Trial Outcomes & Findings for Personal Relevance of Psychotherapy for Asian Americans (NCT NCT06632158)

We assessed the efficacy MindBoba using a repeated-measures RCT with participants identifying as being Asian-American specifically as Chinese and/or Taiwanese, with 263 enrolled and 229 completing. 213 participants identified as Chinese, 26 as Taiwanese, 22 as Chinese and Taiwanese, and 2 from Hong Kong. Upon completion of pretest participants were randomly assigned to condition, with 87 to the MindBoba group, 87 to Mindshift active control, and 89 assigned to a business-as-usual.

Personal Relevance of Psychotherapy for Asian Americans

Self-efficacy will be measured using the Mental Health Self-Efficacy Scale (MHSES),127 a 6-item Likert-type single-factor scale measuring one's capability to perform behaviors related to mental health. The MHSES has demonstrated good internal reliability (alpha = .89) and is positively correlated with work, social adjustment, and emotional stability, and negatively correlated with measures of depression. The reported data uses the average of the 6 items on the scale with a possible range of 1 to 10, with higher scores indicating significantly greater self-efficacy (higher are better outcomes).

Stress will be assessed using the Depression Anxiety and Stress Scale-21 (DASS-21).128 The DAS-21 is a 21-item scale that measures three related negative states of depression, anxiety, and stress. It has shown strong internal reliability and moderate validity through confirmatory factor analysis. The reported data uses the total of the 7 items on the depression subscale scale with a possible range of 7 to 28, with higher scores indicating significantly higher stress (higher are worse outcomes).

Anxiety will be assessed using the Depression Anxiety and Stress Scale-21 (DASS-21).The DAS-21 is a 21-item scale that measures three related negative states of depression, anxiety, and stress. It has shown strong internal reliability and moderate validity through confirmatory factor analysis. The reported data uses the total of the 7 items on the anxiety subscale scale with a possible range of 7 to 28, with higher scores indicating significantly higher anxiety (higher are worse outcomes).

Depression will be assessed using the Depression Anxiety and Stress Scale-21 (DASS-21).128 The DAS-21 is a 21-item scale that measures three related negative states of depression, anxiety, and stress. It has shown strong internal reliability and moderate validity through confirmatory factor analysis. The reported data uses the total of the 7 items on the depression subscale scale with a possible range of 7 to 28, with higher scores indicating significantly higher depression (higher are worse outcomes).

Attitudes towards seeking mental help will be assessed using the Mental Help Seeking Attitudes Scale (MHSAS). The MHSAS a 9-item scale that measures participants' overall attitudes (positive or negative) towards seeking help from a mental health expert. The average of the 9-item scales are reported, with a possible range of 1 to 7, with higher scores indicating more positive attitudes (higher are better outcomes).

Knowledge was measured using a 14-item multiple-choice survey that the project developed to determine the extent to which participants understand basic information delivered in the program around Problem-Solving Therapy skills and content. Total correct answers are reported, with possible range of 0 to 14. Higher scores indicate more correct (higher are better outcomes).

Social problem-solving will be measured using the Social Problem-Solving Inventory-Revised: Short Form (SPSI-R).The SPSI-R: Short Form is a 25-item multi-dimensional measure of social problem solving derived from a factor analysis of the original 70-item theory-driven Social Problem-Solving Inventory. In addition to a total score, it consists of five scales that measure two constructive dimensions (positive problem orientation, rational problem solving) and three dysfunctional dimensions (negative problem orientation, impulsivity/carelessness style, avoidance style). This analysis is of the average the 5 avoidant subscale items with a possible range of 1 to 5, with higher scores indicating more use of avoidant strategies (higher are worse outcomes).

Social problem-solving will be measured using the Social Problem-Solving Inventory-Revised: Short Form (SPSI-R).The SPSI-R: Short Form is a 25-item multi-dimensional measure of social problem solving derived from a factor analysis of the original 70-item theory-driven Social Problem-Solving Inventory. In addition to a total score, it consists of five scales that measure two constructive dimensions (positive problem orientation, rational problem solving) and three dysfunctional dimensions (negative problem orientation, impulsivity/carelessness style, avoidance style). This analysis is of the average of the 5 rational subscale items with a possible range of 1 to 5, with higher scores indicating more use of rational strategies (higher are better outcomes).

Social problem-solving will be measured using the Social Problem-Solving Inventory-Revised: Short Form (SPSI-R).The SPSI-R: Short Form is a 25-item multi-dimensional measure of social problem solving derived from a factor analysis of the original 70-item theory-driven Social Problem-Solving Inventory. In addition to a total score, it consists of five scales that measure two constructive dimensions (positive problem orientation, rational problem solving) and three dysfunctional dimensions (negative problem orientation, impulsivity/carelessness style, avoidance style). This analysis is of the average of the 5 negative problem orientation subscale items with a possible range of 1 to 5, with higher scores indicating more use of avoidant strategies (higher are worse outcomes).

