Accepted for/Published in: JMIR Mental Health
Date Submitted: Jun 27, 2024
Date Accepted: Dec 26, 2024
Warning: This is an author submission that is not peer-reviewed or edited.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.
Evaluation of a Guided Chatbot Intervention for Young People in Jordan: A Feasibility Randomized Controlled Trial
ABSTRACT
Background:
Depression and anxiety are a leading cause of disability worldwide, which often start during adolescence and young adulthood. The majority of young people live in low- and middle-income countries where there is a lack of mental health services. The World Health Organization (WHO) developed a guided, non-artificial intelligence chatbot intervention called Scalable Technology for Adolescents and Youth to Reduce Stress (STARS) to reduce symptoms of depression and anxiety among young people affected by adversity.
Objective:
The objective of this study was to evaluate the safety, acceptability and feasibility of the STARS intervention and study procedures among young people in Jordan.
Methods:
A two-arm, single-blind feasibility randomized controlled trial was conducted among 60 young people living in Jordan aged 18-21 years old with self-reported elevated levels of psychological distress. Immediately after baseline, participants were randomized 1:1 into the STARS intervention (STARS) or enhanced care as usual (ECAU). STARS consisted of 10 lessons in which participants interacted with a chatbot and learnt several cognitive behavioral therapy strategies, with optional guidance by a trained e-helper through five weekly phone calls. ECAU consisted of a static webpage providing basic psychoeducation. Online questionnaires were administered at baseline (week 0) and post-assessment (week 8), assessing depression (Hopkins Symptom Checklist; HSCL-25), anxiety (HSCL-25), functional impairment (WHODAS 2.0), psychological wellbeing (WHO-5), and agency (State Hope Scale). Process evaluation interviews with stakeholders were conducted after the post-assessment.
Results:
Participants were recruited in December 2022-January 2023. Out of 700 screening website visits, 160 participants were eligible and 60 (M age 19.7 years; 81.7% female) continued to baseline and were randomized into STARS (n=30) or ECAU (n=30). Of those who received STARS, 36.7% completed at least eight chatbot lessons and 13.3% completed all five support calls. The research protocol functioned well in terms of balanced randomization, high retention at post-assessment (80.0%), and good psychometric properties of the online questionnaires. Process evaluation interviews with STARS participants, ECAU participants, e-helpers and the clinical supervisor indicated the acceptability of study procedures, STARS and ECAU conditions, and pointed at several aspects that could be improved, including the e-helper support and features of the STARS chatbot.
Conclusions:
This study demonstrated the feasibility and acceptability of the STARS intervention and research procedures. A fully powered, definitive RCT will be conducted to evaluate the effectiveness of STARS. Clinical Trial: https://doi.org/10.1186/ISRCTN19217696
Citation
