Effectiveness of a Waitlist App "Stappvoorstap" During Mental Healthcare Waiting Times

Bridging the Gap: A Multiple Baseline Design Study on the Effectiveness of a Mobile-based Stress Management Intervention in Adults on Waiting Lists for Mental Healthcare

This study evaluates the effectiveness of Stappvoorstap, a mobile self-management application designed for adults on mental health waiting lists in the Netherlands. The app helps users monitor daily stress levels, recognize personal stress patterns, and provides coping strategies, relaxation exercises, and supportive resources. Using a multiple baseline single-case experimental design, participants use the app for 4 weeks while completing weekly questionnaires measuring perceived stress, coping self-efficacy, and quality of life. The study aims to determine whether the app can reduce stress and improve wellbeing during the waiting period before mental healthcare treatment begins.

Study Overview

• Status: Recruiting
• Conditions: Quality of Life; Mental Health; Coping Skills; Psychological Stress; Coping Ability
• Intervention / Treatment: Behavioral: Stappvoorstap: mobile self-management waitlist intervention

Detailed Description

Prolonged waiting times for mental healthcare pose significant challenges, with nearly 100,000 people on waiting lists in the Netherlands as of December 2023. During this period, symptoms can worsen, daily functioning may decline, and quality of life decreases. Stappvoorstap was developed in co-creation with waitlist clients and experts-by-experience to address this gap. The app is based on stress-signaling plans used in Dutch mental healthcare and functions as an ecological momentary intervention. It measures perceived stress 2-4 times daily, creates visual overviews of stress patterns, and provides real-time coping suggestions, mindfulness exercises, informational articles, and personal stories from other clients. This study uses a nonconcurrent multiple baseline design with A-B-A design. Participants are randomly assigned to 3, 4, or 5-week baseline phases, followed by 4 weeks of app use, and 3 weeks of follow-up. Weekly assessments include the Perceived Stress Scale (PSS-10), Coping Self-Efficacy Scale (CSES-13), and WHOQOL-BREF. Both group-level and individual case analyses will be conducted using mixed-effects modeling and Tau-(BC) effect size measures.

Participants are recruited from mental health waiting lists across the Netherlands. As this is a mobile app-based intervention, participation is location-independent and takes place remotely.

• Study Type: Interventional
• Enrollment (Estimated): 54
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Sevda Demirel, MSc; Phone Number: +31 6 57511938; Email: s.demirel@ggzcentraal.nl
• Study Contact Backup: Name: Yvette Roke, MD, PhD; Phone Number: +31 36 538 3250; Email: y.roke@ggzcentraal.nl

Study Locations

• Netherlands
  • Flevoland
    • Almere Stad, Flevoland, Netherlands, 1326 AD
      • Recruiting
      • GGZ Centraal
      • Contact: Sevda Demirel, MSc; Phone Number: +31 6 57511938; Email: s.demirel@ggzcentraal.nl
      • Contact: Yvette Roke, MD, PhD; Phone Number: +31 36 538 3250; Email: y.roke@ggzcentraal.nl
      • Principal Investigator: Sevda Demirel, MSc

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Currently on a waiting list at a mental health organization in the Netherlands.
• Aged 18 years or older
• Owns a smartphone and has the ability to operate it
• Sufficient proficiency in Dutch or English language (at least B1 level)

Exclusion Criteria:

