JMIR Publications

ABSTRACT

Background:

Trials of stress management interventions have shown modest and inconsistent effects. Emerging evidence suggests that structural constraints may limit the real-world effectiveness of behavioural strategies, yet this process has rarely been examined empirically. Population-level tools for monitoring stress and stress-management processes over time remain limited.

Objective:

To develop and pilot a mixed-methods surveillance platform for repeated measurement of stress and stress-management effectiveness in real-world contexts, and to assess its feasibility, validity, and ability to detect equity-relevant patterns.

Methods:

Adults living in Australia completed baseline assessments including sociodemographics, perceived stress (PSS-10), psychological flexibility (MPFI), social resources, and health measures. Participants then completed brief fortnightly surveillance surveys for up to 12 months comprising 0–10 visual analogue scale (VAS) ratings of stress and perceived stress management effectiveness, a stress-related symptom checklist, and open-ended reporting of stressors and coping strategies. We assessed feasibility, convergent validity of early VAS indicators, and preliminary equity patterning.

Results:

Seventy-seven participants completed baseline measures, and 1,195 fortnightly check-ins were recorded as of June 2025. Early VAS stress demonstrated strong convergent validity with baseline perceived stress and stress symptoms. Despite pilot recruitment skewing toward higher socioeconomic status, clear gradients were observed in both stress and stress management. Lower-income participants reported higher stress, lower perceived stress management, and fewer good stress-management check-ins. Psychological flexibility was positively associated with stress management overall, but showed weaker associations among lower-income participants.

Conclusions:

Brief, repeated stress surveillance is feasible and can generate equity-informative signals. Findings support a model in which adaptive skills are widely available but their effective expression is shaped by structural conditions. The FocUS-R platform provides a scalable approach for monitoring population stress processes and identifying contexts where structural constraints may limit the effectiveness of behavioural strategies.