This proposed study aims to evaluate the implementation of integrating the existing services in tertiary education institutions with the JCTH+ platform. The study aims to evaluate the efficacy of JCTH+ on students' mental health outcomes as compared to service as usual, and to assess the cost-utility of the platform to determine whether the benefits of implementing the platform justify the costs associated. It is hypothesized that participants who receive integrated self-help and support services will show (H1) a greater reduction in mental health symptoms, and (H2) better mental well-being compared with participants in the control condition, i.e. service-as-usual (SAU).
This study is a parallel pragmatic cluster-randomized control trial evaluating the efficacy and cost-utility of a JCTH+-integrated services, as compared to service-as-usual among tertiary education institutions in Hong Kong. Randomisation will be carried out at institution level based on a computer-generated sequence. The estimated sample size will be 1,684, with 842 participants per condition. A factorial design will be adopted with all eligible participants completing assessments at 7 timepoints: baseline, 4 months post-test, 8-, 12-, 16-, 20- and 24-months follow-up. The primary endpoint is 4 months at post-test after baseline assessment. Concurrently, all staff involved in the project will be interviewed qualitatively at 12 months and 24 months from enrolment to understand their experience in the integration process and effectiveness of implementation.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
1,684
Transdiagnostic cognitive behavioural therapy for both depression and anxiety that including modules from (1) Mindfulness-based intervention, (2) Rumination-focused cognitive behavioural therapy, and also including modules for insomnia and from Mindwork (Internet-based cognitive behavioural therapy).
Diversity and Well-being Lab
Hong Kong, Hong Kong
RECRUITINGRecovery Quality of Life-20
It measures the quality of life in individuals with mental health conditions using a 5-point scale from 0 (none of the time) to 4 (most or all of the time). It focuses on aspects crucial to those recovering from mental illness, such as well-being, self-perception, relationships, and activity. Total scores ranged from 0 to 80, where higher scores indicated higher overall quality of life. The scale is validated for its reliability and sensitivity in the Chinese-Hong Kong population, making it an effective tool for both clinical settings and research to track recovery progress and treatment outcomes in mental health in the local context.
Time frame: Baseline, 4 months, 8 months, 12 months, 16 months, 20 months and 24 months
Generalized Anxiety Disorder Assessment
It is a 7-item scale to assess the extent to which respondents are bothered by anxiety-related symptoms using a 4-point scale from 0 (not at all) to 3 (nearly every day). Scores of 5, 10, and 15 denote the mild, moderate, and severe levels of anxiety respectively (range: 0-21). At a cut-off of 10, GAD-7 has sensitivity of 0.89 and specificity of 0.82 in detecting generalized anxiety disorder (GAD). The internal consistency of the Chinese version was 0.93.
Time frame: Baseline, 4 months, 8 months, 12 months, 16 months, 20 months and 24 months
Patient Health Questionnaire
It includes 9 items to assess the extent to which respondents are bothered by depression-related symptoms using a 4-point scale from 0 (not at all) to 3 (nearly every day). PHQ-9 has been validated and used widely in the general population for screening and measuring depression severity. Scores of 5, 10, 15, and 20 denote mild, moderate, moderately severe, and severe levels of depression respectively (range: 0-27). PHQ-9 has sensitivity of 0.88 and specificity of 0.88 in detecting major depressive disorder (MDD) at a cut-off of 10. The internal consistency reliability of the Chinese version of the scale was 0.86.
Time frame: Baseline, 4 months, 8 months, 12 months, 16 months, 20 months and 24 months
Self-Stigma Of Seeking Help
It assesses the person's perception and reaction to seeking professional help using a 5-point scale from 1 (Strongly Disagree) to 5 (Strongly Agree). The SSOH consists of 10 items. Total scores ranged from 10 to 50, where higher scores indicate higher levels of self-stigma of seeking help. The measurement demonstrated good reliability and validity in previous studies.
Time frame: Baseline, 4 months, 8 months, 12 months, 16 months, 20 months and 24 months
Youth Empowerment Scale-Mental Health
The individual level subscale was adopted, which contains 6 items to assess the level of self-empowerment in mental health using a 5-point scale from 0 (Never or almost never) to 5 (Always or almost always). Total scores ranged from 6 to 30, where higher scores indicated higher level of ability in managing emotion and mental health. The scale has demonstrated good internal consistency and construct validity.
