Previously submitted to: JMIR Formative Research (no longer under consideration since Mar 15, 2024)
Date Submitted: Aug 21, 2023
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Examining a Brief Web and Longitudinal App-Based Intervention [Wysa] for Mental Health Support in Singapore during the COVID-19 Pandemic: Mixed-Methods Retrospective Observational Study
ABSTRACT
Background:
The COVID-19 pandemic in Singapore led to limited access to mental health support services, resulting in increased distress among the population. This study aimed to assess the potential benefits of offering a digital mental health intervention (Wysa) in the form of a brief and longitudinal intervention, as part of the mindline.sg initiative launched by the MOH Office for Healthcare Transformation in Singapore.
Objective:
i) Evaluate the engagement and retention of Singaporean users across the brief intervention on the mindline.sg website and the longitudinal app version of Wysa; ii) Examine the types of negative thoughts and challenges managed during the pandemic; iii) Assess the impact of the conversational agent (CA) in supporting cognitive restructuring across attributional styles, and cognitive patterns.
Methods:
A retrospective observational design with a mixed-methods approach was utilized. The study included a sample of website users (N=69,055) and app users (N=4,547) from September 1, 2020, to July 25, 2022. App and website usage data were analyzed to evaluate engagement and retention. T-tests were employed for comparing engagement and retention levels between the app and website. A thematic analysis was examined to assess the types of negative thoughts and the success of cognitive restructuring. Logistic regression was used to estimate the likelihood of restructuring based on negative thought type and attributional style.
Results:
Those who used the longitudinal intervention after first using a brief intervention demonstrated significantly higher engagement and retention (P<.001). In user ratings received for mindline.sg (n=8,959), 83.03% rated the app 3 or higher (out of 5) on helpfulness. 91.6% of the users (n=862) who attempted cognitive restructuring (n=790) on the app successfully reframed a thought. The logistic regression analysis indicated significance in the ability to restructure future-oriented negative thoughts (P<.001), and internal, stable and global (P<.001) negative thoughts in a single conversation with Wysa, while other attributional styles required more intervention. A qualitative thematic analysis of the negative thoughts mentioned within the CA documented the psychosocial challenges being managed by users during COVID-19.
Conclusions:
The findings demonstrated that brief interventions can facilitate enhanced engagement with digital mental health interventions and digital interventions can successfully facilitate cognitive restructuring, and improvement of mental health outcomes.
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