A Study Protocol on Peer Digital Acceset (PDA)
Condition: Mental Health Issue
Study type: Interventional

Summary: 
      This protocol delineates a randomized controlled trial for evaluating the implementation and
      clinical effectiveness of Assecet, a digital peer support intervention for youth mental
      well-being, which comprises two components. The digital peer support training curriculum aims
      to equip youth befrienders (i.e., peers who provide support) with knowledge and skills in
      harnessing four active ingredients of youth mental well-being-specifically, Mattering,
      selfhood, compassion, and mindfulness, in providing effective peer support for seekers (peers
      who seek support). The Acceset intervention that involves three components-digital biomarkers
      of psychological well-being, peer emotional disclosure process and community engagement.
    

Detailed description: 
      Background: The burgeoning mental health issues among emerging adults (ages 19 to 25)
      worldwide has fuelled concerns about youths' widespread experiences of emotional distress,
      specifically concerning anxiety and depression, and coping mechanisms. Digital peer support
      intervention has demonstrated varying degrees of clinical effectiveness for positive health
      and psychological outcomes across different developmental stages. The onset of the COVID-19
      pandemic has resulted in prolonged isolation and reduced social connections, and emerging
      literature is amounting to the import of digital peer emotional disclosure and support for
      young people psychological well-being. However, much remains to be explored regarding
      implementation and clinical effectiveness-how best to conduct digital peer intervention in
      support of youths' psychological well-being, and the associated mechanism of change.

      Objective: This protocol delineates a randomized controlled trial for evaluating the
      implementation and clinical effectiveness of Assecet, a digital peer support intervention for
      youth mental well-being, which comprises two components. The digital peer support training
      curriculum aims to equip youth befrienders (i.e., peers who provide support) with knowledge
      and skills in harnessing four active ingredients of youth mental well-being-specifically,
      Mattering, selfhood, compassion, and mindfulness, in providing effective peer support for
      seekers (peers who seek support). The Acceset intervention that involves three
      components-digital biomarkers of psychological well-being, peer emotional disclosure process
      and community engagement.

      Methods: Participants will consist of 100 students ages 19 to 25 from the National University
      of Singapore to engage with the Acceset platform. At the time of recruitment, individuals
      will be screened for inclusion and exclusion criteria based on self-reporting. The qualified
      participants (seekers) will be randomly allocated into two arms. Arm 1 (n = 50) seekers will
      engage with the Acceset platform for a period of 3 weeks, together with befrienders (n = 30)
      and moderators (n = 30). Arm 2 (n = 50) a control group will be placed on a waitlist for
      Acceset intervention. These individuals will be age and gender matched with the intervention
      group (i.e., arm 1). Their mental well-being, as well as their help seeking behavior, at the
      same time points and via the same questionnaire battery will be compared with those in arm 1.
      Both seekers and befrienders will be monitored using a questionnaire battery listed
      (including help seeking behaviors beyond the Acceset platform) at 4 time points: baseline
      (before the intervention), 3 weeks (the end of the intervention), 6 weeks and 9 weeks (to
      measure carry over effects). The implementation outcomes will be adoption and fidelity
      evaluation of the digital peer support training curriculum, the feasibility and acceptability
      of Acceset in providing continuous access to online peer support throughout the duration of
      the seekers' engagement. The clinical outcomes will include Mattering, self-hood, compassion,
      mindfulness, psychological well-being scores for befrienders and seekers, and additionally
      perceived social support for seekers. The mechanism of change linking befrienders' support
      and seekers' mental well-being will be assessed using latent growth curve modelling.

      Data Collection, Management and Analyses: We conducted power analysis to ascertain the
      adequate sample size needed for the randomized controlled trial, specifically in comparing
      the intervention and control groups on different clinical outcomes, so that the study has
      sufficient power to detect valid effects. The study sample size of n = 50 for intervention
      and n = 50 for control is needed because of multiple dependent variables measuring clinical
      outcomes included in the study and the testing of implementation outcomes (i.e., feasibility,
      utility). In dealing with missing data, we will first determine if missing data is missing
      completely at random (MCAR). If missing data is not systematic, as indicated by the
      non-significant result from Little's Missing Completely at Random Test, this study will
      handle missing data using full information maximum likelihood imputation.

      Data will be analyzed and interpreted through three means. First, independent sample t-tests
      will be conducted whenever we need to compare intervention vs. control group on the different
      clinical outcomes in this study. Second, to elucidate the content of emotional disclosure on
      the Acceset platform, particularly in relation to the four active ingredients of
      psychological well-being (i.e., Mattering, self-hood, compassion and mindfulness), we will
      perform topic modelling using Latent Dirichlet Allocation (LDA) analyses with R to filter the
      huge amount of data available and drill down relevant themes and topics. LDA is an advanced
      statistical method that increases precision and accuracy in coding as compared to the
      exclusive use of qualitative approach /analyses. Third, to compare the mechanism of change ,
      we will use Latent Growth Curve Modelling (LCM) to examine the trajectories of Acceset
      intervention in predicting the change in clinical outcomes experienced by youths. LCM
      elucidates whether an increasing trend in befrienders' digital peer support predicts
      increasing trends in youths' sense of Mattering, self-hood, compassion, mindfulness, and
      psychological well-being (i.e., clinical outcomes).
    

Intervention name(s): Acceset Intervention
Intervention type(s): Behavioral
Intervention description(s): . The intervention comprises of: i) Digital peer support training for youth befrienders to equip them with the knowledge and application of the four active ingredients-Mattering, selfhood, compassion, and mindfulness-to provide effective peer support as they respond to youth seekers' emotional experiences.
ii) Acceset Intervention with features or digital markers of psychological well-being, peer emotional disclosure process and community engagement.
Other intervention name(s): Digital Peer Support Intervention
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: We propose an interventional prospective study with hybrid design that evaluates both implementation of Acceset platform (e.g., fidelity, adoption, and utility), as well as clinical outcomes (e.g., anxiety and depressive symptoms) using randomized controlled trials. The intervention comprises of two components: (1) digital peer support training and (2) digital intervention involving three features, specifically emotionality, motivations and functional improvement serving as digital markers of psychological well-being, the peer emotional disclosure process, as well as community engagement.
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Mattering; Self-hood; Compassion; Mindfulness; Digital Peer Support Intervention; peer emotional disclosure; community; Mental Well-being; Digital biomarkers