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Cited by 30Mental Health Treatment and AccessStudent Stress and CopingInternational Student and Expatriate Challenges

Making the grade: a pilot investigation of an e-intervention to increase mental health literacy and help-seeking intentions among international university students

Open access
Clough, Bonnie A., Nazareth, Sonia M., Casey, Leanne M.·2020·British Journal of Guidance & Counselling
DOI 10.1080/03069885.2019.1673312
Open this paper in CoChat — free accountOpen PDF

Abstract

International students may have less understanding and awareness of mental health issues and appear unlikely to seek help. The purpose of the current study was to construct and evaluate a brief online educational intervention designed to increase mental health literacy (MHL) and help-seeking among international tertiary students studying in Australia. The intervention was tested among 45 international tertiary students (undergraduate and postgraduate), who were randomly allocated to control and intervention conditions. The intervention led to significant improvements in help-seeking attitudes, particularly in stigmatising attitudes. No significant effects were found for MHL or help-seeking intentions. A brief educational intervention can improve help-seeking attitudes among international tertiary students. Future research may focus on establishing optimal intervention dosage.

AI snapshot

Written from the paper’s full text.

TL;DR

This pilot study tested a brief online mental health literacy intervention against an active control among 45 international tertiary students in Australia. It found significant improvements in help-seeking attitudes and stigma-related attitudes, but no significant effects on mental health literacy or help-seeking intentions.

Key findings

  • Help-seeking attitudes showed a significant group-by-time interaction, \(F(1, 39) = 5.43\), \(p = .02\), \(\eta^2 = .12\); the experimental group increased from pre to post, \(t(22) = 2.66\), \(p = .01\), \(d = .22\), while the control group did not, \(t(17) = .94\), \(p = .36\), \(d = .13\).
  • The indifference-to-stigma subscale showed a significant interaction, \(F(1, 39) = 7.70\), \(p < .001\), \(\eta^2 = .17\); the experimental group increased, \(t(22) = 2.90\), \(p = .01\), \(d = .25\), while the control group did not, \(t(17) = 1.27\), \(p = .22\), \(d = .15\).
  • Mental health literacy showed no significant interaction or main effects (\(p\)'s > .34; \(\eta^2\)'s < .03).
  • Help-seeking intentions showed no significant effects for emotional problems (\(p\)'s > .49; \(\eta^2\)'s < .01) or suicidal thoughts (\(p\)'s > .38; \(\eta^2\)'s < .02).

Methods

  • Pilot mixed factorial design with 45 international tertiary students in Australia, aged 17–52 years (\(M = 25.80\), \(SD = 6.68\)); 18 males and 27 females. Participants were recontacted from a previous study, consented, and completed pre- and one-week post-intervention measures.
  • Participants were allocated to either a depression-focused online MHL intervention (\(n = 26\)) or an active control condition on influenza prevention and hygiene (\(n = 19\)); allocation occurred during the previous study, producing uneven groups.
  • Measures included the Mental Health Literacy Scale, Inventory of Attitudes toward Mental Health Services, and General Help-Seeking Questionnaire; analyses used mixed ANOVAs and follow-up paired-samples \(t\)-tests with Bonferroni correction.

Limitations

  • The paper states that the intervention may have had insufficient duration or dose, that MHL was already higher in this sample than in a previous population study, suggesting possible sampling bias, that unequal allocation to conditions may affect generalisability, and that the pilot was underpowered with small effect sizes whose reliability is not yet established.
  • The paper also notes that no further information was provided during the one-week interval, so learning effects may have attenuated, and cites a systematic review identifying a lack of precision in help-seeking intention measurement.
  • Evident from the text: the sample was small, opt-in, recontacted from a prior study, and followed for only one week; outcomes were self-reported, and the control condition addressed an unrelated health topic.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1080/03069885.2019.1673312

Cites

Statistics

6 tests recomputed · 0 with the reported and recomputed p on opposite sides of .05

Claims the paper makes

0 of 29 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    For help-seeking intentions for suicidal thoughts, no significant interactions or main effects were found.

    “For the highest rating (among professional sources) of help-seeking intentions for suicidal thoughts, no significant interaction or main effects were found (p's >.38, <.02).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The measures used (IAMHS, GHSQ, MHLS) are valid and appropriate for assessing MHL and help-seeking among international tertiary students.
    • Rests on an assumption: The one-week follow-up period is sufficient to detect changes in MHL, help-seeking attitudes, and intentions.
  • Findingown data

    No such increase in IASMHS scores was observed for the control group.

