Predictors of Adolescent Engagement and Outcomes: A cross-sectional study using the Togetherall (formerly Big White Wall) digital mental health platform

Online mental health platforms can improve access to, and use of, mental health support for young people who may find it difficult to engage with face-to-face delivery. We modelled engagement and change in anxiety and depression symptoms in adolescent users of the Togetherall (formerly Big White Wall) anonymous digital mental health peer-support platform. A cross-sectional study assessed online activity data from members of Togetherall in UK adolescents referred from mental health services (N=606). Baseline demographics, depression, anxiety, and usage statistics were assessed. Symptom levels among participants who chose to take validated anxiety and depression measures were measured. And participant characteristics were used to predict engagement. Mean number of logins for adolescent members was higher for older adolescents, and for a longer duration than younger adolescents. Mean number of logins and usage time was higher in female adolescents than males. For the total sample, 47.9% of users accessed more than one course, and 27% accessed at least one self-help resource. Gender and age predicted number of joined courses. Greater accessed self-help materials predicted reduced anxiety symptoms. Members mean baseline symptom levels were: GAD-7 between 13.63 and 14.79; PHQ-9 between 16.8 and 18.58. Data were derived from a naturalistic design and modelling of multiple symptom scores should be interpreted with caution. Findings show that adolescents readily engage with an anonymous online platform for common mental disorder, with scope for tailored pathways for different symptom profiles. Members benefit from engagement with Togetherall materials and courses.

Developing an explanatory theoretical model for engagement with a web-based mental health platform: results of a mixed methods study

Background With the growing need for accessible, high-quality mental health services, especially during the COVID-19 pandemic, there has been increasing development and uptake of web-based interventions in the form of self-directed mental health platforms. The Big White Wall (BWW) is a web-based platform for people experiencing mental illness and addiction that offers a range of evidence-based self-directed treatment strategies. Drawing on existing data from a large-scale evaluation of the implementation of BWW in Ontario, Canada (which involved a pragmatic randomized controlled trail with an embedded qualitative process evaluation), we sought to investigate the influences on the extent to which people engage with BWW. Methods In this paper we drew on BWW trial participants’ usage data (number of logins) and the qualitative data from the process evaluation that explored participants’ experiences, engagement with and reactions to BWW. Results Our results showed that there were highly complex relationships between the influences that contributed to the level of engagement with BWW intervention. We found that a) how people expected to benefit from using a platform like BWW was an important indicator of their future usage, b) moderate perceived symptoms were linked with higher engagement; whereas fewer actual depressive symptoms predicted use and anxiety had a positive linear relationship with usage, and that c) usage depended on positive early experiences with the platform. Conclusions Our findings suggest that the nature of engagement with platforms such as BWW is not easily predicted. We propose a theoretical framework for explaining the level of user engagement with BWW that might also be generalizable to other similar platforms.

Correction: A Direct-to-Public Peer Support Program (Big White Wall) Versus Web-Based Information to Aid the Self-management of Depression and Anxiety: Results and Challenges of an Automated Randomized Controlled Trial (Preprint)

UNSTRUCTURED REMOVE

Outcomes of a public health campaign and automated randomised controlled trial of a direct to public peer support programme (Big White Wall) versus web-based information to aid self-management of depression and anxiety (The REBOOT study). (Preprint)

