Evaluation of a Guided Chatbot Intervention for Young People in Jordan: Feasibility Randomized Controlled Trial
BackgroundDepression and anxiety are a leading cause of disability worldwide and often start during adolescence and young adulthood. The majority of young people live in low- and middle-income countries where there is a lack of mental health services. The World Health Organiz...
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JMIR Publications
2025-02-01
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| Series: | JMIR Mental Health |
| Online Access: | https://mental.jmir.org/2025/1/e63515 |
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| author | Anne Marijn de Graaff Rand Habashneh Sarah Fanatseh Dharani Keyan Aemal Akhtar Adnan Abualhaija Muhannad Faroun Ibrahim Said Aqel Latefa Dardas Chiara Servili Mark van Ommeren Richard Bryant Kenneth Carswell |
| author_facet | Anne Marijn de Graaff Rand Habashneh Sarah Fanatseh Dharani Keyan Aemal Akhtar Adnan Abualhaija Muhannad Faroun Ibrahim Said Aqel Latefa Dardas Chiara Servili Mark van Ommeren Richard Bryant Kenneth Carswell |
| author_sort | Anne Marijn de Graaff |
| collection | DOAJ |
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BackgroundDepression and anxiety are a leading cause of disability worldwide and often start during adolescence and young adulthood. The majority of young people live in low- and middle-income countries where there is a lack of mental health services. The World Health Organization (WHO) developed a guided, nonartificial intelligence chatbot intervention called Scalable Technology for Adolescents and youth to Reduce Stress (STARS) to reduce symptoms of depression and anxiety among young people affected by adversity.
ObjectiveThe objective of this study was to evaluate the feasibility of the STARS intervention and study procedures among young people in Jordan.
MethodsA 2-arm, single-blind, feasibility randomized controlled trial was conducted among 60 young people aged 18 years to 21 years living in Jordan with self-reported elevated levels of psychological distress. Immediately after baseline, participants were randomized 1:1 into the STARS intervention or enhanced care as usual (ECAU). STARS consisted of 10 lessons in which participants interacted with a chatbot and learned several cognitive behavioral therapy strategies, with optional guidance by a trained e-helper through 5 weekly phone calls. ECAU consisted of a static web page providing basic psychoeducation. Online questionnaires were administered at baseline (week 0) and postassessment (week 8) to assess depression (Hopkins Symptom Checklist-25 [HSCL-25]), anxiety (HSCL-25), functional impairment (WHO Disability Assessment Schedule [WHODAS] 2.0), psychological well-being (WHO-Five Well-Being Index [WHO-5]), and agency (State Hope Scale). Process evaluation interviews with stakeholders were conducted after the postassessment.
ResultsParticipants were recruited in December 2022 and January 2023. Of 700 screening website visits, 160 participants were eligible, and 60 participants (mean age 19.7, SD 1.16 years; 49/60, 82% female) continued to baseline and were randomized into STARS (n=30) or ECAU (n=30). Of those who received STARS, 37% (11/30) completed at least 8 chatbot lessons, and 13% (4/30) completed all 5 support calls. The research protocol functioned well in terms of balanced randomization, high retention at postassessment (48/60, 80%), and good psychometric properties of the online questionnaires. Process evaluation interviews with STARS participants, ECAU participants, e-helpers, and the clinical supervisor indicated the acceptability of the study procedures and the STARS and ECAU conditions and highlighted several aspects that could be improved, including the e-helper support and features of the STARS chatbot.
ConclusionsThis study demonstrated the feasibility and acceptability of the STARS intervention and research procedures. A fully powered, definitive randomized controlled trial will be conducted to evaluate the effectiveness of STARS.
