Promoting Positive Thinking and Reducing Perceived Stress Using the Be Aware of Stress Smartphone Application among At-risk Adolescents: A Quasi-experimental Study.

Authors

  • Pornpat Hengudomsub Faculty of Nursing, Burapha University, Chonburi, Thailand.
  • Pornpun Sudjai Faculty of Nursing, Burapha University, Chonburi, Thailand.
  • Praphat Kangwanphanit Ban Suan Udomwittaya School, Chonburi, Thailand.
  • Pornpimon Thongkamdee Ban Suan Udomwittaya School, Chonburi, Thailand.
  • Sue Turale Editor, Pacific Rim Journal of International Nursing Research.

DOI:

https://doi.org/10.60099/prijnr.2024.268281

Keywords:

Adolescents, Acceptance and Commitment Therapy, Application software, Junior high school students, Perceived stress, Positive thinking, Quasi-experimental

Abstract

It is estimated that globally, millions of adolescents experience mental health problems, especially anxiety and depression. Adolescents with high perceptions of stress often encounter mental issues, have negative thoughts or are dissatisfied with daily life events. This study employed a quasi-experimental design with two groups and repeated measures to test an innovative nursing intervention, the Be Aware of Stress Smartphone Application. This application aims to increase positive thinking and reduce perceived stress among at-risk adolescents aged 13 to 16, and we sought to determine their satisfaction with its usability. The study was conducted with 44 junior high school students from an opportunity expansion high school in Eastern Thailand, who were randomly assigned to experimental and comparison groups (22 each). Data were collected between December 2023 and February 2024 using the General Information Questionnaire, Positive Thinking Test, Perceived Stress Questionnaire, and Satisfaction of Application Usability scale. The outcomes were measured at baseline, after completing the program at week 4, and at week 8 after using the application. The chi-square test and repeated measures analysis of variance were used to analyze the data.

The results of this study have important implications for future research. They indicate a significant improvement in positive thinking and a reduction in perceived stress within the experimental group, compared to the comparison group, at weeks 4 and 8. Moreover, the experimental group reported high satisfaction with the application’s usability. These findings suggest that the Be Aware of Stress application is beneficial for community nurses and others to prevent adolescent stress. The study also highlights the need for future research to enhance the application’s functionality and compatibility with various phone operating systems to ensure widespread and effective use.

References

Burnet Institute, Department of Mental Health, Mahidol University, UNICEF Thailand. Strengthening mental health and psychosocial support system and services for children and adolescents in East Asia and Pacific Region: Thailand report 2022. [Internet]. 2022. [cited 2024 Apr 24]. Available from: https://www.unicef.org/thailand/media/8871/file/MHPSS%20Report%202022.pdf

Lertrat, W., Ruangdechawiwat, P., & Khamphuch, K. Thai children and families at the crossroads: Report on the situation of children, youth and families in 2023. [Internet]. 2023. [cited 2024 Feb 19]. Available from: https://kidforkids.org/child-family-situationreport2023/

National Statistical Office, Ministry of Digital Economy and Society. The use of Information and Communication Technology (ICT) for child and youth in 2022. [Internet]. 2023. [cited 2024 Apr 24]. Available from: https://www.nso.go.th/nsoweb/nso/survey_detail/AQ?set_lang=en

Office of the Basic Education Commission, Department of Mental Health, Ministry of Public Health, The Equitable Education Fund. Information system development project to guarantee learning opportunities, student support, and mental health systems in the new way school (School Health Hero). [Internet]. 2022. [cited 2024 Feb 19]. Available from:

https://www.eef.or.th/news190723/?fbclid=IwAR2qGPttMOghkoD9bAJgDJux3f_W7Ax4CMgNRthmnytb6wjBlAEqhV7eiU.

Lertrat, W., & Sitthuprama, S. Thai children and families at the crossroads: report on the situation of children, youth and families in 2023: important situation. [Internet]. 2023. [cited 2024 Feb 19]. Available from: https://kidforkids.org/child-family-situation-report-2023/

Anttila M, Sittichai R, Katajisto J, Välimäki M. Impact of a web program to support the mental wellbeing of high school students: A quasi experimental feasibility study. Int J Environ Res Public Health. 2019;16(14):2473. doi: 10.3390/ijerph16142473. DOI: https://doi.org/10.3390/ijerph16142473

Rungrojwatanasiri P, Jirarode A, Petpichetchian W. The effects of an Internet-based cognitive behavioral therapy program on depression in Thai high school students: A Quasi-experimental study. PRIJNR [Internet]. 2024. [cited 2024 Apr 25]; 28(2):439-54. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/262983 DOI: https://doi.org/10.60099/prijnr.2024.262983

