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

Abstract

<p>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.</p> <p>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.</p> <p>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.</p> <p>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 (<em>P</em>≤.001). No significant between-group differences were observed for outcomes in any measure: mental health (<em>P</em>=.77), vitality (<em>P</em>=.65), depression (<em>P</em>=.93), anxiety (<em>P</em>=.25), stress (<em>P</em>.57), SWLS (<em>P</em>=.65), and Flourishing Scale (<em>P</em>=.99). Adherence was not significantly different between groups for mean videos watched (<em>P</em>=.42) and practical activity engagement (<em>P</em>=.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 (<em>P</em>=.006; <em>d</em>=0.71), vitality (<em>P</em>=.005; <em>d</em>=0.73), depression (<em>P</em>=.04; <em>d</em>=0.54), and life satisfaction (<em>P</em>=.046; <em>d</em>=0.50) compared with participants who attended less than 7.</p> <p>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.</p>