The University of Macau (UM) and New York University Shanghai (NYU Shanghai) jointly developed a mobile application for mental health intervention called ‘Step-by-Step’ (SbS) and conducted the first randomised controlled trial on UM students to investigate its effectiveness. The latest research results were released at UM today (26 March). The results show that SbS is effective in alleviating depressive symptoms among Chinese university students in the short term and improving their psychological well-being in the long term, pointing to a promising future for digital mental health intervention.

Prior to the trial, the research team spent several months conducting interviews with focus groups in order to enhance the elements of SbS, including the stories, visuals, and linguistic content, and make necessary adaptations to suit the Chinese context. A feasibility study was then conducted to collect feedback to ensure the seamless implementation of the subsequent large-scale randomised controlled trial, which ran for one year with a total of 371 participants. The entire intervention process lasted eight weeks, during which the effectiveness of the intervention was assessed on a weekly basis. Post-intervention assessment and follow-up interviews were conducted at the end of the intervention and three months after the intervention, respectively.

Data from the study shows that participants rated the effectiveness of the intervention in reducing stress at seven out of ten. The majority of participants reported that the content and presentation of SbS were better than expected. More than half of the participants felt that they had acquired new knowledge and skills in managing their emotions, making plans, and overcoming negative emotions. The study provides empirical support for the effectiveness of the application as an evidence-based mental health intervention, highlighting its potential to enhance the mental well-being of Chinese university students, as well as its applicability in wider clinical settings. The research results were also published in the medical journal Translational Psychiatry.

‘Step-by-Step’ is an English-language digital mental health intervention application developed by the World Health Organization (WHO). It teaches users behavioural activation and stress management strategies through an illustrated story of a person who has learned ways to cope with stress, anxiety, and depression. In addition, users can receive 15 to 20 minutes of guidance per week via phone or chat messaging from online peer supporters, who are trained and supervised non-mental health professionals.

The digital mental health intervention application used in the trial was the latest Chinese version. With the support of UM, the application was introduced to Macao in 2020, with other language versions available for different ethnic groups.

This Chinese version, which is tailed for Chinese university students, is supported by the Bank of China Macau Branch, and sponsored by the Rotary Club of Amizade, Macau, the Rotary Club of Macau, and the Rotary Club of Penha, Macao. UM’s Centre for Macau Studies recruited university students to join the project as participants in the clinical trial, while the Student Counselling Section of the Student Affairs Office, Moon Chun Memorial College, and Shiu Pong College provided training for peer supporters in the project.