Pilot Evaluation of Peer-support Coaching to Increase Adherence to Online Self-help for College Mental Health

Study Overview
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Brief Summary
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This study aims to test if coaching can improve program adherence to an online mental health program in college students if delivered by undergraduate peers. Participants will be randomly assigned to either receive phone coaching, text message coaching, or no coaching. It is hypothesized that participants who receive phone coaching will exhibit greater adherence to the provided online mental health program than participants who receive text message coaching or no coaching.

Detailed Description
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The purpose of this study is to test the feasibility and effectiveness of an innovative peer support coaching model for college students. The primary aim of the coaching model is to increase participants' adherence to ACT Guide, an online mental health program. To test the effects of peer-support coaching on ACT Guide adherence rates and outcomes, the investigators will conduct a randomized controlled trial with three conditions (peer-support phone coaching, peer-support text message coaching, and a no support control group) using a sample of 300 Utah State University undergraduate students. Individuals who indicate interest in participating will complete an automated online workflow through Qualtrics which will include informed consent, baseline assessment, ACT Guide registration, and randomization into one of the three conditions. Participants will then gain access to a research version of ACT Guide, either with no additional support, with concurrent peer-support coaching, or with concurrent peer-support text messaging based on their randomly assigned condition. Coaching will take place over 10 weeks, with the post assessment being administered 10 weeks after baseline assessment. The investigators hypothesize that participants will adhere to coaching (80% completing ≥ 6 coaching calls; 80% responding to texts > 6 weeks), be satisfied with coaching (M = 5 agree on a 6-point self-reported coaching satisfaction scale), and that coaching fidelity will be maintained (80% of audited coaching calls/texts meeting criteria for fidelity). The investigators also hypothesize that participants who receive peer-support phone coaching will complete more ACT Guide modules and will report greater improvements in mental health relative to both the text messaging and no support conditions, and that the text messaging condition will perform greater in this regard than the no support condition.

Official Title
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Pilot Evaluation of Peer-support Coaching to Increase Adherence to Online Self-help for College Mental Health

Conditions
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Treatment Adherence

Intervention / Treatment
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* Behavioral: Phone Coaching
* Behavioral: Text Message Coaching
* Behavioral: ACT Guide


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: USU undergraduate student Fluent in English Exclusion Criteria: Must have not used ACT Guide in the past

