Exploring the influence of testimonial source on attitudes towards e-mental health interventions among university students: Four-group randomized controlled trial

Abstract

Electronic mental health services (eMHSs) offer additional options for the dissemination of psychological interventions for university students. Still, many university students are reluctant to use eMHSs. Narrative messages may help increase the awareness and acceptance of quality-approved programs. However, little is known about the usefulness of narrative messages to improve attitudes towards eMHSs. In this experiment, we thus aimed to explore in how far different ways of targeting information to students affect their attitudes towards eMHSs for stress prevention and therapy, and to identify potential determinants of attitude change. N = 451 students (Mean = 32.6 years, SD = 10.2, 75% female, 7% with eMHS experience) were randomly assigned to one of four study arms involving information designed to induce different levels of perceived similarity. While the active control condition only received general information (arm 1, “information only”, n = 116), the other experimental arms were additionally exposed to testimonials on specific eMHSs either addressing an unspecified audience (arm 2, n = 112), employees (arm 3, n = 115) or working university students (arm 4, n = 108). Two-way ANOVA revealed no impact of information on the alteration of attitudes towards eMHSs for stress coping (d = 0.20). Only a small effect of target-group specific testimonials on attitudes towards online therapies was identified at post-intervention (d = 0.29). Regression analyses demonstrated significant influences of source credibility and perceived similarity on attitudes for preventative eMHSs (ps<0.01), as well as a partial mediation effect of perceived similarity in favor of testimonials targeted to students (95% CI [0.22, 0.50]). Overall, this study indicated no meaningful impact of information on attitudes and limited evidence for benefits of tailored narrative messages. Since attitudes were already positive at baseline, further research with a representative student sample mimicking real-world decision scenarios is needed to gain an in-depth understanding of acceptance-facilitating message features that may contribute to promote the adoption of evidence-based eMHSs.

Investigating the Persuasive Effects of Testimonials on the Acceptance of Digital Stress Management Trainings Among University Students and Underlying Mechanisms: A Randomized Controlled Trial

“…The complete contents of the interventions are shown in Supplementary Material 1. In contrast to the pilot studies (e.g., Apolinário-Hagen et al, 2021), we did not include brands of existing digi-MHSs, albeit the described service was based on an evidence-based, guided digital stress management training (Ebert et al, 2016;Harrer et al, 2021). Moreover, the revised study material was designed more consistently and less detailed (e.g., exclusively scoping on stress prevention, missing age of testimonial sources) while trying to achieve external validity (e.g., emulating existing testimonials, experts as additional source).…”

“…Next, baseline attitudes and intentions regarding digi-MHSs were measured using three items each on a response scale ranging from 1 ("fully disagree") to 7 ("fully agree"). Specifically, we assessed behavioral intentions based on the Unified Theory of Acceptance and Use of Technology (UTAUT; Venkatesh et al, 2003) using a German adaptation (Hennemann et al, 2016), while the attitude short scale emphasizing perceived usefulness (PU) was grounded on the Theory of Planned Behavior (TPB; Ajzen, 1991) and pretested in previous work (Apolinário-Hagen et al, 2021). Perceived stress in the past 2 weeks was measured with the validated 10-items German version of the Perceived Stress Scale (PSS-10; Klein et al, 2016) on a Likert scale ranging from 1 ("never") to 5 ("very often"; adapted scale sum range: 10-50).…”

“…At post-intervention, we assessed the mediators perceived similarity (five items, IGs only) and source credibility (three items, all four groups) in line with a pilot trial (Apolinário-Hagen et al, 2021). Attitudes and intentions were measured again with the short scales described above.…”

“…Interestingly, research indicated a higher acceptance of digi-MHSs among university students with personal use experience, but the utilization rates of existing digital interventions remain very low (Dunbar et al, 2018;Hadler et al, 2021;Lavergne and Kennedy, 2021). Potentially, suitable digi-MHSs are yet not well known and thus seldom used by university students despite overall positive attitudes (Mayer et al, 2019;Apolinário-Hagen et al, 2021). Although many university students appear ready to use digital health solutions, they still report difficulties in finding reliable information online (Machleid et al, 2020;Dadaczynski et al, 2021).…”

Mental Health and the City in the Post-COVID-19 Era

“…The outbreak has changed the therapeutic model with partial e-mental health to a full virtual one [46]. For many people, that model of care is hardly acceptable and is difficult to use, which might cause their mental health to worsen [47,48].…”