    “No such increase was observed for the control group (t (17) = .94,p = .36,d = .13).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The measures used (IAMHS, GHSQ, MHLS) are valid and appropriate for assessing MHL and help-seeking among international tertiary students.
    • Rests on an assumption: The one-week follow-up period is sufficient to detect changes in MHL, help-seeking attitudes, and intentions.
  • Findingown data

    No significant effects were found for mental health literacy.

    “No significant effects were found for MHL or help-seeking intentions.”
    • Also stated in: § Preliminary Analyses. · plain
      “The interaction and main effects were not found to be significant for MHL (p's > .34),with small effect sizes observed ( 's <.03).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The measures used (IAMHS, GHSQ, MHLS) are valid and appropriate for assessing MHL and help-seeking among international tertiary students.
    • Rests on an assumption: The one-week follow-up period is sufficient to detect changes in MHL, help-seeking attitudes, and intentions.
  • Findingown data

    There was a significant interaction between group and time for indifference to stigma.

    “However, a significant interaction was found (F (1, 39) = 7.70, p < .001),with a large effect size ( =.17) observed.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The measures used (IAMHS, GHSQ, MHLS) are valid and appropriate for assessing MHL and help-seeking among international tertiary students.
    • Rests on an assumption: The one-week follow-up period is sufficient to detect changes in MHL, help-seeking attitudes, and intentions.
  • Findingown data

    No such increase in indifference to stigma scores was observed for the control group.

    “No such increase was observed for the control group (t (17) = 1.27, p = .22,d = .15).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The measures used (IAMHS, GHSQ, MHLS) are valid and appropriate for assessing MHL and help-seeking among international tertiary students.
    • Rests on an assumption: The one-week follow-up period is sufficient to detect changes in MHL, help-seeking attitudes, and intentions.
  • May combine two claims. 12
  • The quote only partly states this claim. 1
  • Classified as probably not a substantial claim. 12

  • May combine two claims.

    Findingown data

    For help-seeking intentions for emotional problems, no significant interactions or main effects were found.

    “For the highest rating (among professional sources) of help-seeking intentions for emotional problems, no significant interactions or main effects were found (p's >.49, 's <.01).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The measures used (IAMHS, GHSQ, MHLS) are valid and appropriate for assessing MHL and help-seeking among international tertiary students.
    • Rests on an assumption: The one-week follow-up period is sufficient to detect changes in MHL, help-seeking attitudes, and intentions.

  • May combine two claims.

    Findingown data

    For the help-seeking propensity subscale, no significant interaction or main effects were found.

    “For the subscale of help-seeking propensity, no significant interaction or main effects were found (p's >.12, 's <.06).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The measures used (IAMHS, GHSQ, MHLS) are valid and appropriate for assessing MHL and help-seeking among international tertiary students.
    • Rests on an assumption: The one-week follow-up period is sufficient to detect changes in MHL, help-seeking attitudes, and intentions.

  • May combine two claims.

    Findingown data

    For the psychological openness subscale, no significant interaction or main effects were found.

    “For the subscale of psychological openness, no significant interaction or main effects were found (p's >.35, 's <.02).”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The measures used (IAMHS, GHSQ, MHLS) are valid and appropriate for assessing MHL and help-seeking among international tertiary students.
    • Rests on an assumption: The one-week follow-up period is sufficient to detect changes in MHL, help-seeking attitudes, and intentions.

  • The quote only partly states this claim.

    Findingown data

    The intervention led to significant improvements in stigmatising attitudes (indifference to stigma).

    “particularly in stigmatising attitudes.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The measures used (IAMHS, GHSQ, MHLS) are valid and appropriate for assessing MHL and help-seeking among international tertiary students.
    • Rests on an assumption: The one-week follow-up period is sufficient to detect changes in MHL, help-seeking attitudes, and intentions.

  • Classified as probably not a substantial claim.

    Findingcitation

    Mental health literacy in the current sample of international students was already considerably higher (approximately 10 points) than that of the previous population study (Clough et al., 2018).

    “Another possible explanation is that MHL in the current sample of international students was already considerably higher (approximately 10 points) than that of the previous population study (Clough, et al., 2018), suggesting potential sampling bias in the opt-in process for this study, thereby limiting capacity for intervention effects to emerge.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Clough, et al., 2018

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Bonferroni correction was utilised to control familywise error rate.

    “A Bonferroni correction (.05/2) was utilised to control the familywise error rate.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Data were checked for test assumptions and transformations did not alter significance or interpretation.

    “Data were checked for test assumptions.Where data were found to be skewed transformations were made.However, as transformations did not alter the significance or interpretation of results, only analyses on untransformed data are reported.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Targeting MHL in international students may lead to more positive attitudes and greater intentions to seek mental health treatment when needed.

