The aim of the present study is to assess the efficacy of a mobile application called esTOCma in promoting mental health literacy, reducing stigmatizing attitudes related to the Obsessive-Compulsive Disorder (OCD) and improving teachers' confidence in dealing with students that might have OCD. A parallel, randomized controlled trial with two conditions (experimental and control group) will be carried out in a sample of teachers that work in primary and secondary education. Pre-post changes will be assessed. Experimental group will use the app until they finish it (within a set period of 10 days), whereas control group will do nothing for 10 days. Primarily, it is expected that after the use of the app, participants will show an improvement in OCD-related literacy, stigmatizing attitudes, desired social distance and their comfort, confidence and perceived ability in teaching and handling students with OCD. Secondarily, the investigators hypothesize that experimental group might show a reduction in obsessive-compulsive symptoms.
Adolescence is a critical stage that is associated with a high vulnerability to developing obsessive-compulsive disorder (OCD). Schools are part of the natural developmental context of adolescents, and teachers are involved in their education and personal development. In this sense, teachers play an essential role in the early detection and referral of students with possible obsessional symptoms and will also have to deal with the management of this symptomatology in the classroom. Moreover, teachers often have low knowledge of mental health problems and lack strategies for handling mental symptomatology in the classroom. esTOCma is a mobile health (mHealth) application that has been developed to promote mental health literacy and reduce stigmatizing attitudes associated with OCD. Previous studies have shown that it is a tool with great potential in terms of intervention on stigma and OCD literacy in the general population. Thus, it could be of great interest to use this app in the field of education, and especially in non-university education since adolescents, a highly vulnerable collective to the development of OCD, spend much of their time in the classroom, and often seek help from school staff.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
SINGLE
Enrollment
175
Participants of the experimental group will use the esTOCma mobile app until completion, within a set period of 10 days. EsTOCma is a a serious game with 10 missions where users have to free 10 characters who have been imprisoned by a monster called esTOCma, which metaphorically represents the stigma in OCD. With each mission, users will gain knowledge about OCD and free an imprisoned character until the tenth mission, when they will defeat the monster. This game has three modules: (1) Psychoeducation (missions 1-5), where general information about OCD, OCD treatments and where to seek help is provided; (2) Indirect Contact (missions 6 and 7), which consists of a series of audio-visual recordings in which OCD patients report their symptoms and the impact the disorder has had on their lives; and finally, (3) Cognitive Restructuring (missions 8-10), where common dysfunctional beliefs about OCD and OCD treatment are challenged.
University of Valencia/ Universitat de València
Valencia, Spain
Change in general OCD literacy
Score change in the knowledge and the attitudes towards obsessive-compulsive disorder measured by the OCD Knowledge Stigma Assessment Scale (OKSAS). It is a self-report ad hoc questionnaire with 24 items and a response scale ranging from 1 "Completely disagree" to 5 "Completely agree". The total score is the sum of the items and higher score indicate more knowledge about the disorder.
Time frame: Through app completion (an estimation of 10 days).
Change in stigmatizing attitudes related to OCD
Score change in stigma will be measured, in association with a vignette, by two questionnaires: 1. Attribution Questionnaire (AQ-9; Corrigan et al., 2015; Spanish version: Muñoz et al., 2015) is a self-report measure for social stigma. It has a Likert scale ranging from 1 = "Not at all" to 9 = "Very much". Investigators will not use the items corresponding to Coercion, Pity and Avoidance. The higher the score (total and per item), the higher the stigma. 2. OCD Stigma Measure (OSM; Ponzini et al., 2023) is a self-report measure composed by 16 items that assess OCD-related stereotypes. 11 items will be used in this study. A total score (sum of all the items) is interpreted. There will be two vignettes that will be randomly assigned. Both portray a student with OCD but one focuses on the contamination content, and the other on the aggression content.
Time frame: Through app completion (an estimation of 10 days).
Change in desired social distance
Score change in desired social distance will be measured by Reported and Intended Behaviour Scale (RIBS; Evans-Lacko et al., 2011; Spanish version: Sayols-Villanueva et al., 2015). It is a self-report measure with 8 items and it inquires about reported and intended behaviour among four different contexts: (1) living with, (2) working with, (3) living nearby and (4) continuing a relationship with someone with a mental health problem. Investigators will use the 4 items corresponding to intended behaviour subscale. Likert scale from 1 "Agree strongly" to 5 " Disagree strongly" and an additional "Don't know" response option. The total score is calculated by adding together the response values, and "Don't know" is coded as a neutral value (i.e. 3). This questionnaire will be used in association with a vignette.
Time frame: Through app completion (an estimation of 10 days).
Change in percieved confidence when addressing students with OCD
Score change in confidence when addressing students with OCD will be measured using items adapted and translated from previous studies (Jorm et al., 2010; Kutcher et al., 2016; Whitley \& Gooderham, 2016). Three dimensions are evaluated separately: Confidence in interacting, composed of three items with a Likert scale ranging from 1 "Completely disagree" to 5 "Completely agree". The total score will be obtained by summing the item responses. Confidence in helping, assessed with a single item ("To what extent do you feel capable of helping a student like N?") rated on a 5-point scale ranging from 1 "Slightly/Not at all confident" to 5 "Extremely/Very confident". Academic confidence, measured with two items rated on a 4-point Likert scale ranging from 1 ("Not at all capable/ Lower academic level") to 4 ("Very capable/Highest academic level"). A total score will be computed by summing both items.
Time frame: Through app completion (an estimation of 10 days).
Change in obsessive-compulsive symptoms
Score change in OCD symptoms will be measured by Obsessive-Compulsive Inventory - Revised. The reduced 4-item version (OCI-4; Abramovich et al., 2021) that assesses four dimensions of OCD (washing, checking, ordering, obsessing) will be used. It has a 5-point Likert scale ranging from 0 "Not at all" to 4 "Very much". The items will be added.
Time frame: Through app completion (an estimation of 10 days).
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