Muro-Culebras A, Escriche-Escuder A, Martin-Martin J, Roldán-Jiménez C, De-Torres I, Ruiz-Muñoz M, et al. Tools for evaluating the content, efficacy, and usability of mobile health apps according to the consensus-based standards for the selection of health measurement instruments: systematic review. JMIR Mhealth Uhealth. 2021;9(12):e15433. doi: 10.2196/15433 DOI: https://doi.org/10.2196/15433

Hayes SC, Levin ME, Plumb-Vilardaga J, Villatte JL, Pistorello J. Acceptance and commitment therapy and contextual behavioral science: examining the progress of a distinctive model of behavioral and cognitive therapy. Behav Ther. 2013;44(2):180-98. doi: 10.1016/j.beth.2009.08.002. Epub 2011 Jun 1. DOI: https://doi.org/10.1016/j.beth.2009.08.002

Hayes SC. Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies - Republished Article. Behav Ther. 2016; 47(6):869-885. doi: 10.1016/j.beth.2016.11.006. DOI: https://doi.org/10.1016/j.beth.2016.11.006

Parmar A, Esser K, Barreira L, Miller D, Morinis L, Chong YY,et al. Acceptance and commitment therapy for children with special health care needs and their parents: A systematic review and meta-analysis. Int J Environ Res Public Health. 2021; 18(15):e8205. doi: 10.3390/ijerph18158205. DOI: https://doi.org/10.3390/ijerph18158205

Binder F, Mehl R, Resch F, Kaess M, Koenig J. Interventions based on acceptance and commitment therapy for stress reduction in children and adolescents: A systematic review and meta-analysis of randomized controlled trials. Psychopathology. 2023; 21:1-17. doi: 10.1159/000535048. DOI: https://doi.org/10.1159/000535048

Lindholdt L, Labriola M, Andersen JH, Kjeldsen MZ, Obel C, Lund T. Perceived stress among adolescents as a marker for future mental disorders: A prospective cohort study. Scand J Public Health. 2022; 50(3):412-417. doi: 10.1177/1403494821993719. DOI: https://doi.org/10.1177/1403494821993719

Ma J, Ji L, Lu G. Adolescents' experiences of acceptance and commitment therapy for depression: An interpretative phenomenological analysis of good-outcome cases. Front Psychol. 2023;14:e1050227. doi: 10.3389/fpsyg.2023.1050227. DOI: https://doi.org/10.3389/fpsyg.2023.1050227

Duan W, Kong Y, Bu H, Guan Q, Chen Z, Luo Q, et al. The online strength-informed acceptance and commitment therapy among COVID-19 affected adolescents. Res Soc Work Pract. 2022; 32(4):465-474. doi: 10.1177/10497315211067270. DOI: https://doi.org/10.1177/10497315211067270

Pollak OH, Guzmán EM, Shin KE, Cha CB. Defeat, entrapment, and positive future thinking: examining key theoretical predictors of suicidal ideation among adolescents. Front Psychol. 2021;12:e590388. doi: 10.3389/fpsyg.2021.590388. DOI: https://doi.org/10.3389/fpsyg.2021.590388

Zisopoulou T, Varvogli L. Stress management methods in children and adolescents: past, present, and future. Horm Res Paediatr. 2023;96(1):97-107. doi: 10.1159/000526946. DOI: https://doi.org/10.1159/000526946

Office of the Basic Education Commission, Department of Mental Health, Ministry of Public Health. Health and Educational Reintegrating Operation. [Internet]. 2022. [cited 2024 May 20]. Available from: https://mhc7.dmh.go.th/wp-content/uploads/2022/12/-School-Health-HERO-7.12.65.pdf

Thai Health Promotion Foundation. Operation of the digital school mental health system. [Internet]. 2022. [cited 2024 May 20]. Available from: https://www.thaihealth.or.th/?p=233660

Lafleur A, Babin MJ, Michaud-Couture C, Lacasse M, Giguère Y, Cantat A, et al. Implementing competency-based education in multiple programs: A workshop to structure and monitor programs' priorities using ADDIE. JCBE. 2021; 6: e1257. doi.org/10.1002/cbe2.1257 DOI: https://doi.org/10.1002/cbe2.1257

Patel SR, Margolies PJ, Covell NH, Lipscomb C, Dixon LB. Using instructional design, analyze, design, develop, implement, and evaluate, to develop e-Learning modules to disseminate supported employment for community behavioral health treatment programs in New York state. Front Public Health. 2018; 7(6):113. doi: 10.3389/fpubh.2018.00113. DOI: https://doi.org/10.3389/fpubh.2018.00113

Cohen, J. Statistical power analysis for the behavioral sciences. [Internet]. 1988. [cited 2023 Apr 22]. Available from: https://www.utstat.toronto.edu/~brunner/oldclass/378f16/readings/CohenPower.pdf

World Health Organization. Definition of adolescent in 2023. [Internet]. 2023. [cited 2023 Apr 22]. Available from: https://www.who.int/health-topics/adolescent-health#tab=tab_1.