Social problem-solving will be measured using the Social Problem-Solving Inventory-Revised: Short Form (SPSI-R).The SPSI-R: Short Form is a 25-item multi-dimensional measure of social problem solving derived from a factor analysis of the original 70-item theory-driven Social Problem-Solving Inventory. In addition to a total score, it consists of five scales that measure two constructive dimensions (positive problem orientation, rational problem solving) and three dysfunctional dimensions (negative problem orientation, impulsivity/carelessness style, avoidance style). This analysis is of the average of the 5 impulsivity/carelessness style subscale items with a possible range of 1 to 5, with higher scores indicating more use of avoidant strategies (higher are worse outcomes).

Social problem-solving will be measured using the Social Problem-Solving Inventory-Revised: Short Form (SPSI-R).The SPSI-R: Short Form is a 25-item multi-dimensional measure of social problem solving derived from a factor analysis of the original 70-item theory-driven Social Problem-Solving Inventory. In addition to a total score, it consists of five scales that measure two constructive dimensions (positive problem orientation, rational problem solving) and three dysfunctional dimensions (negative problem orientation, impulsivity/carelessness style, avoidance style). This analysis is of the average of the 5 positive problem orientation subscale items with a possible range of 1 to 5, with higher scores indicating more use of avoidant strategies (higher are better outcomes).

Loss of face will be examined as a moderator of the effect of the program, and will be measured using the Loss of Face scale (LOF). The LOF is a 21-item, 7-point Likert-type scale that evaluates concern about violating social norms and concern about causing others to lose face. The LOF has demonstrated good internal reliability (alpha = .83), as well as concurrent and discriminant validity (correlating with other-directedness, private and public self-consciousness, and social anxiety). The LOF has been translated into Chinese. The average of the 21-item scale is reported with a possible range of 1 to 7, with higher scores indicating more concern over loss of face.

Motivation to engage with the intervention will be assessed using the Situational Motivation Scale (SIMS). The SIM is a 16-item Likert-type scale with four internally consistent factors (alphas \> .77): intrinsic motivation, identified regulation, external regulation, and motivation. The SIMS has been used extensively to evaluate motivation in many contexts and towards many activities, including mandated training, and has been translated into Chinese. The average score on the 4 items of the Intrinsic Subscale are reported here, with a possible range of 1 to 7, with higher scores indicating greater intrinsic motivation (higher are better outcomes).

Motivation to engage with the intervention will be assessed using the Situational Motivation Scale (SIMS). The SIM is a 16-item Likert-type scale with four internally consistent factors (alphas \> .77): intrinsic motivation, identified regulation, external regulation, and motivation. The SIMS has been used extensively to evaluate motivation in many contexts and towards many activities, including mandated training, and has been translated into Chinese. The average score on the 4 items of the Identified Regulation Subscale are reported here, with a possible range of 1 to 7, with higher scores indicating greater identified regulation (higher are better outcomes).

Motivation to engage with the intervention will be assessed using the Situational Motivation Scale (SIMS). The SIM is a 16-item Likert-type scale with four internally consistent factors (alphas \> .77): intrinsic motivation, identified regulation, external regulation, and motivation. The SIMS has been used extensively to evaluate motivation in many contexts and towards many activities, including mandated training, and has been translated into Chinese. The average score on the 4 items of the External Regulation Subscale are reported here, with a possible range of 1 to 7, with higher scores indicating greater identified regulation (higher are worse outcomes).

Motivation to engage with the intervention will be assessed using the Situational Motivation Scale (SIMS). The SIM is a 16-item Likert-type scale with four internally consistent factors (alphas \> .77): intrinsic motivation, identified regulation, external regulation, and motivation. The SIMS has been used extensively to evaluate motivation in many contexts and towards many activities, including mandated training, and has been translated into Chinese. The average score on the 4 items of the amotivation Subscale are reported here, with a possible range of 1 to 7, with higher scores indicating greater identified regulation (higher are worse outcomes).

Usability, content utility and validity, user satisfaction, will be assessed using the System Usability Scale (SUS) to assess overall usability, with minor wording changes to align the questions with the product being assessed and the addition of an adjective rating scale to help communicate the numeric results to those less familiar with usability studies. The scores reported are the total of the 10 SUS items each with a range of 0 to 4, then multiplied by 2.5 ending with a total scale score ranging from 0 to 100. Higher scores indicate the app is rated more positively. Comparisons of the MindBoba and MindShift interventions are reported.