SCoPE Health Education Module: A Health Belief Model-Based Digital Behavior Change Intervention for Internet Addiction Prevention among Higher Education Students in Malaysia – A Cluster Randomized Controlled Trial (Preprint)

Abstract

BACKGROUND The rapid growth of Internet usage has raised urgent concerns about Internet addiction. The prevalence of Internet addiction among undergraduate students is notably high, necessitating timely interventions. However, there is a lack of evidence surrounding preventive interventions such as health education programs that are used to address this issue. The efficacy of health education programs depends heavily on employing appropriate theories. OBJECTIVE Our study aimed to develop, implement, and assess the impact of the SCoPE (Self-efficacy, Cues to take action, and PErception) health education module for Internet addiction prevention among undergraduate students using Health Belief Model (HBM) theory. The primary outcome was aimed at reducing Internet addiction test scores while secondary outcomes included knowledge of Internet addiction and constructs of HBM theory (perceived barriers to reducing Internet use, perceived susceptibility, severity, benefit of reducing use, cues to action, and self-efficacy in reducing Internet use). METHODS A two-arm, parallel, single-blind cluster randomized controlled trial was conducted among undergraduate students at a Malaysian public university. Clusters were divided into two groups: the SCoPE group and a waitlist control group. The SCoPE group received the SCoPE health education module based on the health belief model, which comprised six animated videos with a total duration of 28 minutes, posted on a private YouTube platform, along with synchronous digital group discussions. Participants adhered to a structured five-day schedule, devoting ten minutes to each video session and 20 minutes to discussion sessions daily facilitated by the researcher. Data were collected at baseline, immediately post-SCoPE, and at three months using validated questionnaires. Data analysis was conducted with generalized linear mixed models with covariates. RESULTS The study included 252 participants with a 28.2% (71/252) attrition rate. The SCoPE health education module significantly improved knowledge of Internet addiction (β=2.089, P < .001) in intervention group compared to the control group. However, it was short lived. The module did not significantly reduce Internet addiction test scores or other HBM constructs. CONCLUSIONS While the SCoPE health education enhanced participants’ knowledge, it did not significantly reduce Internet addiction and other HBM constructs. Addressing high attrition rates and broader contextual factors like peer influences are crucial in the development of future interventions. Incorporating a combination of online and face-to-face methods, longer module durations, and exploring additional behavioral theories may enhance the efficacy of Internet addiction prevention programs CLINICALTRIAL Thai Clinical Trial Registry TCTR20230408003 https://www.thaiclinicaltrials.org/show/ TCTR20230408003