Promoting Mental Health Resource Use on Campus by “Trying Something New”

Abstract

Purpose:

To design and test a persuasive health promotion campaign that aligns with the qualities of trying something new for the first time. Given that a majority of students have not previously sought/considered professional mental health assistance before, the hypothesis tested in this study asked whether a campaign that takes this into account is effective with this audience.

Design:

Participants viewed an online informational message (n = 84), information message plus first-time experience banner (n = 99), or 1 of 4 full campaigns, each depicting a student story and photo about a first-time experience (moving from home [n = 48], skydiving [n = 52], acting in a play [n = 48], and exercising with personal trainer [n = 48]).

Measures:

Visual poster items: appeal (visually pleasing, 7 items, α = .92), support (value of poster, 5 items, α = .86) and behavioral intention items: engagement (participant seek help/pay attention, 3 items, α = .86), relevance (content as relevant, 3 items, α = .84), and judgment (judgment of others for not seeking help, 2 items, α = .87).

Participants:

College students (N = 380).

Results:

In comparison to information-only messages, framing mental health help seeking as a first-time experience was linked with increased appeal, support, and engagement (M_{informationonly} = 2.79 [standard deviation, SD = 1.34], M_{informationplusbanner} = 3.25 [SD = 1.23], M_fullcampaign = 4.07 [SD = 1.28], P < .001, M_{informationonly} = 4.38 [SD = 1.47], M_{informationplusbanner} = 4.92 [SD = 1.21], M_fullcampaign = 4.57 [SD = 1.26], P = .014, and M_{informationonly} = 3.13 [SD = 1.76], M_{informationplusbanner} = 3.56 [SD = 1.48], M_fullcampaign = 4.02 [SD = 1.42], P < .001, respectively). As anticipated, the full campaign garnered the highest affect and engagement scores. When comparing the 4 first-time experiences, there were main effects on support and engagement (M_train = 5.06 [SD = 1.17], M_plane = 4.27 [SD = 1.28], M_home = 4.59 [SD = 1.19], M_play = 4.38 [SD = 1.29], P = .009 and M_train = 4.50 [SD = 1.27], M_plane = 3.75 [SD = 1.43], M_home = 4.01 [SD = 1.49], M_play = 3.84 [SD = 1.39], P = .042, respectively), with the novel experience of “working with a personal trainer” rated highest.

Conclusion:

Findings from this study have implications for the design of health promotion materials on college campuses. Specifically, campaigns that frame seeking help for mental health as a new experience potentially increase student engagement in this behavior. A key finding from the present study is that a campaign in which this behavior is linked to a familiar form of interpersonal help seeking (personal training) can create receptivity to the stigmatized issue of mental health help seeking.

Keywords

mental health mass media social marketing health communication health promotion university/college health

Purpose

Despite previous efforts to reduce student mental health issues on college campuses, these challenges remain prevalent. Undergraduate students report that anxiety (24.4% of students surveyed), depression (16.2%), and stress (33.8%) impact their ability to complete academic goals and 59.1% reported experiencing overwhelming anxiety (in general) over the past year.¹

Unfortunately, most college students with mental health concerns will not seek help for these issues. Roughly 74.9% of college students reported no mental health diagnosis or treatment in the past year.¹ Treatment such as psychotherapy and other tools show considerable benefits for those experiencing mental health issues.² In many cases, untreated issues negatively influenced overall well-being, including academic success and college graduation rates,³ and other negative outcomes including suicide.⁴ There are a number of reasons why students do not seek professional help.⁵ Mental health help seeking continues to be stigmatized on college campuses.⁶ As such, students may feel that asking questions about mental health will receive negative reactions. Also, many students believe their mental health experiences in college are “normal” and do not feel inclined to seek help.⁵

Strategic and educational mental health campaigns attempt to increase knowledge and acceptance of mental health concerns⁷; yet it remains unclear what strategies are effective. Message framing is a technique used to help a viewer classify and establish meaning for content, thereby facilitating decision-making.⁸ This borrows from Tversky and Kahneman’s consumer behavior modeling, whereby people make decisions according to potential gains and losses based on mental schema (ie, prospect theory). It is argued that mental health help seeking and the processing of advertised promotion messages are akin to consumption decision-making. Gain/loss framing for health behaviors exhibits mixed results.^9,10 However, other framing techniques such as metaphors, use of contrast, and aligning concepts with tradition/stories⁸ remain unexplored by health behavior research. In this study, a message framing metaphor is used to align mental health help seeking schema with first-time experience schema to produce positive perceptions of mental health help seeking.