BACKGROUND Effective help for depression and anxiety only reaches a small proportion of those who might benefit from it. The scale of the problem suggests a role for effective, safe public health online services delivered directly to the public. One model is Big White Wall, which offers peer support at low cost. Since these interventions are delivered digitally, we tested whether a randomised controlled trial (RCT) intervention could also be fully delivered and evaluated digitally. OBJECTIVE To determine the reach, feasibility, acceptability, baseline costs and outcomes of a public health campaign for an automated randomised controlled trial of Big White Wall (BWW) providing digital peer support and information, compared with a standard website used by the National Health Service (NHS Choices Moodzone, MZ) in people with probable mild to moderate depression and anxiety disorder. The primary outcome was change in self-rated well-being at 6 weeks, measured by the Warwick-Edinburgh Mental Well-Being Scale. METHODS An 18 month campaign was performed across Nottinghamshire, United Kingdom (target population 914,000) to advertise the trial direct to the public through general marketing, online and social media sources, health services, other public services and third sector groups. The population reach of this campaign was examined by numbers accessing the study website and self-registering to the study. A pragmatic, parallel group, single blind RCT (ISRCTN ) was then conducted using a fully automated trial website in which eligible participants were randomised to receive either 6 months access to BWW or signposted to MZ. Those eligible for participation were over 16 years with probable mild to moderate depression or anxiety disorders. RESULTS Of 6483 visitors to the study website, only 1,510 were eligible. 790 (52.3% of eligible) participated, 397 randomised to BWW and 393 to MZ. Their mean age (sd) was 38.0 (13.8) years, 640 (82.0%) were female, 738 (93.7%) were white, all had educational qualifications, and 271 (47.4%) had no contact with health services in the previous three months. We estimated 3-month productivity losses of £1019.05 (1057.70) per person for those employed. Only 131 (16.6%) participants completed the primary outcome assessment. There were no differences in primary nor secondary outcomes between the two groups. CONCLUSIONS Most participants reached and eligible for this trial of digital intervention providing information and/or support for mild to moderate depression and anxiety were educated women of white ethnicity not in recent contact with health services, and whose productivity losses represent a significant annual societal burden A fully automated RCT recruiting directly from the public failed to recruit and retain sufficient participants to test the clinical effectiveness of this digital intervention. CLINICALTRIAL International Standard Randomized Controlled Trial Number (ISRCTN) 12673428; http://www.controlled-trials.com/ISRCTN12673428/12673428. INTERNATIONAL REGISTERED REPORT RR2-10.2196/resprot.8061

Multi-Angle Interpretation of H.G. Wells’s Binary Structure in “The Door in the Wall”

H.G. Wells, as a famous writer, has been paid less attention to his idea of binary structure. In the short story “The Door in the Wall”, H. G. Wells portrays two different worlds separate from each other by a wall, and the only channel connecting the two realms is the green door in the white wall. H.G. Wells tells us the protagonist’s attempt to pass through the door to achieve the integration of the world inside and outside the wall, which turn out to be a failure. This article provides a multi-angle interpretation of H.G. Wells’ binary structure of the story: H.G. Wells’ view on interpersonal relationship, his utopian imagination and writing thought.

COMPATIBILITY OF VISIBILITY AND HARMONY OF PICTOGRAM -FOCUS ON RESTROOM MARK-

In recent years, there are various design signs to guide people. In the signature "pictogram" which enables guidance without using words is often used. However, when looking into the building, the signature using the pictogram is given its own design to match with the indoor space, and signs which are difficult for the user to understand are distributed. It can be thought that these pictograms are being redesigned to adapt to architecture. Therefore, the research aimed for a sign plan which is easy for users to understand, and thought that standard pictograms harmonizing with various buildings are necessary. Visibility is important for pictograms, and in this research, the objective is to study the conditions of pictograms that compatibility of visibility and harmony.For reference to the research conducted for each generation, The author conducted an experiment using the pictogram of the Japanese Industrial Standard toilet mark, which had high recognition among all generations. The author divide the pictograms into pictograms for men and women whereby the existing designs filled with color and new designs with only contour lines are more harmonious using textures of concrete, brick, white wall, wood pictograms were synthesized. The author compared with that pictograms . As a result, The author received responses that the design of only the outline of the pictogram for men and the pictogram for women is more harmonious in all scenes. Among them, both male pictograms and female pictograms showed significant differences in the two scenes, and a significant trend was observed in the remaining two scenes. The author conducted experiments on the width of the contour line using 4 scenes images same as comparison and study the pictograms of the line widths with the greatest thickness. As a result, there was not much difference in the width of the width of the contour line of the pictogram in all scenes of male pictograms and female pictograms. The author discussed the effect on visibility and harmony by shape and color as future prospect.