Co-design and Evaluation of an Online Personalised Feedback Intervention Toolkit to Increase Help-seeking for Mental Health Problems among Students

Mental health problems and poor wellbeing are increasing among UK university students and are increasing at a faster rate than in the general population (Cuijpers et al. 2019). The UK government has declared student mental health a national priority (Gyimah 2018) and the WHO identified a need for web-based intervention strategies (Cuijpers et al. 2019). Mental health problems during university study affect academic performance and dropout (Cuijpers et al. 2019; Hartley 2010), and long-term life and career functioning (Kernan et al. 2008). Effective treatments for mental health problems exist but help-seeking behaviours are low in student populations (Cuijpers et al. 2019) due to factors such as low mental health literacy, personal attitudes, perceived stigma, and health system structure (Reavley & Jorm 2010). Young people are more likely to seek help when they recognise a mental health problem and have the knowledge and support to seek help (Kelly et al. 2007). Personalised feedback are emerging educational interventions that provide individuals with feedback about symptoms and suggestions for coping strategies, such as self-help and help-seeking behaviours (Reavley & Jorm 2010). Multiple trials found that personalised feedback increases help-seeking, for example one trial found that individuals at risk of depression who received a personalised online assessment were three times more likely to seek help (Haas et al. 2008). Online self-assessment tools can overcome barriers to accessing face-to-face assessments such as social anxiety and stigma; they are widely acceptable to students and are cost-effective to implement compared to face-to-face assessments that require trained clinicians. It is hypothesised that a personalised feedback intervention will increase help-seeking and/or self-help behaviours for mental health problems.

This project aims to co-design and evaluate an online intervention toolkit to increase help-seeking and self-help behaviour among university students with, or at risk of, mental health problems, via the following objectives:
1. Explore existing evidence on personalised feedback interventions;
2. Co-design an accessible and engaging online personalised feedback intervention and evaluate user perspectives of the toolkit;
3. Trial the intervention's effectiveness to increase help-seeking or self-help behaviours.

I will perform a systematic review of the evidence to identify personalised feedback interventions that increase help-seeking or self-help behaviour. This evidence will inform stage two. Secondly, I will use an iterative group feedback process to co-design the study intervention with student representatives. A small group of students will then test an intervention prototype and I will explore user perspectives via qualitative interviews. This evidence will feed back into the iterative co-design process. Finally, I will test the intervention's effectiveness to increase help-seeking and self-help behaviours by embedding a randomised controlled trial within the York student cohort to perform a rapid evaluation.
Six UK university students provided feedback on the proposal. All representatives said there was a need for the proposed intervention and that it had clear potential to help students recognise symptoms and benefit their mental health. Face-to-face assessments were perceived to be anxiety-provoking and an online intervention would overcome this barrier. The personalised feedback being provided immediately was highly attractive to students with busy schedules. All representatives said they would rather use the proposed intervention than initially approach professional sources of support. Early intervention would likely reap major benefits to student's mental health and long-term life and career functioning (Kernan et al., 2008), and has long-term health and economic benefits to society. Findings will be disseminated widely with an aim for UK universities to adopt the toolkit.