Mental Health Stigma, Misconceptions, and Help-seeking among University Students. Experimental Evidence from Kenya

Last registered on July 08, 2022

Pre-Trial

Trial Information

General Information

Title
Mental Health Stigma, Misconceptions, and Help-seeking among University Students. Experimental Evidence from Kenya
RCT ID
AEARCTR-0009676
Initial registration date
June 30, 2022

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
July 08, 2022, 9:13 AM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Locations

Region

Primary Investigator

Affiliation
University of ZĂĽrich

Other Primary Investigator(s)

PI Affiliation
Strathmore Business School

Additional Trial Information

Status
In development
Start date
2022-07-04
End date
2022-12-31
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
In this incentivized online survey experiment, I study the impact of information provision on beliefs and demand for mental health support among university students in Nairobi. A random sample of participants receives information targeting misperceptions about help-seeking behavior, namely, two statistics from two previous surveys of university students in Kenya which report the share of respondents who had experience with mental health support and the share interested in a voucher for a subsidized online counselling session with a certified therapist. Another group is exposed to two written testimonials from students who tried counseling on campus and shared their experience. First, I assess the impact of the information interventions on posteriors about the prevalence of help-seeking experiences and intentions among university peers. In the main analysis, I plan to study the impact of the two information treatments on participants’ stereotypical beliefs (i.e. negative representations of help-seekers), efficacy beliefs (i.e. beliefs about the perceived need and effectiveness of counseling), and help-seeking behavior (through incentivized measures of demand for mental health support).
External Link(s)

Registration Citation

Citation
Acampora, Michelle and Christine Mwangi. 2022. "Mental Health Stigma, Misconceptions, and Help-seeking among University Students. Experimental Evidence from Kenya." AEA RCT Registry. July 08. https://doi.org/10.1257/rct.9676-1.0
Experimental Details

Interventions

Intervention(s)
Participants are randomized into one of three groups:
- A first treatment arm which receives infographics on experiences with mental health support and intentions to seek help for mental health from a sample of university students. The statistics provided are based on data collected among university students in Nairobi between October and December 2021.
- A second treatment arm which receives testimonials from university students in one of the participating universities who tried counseling and volunteered a testimonial on their experience.
- A pure control group which receives no information.
Intervention (Hidden)
Intervention Start Date
2022-07-04
Intervention End Date
2022-09-30

Primary Outcomes

Primary Outcomes (end points)
- Posterior beliefs on each of the two statistics provided in the first treatment arm
- Stereotypical beliefs
- Efficacy beliefs
- Extensive and intensive margin of demand for mental health support. The extensive margin is measured through a binary choice which captures interest in a counseling voucher offered at a subsidized price. The intensive margin is an incentivized measure of willingness to pay for the counseling voucher.
Primary Outcomes (explanation)
Stereotypical beliefs are elicited by referring to the character of a vignette. The first measure relies on agreement with two statements borrowed from the psychological literature on stigma attached to help-seeking for mental health. The second measure relies on the assessment of two traits of the character of the vignette. In both cases, answers are measured on a Likert-type scale and will be converted in a standardized index.

Efficacy beliefs are elicited both by referring to the character of the vignette and to the respondent. The questions assess the likelihood of symptoms remittance for the character of the vignette in the absence of therapy, the hypothetical likelihood of symptoms remittance if the respondent experienced similar symptoms, and expected benefits from counseling for the respondent. For each question, answers are measured on a Likert-type scale and will be converted in a standardized index.

Willingness to pay is measured using a Becker-deGroot-Marschak procedure in which participants formulate a bid for the counseling voucher. The bid is compared to a price determined by a random number generator on Qualtrics. If the participant's bid is greater than the price, they participate in a lottery for the vouchers and if they win, they pay for the voucher using the participation token.

Secondary Outcomes

Secondary Outcomes (end points)
- Second-order stereotypical beliefs
- Binary choices for two hypothetical vouchers for a counseling session, in which the location of the session is varied compared to the primary outcome
-Demand for a mental health app: extensive and intensive margin assessed in the same way as for the counseling voucher, and clicking behavior to capture download of the free version of the app
- Incentivized willingness to disclose interest in the counseling vouchers with peers
- Self-reported help-seeking behavior and intentions, and mental health status measured at follow-up. Mental health status will be measured using the brief screening tool PHQ-4.
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
The study relies on an incentivized online survey experiment. Participants will be assigned at random into one of three groups:
- A first treatment arm which is exposed to two infographics based on data collected in two smaller-scale surveys targeting university students in Nairobi. The infographics will report: the share of students who reported ever seeking professional mental health support, and the share of students who made a bid for a voucher for one online counseling session at a subsidized price.
- A second treatment which is exposed to two testimonials from a male and a female student from one of the participating universities who volunteered a testimonial about their own experience with psychological counseling.
- A pure control group which receives no information.

After exposure to the information treatments, I will elicit posterior beliefs and demand for mental health support options, which will constitute the primary outcomes of the empirical analysis.

Students are invited to participate in the main survey, which will include both pre-treatment information about prior beliefs, socio-demographics, and post-treatment elicitation of posterior beliefs and outcome variables. After 2 to 3 weeks after participating in the main survey, participants will receive an invitation to participate in a short follow-up survey, which aims to test for persistent effects on help-seeking behavior and mental health.
Experimental Design Details
Randomization Method
Randomization done in Qualtrics using a random number generator.
Randomization Unit
Randomization is at the individual level.
Was the treatment clustered?
No

Experiment Characteristics

Sample size: planned number of clusters
1500 students recruited from three different universities in Nairobi.
Sample size: planned number of observations
1500 students recruited from three different universities in Nairobi.
Sample size (or number of clusters) by treatment arms
500 assigned to treatment 1, 500 assigned to treatment 2, 500 assigned to control.
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
IRB

Institutional Review Boards (IRBs)

IRB Name
Strathmore University Institutional Ethics Review Committee
IRB Approval Date
2022-04-26
IRB Approval Number
SU-IERC1064/21
IRB Name
Human Subjects Committee of the Faculty of Economics, Business Administration, and Information Technology, University of Zurich
IRB Approval Date
2022-06-17
IRB Approval Number
OEC IRB # 2022-049
Analysis Plan

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Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
No
Data Collection Complete
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials