Mental Health Literacy and Peer Support Among Caregivers

May 25, 2026 updated by: Dr Angela Leung, The Hong Kong Polytechnic University

Increasing Mental Health Literacy and Peer Support Among Caregivers: An Electronic Painting and Peer Supportive (EPPS) Platform

This study aims to assess the efficacy of an electronic painting and peer support platform on help seeking behaviour and emotion (depression, anxiety and stress) among caregivers. This is a 2-arm randomized controlled trial with 700 caregivers being randomized to intervention group (IG) or control group (CG). Participants of the IG will use the EPPS system for 8 weeks, making electronic paintings, sharing the paintings with peers, self-assessing emotion and use the provided list to seek for help if necessary. At the same time, they will continue to receive the usual supportive service to caregivers in the NGOs, while the caregivers in the CG will receive e-chat and usual care (the usual supportive service to caregivers in the NGOs). After 8 weeks, the caregivers in the CG will be given opportunities to draw paintings in the EPPS system. All caregivers are invited to complete an online survey at Week 0 (before they use the system), Week 8 (immediately after the system use) and Week 12 (4 weeks after the system use). 30 to 40 caregivers will be invited to attend focus group interviews to indicate their comments and views on the use of the EPPS system after Week 8. Such qualitative data collection will be ceased when no new comments is received. The findings of the study will provide evidence of technology use in supporting caregivers for help seeking and reducing depression, anxiety and stress.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

During the 8-week period, caregivers are encouraged to draw paintings. There is no fixed frequency for making the paintings but they are recommended to draw at least one painting per week. Caregivers could draw the electronic paintings at any time when they are free. They could share the paintings with friends or peers in the group. 10-12 caregivers will be gathered as a small group for interaction supported by a supportive team member (e-chat). During this period, the supportive team members will announce a theme for drawing each week. Caregivers can self-assess their mental health status by using the validated scale, Depression, Anxiety and Stress Scale (DASS-8) which is installed in the EPPS system at Week 0, Week 8 and Week 12. At any time, they draw the painting, caregivers can self-assess their mood by completing PHQ-2. Caregivers can look for the available mental health support services (shown in the system) and seek help, if necessary. They would also approach the facilitators if they need help. On the other hand, the supportive team members will also monitor the mental health assessment scores and make referral to the professionals if necessary.

Study design. A randomized controlled trial with focus group interviews with caregivers and members of supportive team will be used to assess the efficacy of the EPPS system. Caregivers will be randomly assigned to intervention group (IG) and control group (CG). Caregivers in the IG will use all the features in the EPPS system for 8 weeks (at the same time, they will continue to receive the usual supportive service to caregivers in the NGOs) while the caregivers in the CG will use only the e-chat function in the EPPS system and receive usual care (the usual supportive service to caregivers in the NGOs). After 8 weeks, the caregivers in the CG will be given opportunities to use all the features in the EPPS system. All caregivers are invited to complete an online survey at Week 0 (before they use the system), Week 8 (immediately after the system use) and Week 12 (4 weeks after the system use). 30 to 40 caregivers will be invited to attend focus group interviews to indicate their comments and views on the use of the EPPS system after Week 8. Such qualitative data collection will be ceased when no new comments is received (data is saturated).

Outcome measures in the evaluation: Attitudes Toward Seeking Professional Psychological Help-Short Form (ATSPPH-SF) (primary outcome). It consists of 10 items measuring the propensity for seeking help for mental disorders. A 4-point Likert scale ranging from "0=disagree" to "3=agree" is used as the response options. Total score, ranging from 0 to 30, is calculated by summing up all the items - higher scores indicate higher propensity to seek help. There are two subscales (1) openness to seeking treatment and (2) need in seeking treatment in this instrument. Other outcome measures include: DASS-8, WHO-5 [9], Chinese version of Zarit Burden Interview (CZBI-short), Modified Medical Outcome Study Social Support Survey (mMOS-SS) and PHQ-2 [12]. The DASS-8 is the shortest version of the DASS-21. It is composed of three subscales: depression (three items, e.g., felt that I had nothing to look forward), anxiety (three items, e.g., felt close to panic), and stress (two items, e.g., was using a lot of my mental energy) (36, 38). The minimum score of the DASS-8 and its subscales is 0, while the maximum scores are 24, 9, 9, and 6, respectively. Cronbach alpha = 0.933, and its correlation with DASS-21 is 0.977.

The sample size required for evaluating the efficacy of the EPPS system (using RCT) is calculated with reference to ATSPPH-SF (primary outcome). In a previous study, 65 adults changed their help seeking behaviour (total score of ATSPPH-SF) after watching a short video, and the mean ATSPPH-SF score was 18.1 (SD = 4.3) at pre-test and 19.4 (SD = 3.8) at post-test. The effect size of this e-learning was 0.46. Using a conservative approach, we assume the learning from the AIMHS system has small effect size (=0.3). Using G*Power 3.1.9.4, we assume an effect size of 0.3 with 90% power, two-tailed 5% significance, and 1:1 allocation ratio, the estimated sample size required is 382 (191 per group). Assuming 55% attrition, we intend to recruit about 700 caregivers.

