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A Cluster Randomised Controlled Trial: Web-based Psychoeducation Intervention Based on Social Cognitive Theory on Reducing Stress Among Undergraduate Students
ABSTRACT
Background:
Stress among undergraduate students is an alarming global public health concern. First-year students are more vulnerable to a multitude of stressors, which are linked to adverse health. To date, there is limited evidence of behavioural theory-based psychoeducation interventions to address this issue.
Objective:
This study aims to develop, implement and evaluate the effect of the CARSS (Coping Strategies, Religiosity, Stress Mindset, Self-Efficacy, and Perceived Social Support) on reducing stress among Malay first-year undergraduate students. The secondary outcomes aimed to improve knowledge of stress, stress mindset, self-efficacy, perceived social support, and coping strategies.
Methods:
A single-blinded, two-arm cluster-randomised controlled trial was conducted among 120 eligible Malay first-year undergraduate students, from 12 faculties at a government university in Selangor. The participants were randomly assigned to the CARSS or waitlist control groups, 60 participants per arm. The CARSS group received an exclusive web-based psychoeducation module based on SCT, coached by health personnel, consisting of six animated videos delivered via Google Meet (3-6 minutes each), followed by 30 minutes of group activity weekly for one month. A waitlist control group received a similar module at the end of the study. The validated self-administered online questionnaire was administered, and data were collected at baseline, immediately post-intervention and three-month follow-up. The effect of the CARSS module was evaluated using generalised linear mixed models.
Results:
120 participants were involved in this study. The overall attrition rate was 13.3%. The CARSS module significantly improved knowledge of stress immediately post-intervention group (ꞵ=0.846, 95% CI: 0.51-1.18, P<0.001), and at the three-month follow-up (ꞵ=0.581, 95% CI: 0.24-0.93, P<0.001) in the CARSS group compared to the waitlist control group. The adaptive coping strategies also improved significantly in the CARSS group at the immediate post-intervention compared to the control group (ꞵ=2.83, 95% CI: 0.39-5.27, P=0.023) but did not sustain at the three-month follow-up. The intervention did not result in a significant reduction in stress; however, improvements were observed in some secondary outcomes.
Conclusions:
As stress was dynamic, the CARSS module did not significantly reduce stress. However, the CARSS module was effective in improving knowledge of stress and short-term adaptive coping strategies. Exploring other unstudied variables and combining web-based and physical delivery can help develop future interventions. Clinical Trial: Thai Clinical Trial Registry (ID: TCTR20250331002)
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