Exploring the influence of testimonial source on attitudes towards and the acceptance of e-mental health interventions among university students

Abstract

E-mental health services (eMHSs) offer a promising approach to promote mental health among post-secondary students. Still, many university students are reluctant to use eMHSs, and little is known about effective communication strategies to improve attitudes as antecedents of eMHS acceptance. The aim of this experiment was thus to explore the effects of information varying in the degree of targeting on students ́attitudes towards eMHSs. Four hundred fifty-one students (Mean=32.6 years, SD=10.2, 75% female) were randomly assigned to one of four study arms. While all participants read the same general information that also served as control condition (arm 1, "information only", n=116), the other three experimental arms additionally received information and testimonials on specific eMHSs differing in addressed target groups. These testimonials were either unspecific (arm 2, n=112), targeted to employees (arm 3, n=115) or targeted to students (arm 4, n=108). We analyzed attitudes towards eMHSs for stress coping and therapy, as well as potential determinants of attitude change. Two-way ANOVA revealed no impact of providing information on the alteration of attitudes towards eMHSs for stress coping (d =0.20). Only a significant but small effect of targeted testimonial on attitudes towards online therapies was identified at post-intervention (d =0.29). Regression analyses revealed statistically significant positive influences of source credibility and perceived similarity on attitude (ps <0.01), as well as a partial mediation effect of perceived similarity in favor of testimonials targeted to students (95% CI [0.22, 0.50]). Overall, this study indicates no meaningful impact of the presented information on attitudes and limited evidence for positive effects of tailored information cues. However, attitudes were already positive at baseline. Further research with a representative sample of university students is needed to gain an in-depth understanding of contextual factors influencing attitudes and relevant attributes for the optimal design of psychoeducational information on eMHSs.

Here, we provide the anonymized data sets on the per-protocol (n=451) and the intention-to-treat (IIT) analyses (n=482) for non-commercial scientific purposes and as supplementary material for a publication. The online experiment explored the influence of narrative information cues on attitudes towards and the acceptance of eMHSs. Although the provided data sets include data for analyzing both study parts (attitudes and acceptance), we only present additional files on the attitude part that will be presented in an upcoming publication. Data set A (German original) and the data set B (with English translation of variable names) refers to the per protocol analysis of valid data sets according to predefined criteria (n=451), while data C includes data for the IIT-analysis (n=482). In addition, we have added the syntax files for the per protocol as well as the IIT analyses (SPSS; sav.files for data sets and sps.-files for the syntax files) and output files on the IIT analyses (pdf.-versions of the spv.files), since details on the IIT analyses will be only partly reported in an upcoming publication due to the length of the paper (i.e., demographic data, hypotheses 1-4). In the planned publication, we have mainly focused on the per protocol analyses. Furthermore, we have uploaded the study information, original full questionnaire including the instructions and text-based informational interventions for the experimental groups (German) and screen shots of the original code book. In the publication that is currently under review, we will provide English translations of the study materials (e.g., the stimulus materials, including testimonials) as well as additional ancillary results as supplementary files. The results on other outcomes, such intentions to use eMHSs (acceptance outcomes), will be potentially reported elsewhere (status date: January 15, 2021). The data for the GESIS repository was prepared and double-checked by two researchers (JAH and FW).

Findings of the online experiment have also been presented at two conferences:
Wopperer, J., Apolinário-Hagen, J., Wals, F., Harrer, M., Kemper, J., Salewski, C., Lehr, D., & Ebert, D.D. (05.09.2019). Exploring the usefulness of testimonials as a tool to improve the acceptance of e-mental health interventions among university students: preliminary results of a pilot RCT. Poster session, 6th Conference of the European Society for Research on Internet Interventions (esrii), 05.09. – 06.09.2019, Copenhagen, Denmark.

Apolinário-Hagen, J., Wopperer, J., Wals, F., Harrer, M., & Ebert, D.D. (14.05.2019). User testimonials to improve attitudes toward digital stress coping interventions among university students: preliminary results of a pilot RCT. Poster session, 1st Conference of the Norwegian society for research on Internet Interventions (NORSII), 14.05.2019, Bergen, Norway.

Keywords (MeSH terms): eHealth, mental health, attitude, acceptability, student health services, stress, personal narratives