DOI: 10.3886/e240561v1
title: ConnectionsRx: A Distance-Based, Community Participation Intervention for Young Adults with Serious Mental Illness (SMI)

description: This project studies the efficacy of ConnectionsRx, a technology-based, distance intervention to increase community participation of young adults with serious mental illnesses. These young adults are receptive to technology-based interventions that target increased participation in the community. This population is already adept at using Short Message Servicing (SMS) and social media technologies and by harnessing these tools, providers can deliver non-invasive interventions that have the potential to reach participants in their communities, providing near-real time support. ConnectionsRx draws upon the Individualized Placements and Supports model and the Competence Enhancement model and consists of a 1-1 intervention with mobile supports and a peer-based social media support group. Specific objectives include: (1) conducting a randomized, controlled trial in order to (2) test the effectiveness, feasibility, and acceptability of ConnectionsRx. This project utilizes a randomized, controlled design with repeated measures (baseline, midpoint, and post treatment) with 80 young adults with serious mental illnesses, gathering data in three areas: efficacy (community participation, participation efficacy, and health-related outcomes), feasibility, and acceptability. Project objectives include: (1) gathering input from individuals with lived experience; (2) developing a ConnectionsRx training manual; and (3) evaluating the feasibility, efficacy, and acceptability of the ConnectionsRx intervention.<br><br>Data were collected at three time points: at baseline and at three-month and six-month follow ups.<br><br>The submitted data include the survey instrument along with the data for all three time points.
description: N/A
description: Response Rates: N/A
description: Presence of Common Scales: <b>Temple University Community Participation (TUCP) Measures</b>

For a list of 27 different activities, The Temple University
Community Participation (TUCP) measure asks individuals to indicate how many
days in the past 30 they participated in the activity, whether this activity is
important, and whether they feel like they do this activity enough, not enough
or more than enough. The scale has good reliability and validity (Salzer et
al., 2014; Salzer et al., 2015; Burns-Lynch et al., 2016). Several measures
were created from the TUCP data:

<b>TUCP – Amount of Participation</b>

The TUCP asks about the amount of community participation
over the past 30 days across 27 domains of everyday life. These domains span
social, recreational, civic, and economic activities, such as going to
restaurants, attending religious services, volunteering, or visiting friends
and family. Sample items include: “In the past 30 days, how many days did
you go to a restaurant or coffee shop?” and “How many days did you visit
friends or family in their homes?” The total score is the sum of days
across all activity types (range 0–810). Higher scores indicate greater amount
of participation. 

<b>TUCP – Importance of Participation</b>

The TUCP also assesses the number of activity domains
individuals consider important in their lives, reflecting the value placed on
community involvement across multiple areas. It provides insight into personal
meaning and goal orientation, separating desired engagement from actual
behavior. Respondents indicate whether each of the 27 TUCP activity types
(e.g., volunteering, attending classes, exercising, socializing) is personally
important. Sample items include “Is going to a park or recreation center important
to you?” and “Is volunteering important to you?” The total score is
the sum of activities marked “important” (range 0–27). Higher scores reflect a
greater number of valued participation areas. This dimension enhances the
TUCP’s conceptual strength by distinguishing between frequency and personal
salience of activities. 

<b>TUCP – Sufficiency of Participation</b>

The TUCP also measures sufficiency of participation - whether
individuals feel they participate as much as they would like in valued
activities. This construct captures alignment between desired and actual
community engagement, providing a self-appraisal of fulfillment. The score is
calculated as the percentage of activities deemed “important” for which the
respondent reports “doing enough” (range 0–100). Higher percentages indicate
greater perceived adequacy and satisfaction with participation. 

<b>TUCP – Breadth Ratio of Participation</b>

The TUCP Breadth Ratio assesses the diversity of community
participation by examining the number of important activity types engaged in at
least once over the past 30 days. While the “amount” score reflects frequency,
the “breadth” score highlights scope and variability, distinguishing between
narrow and wide engagement across life domains. For example, someone who
participates frequently in one or two areas (e.g., social visits and shopping)
would have a lower breadth ratio than someone who participates occasionally
across many areas. The measure is calculated as the number of important activities
performed at least once divided by the total number of important activities,
resulting in a score from 0 to 1. Higher scores indicate greater diversity and
inclusion across community settings. <br>

