JMIR Publications

ABSTRACT

Background:

College students are at heightened risk for mental health problems, yet professional help-seeking remains low. Although digital mental health tools can improve accessibility and reduce stigma, many focus on isolated functions, such as self-screening, psychoeducation, or symptom management, and are not fully integrated with campus counseling services. Multi-domain platforms that combine screening, mental health information, counseling access, and campus service navigation may support help-seeking in university settings; however, their acceptability and implementation value remain underexplored.

Objective:

This mixed-methods study examined the refinement and preliminary evaluation of Fruto, a campus-integrated, multi-domain app developed to support university students’ help-seeking attitudes and counseling-related beliefs in a real-world counseling-center setting. Phase 1 used scenario-based prototype sessions to analyze students’ interactions with the platform and inform refinement. Phase 2 assessed whether 8 weeks of Fruto use was associated with pre-post changes in attitudinal and counseling-related outcomes.

Methods:

We conducted a two-phase, mixed-methods study. Phase 1 involved vignette-based prototype sessions and semi-structured interviews with 16 students to explore user experiences with an early version of Fruto. Scenario-based tasks facilitated feedback on the platform, and thematic analysis identified design implications that guided refinement. Phase 2 involved an 8-week single-group pre-post evaluation. A total of 109 students completed the baseline survey, and 70 provided follow-up responses. Surveys assessed help-seeking attitudes, counseling-related beliefs, and perceived app quality. Linear mixed-effects models examined pre-post changes using all available data, and exploratory baseline-adjusted regressions examined association between overall perceived app quality and post-use outcomes.

Results:

Scenario-based prototype sessions elicited actionable feedback on how students might use Fruto in realistic help-seeking contexts. Qualitative findings identified three refinement priorities that informed subsequent app updates: trusted and identifiable content providers, seamless integration across app features, and relatable self-discovery content to lower psychological barriers to app use. Following these refinements, Phase 2 assessed 8-week pre-post changes using linear mixed-effects models. Fruto use was associated with significant increases in positive help-seeking attitudes (B=0.884, SE=0.284, 95% CI 0.327 to 1.441; P=.002) and positive counseling expectations (B=1.585, SE=0.541, 95% CI 0.526 to 2.645; P=.003). No significant changes were observed in negative attitudes, negative counseling beliefs, or socially supportive beliefs. In exploratory baseline-adjusted regressions, overall perceived app quality was associated with positive counseling expectations, but not with positive help-seeking attitudes.

Conclusions:

Fruto shows promise as a campus-integrated, multi-domain platform associated with more favorable help-seeking attitudes and counseling expectations among university students. These findings suggest that multi-domain platforms may strengthen positive, approach-oriented beliefs toward professional support. Future studies with longer follow-up and objective usage or service-utilization data are needed to examine whether attitudinal changes translate into help-seeking behavior. Clinical Trial: Clinical Research Information Service (CRIS) KCT0010622; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=30274&status=5&seq_group=30274&search_page=M The trial registration refers to Phase 2, the 8-week single-group evaluation of the campus-deployed Fruto platform, rather than the entire project.