Given that many students have not sought professional help for mental health issues while in college, a campaign was built for this study that asks viewers to compare this novel experience to other events students have tried for the first time. The goal was to align mental health help seeking with the qualities of trying something new for the first time. If students feel accomplished or successful about other new challenges, perhaps they would give mental health counseling a go. In this case, the campaign encouraged students to visit (in-person or online) the campus counseling and testing center, an important resource for students. This center is the main place for students to receive psychological services on campus and includes licensed clinicians on staff, as well as a variety of individual, couple, and group counseling opportunities. As such, the center serves as a detection, referral, and service office. In aligning these 2 events (mental health help seeking and other novel experiences), it was hoped that students might acknowledge that many new experiences will be met with hesitation and anxiety but are ultimately rewarding.

To better understand the viability of different message types, the following question was asked:

RQ1: Compared to an information-only health message, how will messages that frame mental health help seeking as “trying something new” be received in terms of overall appeal, support, engagement, relevance, and judgment?

Given a lack of evaluating previous mental health promotion campaign strategies, another aim was to determine whether specific previous “first-time” experiences were more effective in helping students process the experience of seeking help. Thus, the following research question was asked:

RQ2: When aligned with seeking professional mental health help, does one first-time experience yield more positive outcomes than others—including overall appeal, support, engagement, relevance, and judgment.

Methods

Campaign Development

For the information and facts about mental health, stakeholder insight was sought from the campus mental health task force, which consisted of faculty, administration, staff, and campus health practitioners. To generate the “first-time experience” messages in the campaign, a group of communication students, through 1 anonymous, open-ended question, was asked to write about something they had recently tried for the first time. With these efforts, the written content for the campaign, including a slogan, “Trying Something New Makes a Better You” was developed. Students report learning about mental health services primarily from friends or fellow students.¹¹ As such, photographs of students were included, as if other students were sharing their stories with the audience (Figures 1 –3). Figure 3, the full version of the campaign poster, ran on campus during the data collection period.

Figure 1.

The information-only condition included facts about services and treatments offered by the university. The content was developed in collaboration with the mental health taskforce.

Figure 2.

The information plus first-time experience banner included the same informational content as the information-only condition. The banner was added to see whether even a simple tag line could make a difference in how this information was perceived by students.

Figure 3.

The full mental health promotion campaign emphasized 4 different first-time student experiences. The campaign goal was to tap into the novelty and affect of trying something new by including a picture of a student presenting a real-world example of a first-time experience.

Participants and Procedures

Participants included currently enrolled students (N = 380, ∼38.7% of the estimated eligible participants) who completed an online survey. All students older than 18 years enrolled in a set of journalism courses were invited to participate. Participants were excluded if they did not complete a majority of the survey. The project was reviewed and approved by the university’s institutional review board. Participants were 29% male, with the average age of 21.5 years (standard deviation = 1.23). In terms of ethnicity, 55.3% was white, 14.5% Hispanic, 17.1% black, 5.7% Asian, and 6.2% mixed/other; 21% reported being Hispanic/Latino regardless of race.

Dependent Measures

Participants indicated their reactions to the poster and behavioral intentions after viewing its content. Sixteen poster reaction items were adapted from the Personal Involvement Inventory Scale.¹² Eight behavioral intention items were adapted from a previous study.¹³ To produce a set of discrete dependent variable factors, the sets of poster reaction items and behavioral intention items were analyzed using 2 principal component analyses—poster reactions: appeal (visually pleasing, 7 items, α = .92) and support (value of poster, 5 items, α = .86) and behavioral intentions: engagement (participant seek help/pay attention, 3 items, α = .86), relevance (content as relevant, 3 items, α = .84), and judgment (judgment of others for not seeking help, 2 items, α = .87). These were determined based on how each item loaded onto a specific factor; items loading highly on multiple factors (ie, 0.4 or higher, n = 3) or no factors (n = 1) were removed from analysis.

Results

Regarding RQ1, an omnibus Multivariate analysis of variance found a significant multivariate main effect for message type; univariate effects were then examined. There were significant main effects on appeal, support, and engagement. Relevance and judgment were not significant. Main effects and post hoc comparisons are presented in Table 1.

Table 1.

Research Question 1 Asked, When Compared to an Information-Only Health Message, How Messages That Frame Mental Health Help Seeking as “Trying Something New” Would Be Received in Terms of Overall Appeal, Support, Engagement, Relevance, and Judgment.^a,b

Dependent Measures	F Statistic df = 3376	P Value	Partial η²	Text, M (SD)	Text/Banner, M (SD)	Full Ad, M (SD)
Appeal	33.497	<.001	.151	2.79 (1.34)^a	3.25 (1.23)^a	4.07 (1.28)^a
Support	4.289	.014	.022	4.38 (1.47)^a	4.92 (1.21)^a	4.57 (1.26)
Engagement	10.692	<.001	.054	3.13 (1.76)^a	3.56 (1.48)^b	4.02 (1.42)^a,b
Relevance	1.510	NS	.008	4.33 (1.54)	4.43 (1.58)	4.13 (1.36)
Judgment	1.265	NS	.007	2.10 (1.33)	2.18 (1.38)	2.35 (1.34)

Abbreviations: M, mean; NS, nonsignificant; SD, standard deviation.