<b><br>Interpersonal Mattering</b>

Perceived mattering in close interpersonal relationships was
assessed using the Interpersonal Mattering Short Form (IM-S; Moschella
& Banyard, 2021). The IM-S is a 12-item self-report measure that captures
the degree to which individuals feel that others in their social network notice
them (Awareness), consider them significant and valued (Importance),
and depend on them or look to them for support (Reliance). Participants
rate each item on a Likert-type scale (typically 1 = strongly disagree to 5 =
strongly agree), and subscale scores and a total mattering score are computed
by averaging items, with higher scores indicating greater perceived mattering.
Prior psychometric evaluations demonstrate a stable three-factor structure
supported by confirmatory factor analysis, strong internal consistency for each
subscale (Cronbach’s α values generally in the .86–.89 range), and good
construct validity, including expected positive associations with well-being,
social connectedness, and academic or interpersonal functioning.

<br><b><br>UCLA Loneliness Scale – 3-Item Version</b>

Loneliness was measured using the 3-item version of the UCLA
Loneliness Scale (Hughes et al., 2004), a widely used brief screening tool
designed to capture subjective feelings of social isolation. The scale includes
three items reflecting core loneliness experiences: feeling a lack of
companionship, feeling left out, and feeling isolated from others. Each item is
rated on a 3-point scale (1 = hardly ever, 2 = some of the time, 3 = often),
and scores are summed to create a total ranging from 3 to 9, with higher scores
indicating greater loneliness. Despite its brevity, the 3-item scale
demonstrates strong psychometric performance across diverse populations,
including good internal consistency for a very short measure, strong
correlations with the long-form UCLA Loneliness Scale, and good predictive
validity for mental health outcomes, social support, and well-being. <br>

<b><br>De Jong Gierveld Loneliness Scale</b>

Loneliness was also assessed with the short version of the
De Jong Gierveld Loneliness Scale (De Jong Gierveld & Van Tilburg, 2006), a
6-item instrument designed to distinguish between emotional loneliness
(feelings of missing an intimate attachment) and social loneliness (feelings of
lacking a broader social network. Following standard scoring procedures,
positively worded items are reverse-coded, and emotional and social loneliness
subscale scores are computed by summing the number of loneliness-indicative
responses, with higher scores reflecting greater loneliness. A total loneliness
score can be derived by summing all six items. The short form has demonstrated
solid psychometric properties across multiple countries and age groups, and
strong convergent and discriminant validity relative to related measures of
social isolation, quality of relationships, and mental health.

<br><b><br>Modified Differential Emotions Scale (mDES)</b>

Emotional experiences were assessed using a shortened
version of the Modified Differential Emotions Scale (mDES; Fredrickson et al.,
2013), which asked participants to report the greatest intensity with which
they experienced several discrete emotions over the past 24 hours using a 0–4
scale (0 = not at all to 4 = extremely). The Positive Emotions subscale
consisted of three items assessing feelings of love and closeness (“What is the
most loved, close or trusted you feel?”), joy (“What is the most joyful, glad
or happy you feel?”), and gratitude (“What is the most grateful, appreciative
or thankful you feel?”). The Negative Emotions subscale consisted of
three parallel items assessing anger (“What is the most angry, irritated or
annoyed you feel?”), sadness (“What is the most sad, downhearted or unhappy you
feel?”), and stress (“What is the most stressed, nervous or overwhelmed you
feel?”). Subscale scores were computed by averaging the three items within each
domain, with higher scores reflecting greater positive or negative emotional
intensity. <br>

<b><br>Bandura’s Self Efficacy Measure</b>

Self-efficacy for engaging in enjoyable activities was
assessed using a 12-item scale adapted from Bandura’s self-efficacy framework.
Participants rated each item from 0 to 100, indicating their degree of
confidence in performing various activity-related behaviors, with higher
numbers reflecting greater self-efficacy. The measure includes four
theoretically derived subscales: Competence, Resilience, Social System
Modification, and Empowerment, each represented by three items.
Competence items assessed confidence in carrying out enjoyable activities
(e.g., “How confident are you that you can participate in everyday, enjoyable
activities at home?”; “How confident are you that you can plan enjoyable
activities for yourself?”). Resilience items assessed confidence in using
enjoyable activities to cope with challenges (e.g., “How confident are you that
you can cope with stress using everyday, enjoyable activities at home?”; “How
confident are you that you will find a way to participate in something you
enjoy, even if there are challenges?”). Social System Modification items
measured confidence in connecting with or mobilizing others through activity
(e.g., “How confident are you that you can connect with others through
everyday, enjoyable activities at home?”; “How confident are you that you will
share your plans to participate in enjoyable activities with others who will
encourage you to participate?”). Empowerment items assessed confidence in
independently making choices and following through on activity participation
(e.g., “How confident are you that you can make your own decisions about
participating in everyday, enjoyable activities at home?”; “How confident are
you that you will go to the enjoyable activities that you have planned?”). Each
subscale score was computed by averaging the three constituent items, and a
total self-efficacy score was calculated by averaging all 12 items, provided at
least 10 responses were non-missing. Higher scores on all scales indicate
greater perceived self-efficacy for engagement, coping, connection, and
autonomous participation in enjoyable activities.

