Mental Health Help-seeking Promotion in Older Adults

February 5, 2026 updated by: LIU Tianyin Bridget, The Hong Kong Polytechnic University

Is a Picture Worth a Thousand Words: A Participatory Approach to Codesign Descriptive and Pictorial Social Norm Nudges and a Randomised Controlled Trial (RCT) to Examine Their Effectiveness in Improving Mental Health Help-seeking Intention

The present study aims to examine the effectiveness of descriptive social norm nudges and pictorial social norm nudges in improving mental health help-seeking intention compared to educational information.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

This study is a three-arm randomised controlled trial (RCT) in 540 older adults aged 60 years and above recruited through NGOs, testing the utility of revised TPB with baseline data, and the effectiveness of descriptive social norm-nudges (intervention group 1) and pictorial social norm- nudges (intervention group 2) comparing to traditional mental health education (control). Participants will be evenly randomised and receive 1 message/picture per day consecutively for 2 weeks. Researchers blind to group allocation will interview participants at baseline (T0), 2 weeks (post-intervention, T1), and 12 weeks (follow-up, T2). The primary outcomes are changes in subjective norms and help-seeking intention assessed using a revised Chinese version of the theory of planned behaviour questionnaire (C-TPB); secondary outcomes include perceived behavioural control, help-seeking attitude, perceived barriers to help-seeking (C-TPB subscales), and mental health assessed by PHQ-9, GAD-7 and UCLA-3.

Study Type

Interventional

Enrollment (Estimated)

540

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

  • Hong Kong
      • Hong Kong, Hong Kong
        • Recruiting
        • The Hong Kong Polytechnic University
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • aged 60 years or above at the time of the baseline assessment
  • have no severe mental disorder or cognitive impairment
  • have no severe visual impairment
  • be able to read Chinese
  • have a smartphone with an instant communication application to receive text and images

Exclusion Criteria:

  • have severe difficulty in reading and communication
  • show imminent suicidal risk at any stage of the study

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Prevention
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Descriptive social norm nudges
Participants receive messages with social norm nudges presented in the word form.
Behavioral: Descriptive social norm nudges
A set of messages with descriptive social norm nudges sent to participants.
Experimental: Pictorial social norm nudges
Participants receive messages with social norm nudges presented in graphic form.
Behavioral: Pictorial social norm nudges
A set of messages with pictorial social norm nudges sent to participants.
Active Comparator: Active control
Participants receive messages with generic mental health knowledge or information.
Behavioral: Service as usual
Traditional mental health education information disseminated to participants.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Subjective norms toward mental health help-seeking
Time Frame: Baseline (T0), post-intervention (T1, two weeks after T0), and to 12 weeks after the baseline (T2)
Subjective norms toward mental health help-seeking will be measured by six items adapted from the validated Chinese version of the TPB questionnaire (C-TPB) . The three items will measure descriptive norms describing what society, in general, does when facing mental health challenges, and the other three items will measure social norms describing what the significant others of the participant would do. Responses will be rated on a 6-point Likert scale, with higher scores indicating higher levels of subjective norms about mental health help-seeking.
Baseline (T0), post-intervention (T1, two weeks after T0), and to 12 weeks after the baseline (T2)
Mental health help-seeking intention
Time Frame: Baseline (T0), post-intervention (T1, two weeks after T0), and to 12 weeks after the baseline (T2)
Mental health help-seeking intention will be measured on a 3-item subscale of C-TPB. Responses will be rated on a 6-point Likert scale, with higher scores indicating higher levels of help-seeking intention.
Baseline (T0), post-intervention (T1, two weeks after T0), and to 12 weeks after the baseline (T2)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Perceived behavioural control
Time Frame: Baseline (T0), post-intervention (T1, two weeks after T0), and to 12 weeks after the baseline (T2)
Perceived behavioural control will be measured on a 3-item subscale of the C-TPB. Responses are rated on a 6-point Likert scale, with higher scores indicating higher levels of behavioural control.
Baseline (T0), post-intervention (T1, two weeks after T0), and to 12 weeks after the baseline (T2)
Help-seeking attitude
Time Frame: Baseline (T0), post-intervention (T1, two weeks after T0), and to 12 weeks after the baseline (T2)
Help-seeking attitude will be measured on a 5-item subscale of C-TPB, items will be measured on a 6-point semantic differential scale, with higher scores indicating a more positive attitude towards help-seeking.
Baseline (T0), post-intervention (T1, two weeks after T0), and to 12 weeks after the baseline (T2)
Perceived barriers to help-seeking
Time Frame: Baseline (T0), post-intervention (T1, two weeks after T0), and to 12 weeks after the baseline (T2)
Perceived barriers to help-seeking will be measured by a 6-item scale adapted from the Chinese American Psychiatric Epidemiological study (CAPES), responses are rated on a 6-point Likert scale, with higher scores indicating more significant perceived barriers to help-seeking.
Baseline (T0), post-intervention (T1, two weeks after T0), and to 12 weeks after the baseline (T2)
Depressive symptoms
Time Frame: Baseline (T0), post-intervention (T1, two weeks after T0), and to 12 weeks after the baseline (T2)
Depressive symptoms will be measured with the Patient Health Questionnaire (PHQ-9). It is a 9-item instrument that incorporates depression diagnostic criteria with other leading major depressive symptoms and rates the frequency of the symptoms, factoring into the scoring severity index. PHQ-9 scores of 5-9, 10-14, 15-19, 20 and above represent mild, moderate, moderately severe, and severe depression, respectively.
Baseline (T0), post-intervention (T1, two weeks after T0), and to 12 weeks after the baseline (T2)
Anxiety symptoms
Time Frame: Baseline (T0), post-intervention (T1, two weeks after T0), and to 12 weeks after the baseline (T2)
Anxiety will be measured with the Generalised Anxiety Disorder 7-item scale (GAD-7). It is a 7-item scale; responses to each item are rated on a 4-point Likert scale and range from 0 to 3. It taps on the most prominent diagnostic features for GAD, and scores of 5, 10, and 15 are taken as the cut-off points for mild, moderate, and severe anxiety, respectively.
Baseline (T0), post-intervention (T1, two weeks after T0), and to 12 weeks after the baseline (T2)
Loneliness
Time Frame: Baseline (T0), post-intervention (T1, two weeks after T0), and to 12 weeks after the baseline (T2)
Loneliness will be measured with the UCLA Loneliness Scale (UCLA-3). It is a 3-item scale measuring an individual's perceived loneliness. Each item is evaluated with scores ranging from 0 (never) to 3 (often), the total score is the sum of all items, and a higher score indicates a higher level of perceived loneliness.
Baseline (T0), post-intervention (T1, two weeks after T0), and to 12 weeks after the baseline (T2)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

The Hong Kong Polytechnic University

Collaborators

The University of Hong Kong

Investigators

  • Principal Investigator: Tianyin Liu, PhD, The Hong Kong Polytechnic University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

December 1, 2024

Primary Completion (Estimated)

June 30, 2026

Study Completion (Estimated)

December 31, 2026

Study Registration Dates

First Submitted

November 25, 2024

First Submitted That Met QC Criteria

November 26, 2024

First Posted (Actual)

November 27, 2024

Study Record Updates

Last Update Posted (Actual)

February 6, 2026

Last Update Submitted That Met QC Criteria

February 5, 2026

Last Verified

February 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • HSEARS20231109001

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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