^aConditions with the same superscript (c and d) are significantly different, P < .05.

^bBox’s M (52.41; P < .01); Wilks λ = .731, F_{10, 744} = 12.63, P < .001, partial η² = .145.

RQ2 focused on whether one first-time experience was particularly effective when aligned with mental health behaviors. Again there was a significant multivariate main effect for message type; thus, univariate effects were examined. There were significant main effects on support and engagement. The personal trainer experience was rated highest for these items. Appeal, relevance, and judgment were not significant. Main effects and post hoc comparisons are presented in Table 2.

Table 2.

Research Question 2 Asked Whether One First-Time Experience Message Yielded More Positive Outcomes Compared to the Others in Terms of Overall Appeal, Support, Engagement, Relevance, and Judgment.^a,b

Dependent Measures	F Statistic df = 3192	P Value	Partial η²	Train, M (SD)	Plane, M (SD)	Home, M (SD)	Play, M (SD)
Appeal	1.011	NS	.016	4.20 (1.19)	4.21 (1.35)	4.01 (1.21)	3.82 (1.36)
Support	3.961	.009	.058	5.06 (1.17)^a,b	4.27 (1.28)^a	4.59 (1.19)	4.38 (1.29)^b
Engagement	2.789	.042	.042	4.50 (1.27)^a	3.75 (1.43)^a	4.01 (1.49)	3.84 (1.39)
Relevance	1.977	NS	.030	4.53 (1.54)	4.10 (1.58)	3.92 (1.36)	3.98 (1.20)
Judgment	0.945	NS	.015	2.49 (1.40)	2.24 (1.30)	2.16 (1.09)	2.54 (1.54)

Abbreviations: M, mean; NS, nonsignificant; SD, standard deviation.

^aConditions with the same superscript (c and d) are significantly different, P < .05.

^bBox’s M (56.47; P = .172); Wilks λ = .822, F_{15, 519} = 2.55, P = .001, partial η² = .063.

Discussion

On college campuses across the nation, health practitioners are increasingly concerned with the problems and stigma surrounding student mental health.¹⁴ To date, research on the design and effectiveness of campus mental health campaigns remains largely unexplored. The present study sought to better understand whether a specific frame, aligning mental health help seeking with the concept of “trying something new,” would encourage students to engage with this important message.

Given that information-only campaigns are lacking in their overall ability to persuade and motivate students,^7,15 this project compared information-only messages with those appealing to the novelty of seeking help. Past survey research suggests many young people often expect to experience anxiety and stress and thus feel they must bear the burden of mental health problems⁵ and/or find stigma in seeking help.⁶

This study argued whether a framing-based metaphor could be applied to student help seeking decision-making. The messages used novel experiences as a schema mechanism, thereby creating a point of reference for which students could determine the gains or losses of engaging in another new experience (ie, help seeking). Results suggest framing help seeking as a first-time experience was significantly linked with increased appeal, support, and engagement. Findings suggest the novel experience approach is a promising strategy that is relatable and exciting to students. Unlike information-only counterparts, appealing to first-time experiences potentially works to break through the clutter and grab students’ attention.

Limitations

First, a convenience sample of undergraduate students was utilized in the current study, and thus, findings from the present study should not be generalized to other populations. Other campuses are welcomed to test and use these materials on other campuses to determine whether the first-time experience concept is effective among other student populations. In the current study, previously used scales were adapted to capture a broad range of participant responses. The items were internally reliable, yet face and content validity could be addressed in future research. Also, more male participants could be recruited for future mental health research initiatives. Communication departments tend to have a high prevalence of female students, which is reflected in the sample of the present study.

SO WHAT?

The increasing prevalence of mental health problems on campus may inspire a desire to reach out to students often and saturate them with important information. Findings from the present study suggest, however, that taking the time to package information and appeal to both students’ fears and inhibitions is worth the effort. A frame of reference, like getting help from a personal trainer, helps students understand that seeking mental health help is normal and useful. By equating this important health behavior with the anxiety or uncertainty evoked by other first-time events, students acknowledge that seeking professional help for mental health can be difficult but attainable.

In this study, the choice of first-time experience scenarios did matter. This suggests that identification and relevance are key factors in developing campaign novel experience scenarios. The use of novel experiences and student spokespeople shows promise for more effective campaigns. Further research should examine whether the gender or race/ethnicity of the poster spokespeople impacts message reception. Moreover, given the potential for wider application, using novelty message framing as a campaign tool can be examined in nonuniversity settings.

Footnotes

Acknowledgment

The authors would like to thank Christina Rodriguez for her contributions in the design of the poster campaign as well as the mental health taskforce at UNT for the content and support.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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