JMIR Publications

ABSTRACT

Background:

Transitioning to adulthood and challenges in college life can result in increased stress levels among college students. Chronic and severe stress is associated with deleterious psychological and physiological effects. Digital interventions could succeed in approaching and helping college students who might be at risk, however, the experiences of students with internet-based stress management interventions are insufficiently understood.

Objective:

This study aims to explore the feasibility and acceptability, and the changes in perceived stress, depressive symptoms, and quality of life from baseline to post-test of a 5-session Internet-based stress management intervention guided by an eCoach developed for college students experiencing stress.

Methods:

A single-arm study was conducted. Students were recruited from different channels, mainly from a web survey. Students were eligible if they 1) scored 20 or higher on the Perceived Stress Scale (PSS-10), 2) were 18 years old or older, and 3) were studying at one of participating universities. Feasibility and acceptability of the intervention were investigated using several indications, including satisfaction (Client Satisfaction Questionnaire [CSQ-8]) and usability (System Usability Scale [SUS-10]). Our secondary goal was to explore the changes in perceived stress (PSS-10), depressive symptoms (Patient Health Questionnaire [PHQ-9]), and quality of life (EuroQol-5 Dimension-5 Level Scale [EQ-5D-5L]) from baseline to post-test. We also investigated indicators of intervention adherence using usage metrics (e.g., the number of completed sessions). In addition, we conducted semi-structured interviews with intervention completers and non-completers to understand user experiences in-depth. For all primary outcomes, descriptive statistics were calculated. Changes from baseline to post-test were examined using paired sample t-tests or Wilcoxon Signed-rank test. Qualitative data were analyzed using thematic analysis.

Results:

Of 436 eligible students, 307 students started using the intervention. A total of 79 completed the core sessions (i.e. sessions 1-3) and post-test assessment. A substantial proportion (74%, 228/307) of the students did not complete the core sessions or fill out the post-test assessment. Students who completed the core sessions reported high satisfaction (M = 25.78, SD = 3.30) and high usability of the intervention (M = 86.01, SD = 10.25). Moreover, this group showed large reductions in perceived stress (Cohen`s d = 0.80), moderate improvements in depression score (Cohen`s d = 0.47), and quality of life (Cohen`s d = -0.35) from baseline to post-test. Qualitative findings highlight that several personal and intervention-related factors play a role in user experience.

Conclusions:

The internet-based stress management intervention seems to be feasible, acceptable, and possibly effective for college students with elevated stress levels. However, given the high drop-out rate and qualitative findings, several adjustments in the content and features of the intervention are needed to maximize the user experience and the impact of the intervention. Clinical Trial: Netherlands Trial Register [Registration number: 8686]