The Use of Task-Sharing to Improve Treatment Engagement in an Online Mindfulness Intervention for Stress among Chinese College Students
Traditional in-person psychotherapies are proving incapable of addressing mental health needs globally. Computer-based interventions are one promising solution to closing the large gap between mental health treatment need and actual treatment received. The overarching aim of this study is to contribute to the body of literature focused on providing new insights into effective ways of leveraging technology to implement large-scale mental health initiatives that are financially feasible, easily transportable and quickly scalable in low-resource setting. Although many meta-analyses have provided evidence to support the efficacy of self-guided, computer-based interventions, most report low rates of treatment engagement (high attrition, low adherence). Accordingly, this dissertation investigates the efficacy of an adjunctive treatment component that uses task-sharing, where mental health care is provided by non-specialist providers (NSP; e.g., nurses, clergy, community members), to enhance engagement in a self-directed, web-based mindfulness intervention for stress and depression among Chinese students.
Fifty-four students from 36 universities across China reporting at least mild stress, anxiety and/or depression were randomly assigned to a brief (4-week online mindfulness intervention (MIND) or to the intervention plus NSP support (MIND+). Fifty-six volunteer NSP candidates without formal training in the delivery of mental health services were screened, ten were invited to participate in a 1-day training, and four were selected. NSPs were instructed to provide six brief (15-20 minute) weekly meetings, with the intention of supporting and encouraging participants in their completion of the online intervention. NSPs received weekly online group supervision. Participants completed daily monitoring of mindfulness practice and mood, as well as baseline and post-treatment self-report packet assessing depression, anxiety and stress symptoms and trait mindfulness.
The study found that participants assigned to the MIND+ (vs. MIND) condition showed significantly less attrition and more adherence, as indicated by a greater likelihood of completing post-treatment assessments and a greater percentage of course completion, respectively. There were no significant between-group differences in daily self-reports of frequency and duration of mindfulness practice across the trial. However, results indicated that participation in the online intervention was associated with significant improvements in pre- to post-treatment mindfulness and mental health outcomes. In addition, individuals in the MIND+ condition reported significant improvements in daily ratings of stress and depression across the trial, compared to individuals in the MIND condition. These findings suggest that volunteer NSPs receiving brief training and weekly supervision may significantly improve participants’ indices of treatment engagement and mental health outcomes in an online mindfulness intervention among college and graduate students in China.
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