinants of SRH including the health outcomes mental health, vitality, body mass index (BMI), select health behaviors, social factors and personal demographics. Structural equation modeling was used to analyze the data and examine the direct and indirect effects of these factors on SRH. RESULTS: The structural model developed was a good fit with the data. The health outcome mental health had the strongest association with SRH (ß = 0.17). Several upstream variables were also associated with higher SRH ratings. The health behavior sleep hours had the strongest association with SRH (ßtotal = 0.178) followed by fruit/vegetable consumption (ßtotal = 0.144), physical activity (ßtotal = 0.135) and a vegetarian diet (ßtotal = 0.103). Of the demographic and social variables measured, adverse childhood experiences (ACEs) had the strongest association with SRH (ßtotal = - 0.125), negatively influencing SRH, and gender also associated with an increase in SRH (ßtotal = 0.092), with the influence of these factors being mediated through other variables in the model. CONCLUSIONS: This study presents a conceptual model that illustrates the complex network of factors concomitantly associated with SRH in adolescents. The outcomes of the study provide insights into the determinants of adolescent SRH which may inform priority areas for improving this construct.

Religious Affiliation Influences on the Health Status and Behaviours of Students Attending Seventh-Day Adventist Schools in Australia.

Students attending Seventh-day Adventist (Adventist) schools in Australia have been shown to have better health status and behaviours compared to secular norms, yet these schools cater for a high percentage of non-Adventist students. The purpose of this study was to investigate the influence of religious affiliation (Adventist/non-Adventist) on the health status and behaviours of students attending Adventist secondary schools in Australia. The sample included 1734 students who responded to a health and lifestyle survey that captured demographic details, self-reported height and weight, self-reported health status, mental health and select health behaviours. Students who identified themselves as Adventist reported significantly better health behaviours than the non-Adventist students in several behavioural domains, especially among the male students. However, this did not translate to a difference in health status. Further research is needed to understand the causal mechanisms responsible for the potential health advantage of Adventist students, which may include family or church religious influences.

Effect of ingested fluid composition on exercise-related transient abdominal pain.

The present study investigated the effect of ingested fluid composition on the experience of exercise-related transient abdominal pain (ETAP). Forty subjects, susceptible to ETAP, completed 4 treadmill exercise trials: a no-fluid trial and flavored water (FW, no carbohydrate, osmolality = 48 mosmol/L, pH = 3.3), sports drink (SD, freshly mixed Gatorade, 6% total carbohydrate, 295 mosmol/L, pH = 3.3), and reconstituted fruit juice (FJ, BERRI trade mark orange, 10.4 % total carbohydrate, 489 mosmol/L, pH= 3.2) trials. Measures of the experience of ETAP and gastrointestinal disturbances, particularly bloating, were quantified. The FJ was significantly (p =.01) more provocative of both ETAP and bloating than all other trials. There was no difference among the no-fluid, FW, and SD in the severity of ETAP experienced, although the difference between the no-fluid and SD approached significance at the.05 level (p =.056). There was a significant relationship between both the mean (r = 0.40, p =.01) and peak (r= 0.44, p=.01) levels of ETAP and bloating. When the level of bloating was controlled for, the FJ remained significantly (p =.01) more provocative of ETAP than the other conditions, with no difference between the FW and SD (p =.37). The results indicate that in order to avoid ETAP, susceptible individuals should refrain from consuming reconstituted fruit juices and beverages similarly high in carbohydrate content and osmolality, shortly before and during exercise. Further, the mechanism responsible for the heightened experience of ETAP in the FJ trial extends beyond a gastric mass explanation.