    “As such, targeting MHL in this population may lead to more positive attitudes and greater intentions to seek mental health treatment when needed (Potvin-Boucher, Szumilas, Sheikh, & Kutcher, 2010).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Potvin-Boucher, Szumilas, Sheikh, & Kutcher, 2010

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    Minimum sample size for the pilot study was determined to be 12 participants, and this minimum was met.

    “An additional 20% allowance was made for attrition, thereby making for a minimum sample size of 12 participants for the pilot study.”
    • Also stated in: § Method Participants · plain
      “As such, minimum sample size was met.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The finding that educational interventions can reduce stigma and improve help-seeking attitudes has previously been reported.

    “The finding that educational interventions can reduce stigma and improve help-seeking attitudes has previously been reported (Bapat, et al., 2009;Kiropoulos, et al., 2011;Perry, et al., 2014;Sharp, Hargrove, Johnson, & Deal, 2006).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Bapat, et al., 2009

      Not checked in the free run.

    • cites Kiropoulos, et al., 2011

      Not checked in the free run.

    • cites Perry, et al., 2014

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The intervention script was evaluated by the university's Head of Counselling Services and feedback was used to inform changes.

    “As a check on the content of the intervention, the script was provided to the associated university's Head of Counselling Services, who was asked to evaluate the script and provide feedback.The feedback from this staff member was evaluated and used to inform changes to the information script.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    The GHSQ scoring method (highest help-seeking intention) is preferable to an average score.

    “As described in Smith and Shochet (2011), this scoring method is preferable to an average score of the professional sources, as an individual need only be willing to seek help from one particular professional source in order to receive appropriate assistance.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Smith and Shochet (2011)

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Stigmatising attitudes have been associated not only with help-seeking, but also with self-efficacy in treatment and treatment outcomes, and have been argued to be the main obstacle to mental health programme success.

    “This effect is of particular importance given that stigmatising attitudes have been associated not only with help-seeking, but to selfefficacy in treatment, treatment outcomes, and have been argued to be the main obstacle to mental health programme success (Sartorius, 2007).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Sartorius, 2007

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    The current study was a small sample size 'proof of concept' study, so the reliability of its effect sizes has yet to be established.

    “However, as the current study was a small sample size “proof of concept” study, the reliability of the effect sizes has yet to be established.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Even small effect sizes have been argued to translate into worthwhile gains in a public health context involving large numbers of people and where an intervention can be delivered conveniently and at low cost.

    “Even small effect sizes have been argued to translate into worthwhile gains in a public health context involving large numbers of people, and where an intervention can be delivered conveniently and at low cost (Jorm et al., 2003).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Jorm et al., 2003

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Among tertiary students, and particularly international students, stigma toward mental health has been found to be elevated and negatively associated with help-seeking.

    “Among tertiary students, and particularly international students, stigma toward mental health has been found to be elevated, and negatively associated with help-seeking (Daniel Eisenberg, Golberstein, & Gollust, 2007).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Daniel Eisenberg, Golberstein, & Gollust, 2007

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The efficacy of the intervention was tested against an active control condition.

    “The efficacy of the intervention was tested against an active control condition, in which participants received information on an unrelated health topic: influenza prevention and hygiene.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    The results of the current study support previous findings that educational interventions often yield small effect sizes.

    “Lastly, in line with previous research (Rüsch, et al., 2005) the results of the current study support previous findings that educational interventions often yield small effect sizes.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Rüsch, et al., 2005

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    There is a discrepancy between needs for mental health services and actual help seeking among international students.

    “However, there is a discrepancy between needs for mental health services and actual help seeking among this student population.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The current study was conducted as a pilot study and was under-powered to detect changes on the remaining variables of interest.

    “Although, significant change was not observed on the remaining variables of interest, it should be noted that the current study was conducted as a pilot study, and as such was under-powered to detect such changes.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Previous research has shown that participants tend to respond more accurately to sensitive questions if they are not required to disclose their names or other identifying information.

    “Previous research has shown that participants tend to respond more accurately to sensitive questions if they are not required to disclose their names or other identifying information (Catania, Gibson, Chitwood, & Coates, 1990).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Catania, Gibson, Chitwood, & Coates, 1990

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    The sample size for preliminary investigative studies should be 10% of the sample projected for the larger study, or at a minimum, 10-30 participants.

    “According to Connelly (2008) the sample size for preliminary investigative studies should be 10% of the sample projected for the larger study, or at a minimum, 10-30 participants (Isaac and Michael, 1995).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Connelly (2008)

      Not checked in the free run.

    • cites Isaac and Michael, 1995

      Not checked in the free run.

22 of 22

  • The paper relies on this without support.