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Participants will be randomly assigned with equal likelihood to receive the online intervention with coaching delivered through weekly phone calls, the online intervention with coaching delivered through weekly text messages, or the online intervention with no coaching.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Phone Coaching Condition<br>Participants will receive weekly, 10-15 minute phone coaching from a trained peer-support coach throughout the 10 weeks that they use ACT Guide, an online program for general mental health. Coaches will adhere to an ACT-based protocol that includes reinforcing adherence, identifying and problem solving non-adherence, strengthening and generalizing ACT skills, and using ACT skills to increase commitment to ongoing program adherence. | Behavioral: Phone Coaching<br>* Participants receiving phone coaching receive one 10-15 minute phone call each week from their randomly assigned peer-support coach. During coaching calls, the peer-support coach will discuss ACT Guide usage with the participant (e.g., asking how many modules the participant completed, asking what the participant liked/disliked about the modules, etc.).<br>Behavioral: ACT Guide<br>* ACT Guide is an online self-help program based on acceptance and commitment therapy (ACT), targeting acceptance, mindfulness, and values-based processes. It is intended to be used for 20 to 40 minutes at time, a few times a week. While using ACT Guide, participants will read about concepts relevant to ACT and engage in guided experiential exercises, with additional exercises being assigned to be completed in between sessions as homework.<br>|
| Experimental: Text Message Coaching Condition<br>Participants assigned to the text messaging condition will receive weekly text messages from their peer-support coach throughout the 10 weeks that they use ACT Guide, an online program for general mental health. These text messages will reflect content delivered in the phone coaching group, but through a briefer protocol that accounts for the abbreviated, asynchronous nature of texting. Text messages will similarly focus on reinforcing adherence, problem solving non-adherence, strengthening ACT skills, and using ACT to increase program adherence. However, these areas will be covered in short messages and with limited exchanges between participants and coaches due to the asynchronous nature of texting. | Behavioral: Text Message Coaching<br>* Participants receiving text message coaching receive text messages on a weekly basis from their randomly assigned peer-support coach. Text messages from the peer-support coach will discuss ACT Guide usage with the participant (e.g., asking how many modules the participant completed).<br>Behavioral: ACT Guide<br>* ACT Guide is an online self-help program based on acceptance and commitment therapy (ACT), targeting acceptance, mindfulness, and values-based processes. It is intended to be used for 20 to 40 minutes at time, a few times a week. While using ACT Guide, participants will read about concepts relevant to ACT and engage in guided experiential exercises, with additional exercises being assigned to be completed in between sessions as homework.<br>|
| Active Comparator: No Coaching Condition<br>Participants will be asked to use ACT Guide, an online program for general mental health, over the course of 10 weeks while receiving no coaching. | Behavioral: ACT Guide<br>* ACT Guide is an online self-help program based on acceptance and commitment therapy (ACT), targeting acceptance, mindfulness, and values-based processes. It is intended to be used for 20 to 40 minutes at time, a few times a week. While using ACT Guide, participants will read about concepts relevant to ACT and engage in guided experiential exercises, with additional exercises being assigned to be completed in between sessions as homework.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| ACT Guide Module Completion | Number of modules completed within ACT Guide, out of a total of 12 modules. This is automatically recorded within the ACT Guide program, and is not self-reported. | Post-treatment (10 weeks after baseline) | 
| Depression, Anxiety, and Stress Scale (DASS-21; Osman et al., 2012) | A self-report measure for depression, anxiety, and stress . Items are rated on a 4-point Likert scale from 0 (did not apply to me at all) to 3 (applied to me most of the time), with a higher score indicating a worse outcome. Minimum total of 0 and maximum total of 63. | Post-treatment (10 weeks after baseline) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Short Form of the Revised Vanderbilt Therapeutic Alliance Scale adapted for coaching (VTAS-R; Shelef & Diamond, 2008) | A self-report measure for therapeutic alliance, with modified wording in order to adapt to a coaching context. Only administered to participants in either coaching condition. Items are rates on a 6-point Likert scale from 0 (not at all) to 5 (a great deal), with a higher score indicating a better outcome. Minimum total of 0 and maximum total of 25. | After completion of first contact with coach and post-treatment (10 weeks after baseline) | 
| Mental Health Continuum Short Form (MHC-SF; Keyes, 2005) | A self-report measure for positive mental health. Items are rated on a 6-point Likert scale from 1 (never) to 6 (every day), with a higher score indicating a better outcome. Minimum total of 14 and maximum total of 84. | Post-treatment (10 weeks after baseline) | 
| The Acceptance and Action Questionnaire (AAQ-II; Bond et al., 2011) | A self-report measure for psychological flexibility. Items are rated on a 7-point Likert scale from 1 (never true) to 7 (always true), with a higher score indicating a worse outcome. Minimum total of 7 and maximum total of 49. | Post-treatment (10 weeks after baseline) | 
| Comprehensive assessment of Acceptance and Commitment Therapy processes (CompACT; Francis, Dawson, & Golijani-Moghaddam, 2016) | A self-report measure for psychological flexibility. Items are rated on a 7-point Likert scale from 0 (strongly disagree) to 6 (strongly agree), with a higher score indicating a better outcome. Minimum total of 0 and maximum total of 138. | Post-treatment (10 weeks after baseline) | 
| Client Satisfaction Questionnaire adapted to Internet-based interventions (CSQ-I; Boß et al., 2016) | A self-report measure for program satisfaction. Items are rated on a 4-point Likert scale from 1 (does not apply to me) to 4 (does totally apply to me), with a higher score indicating a better outcome. Minimum total of 8 and a maximum total of 32. | Post-treatment (10 weeks after baseline) | 
| Novel user experience item 1 | Participants will be asked to rate agreement from 1 (Strongly disagree) to 6 (Strongly agree) with the statement Overall, I was motivated to use ACT Guide This is a user experience item specific to this study. | Post-treatment (10 weeks after baseline) | 
