Optimising the implementation of a universal web-based mental health service for Australian secondary schools: A cluster randomised controlled trial

BackgroundSecondary schools are increasingly delivering a range of mental health interventions with varied success. This trial examined the effectiveness of two implementation strategies, class time allocation, and financial incentives, on secondary students engagement with a universal web-based mental health service, Smooth Sailing. MethodsA three-arm, cluster-randomised trial was conducted over 12 weeks with Grade 8 and 9 students from 20 schools in two Australian states. The primary outcome was student engagement, measured by the number of modules accessed at 12-weeks post-baseline. Secondary outcomes included uptake, retention, help-seeking intentions for mental health problems, service satisfaction, and barriers to use. ResultsA total of 20 schools consented to take part and 1295 students consented to the study. The mean number of modules accessed by students was higher in the enhanced conditions (class time allocation and financial incentive) but not statistically significant (P>0.140). There were no significant differences in uptake (P=0.554) or retention (P=0.945) between conditions. Help-seeking intentions significantly improved at 6- and 12-weeks in the standard service and class time conditions only. Common barriers to service use among students were forgetfulness and low motivation. ConclusionsNone of the implementation strategies examined by this trial significantly increased student engagement when measured by modules accessed. Trial registrationAustralian New Zealand Clinical Trial Registry (ACTRN12621000225819) and Universal Trial Number (U1111-1265-7440). Trial fundingThe trial operations were funded by the Prevention Hub, Australian Government Department of Health.