Ministry of Public Health. Department of Mental Health screening test for stress 5 items (ST-5) [Internet]. 2009. [cited 2023 Apr 22]. Available from: http://www.dmh.go.th/test/qtest 5/

Thepmong M, Prachanban P. A construction of positive thinking test for high school students. JEI. 2020; 24(1):226-35. Available from: https://so06.tci-thaijo.org/index.php/edujournal_nu/article/view/242450 (in Thai)

Ventrella, S. The Power of Positive Thinking in Business. [Internet]. 2001. [cited 2023 Apr 22]. Available from: https://www.perlego.com/book/780921/the-power-of-positive-thinking-in-business-ten-traits-for-maximum-results-pdf

Levenstein S, Prantera C, Varvo V, Scribano ML, Berto E, Luzi C, et al. Development of the perceived stress questionnaire: a new tool for psychosomatic research. J Psychosom Res. 1993; 37(1):19-32. doi: 10.1016/0022-3999(93)90120-5. DOI: https://doi.org/10.1016/0022-3999(93)90120-5

Wachirawat W, Hanucharurnkul S, Suriyawongpaisal P, Boonyapisit S, Levenstein S, Jearanaisilavong J, et al. Stress, but not Helicobacter pylori, is associated with peptic ulcer disease in a Thai population. J Med Assoc Thai. 2003; 86(7):672-85. PMID: 12948263.

Healthcare Information and Management Systems Society. Selecting a mobile app: Evaluating the usability of medical applications. [Internet]. 2012. [cited 2023 Apr 22]. Available from: http://s3.amazonaws.com/rdcms-imss/files/production/public/

Lapponampai W, Pamonsinlapatham P. Application program for Anti-HIV drug self-management on android smartphone. tjst 2018;27(4): 738-50 (in Thai). Available from: https://li01.tci-thaijo.org/index.php/tstj/article/view/190004

Zhao Z, Zhao C, Ren Z, Shi C, Lai L. Efficacy and mechanisms of mobile application-delivered Acceptance and Commitment Therapy for posttraumatic stress disorder in China: Study protocol for a randomized controlled trial. Internet Interv. 2022;30:e100585. doi: 10.1016/j.invent.2022.100585. DOI: https://doi.org/10.1016/j.invent.2022.100585

Anagnostou M, Drigas A. Mobile applications for stress management. Sci. Electronic Arch. 2022;15(2):58-62. doi.org/10.36560/15220221507. DOI: https://doi.org/10.36560/15220221507

Yoon M, Yun H. Relationships between adolescent smartphone usage patterns, achievement goals, and academic achievement. Asia Pacific Educ. Rev. 2023;24(1):13–23. doi: 10.1007/s12564-021-09718-5. DOI: https://doi.org/10.1007/s12564-021-09718-5

Gulec H, Smahel D. Individual and parental factors of adolescents' mHealth app use: Nationally representative cross-sectional study. JMIR Mhealth Uhealth.2022;10(12):e40340. doi: 10.2196/40340. DOI: https://doi.org/10.2196/40340

Leech T, Dorstyn D, Taylor A, Li W. Mental health apps for adolescents and young adults: A systematic review of randomised controlled trials. Child Youth Serv Rev, 2021;127:e16073. doi.org/10.1016/j.childyouth.2021.106073 DOI: https://doi.org/10.1016/j.childyouth.2021.106073

Piekarska J. Determinants of perceived stress in adolescence: The role of personality traits, emotional abilities, trait emotional intelligence, self-efficacy, and self-esteem. Adv Cogn Psychol. 2020;16(4):309-320. doi: 10.5709/acp-0305-z. DOI: https://doi.org/10.5709/acp-0305-z

Downloads

Published

2024-06-03

How to Cite

1.
Hengudomsub P, Sudjai P, Kangwanphanit P, Thongkamdee P, Turale S. Promoting Positive Thinking and Reducing Perceived Stress Using the Be Aware of Stress Smartphone Application among At-risk Adolescents: A Quasi-experimental Study. PRIJNR [Internet]. 2024 Jun. 3 [cited 2024 Nov. 22];28(3):599-618. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/268281