| Novel user experience item 2 | Participants will be asked to rate agreement from 1 (Strongly disagree) to 6 (Strongly agree) with the statement I had the support I needed to use ACT Guide. This is a novel user experience item specific to this study. | Post-treatment (10 weeks after baseline) | 
| Novel user experience item 3 | Participants will be asked to rate agreement from 1 (Strongly disagree) to 6 (Strongly agree) with the statement I understood the concepts and skills presented in ACT Guide. This is a novel user experience item specific to this study. | Post-treatment (10 weeks after baseline) | 
| Novel user experience item 4 | Participants will be asked to rate agreement from 1 (Strongly disagree) to 6 (Strongly agree) with the statement I was able to apply skills I learned in ACT Guide to my personal struggles and daily life. This is a novel user experience item specific to this study. | Post-treatment (10 weeks after baseline) | 
| Novel user experience item 5 | Participants will be asked to rate agreement from 1 (Strongly disagree) to 6 (Strongly agree) with the statement I was able to identify and problem solve barriers to using ACT Guide. This is a novel user experience item specific to this study. | Post-treatment (10 weeks after baseline) | 
| Novel user experience item 6 | Participants will be asked to rate agreement from 1 (Strongly disagree) to 6 (Strongly agree) with the statement Many college students who struggle with mental health issues use self-help resources like ACT Guide for support. This is a novel user experience item specific to this study. | Post-treatment (10 weeks after baseline) | 
| Novel user experience item 7 | Participants will be asked to rate agreement from 1 (Strongly disagree) to 6 (Strongly agree) with the statement People would judge me negatively if they found out I was using ACT Guide. This is a novel user experience item specific to this study. | Post-treatment (10 weeks after baseline) | 
| Novel user experience item 8 | Participants will be asked to rate agreement from 1 (Strongly disagree) to 6 (Strongly agree) with the statement College students approve of the use of self-help resources like ACT Guide for addressing mental health issues. This is a novel user experience item specific to this study. | Post-treatment (10 weeks after baseline) | 
| Novel coaching experience item 1 | Participants will be asked to rate agreement from 1 (Strongly disagree) to 6 (Strongly agree) with the statement I would have preferred using ACT Guide without a coach. This is a novel coaching experience item specific to this study. Only administered to participants in either coaching condition. | Post-treatment (10 weeks after baseline) | 
| Novel coaching experience item 2 | Participants will be asked to rate agreement from 1 (Strongly disagree) to 6 (Strongly agree) with the statement ACT Guide would have been just as helpful to me without a coach. This is a novel user experience item specific to this study. Only administered to participants in either coaching condition. | Post-treatment (10 weeks after baseline) | 
| Novel coaching experience item 3 | Participants will be asked to rate agreement from 1 (Strongly disagree) to 6 (Strongly agree) with the statement I would have preferred to receive coaching from a mental health professional. This is a novel user experience item specific to this study. Only administered to participants in either coaching condition. | Post-treatment (10 weeks after baseline) | 
| Novel coaching acceptability item 1 | Participants will be asked to rate Coaching through phone calls on a scale from 1 (Unacceptable) to 5 (Strongly preferred). This is a novel coaching acceptability item specific to this study. Only administered to participants in either coaching condition. | Post-treatment (10 weeks after baseline) | 
| Novel coaching acceptability item 2 | Participants will be asked to rate Coaching through text messaging on a scale from 1 (Unacceptable) to 5 (Strongly preferred). This is a novel coaching acceptability item specific to this study. Only administered to participants in either coaching condition. | Post-treatment (10 weeks after baseline) | 
| Novel coaching acceptability item 3 | Participants will be asked to rate Coaching through email on a scale from 1 (Unacceptable) to 5 (Strongly preferred). This is a novel coaching acceptability item specific to this study. Only administered to participants in either coaching condition. | Post-treatment (10 weeks after baseline) | 
| Novel coaching acceptability item 4 | Participants will be asked to rate Coaching through videoconferencing software on a scale from 1 (Unacceptable) to 5 (Strongly preferred). This is a novel coaching acceptability item specific to this study. Only administered to participants in either coaching condition. | Post-treatment (10 weeks after baseline) | 
| Novel coaching satisfaction item 1 | Participants will be asked What was helpful about the coaching process? to gather qualitative feedback on their respective coaching intervention. Only administered to participants in either coaching condition. | Post-treatment (10 weeks after baseline) | 
| Novel coaching satisfaction item 2 | Participants will be asked What was unhelpful about the coaching process? to gather qualitative feedback on their respective coaching intervention. Only administered to participants in either coaching condition. | Post-treatment (10 weeks after baseline) | 
| Novel coaching satisfaction item 3 | Participants will be asked How did having another USU undergraduate be your coach affect the coaching process? to gather qualitative feedback on their respective coaching intervention. Only administered to participants in either coaching condition. | Post-treatment (10 weeks after baseline) | 
| Novel coaching satisfaction item 4 | Participants will be asked How can the coaching process be improved in the future? to gather qualitative feedback on their respective coaching intervention. Only administered to participants in either coaching condition. | Post-treatment (10 weeks after baseline) | 
| Phone coaching adherence | Number of coaching calls answered, out of a total of 10 calls. This is based on coaches call logs, and is not self-reported. Only applicable to participants in the phone coaching condition. | Post-treatment (10 weeks after baseline) | 
| Text coaching adherence | Number of initial coaching text messages responded to, out of a total of 10 initial text messages (one sent per week, not including text messages continuing a conversation stemming from an initial text message). This is based on coaches text message logs, and is not self-reported. Only applicable to participants in the text message coaching condition. | Post-treatment (10 weeks after baseline) |