A Feasibility Study for Evaluating the Effectiveness of Mindhelper- a National Youth Mental Health Promotion Website

Introduction Up to 25% of young people in Denmark do not enjoy their daily lives; they report increasing levels of stress, loneliness, sleep problems, and symptoms of anxiety and depression. Online mental health promotion has the potential to address some of the mental health needs of young people. However, the evidence-base for the effectiveness of online mental health promotion is still sparse. The Mindhelper Study will evaluate the effectiveness of the most comprehensive online youth mental health promotion website in Denmark; Mindhelper.dk. Mindhelper is targeted at young people in need of mental health promotion. This is a broad group that encompasses three different subgroups of young people; (i) those who need advice on various well-being issues such as dealing with peer-pressure or a broken heart, (ii) those with early signs of mental health problems, and (iii) those who have mental disorders (or other chronic diseases) who need help to promote their mental health and well-being - such as dealing with loneliness, sleep problems, or structuring their everyday life - alongside more specialized treatment.

The Mindhelper website is designed as a first step in a stepped-care approach to organize the mental health system. At the website, young people are provided trusted mental health information and tools to improve their mental health and well-being. The feasibility study described in this document is the first step of the evaluation.

Feasibility study The feasibility study will investigate the potential of online recruitment for a randomized trial of the effectiveness of Mindhelper. Recruiting participants for intervention studies is increasingly difficult, as there are many commercials and research projects competing for people's attention. Thus, participation rates in research projects are generally declining. The widespread access to the internet, especially among adolescents, offers a new and attractive alternative strategy to recruit participants for intervention studies.

While online recruitment may seem feasible and useful for recruiting subpopulations that are normally difficult to include in intervention studies, such as young people with mental health problems, only few studies have been undertaken. Some studies have examined the feasibility of online recruitment among the general population, couples planning pregnancy, patients with urinary incontinence, and people with drug or alcohol dependencies. The lessons learned from these studies are that the costs per participant are lower, compared to offline recruitment methods; that it is possible to reach populations who are otherwise challenging to enroll because they have sensitive health concerns; and that the recruited persons are younger, more highly educated, and have poorer self-rated health and higher self-efficacy than representative samples. Concerns have been raised that internet- based studies may be particularly prone to selection bias. However, a Danish study of reproductive women showed that internet-based cohorts were not more prone to selection bias than other recruitment methods, which has also been shown among smokers recruited by email or online for a smoking cessation trial.

The feasibility study will inform us whether it is possible to recruit young people with mental health problems who are not familiar with Mindhelper and then randomize them to use or not to use the website (block randomization). Furthermore, it is necessary to know whether it is possible to follow the two groups over time and assess relevant outcomes.