<br><b><br>PROMIS Global Health v. 1.2</b>

Overall physical and mental health were assessed using the PROMIS
Global Health v1.2 measure (https://www.healthmeasures.net/images/PROMIS/manuals/Scoring_Manual_Only/PROMIS_Global_Health_Scoring_Manual_30Aug2024.pdf,
pp.7-11), a 10-item instrument that provides brief indicators of general
health, quality of life, functioning, and recent symptoms. Items asked
participants to rate their overall health, quality of life, physical
functioning, mental health, satisfaction with social roles, and recent
experiences of pain, fatigue, and emotional distress. Because the response
scale used in this study was reversed from the original measure, all items were
recoded so that higher values consistently reflected better health. Following
PROMIS scoring conventions, four items were summed to create a Global
Physical Health raw score, reflecting pain, physical functioning, physical
health, and fatigue, and four separate items were summed to create a Global
Mental Health raw score, reflecting quality of life, mental health,
satisfaction with social activities, and frequency of emotional problems. Each
raw score was then converted to a standardized T-score using the official
PROMIS lookup tables, where T-scores have a population mean of 50 and standard
deviation of 10, and higher values indicate better physical or mental health.
Two additional items assessing General Health and Ability to Carry
Out Usual Social Roles were scored individually but not included in the
summary scores. The PROMIS Global Health v1.2 measure is widely
validated and provides concise, reliable indicators of participants’ overall
health status for use in behavioral and rehabilitation research.

<br><b><br>Self-Management</b>

Self-management related to daily and community participation
was assessed using a 16-item scale developed for this study. Participants rated
their agreement with each statement on a 1 to 6 scale, where 1 indicated
strongly disagree and 6 indicated strongly agree. Items assessed an
individual’s ability to set goals, maintain routines, problem-solve around
barriers, sustain meaningful activity, and seek support when needed. Example
items include “I know how to or have developed daily goals for myself,” “I can
manage what I do on a day-to-day basis,” and “I can remove or overcome the
barriers that are preventing me from doing what I want to do.” Several items
reflecting difficulties with goals, routines, or problem solving were reverse
coded so that higher scores consistently reflected better self-management (for
example, “I find it difficult to develop long-term goals for myself” and “I
struggle to create a routine that I follow on most days”). A total
self-management score was created by averaging all items, provided that at
least 13 of the 16 responses were non-missing. Higher scores on the resulting
scale indicate greater self-management capacity.

<br><b><br>Precursors to Participation</b>

To assess the precursor activities that support community
participation, we administered a set of questions grounded in a
contingency-based model of behavior, which emphasizes that motivation, ease,
and reinforcing consequences shape the likelihood of engaging in daily
activities. Participants rated four attributes - ease, motivation,
satisfaction, and enjoyment - across five common precursor activities that
often precede participation: getting ready, doing something outside, contacting
friends or family, planning activities, and traveling to a location. Each
attribute for each activity was rated on a 1 to 4 scale (1 = not at all, 2 =
slightly, 3 = very, 4 = extremely). Consistent with our analytic goals,
responses were recoded to combine very and extremely into a single category,
yielding a 0 to 2 metric (0 = no, 1 = slight, 2 = strong). For scoring, we
averaged the five items within each construct to create indices reflecting the
overall Ease of performing precursor activities, the Motivation
to perform them, and a combined measure of satisfaction and enjoyment. The
latter was conceptualized as Positive Automatic Reinforcement,
representing the extent to which precursor activities are experienced as
intrinsically rewarding. Higher scores on each index reflect greater ease,
motivation, or positive reinforcement associated with engaging in the
foundational steps that typically precede community participation.