• Currently enrolled in another medical-scientific research study

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Group 1: 3-week baseline; Participants receive 3 weeks of baseline measurements, 4 weeks of Stappvoorstap app intervention, and 3 weeks of follow-up (10 total measurements).	Behavioral: Stappvoorstap: mobile self-management waitlist intervention; Stappvoorstap is a free mobile self-management application developed in co-creation with mental health waitlist clients. The app measures daily stress levels 2-4 times per day through short questionnaires, creates visual overviews of personal stress patterns on daily and weekly scales, provides real-time coping suggestions, offers mindfulness and relaxation exercises (breathing exercises, meditation, nature sounds, calming music), and includes informational articles and personal experience stories.
Experimental: Group 2: 4-week baseline; Participants receive 4 weeks of baseline measurements, 4 weeks of Stappvoorstap app intervention, and 3 weeks of follow-up (11 total measurements).	Behavioral: Stappvoorstap: mobile self-management waitlist intervention; Stappvoorstap is a free mobile self-management application developed in co-creation with mental health waitlist clients. The app measures daily stress levels 2-4 times per day through short questionnaires, creates visual overviews of personal stress patterns on daily and weekly scales, provides real-time coping suggestions, offers mindfulness and relaxation exercises (breathing exercises, meditation, nature sounds, calming music), and includes informational articles and personal experience stories.
Experimental: Group 3: 5-week baseline; Participants receive 5 weeks of baseline measurements, 4 weeks of Stappvoorstap app intervention, and 3 weeks of follow-up (12 total measurements).	Behavioral: Stappvoorstap: mobile self-management waitlist intervention; Stappvoorstap is a free mobile self-management application developed in co-creation with mental health waitlist clients. The app measures daily stress levels 2-4 times per day through short questionnaires, creates visual overviews of personal stress patterns on daily and weekly scales, provides real-time coping suggestions, offers mindfulness and relaxation exercises (breathing exercises, meditation, nature sounds, calming music), and includes informational articles and personal experience stories.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Perceived Stress	Measured using the Perceived Stress Scale with 10 items (PSS-10). The PSS-10 is a validated self-report questionnaire assessing how stressful situations were perceived in the past week. Items are rated on a 5-point scale (1=never to 5=very often). Higher scores indicate higher perceived stress. Change from baseline phase to intervention phase, and to follow-up will be assessed.	Weekly measurements for 10-12 weeks (depending on group assignment)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Coping Self-Efficacy	Measured using the Coping Self-Efficacy Scale with 13 items (CSES-13). The CSES-13 measures confidence in coping behaviors across three subscales: problem-focused coping, emotion-focused coping, and social support coping. Items are rated on a 10-point scale (0=cannot do at all to 10=certainly can do). Higher scores indicate greater coping self-efficacy.	Weekly measurements for 10-12 weeks (depending on group assignment)
Change in Quality of Life	Measured using selected domains of the World Health Organization Quality of Life Brief version (WHOQOL-BREF): physical health (7 items), psychological health (6 items), and social relationships (3 items), plus 2 items on overall quality of life and general health. Items rated on 5-point Likert scales. Higher scores indicate better quality of life.	Weekly measurements for 10-12 weeks (depending on group assignment)

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
User Experience and Perceived Usefulness	Semi-structured interview assessing participants' experiences with the Stappvoorstap app, including perceived usefulness, usability, barriers and facilitators, and suggestions for improvement. Open-ended questions explore how participants integrated the app into daily life and their overall satisfaction.	After completion of the 4-week intervention period

Collaborators and Investigators

• Sponsor: GGZ Centraal
• Collaborators: Leiden University Medical Center

Publications and helpful links

Helpful Links

• Official website with information about the Stappvoorstap app, and resources for people on mental health waiting lists.

Study record dates

Study Major Dates

• Study Start (Actual): March 17, 2025
• Primary Completion (Estimated): December 1, 2027
• Study Completion (Estimated): December 1, 2027

Study Registration Dates

• First Submitted: January 29, 2026
• First Submitted That Met QC Criteria: January 29, 2026
• First Posted (Actual): February 5, 2026

Study Record Updates

• Last Update Posted (Actual): February 5, 2026
• Last Update Submitted That Met QC Criteria: January 29, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: mobile health; self-management; mental health; mHealth; stress management; single-case experimental design; ecological momentary intervention; waiting list; perceived stress
• Additional Relevant MeSH Terms: Behavioral Symptoms; Behavior; Personal Satisfaction; Stress, Psychological; Psychological Well-Being
• Other Study ID Numbers: Stappvoorstap_N24.084; KPO-79 (Other Grant/Funding Number: Zorgondersteuningsfonds)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be shared. Anonymized group-level data may be made available upon reasonable request to the principal investigator, in accordance with institutional and ethical guidelines.

Drug and device information, study documents

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