Trial RegistrationISRCTN ISRCTN19217696; https://doi.org/10.1186/ISRCTN19217696 |
| format | Article |
| id | doaj-art-6ff7c10a5674442da367a9c228acc750 |
| institution | Kabale University |
| issn | 2368-7959 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | JMIR Mental Health |
| spelling | doaj-art-6ff7c10a5674442da367a9c228acc7502025-02-05T21:00:36ZengJMIR PublicationsJMIR Mental Health2368-79592025-02-0112e6351510.2196/63515Evaluation of a Guided Chatbot Intervention for Young People in Jordan: Feasibility Randomized Controlled TrialAnne Marijn de Graaffhttps://orcid.org/0000-0001-6686-4432Rand Habashnehhttps://orcid.org/0009-0008-9629-8548Sarah Fanatsehhttps://orcid.org/0009-0002-2877-0640Dharani Keyanhttps://orcid.org/0000-0002-9406-7542Aemal Akhtarhttps://orcid.org/0000-0002-8510-3636Adnan Abualhaijahttps://orcid.org/0009-0009-8502-6173Muhannad Farounhttps://orcid.org/0009-0001-3388-4872Ibrahim Said Aqelhttps://orcid.org/0000-0002-7558-7059Latefa Dardashttps://orcid.org/0000-0001-5437-4778Chiara Servilihttps://orcid.org/0000-0002-1885-822XMark van Ommerenhttps://orcid.org/0000-0002-5460-8842Richard Bryanthttps://orcid.org/0000-0002-9607-819XKenneth Carswellhttps://orcid.org/0000-0001-5344-5802 BackgroundDepression and anxiety are a leading cause of disability worldwide and often start during adolescence and young adulthood. The majority of young people live in low- and middle-income countries where there is a lack of mental health services. The World Health Organization (WHO) developed a guided, nonartificial intelligence chatbot intervention called Scalable Technology for Adolescents and youth to Reduce Stress (STARS) to reduce symptoms of depression and anxiety among young people affected by adversity. ObjectiveThe objective of this study was to evaluate the feasibility of the STARS intervention and study procedures among young people in Jordan. MethodsA 2-arm, single-blind, feasibility randomized controlled trial was conducted among 60 young people aged 18 years to 21 years living in Jordan with self-reported elevated levels of psychological distress. Immediately after baseline, participants were randomized 1:1 into the STARS intervention or enhanced care as usual (ECAU). STARS consisted of 10 lessons in which participants interacted with a chatbot and learned several cognitive behavioral therapy strategies, with optional guidance by a trained e-helper through 5 weekly phone calls. ECAU consisted of a static web page providing basic psychoeducation. Online questionnaires were administered at baseline (week 0) and postassessment (week 8) to assess depression (Hopkins Symptom Checklist-25 [HSCL-25]), anxiety (HSCL-25), functional impairment (WHO Disability Assessment Schedule [WHODAS] 2.0), psychological well-being (WHO-Five Well-Being Index [WHO-5]), and agency (State Hope Scale). Process evaluation interviews with stakeholders were conducted after the postassessment. ResultsParticipants were recruited in December 2022 and January 2023. Of 700 screening website visits, 160 participants were eligible, and 60 participants (mean age 19.7, SD 1.16 years; 49/60, 82% female) continued to baseline and were randomized into STARS (n=30) or ECAU (n=30). Of those who received STARS, 37% (11/30) completed at least 8 chatbot lessons, and 13% (4/30) completed all 5 support calls. The research protocol functioned well in terms of balanced randomization, high retention at postassessment (48/60, 80%), and good psychometric properties of the online questionnaires. Process evaluation interviews with STARS participants, ECAU participants, e-helpers, and the clinical supervisor indicated the acceptability of the study procedures and the STARS and ECAU conditions and highlighted several aspects that could be improved, including the e-helper support and features of the STARS chatbot. ConclusionsThis study demonstrated the feasibility and acceptability of the STARS intervention and research procedures. A fully powered, definitive randomized controlled trial will be conducted to evaluate the effectiveness of STARS. Trial RegistrationISRCTN ISRCTN19217696; https://doi.org/10.1186/ISRCTN19217696https://mental.jmir.org/2025/1/e63515 |
| spellingShingle | Anne Marijn de Graaff Rand Habashneh Sarah Fanatseh Dharani Keyan Aemal Akhtar Adnan Abualhaija Muhannad Faroun Ibrahim Said Aqel Latefa Dardas Chiara Servili Mark van Ommeren Richard Bryant Kenneth Carswell Evaluation of a Guided Chatbot Intervention for Young People in Jordan: Feasibility Randomized Controlled Trial JMIR Mental Health |
| title | Evaluation of a Guided Chatbot Intervention for Young People in Jordan: Feasibility Randomized Controlled Trial |
| title_full | Evaluation of a Guided Chatbot Intervention for Young People in Jordan: Feasibility Randomized Controlled Trial |
| title_fullStr | Evaluation of a Guided Chatbot Intervention for Young People in Jordan: Feasibility Randomized Controlled Trial |
| title_full_unstemmed | Evaluation of a Guided Chatbot Intervention for Young People in Jordan: Feasibility Randomized Controlled Trial |
| title_short | Evaluation of a Guided Chatbot Intervention for Young People in Jordan: Feasibility Randomized Controlled Trial |
| title_sort | evaluation of a guided chatbot intervention for young people in jordan feasibility randomized controlled trial |
| url | https://mental.jmir.org/2025/1/e63515 |
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