    No previous study has designed and assessed the effectiveness of a single online intervention based on the promotion of MHL in an international student population.

    “To the researchers' knowledge, there has been no research that has designed and assessed the effectiveness of a single online intervention based on the promotion of MHL in an international student population.”

  • The paper relies on this without support.

    The measures used (IAMHS, GHSQ, MHLS) are valid and appropriate for assessing MHL and help-seeking among international tertiary students.

    “MHL was assessed using the Mental Health Literacy Scale (O'Connor and Casey, 2015), which measures knowledge about mental health and related issues.”

  • The paper relies on this without support.

    The one-week follow-up period is sufficient to detect changes in MHL, help-seeking attitudes, and intentions.

    “Participants completed measures relating to MHL and help-seeking intentions pre-intervention and one week following the intervention.”

  • The paper relies on this without support.

    The sample of 45 international students is representative of the broader international tertiary student population in Australia.

    “A brief educational intervention can improve help-seeking attitudes among international tertiary students.”

  • The paper relies on this without support.

    The intervention content (depression vignette, etc.) is relevant to the majority of international students.

    “As a universal intervention, the focus was on content that was deemed relevant to the majority of students.”
5 of 5

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Statistics that don’t add up

Each reported p-value recomputed from its test statistic and degrees of freedom.

  • Inconsistent p-value: F (1, 39) = 7.70, p < .001

    Minor

    The paper reports p < .001 here; recomputing from the test statistic and its degrees of freedom gives p = .008. The check cannot tell whether the statistic or the p-value is the misprint.

    Reported p < .001 · recomputed p = .008

1 of 1

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Doesn’t add upF(1, 39) = 7.7reported p < .001 · recomputed p = .008

    “F (1, 39) = 7.70, p < .001”

  • ConsistentF(1, 39) = 5.43reported p = .02 · recomputed p = .025

    “F (1, 39) = 5.43, p = .02”

  • Consistentt(22) = 2.66reported p = .01 · recomputed p = .014

    “t (22) = 2.66, p = .01”

  • Consistentt(17) = 0.94reported p = .36 · recomputed p = .360

    “t (17) = .94,p = .36”

  • Consistentt(22) = 2.9reported p = .01 · recomputed p = .008

    “t (22) = 2.90, p = .01”

  • Consistentt(17) = 1.27reported p = .22 · recomputed p = .221

    “t (17) = 1.27, p = .22”

6 of 6

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Randomisation is placed at two different stages

    Minor

    The participants are described as having been allocated during data collection for a previous study, but the procedure says LimeSurvey allocated each participant during the current survey. These accounts conflict about when allocation occurred.

1 of 1

The citation lists haven’t been fetched yet

References 72 · Cited by 30

Research works printed but not linked: 9

  1. Ang P., 2008, Australian Journal of Adult Learning, 48, 109
  2. Clough B. A., 2018, British Journal of Guidance & Counselling, 47, 1
  3. Connelly L. M., 2008, MEdsurg Nursing, 17, 411
  4. Feast V., 2002, International Education Journal, 3, 70
  5. International Strategy Office, 2017, International trends in higher education 2016-17
  6. Morgan T., 2003, Canadian Journal of Counselling, 37, 151
  7. Morris N. S., 2006, BMC Family Practice, 7
  8. Singh H., 2003, Educational Technology-Saddle Brook Then Englewood Cliffs NJ, 43, 51
  9. Wilson G., 2005, Canadian Journal of Counselling, 39, 15

Authors
Clough, B. A., Nazareth, S. M., & Casey, L. M.
Affiliations
Griffith University (AU)
Corresponding author
Clough, Bonnie A.
ORCID
Clough, Bonnie A.
Venue
British Journal of Guidance & Counselling
Publisher
Informa UK Limited
Published
2019-10-03
Volume
48
Issue
3
Pages
347-359
ISSN
  • 0306-9885 (ISSN-L)
  • 1469-3534
DOI
10.1080/03069885.2019.1673312
OpenAlex
W2978528773
Semantic Scholar
aa214c3c4dbb571c060b9a3c1e206dca4fcfba10
Cited by
30
References
72
Citations by year
2026: 3 · 2025: 3 · 2024: 4 · 2023: 12 · 2022: 3 · 2021: 5
FWCI
2.51
Type
journal article
Language
en
Open access
Locations
  • British Journal of Guidance and Counselling (publishedVersion)
  • Griffith Research Online (submittedVersion)
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Developmental and Educational Psychology › Student Stress and Coping
  • Social Sciences › Communication › International Student and Expatriate Challenges
Keywords
mental health literacy, help-seeking intentions, international students, online educational intervention, help-seeking attitudes, mental health stigma, university students

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