Engagement and Effectiveness of a Healthy-Coping Intervention via Chatbot for University Students During the COVID-19 Pandemic: Mixed Methods Proof-of-Concept Study

Abstract

Background University students are increasingly reporting common mental health problems, such as stress, anxiety, and depression, and they frequently face barriers to seeking psychological support because of stigma, cost, and availability of mental health services. This issue is even more critical in the challenging time of the COVID-19 pandemic. Digital mental health interventions, such as those delivered via chatbots on mobile devices, offer the potential to achieve scalability of healthy-coping interventions by lowering cost and supporting prevention. Objective The goal of this study was to conduct a proof-of-concept evaluation measuring the engagement and effectiveness of Atena, a psychoeducational chatbot supporting healthy coping with stress and anxiety, among a population of university students. Methods In a proof-of-concept study, 71 university students were recruited during the COVID-19 pandemic; 68% (48/71) were female, they were all in their first year of university, and their mean age was 20.6 years (SD 2.4). Enrolled students were asked to use the Atena psychoeducational chatbot for 4 weeks (eight sessions; two per week), which provided healthy-coping strategies based on cognitive behavioral therapy, positive psychology, and mindfulness techniques. The intervention program consisted of conversations combined with audiovisual clips delivered via the Atena chatbot. Participants were asked to complete web-based versions of the 7-item Generalized Anxiety Disorder scale (GAD-7), the 10-item Perceived Stress Scale (PSS-10), and the Five-Facet Mindfulness Questionnaire (FFMQ) at baseline and postintervention to assess effectiveness. They were also asked to complete the User Engagement Scale–Short Form at week 2 to assess engagement with the chatbot and to provide qualitative comments on their overall experience with Atena postintervention. Results Participants engaged with the Atena chatbot an average of 78 (SD 24.8) times over the study period. A total of 61 out of 71 (86%) participants completed the first 2 weeks of the intervention and provided data on engagement (10/71, 14% attrition). A total of 41 participants out of 71 (58%) completed the full intervention and the postintervention questionnaires (30/71, 42% attrition). Results from the completer analysis showed a significant decrease in anxiety symptoms for participants in more extreme GAD-7 score ranges (t39=0.94; P=.009) and a decrease in stress symptoms as measured by the PSS-10 (t39=2.00; P=.05) for all participants postintervention. Participants also improved significantly in the describing and nonjudging facets, based on their FFMQ subscale scores, and asked for some improvements in the user experience with the chatbot. Conclusions This study shows the benefit of deploying a digital healthy-coping intervention via a chatbot to support university students experiencing higher levels of distress. While findings collected during the COVID-19 pandemic show promise, further research is required to confirm conclusions.

Loneliness in Young Adults During the First Wave of COVID-19 Lockdown: Results From the Multicentric COMET Study

“…Another interesting finding is that adaptive coping strategies, such as planning and positive reframing, work as protective factors against loneliness. This is a relevant finding considering that coping strategies may easily change following specific psychosocial interventions, such as psychoeducation (87,88) and problem-solving oriented interventions (89) or by improving the levels of resilience (25,81,90,91).…”

Does an Online Positive Psychological Intervention Improve Positive Affect in Young Adults During the COVID-19 Pandemic?

“…Yet another important factor to consider is whether a 2-week intervention is long enough to impact positive affect in the context of a significant stressful event, such as a global pandemic. To date, a few short-term interventions have been utilized to promote mental health during the COVID-19 pandemic, with success in increasing positive affect (Brouzos et al, 2021 ), while reducing anxiety, depression, perceived stress, and loneliness (Brouzos et al, 2021 ; Riva et al, 2021 ; Wei et al, 2020 ; Gabrielli et al, 2021 ). While the mode of delivery spanned from self-help and virtual reality (Wei et al, 2020 ; Riva et al, 2021 ) to group or individual formats (Gabrielli et al, 2021 ; Brouzos et al, 2021 ), one consistent factor was that each study incorporated aspects of mindfulness and relaxation exercises in addition to activities consistent with positive psychology and cognitive behavioral therapy.…”

Digital Mental Health Amid COVID-19

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