<br><b><br>Capabilities Related to Participation</b>

Capabilities related to community participation were
assessed using a 7-item scale developed for this study and grounded in the
capability component of the COM-B model, which emphasizes the physical and
psychological capacities required to engage in behavior. Participants rated
each item from 1 (strongly disagree) to 6 (strongly agree). Items assessed
whether individuals felt physically and mentally able to leave home, had the
skills needed to locate and access activities, were comfortable navigating
social situations, and could participate independently in the community. Example
items include “I am physically and mentally well enough to leave my home on
most days,” “I know how to find the locations and schedules for things I might
want to do,” and “I do things in the community or go places in the community by
myself.” Items reflecting difficulty or discomfort with participation were
reverse coded so that higher values consistently represented greater capability
(for example, “I have difficulty finding new activities or events that might be
of interest to me” and “I do not feel comfortable talking to people I do not
know in the community”). A capability index was computed by averaging the
remaining items, with higher scores indicating greater capability related to
participation.

<br><b><br>Opportunities Related to Participation</b>

Opportunities related to community participation were
assessed using a 6-item scale developed for this study and grounded in the
opportunity component of the COM-B model, which emphasizes the environmental
and social conditions that enable or constrain behavior. Participants rated
each item from 1 (strongly disagree) to 6 (strongly agree). Items assessed the
availability, affordability, and accessibility of activities, as well as the
presence of social supports that facilitate participation. Example items include
“There are activities or events that are near me that I can reach by car or
with public transportation,” “I get reminders about events or activities that I
might be interested in,” and “I know people that will do activities with me.”
Items reflecting barriers such as unaffordable activities, unaffordable
transportation, or lack of encouragement were reverse coded so that higher
scores consistently represented more opportunities (for example, “There are
activities I want to go to, but I cannot afford them” and “I do not have people
in my life that encourage me to do things”). An opportunities index was created
by averaging the remaining items, with higher scores indicating greater
environmental and social opportunities for community participation.

<br><b><br>Habits Related to Participation</b>

Habits related to activity participation were assessed using
a modified version of the Habits Scale developed by Grove et al. (2014). The
original measure assesses several domains of habitual behavior, and for the
present study items were adapted to reflect habits surrounding daily and
community participation. Items were rated from 1 (strongly disagree) to 6
(strongly agree). Four subscales were derived. The Negative Consequences
subscale captures the emotional or physiological discomfort participants experience
when they do not engage in activities, using items such as “If I do not
engage in activities, I feel irritable,” “When I participate in activities, I
feel better,” and “I feel anxious when I do not participate in activities.” The
Patterned Action/Ease subscale reflects the degree to which activity
participation follows stable, predictable patterns, including engaging in the
same activities on most days, going to activities on the same days each week,
participating for similar durations each time, or reliably frequenting the same
places (e.g., store, park, friend’s home). The Strong Bonds subscale
assesses the social influences that promote activity participation, such as
being more likely to join an activity if someone else in the household is doing
so, responding positively when invited by others, or being motivated by
specific situations or opportunities to see people. The Automaticity subscale
reflects the extent to which activity participation occurs with little
conscious effort or planning, using items such as “I engage in activities that
are important to me without conscious reminders” and “I tend to go out and do
things without having to think about it or plan.” Subscale scores were computed
by averaging the relevant items, with higher scores indicating stronger
endorsement of each habitual pattern.

<br><b><br>CAINS Motivation and Pleasure Measure</b>

The CAINS
Motivation and Pleasure scale includes three items that assess motivation for
recreational activities and the experience or anticipation of pleasure. Item 1
measures current motivation to engage in hobbies and recreational activities. A
score of 0 indicates no impairment, meaning the person is very motivated,
initiates activities on their own, and persists well within normal limits,
whereas a score of 4 reflects a severe deficit marked by no motivation at all
and a near-total lack of initiation or persistence. Item 2 captures the
frequency and variety of pleasurable recreational activities experienced in the
past week. A score of 0 indicates at least three different types of pleasurable
experiences occurring daily, while a score of 4 indicates no pleasurable
experiences during the past week. Item 3 assesses anticipated pleasure in the
upcoming week. A score of 0 reflects an expectation of many pleasurable
experiences (seven or more), whereas a score of 4 reflects an expectation of no
pleasurable activities at all. <br>
<b></b>
description: Convenience sampling
description: Smallest Geographic Unit: N/A
description: Participants were interviewed via Zoom by research assistant. Data were entered into Qualtrics by the research assistant.