Online Social Support Program for Physical and Mental Health of Filipino Migrant Domestic Workers in Hong Kong

Study Overview
=================
Brief Summary
-----------------
The goal of this study is to test the effect of informational and emotional social support (via nutrition education, mental health support, and/or baking classes) through two different communication modalities (online vs. mixed mode / hybrid) on physical and mental health outcomes Our research questions are the following. Does an online social support program that provides informational and emotional support improve diet, anthropometry, and mental health? Does a mixed-mode social support program that provides informational, emotional support through both online and face-to-face mode improve diet, anthropometry, and mental health? Is a mixed mode social support program more effective in improving outcomes? Does meeting the group members face-to-face change the dynamics of online communication? If yes, what are the mechanisms? Are there differences in the following outcomes by communication modality? Online bonding Group identity Quality of relationship

Detailed Description
-----------------
Study design: Randomized controlled trial Study description Filipino Migrant Domestic workers (MDWs) working in Hong Kong will be eligible to apply. The investigators will advertise in Newspapers and Facebook commonly read by Filipino MDWs in Hong Kong. The investigators will recruit 400 MDWs over two phases and randomly assign them across three arms, T1) mixed-mode social support program; T2) Online social support program; and C) Control. Online social support program will be delivered through WhatsApp group chat. MDWs will self-fill surveys at Caritas office, but surveys will be assisted by survey enumerators as a group. Logistics Due to administrative constraints delivering interventions to 400 participants at the same time, the investigators will deliver interventions over two cohorts. Cohort 1 ( 200 participants) Oct 31st-Dec 18th 2022 Baseline survey Jan 8th-March 18th 2023 Intervention (10 weeks) March 26th -April 16th 2023 Follow-up survey Cohort 2 ( 200 participants) Feb 5th-March 19th 2023 Baseline survey March 20th-May 27th Intervention (10 weeks) May 28th - June 25th follow-up survey Note 1: The investigators will enroll participants until the scheduled date for baseline survey or until the investigators recruit target sample size, whichever comes earlier. Note 2: The investigators will keep the intervention design exactly the same for cohort 1 and cohort 2, and will not analyze data until data collection for both cohort 1 and cohort 2 is complete. Cohort 1 and cohort 2 will be analyzed as one sample. Statistical analysis model - Estimation of treatment effect In this section, the investigators outline the basic estimation approach to measuring the effect of the treatments on various outcomes. Our basic treatment effects specification estimates the following equation: y= β₀ + β₁T1 + β₂T2+ β₃X+ ε where y is the outcome of interest. T1 and T2 are dummy variables equal to 1 if the participant was randomly assigned to the T1 and T2 group, respectively, and 0 otherwise. β₁ and β₂ represent the effect of being assigned to the specific treatment arm. X is a vector of baseline outcome and individual's characteristics including age, marital status, years working as migrant domestic workers, level of education, received food allowance. ε is an error term. The primary outcome variable, y, include nutrition knowledge, perceived social support, healthy diet, stress, anxiety, and depression. To compare the difference between T1 and T2, we will use F-test coefficient of equality.

Official Title
-----------------
Online Social Support Program for Physical and Mental Health of Filipino Migrant Domestic Workers in Hong Kong

Conditions
-----------------
Healthy Diet, Mental Health Wellness

Intervention / Treatment
-----------------
* Behavioral: T1: Mixed mode social support group
* Behavioral: T2: Online mode social support group


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Filipino Migrant domestic worker working in Hong Kong Exclusion Criteria: None
Sexes Eligible for Study
-----------------
Female

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: The investigators are providing informational and emotional social support (nutrition, mental health, baking classes) through two different communication modalities (online vs. mixed mode) whose effects will be contrasted against each other and a third, control, condition. Treatment 1: Mixed-mode social support group Treatment 2: Online social support group Control: No intervention
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: T1: Mixed mode social support group<br>This group will receive programs in both online and off-line setting. There will be one face-to-face group session to get to know participant's peer group members. After the in-person group meeting, participants will meet in WhatsApp group. In WhatsApp group, facilitator will provide the following program | Behavioral: T1: Mixed mode social support group<br>* This group will receive programs in both online and off-line setting. There will be one face-to-face group session to get to know participant's peer group members. After the in-person group meeting, participants will meet in WhatsApp group. In WhatsApp group, facilitator will provide the following program In person get to know your group member activities Nutrition information through WhatsApp Tips and advice to maintain good mental health through WhatsApp Motivational messages through WhatsApp Reminder through WhatsApp In-person baking class x 1 session<br>|
| Experimental: Online social support group<br>This group will receive the same program as mixed mode social support group. The key differences would be delivery of all program components online. | Behavioral: T2: Online mode social support group<br>* This group will receive the same program as mixed mode social support group. The key differences would be delivery of all program components online. Online get to know your group member activities Nutrition information through WhatsApp Tips and advice to maintain good mental health through WhatsApp Motivational messages through WhatsApp Reminder through WhatsApp Online baking class x 1 session through WhatsApp<br>|
| No Intervention: Control<br>This is the control group. Control group will only participate in baseline and follow-up survey | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Nutrition knowledge score (change) | Questions to test nutrition knowledge, survey questionnaire (score range 0-17, higher score means better outcome) | Change from baseline nutrition knowledge at approximately 3-6 months. | 
| Perceived social support (change) | Participant's perceived social support score, scale adapted from Oslo social support scale (OSSS-3), survey questionnaire, higher score means better outcome. | Change from baseline perceived social support at approximately 3-6 months. | 
| Healthy diet practices (change) | Questions adapted from starting the conversation (STC) food frequency instrument, scale range 0-50, higher score means better outcome, survey questionnaire | Change from baseline diet practices at approximately 3-6 months. | 
| Stress (change) | Screen for stress using DASS-21 questionnaire, survey questionnaire (score range (0-42), higher score means worse outcome | Change from baseline mental health at approximately 3-6 months. | 
| Anxiety (change) | Screen for anxiety using DASS-21 questionnaire, survey questionnaire, score range (0-42), higher score means worse outcome | Change from baseline mental health at approximately 3-6 months. | 
| Depression (change) | Screen for depression using DASS-21 questionnaire, survey questionnaire, score range (0-42), higher score means worse outcome | Change from baseline mental health at approximately 3-6 months. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Body mass index (change) | kg/m2, anthropometry measurements | Change from baseline BMI at approximately 3-6 months. | 
| Waist-to-hip ratio (change) | waist circumference (cm) /hip circumference (cm), anthropometry measurements | Change from baseline waist-to-hip ratio at approximately 3-6 months. | 
| Waist-to-stature ratio (change) | Waist circumference (cm)/Height (cm), anthropometry measurements | Change from baseline waist-to-stature ratio at approximately 3-6 months. | 
| Self-efficacy (change) | four questions, General self-efficacy scale (GSE) survey questionnaire, score range 0-30, higher score means better outcome | Change from baseline self-efficacy at approximately 3-6 months. | 
| Group identity | 4 questions: 5 point scale (strongly agree to strongly disagree) , survey questionnaire | measured at end-line only ( 3-6 months after baseline survey) | 
| Online bonding | 10 questions: 5 point scale (strongly agree to strongly disagree), survey questionnaire | measured at end-line only (3-6 months after baseline survey) | 
| Peer pressure | 10 questions: 5 point scale (strongly agree to strongly disagree), survey questionnaire | measured at end-line only (3-6 months after baseline survey) | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
social support, weight management, emotional support, online support groups, eating behavior, mental health, informational support