Time frame: Baseline, 4 months, 8 months, 12 months, 16 months, 20 months and 24 months
5-level EQ-5D version
The EQ-5D-5L comprises five dimensions, MOBILITY, SELF-CARE, USUAL ACTIVITIES, PAIN /DISCOMFORT and ANXIETY/ DEPRESSION, each dimension has five response levels: no problems, slight problems, moderate problems, severe problems, unable to/extreme problems. The respondent is asked to indicate his/her health state by checking the box next to the most appropriate response level for each of the five dimensions. Responses are coded as single-digit numbers expressing the severity level selected in each dimension. The digits for the five dimensions can be combined in a 5-digit code that describes the respondent\'s health state; for instance, 21111 means slight problems in the mobility dimension and no problems in any of the other dimensions.
Time frame: Baseline, 4 months, 8 months, 12 months, 16 months, 20 months and 24 months
Nonattachment Scale-Short Form
Nonattachment Scale-Short Form (NAS-SF) includes 8 items to measure nonattachment using a 6-point Likert scale from 1 (strongly disagree) to 6 (strongly agree). Total scores ranged from 8 to 48, where higher scores indicated higher levels of nonattachment. It yielded satisfactory internal consistency and validity.
Time frame: Baseline, 4 months, 8 months, 12 months, 16 months, 20 months and 24 months
General Mattering Scale
The 5-item General Mattering Scale measures perceptions and feelings of being important to other people (e.g., "How much would you be missed if you went away?"). Items are rated on a scale ranging from 1 (Not at all) to 4 (A lot) with good reliability and validity. Total scores ranged from 5 to 20, where higher scores indicated higher level of mattering.
Time frame: Baseline, 4 months, 8 months, 12 months, 16 months, 20 months and 24 months
Anti-Mattering Scale
The Anti-Mattering Scale is a five-item scale ranging from 1 (Not at all) to 4 (A lot) assessing the degree to which people feel like they do not matter to others. Sample item include "To what extent have you been made to feel like you are invisible?". Total scores ranged from 5 to 20, where higher scores indicated lower levels of mattering.
Time frame: Baseline, 4 months, 8 months, 12 months, 16 months, 20 months and 24 months
Perceived Competence
It contains 4 items on a 7-point Likert scale from 1 (none at all) to 7 (very true) to assess the self-perceived competence in maintaining regular self-care. Total scores ranged from 4 to 28, where higher scores indicated higher levels of self-perceived competence in maintaining regular self-care.
Time frame: Baseline, 4 months, 8 months, 12 months, 16 months, 20 months and 24 months
Treatment Self-regulation Questionnaire
It contains 15 items on a 7-point Likert scale from 1 (not true at all) to 5 (completely true) to understand the reason for beginning or keeping regular mental self-care. Higher scores in each item indicate higher importance of the reason for keeping mental self-care.
Time frame: Baseline, 4 months, 8 months, 12 months, 16 months, 20 months and 24 months
Mindful Self-Care Scale
The scale utilizes a 6-point Likert scale, ranging from 0 = never to 4 = regularly, to measure self-care in six factors: physical care, supportive relationships, mindful awareness, self-compassion and purpose, mindful relaxation, and supportive structure. A higher score indicates a higher frequency of engaging in mindful self-care within the past week. The scale demonstrates adequate reliability with Cronbach's coefficient alphas equal to 0.89 for the total 33-item.
Time frame: Baseline, 4 months, 8 months, 12 months, 16 months, 20 months and 24 months
College Self-Efficacy Inventory
It evaluates the self-efficacy of college students in academic settings. It consisted of 20 items that load into three subscales: Course Efficacy, Social Efficacy, and Roommate Efficacy. In this study, only 16 items on Course Efficacy, Social Efficacy will be included since dormitory is not usually available for students at post-secondary institutions. The confidence level is measured by using a scale ranging from 1 (Not confident at all) to 10 (Extremely confident). Higher scores in each subscale demonstrate a higher level of self-efficacy in that dimension.
Time frame: Baseline, 4 months, 8 months, 12 months, 16 months, 20 months and 24 months
Basic Psychological Need Satisfaction in General
It contains 21 items to measure basic psychological need satisfaction in 3 subscales: Autonomy, Competence, and Relatedness. The scale used a 7-point Likert scale from 1 (not at all true ) to 7 (very true). Higher scores in each subscale indicated a higher degree to which the person experiences satisfaction with each of the three needs.
Time frame: Baseline, 4 months, 8 months, 12 months, 16 months, 20 months and 24 months
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