Effects of Internet-based Storytelling Programs in Reducing Mental Illness Stigma With Mediation by Interactivity and Stigma Content

Mental illness stigma has been a concerning issue globally due to its adverse effects on the recovery of people with mental illness and may delay help-seeking for mental health out of the concern of being stigmatized. With technological advancement, Internet-based mental health stigma reduction interventions have been developed to combat mental illness stigma and the effects have been promising.

The present study aimed to examine the differential effects of Internet-based storytelling programs varied on level of interactivity and stigma content in reducing mental illness stigma.

In the present study, the investigator hypothesized that an Internet-based storytelling program with a combination of interactivity and stigma content would lead to the most significant reduction in public stigma, microaggression, and social distance from people with mental illnesses, followed by Internet-based storytelling program with stigma content-only and interactivity-only, compared with control. Secondly, the investigator hypothesized that the effects observed in stigma reduction would be mediated by perceived autonomy and immersiveness due to the presence of interactivity.

Study Overview

• Status: Completed
• Conditions: COMBO Condition; STIGMA Condition; INTERACT Condition; CONTROL Condition
• Intervention / Treatment: Behavioral: Internet-based storytelling programs with interactivity and stigma content; Behavioral: Internet-based storytelling programs with stigma content only; Behavioral: Internet-based storytelling programs with interactivity only; Behavioral: Internet-based storytelling programs with no interactivity and no stigma content

• Study Type: Interventional
• Enrollment (Actual): 263
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Hong Kong
  • Hong Kong, Hong Kong, HKG
    • The Chinese University of Hong Kong

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• aged 18 years or above
• able to read and understand Chinese

Exclusion Criteria:

• less than 18 years of age
• unable to read or understand Chinese

Study Plan

How is the study designed?

Design Details

• Primary Purpose: OTHER
• Allocation: RANDOMIZED
• Interventional Model: FACTORIAL
• Masking: NONE

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: COMBO condition; An interactive stigma content website.	Behavioral: Internet-based storytelling programs with interactivity and stigma content; Participants viewed an interactive stigma content website. Within 10 minutes post-experiment, participants completed the post-experiment questionnaire. One week after the experiment, participants completed the follow-up questionnaire.
Experimental: STIGMA condition; A non-interactive stigma content website.	Behavioral: Internet-based storytelling programs with stigma content only; Participants viewed a non-interactive stigma content website. Within 10 minutes post-experiment, participants completed the post-experiment questionnaire. One week after the experiment, participants completed the follow-up questionnaire.
Experimental: INTERACT condition; An interactive non-stigma content website.	Behavioral: Internet-based storytelling programs with interactivity only; Participants viewed an interactive non-stigma content website. Within 10 minutes post-experiment, participants completed the post-experiment questionnaire. One week after the experiment, participants completed the follow-up questionnaire.
Placebo Comparator: CONTROL condition; A non-interactive non-stigma content website.	Behavioral: Internet-based storytelling programs with no interactivity and no stigma content; Participants viewed a non-interactive non-stigma content website. Within 10 minutes post-experiment, participants completed the post-experiment questionnaire. One week after the experiment, participants completed the follow-up questionnaire.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change from Baseline Public Stigma towards People with Mental Illness within 10 minutes post-experiment, and at 1-week follow-up	The 21-item Public Stigma Scale-Mental Illness-Short Version was used to assess mental illness public stigma and personal advocacy. Each item was rated on a 6-point Likert scale from 1 (strongly disagree) to 6 (strongly agree). Reverse scoring was done for personal advocacy items. Higher scores indicated a higher level of public stigma towards people with mental illness.	baseline, within 10 minutes post-experiment, and 1-week follow-up
Change from Baseline Microaggression within 10 minutes post-experiment, and at 1-week follow-up	Microaggression was measured by the 17-item Mental Illness Microaggressions Scale, which covers assumption of inferiority, patronization, and fear of mental illness. Each item was rated on a 4-point Likert scale from 1 (strongly disagree) to 4 (strongly agree). Higher scores indicated a higher level of mircroaggression.	baseline, within 10 minutes post-experiment, and 1-week follow-up
Change from Baseline Social Distance from People with Mental Illness within 10 minutes post-experiment, and at 1-week follow-up	The 8-item Social Distancing Scale was used to measure the social distance from people with mental illnesses. Each item was rated on a 6-point Likert scale from 1 (very willing) to 6 (very unwilling). Higher scores indicated a higher level of social distance from people with mental illness.	baseline, within 10 minutes post-experiment, and 1-week follow-up
Perceived autonomy	To assess perceived autonomy of the Web page experience, the 10-item Self Determination Scale (SDS) was used in the post-experiment questionnaire. Each item was a pair of opposite statements, where participants rated their level of perceived choice and self-awareness with a slider from 1 (only A feels true) to 5 (only B feels true). Higher scores indicated a higher level of perceived autonomy.	within 10 minutes post-experiment
Immersiveness	The 15-item Transportation Scale was used to assess participants' immersiveness in the Web experience. It had a 4-point Likert scale from 1 (very much) to 4 (not at all). Items 2, 5 and 9 were framed negatively. All the items are scored in the direction that higher scores indicated a higher level of immersivenss.	within 10 minutes post-experiment

Collaborators and Investigators

• Sponsor: Chinese University of Hong Kong
• Investigators: Study Chair: Winnie Wing-Sze Mak, PhD, Chinese University of Hong Kong

Publications and helpful links

General Publications

• Fong THC, Mak WWS. The Effects of Internet-Based Storytelling Programs (Amazing Adventure Against Stigma) in Reducing Mental Illness Stigma With Mediation by Interactivity and Stigma Content: Randomized Controlled Trial. J Med Internet Res. 2022 Aug 12;24(8):e37973. doi: 10.2196/37973.

Helpful Links

• Related Info

Study record dates

Study Major Dates

• Study Start (Actual): December 27, 2020
• Primary Completion (Actual): March 4, 2021
• Study Completion (Actual): March 4, 2021

Study Registration Dates

• First Submitted: March 31, 2022
• First Submitted That Met QC Criteria: April 13, 2022
• First Posted (Actual): April 19, 2022

Study Record Updates

• Last Update Posted (Actual): April 19, 2022
• Last Update Submitted That Met QC Criteria: April 13, 2022
• Last Verified: April 1, 2022

More Information

Terms related to this study

• Keywords: storytelling; Internet-based; mental illness stigma; interactivity; social distance; microaggression
• Additional Relevant MeSH Terms: Pathologic Processes; Disease; Mental Disorders
• Other Study ID Numbers: dre20024

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

IPD Plan Description

The identifiable personal information collected will be de-linked from the research data and stored separately. The research data will receive a unique number that cannot be traced back to the individuals.

All information obtained in the course of this experiment will be used for research purposes only; it will be protected and kept confidential by the researchers of this project and not be shared with a third party unless forced by law.

The identifiable information will be destroyed after data analysis and reporting.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No