Study Type

Interventional

Enrollment (Actual)

727

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 Locations

  • Hong Kong
      • Hong Kong, Hong Kong
        • The Hong Kong Polytechnic University

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:

  • Family caregivers who take care of elderly, disabled, demented, or mentally ill persons
  • Able to speak Cantonese
  • Live in Hong Kong

Exclusion Criteria:

  • currently suffer from severe acute illnesses

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: Supportive Care
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Intervention Group (IG)
Caregivers in the IG will use the e-painting and e-chat features in the EPPS system for 8 weeks (at the same time, they will continue to receive the usual supportive service to caregivers in the NGOs).
Behavioral: Electronic Painting and Peer Supportive
The EPPS system consists of five features: 1) electronic painting (e-painting); 2) picture sharing; 3) e-chat; 4) mood self-assessment and 5) announcement. The IG is given all the five features for 8 weeks. At the same time, they will continue to receive the usual supportive service to caregivers in the NGOs.
Active Comparator: Control group (CG)
The caregivers in the CG will receive e-chat and usual care (the usual supportive service to caregivers in the NGOs). After 8 weeks, the caregivers in the CG will be given opportunities to use the e-painting in the EPPS system.
Behavioral: Usual Care
The CG receives usual supportive service to caregivers in the NGOs and get access to e-chat in the EPPS system.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Attitudes Toward Seeking Professional Psychological Help-Short Form (ATSPPH-SF)
Time Frame: T0 (baseline), T1 (after the intervention at Week 9), and T2 (week 12)
It consists of 10 items measuring the propensity for seeking help for mental disorders. A 4-point Likert scale ranging from "0=disagree" to "3=agree" is used as the response options. Total score, ranging from 0 to 30, is calculated by summing up all the items - higher scores indicate higher propensity to seek help. There are two subscales (1) openness to seeking treatment and (2) need in seeking treatment in this instrument.
T0 (baseline), T1 (after the intervention at Week 9), and T2 (week 12)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
DASS-8
Time Frame: T0 (baseline), T1 (after the intervention at Week 9), and T2 (week 12)
The DASS-8 is the shortest version of the DASS-21. It is composed of three subscales: depression (three items, e.g., felt that I had nothing to look forward), anxiety (three items, e.g., felt close to panic), and stress (two items, e.g., was using a lot of my mental energy) (36, 38). The minimum score of the DASS-8 and its subscales is 0, while the maximum scores are 24, 9, 9, and 6, respectively. Cronbach alpha = 0.933, and its correlation with DASS-21 is 0.977
T0 (baseline), T1 (after the intervention at Week 9), and T2 (week 12)
WHO-5
Time Frame: T0 (baseline), T1 (after the intervention at Week 9), and T2 (week 12)
The WHO-5 is a self-report instrument measuring mental well-being. It consists of five statements relating to the past two weeks. Each statement is rated on a 6-point scale, with higher scores indicating better mental well-being.
T0 (baseline), T1 (after the intervention at Week 9), and T2 (week 12)
Chinese version of Zarit Burden Interview (CZBI-short)
Time Frame: T0 (baseline), T1 (after the intervention at Week 9), and T2 (week 12)
The Chinese version of the Zarit Burden Interview (CZBI) is a tool used to assess the burden experienced by caregivers of individuals with dementia. It has a full 22-item version and a shorter 12-item version, known as the CZBI-Short, which is specifically validated for use with Cantonese-speaking caregivers in clinical and social care settings.
T0 (baseline), T1 (after the intervention at Week 9), and T2 (week 12)
Modified Medical Outcome Study Social Support Survey (mMOS-SS)
Time Frame: T0 (baseline), T1 (after the intervention at Week 9), and T2 (week 12)
The Modified Medical Outcomes Study Social Support Survey (mMOS-SS) is a shortened, 8-item version of the original 19-item Medical Outcomes Study Social Support Survey (MOS-SS). It assesses an individual's perception of social support, specifically focusing on emotional and instrumental (tangible) support. The abbreviated version is designed to be more time-efficient while maintaining the core structure of the original survey and identifying potential deficits in social support.
T0 (baseline), T1 (after the intervention at Week 9), and T2 (week 12)
PHQ-2
Time Frame: T0 (baseline), T1 (after the intervention at Week 9), and T2 (week 12)
Patient Health Questionnaire-2, is a brief two-question screening tool used to identify individuals who may be experiencing symptoms of depression. It is a subset of the PHQ-9 and focuses on the frequency of depressed mood and anhedonia (loss of interest or pleasure) over the past two weeks.
T0 (baseline), T1 (after the intervention at Week 9), and T2 (week 12)
Multidimensional Scale of Perceived Social Support (MSPSS)
Time Frame: T0 (baseline), T1 (after the intervention at Week 9), and T2 (Week 12)
The MSPSS has 12 items measuring perceived social support from 3 sources: family, friends and a significant other. Items were rated on a 7-point Likert scale. The MSPSS total score ranges 7 - 84 and scores of the three dimensions range 4 -24, with higher scores indicating higher levels of social support.
T0 (baseline), T1 (after the intervention at Week 9), and T2 (Week 12)

Collaborators and Investigators

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

Sponsor

The Hong Kong Polytechnic University

Investigators

  • Principal Investigator: Angela Leung, PhD, The Hong Kong Polytechnic University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

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)

May 1, 2023

Primary Completion (Actual)

October 30, 2025

Study Completion (Actual)

October 30, 2025

Study Registration Dates

First Submitted

August 9, 2025

First Submitted That Met QC Criteria

January 6, 2026

First Posted (Actual)

January 13, 2026

Study Record Updates

Last Update Posted (Actual)

May 28, 2026

Last Update Submitted That Met QC Criteria

May 25, 2026

Last Verified

January 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • HSEARS20230421001

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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