BACKGROUND

Mental health disorders affect 1 in 8 people worldwide, yet many face barriers to accessing care. E-mental health interventions, including self-guided internet-based programs, offer promising solutions. However, the mechanisms driving knowledge gain in such programs remain poorly understood. The role of medium, topic, sequence, and confidence and their interaction in learning outcomes need further investigation. Additionally, the influence of knowledge gaps on the outcome of psychoeducational intervention is not well understood (eg, whether psychoeducation requires an existing knowledge gap to be effective).

OBJECTIVE

This randomized controlled trial investigated the role of medium, topic, sequence, and participants' initial knowledge levels on knowledge gain and confidence in fully automated self-guided e-mental health psychoeducation.

METHODS

A total of 158 adults (mean age 34, SD 12.4 years; n=118, 74.7% female) were randomized to 8 experimental conditions (receiving video, texts, or both containing psychoeducational content on sleep or social competence; n=142) or a control group (neutral video; n=16). The fully automated interventions (videos) were developed for use in web-based e-mental health interventions. They address transdiagnostic symptoms and hence are relevant across various disorders. To assess the added value of video production for knowledge gain, text-based scripts corresponding to the video content were created and compared. All interventions and outcome assessments were delivered on the web via Qualtrics without face-to-face components. Pre- and postintervention knowledge was assessed using a validated 30-item knowledge test (true/false). Confidence in responses was rated on a 0% to 100% scale. Statistical analyses included 3-way ANOVA and multivariate ANOVA.

RESULTS

Knowledge significantly increased across experimental groups (F=17.272; P<.001; η=0.10). Participants with social competence deficits had significantly lower baseline knowledge (P=.04; d=0.41). For sleep deficits, a nonsignificant trend emerged (P=.09; d=0.28). Participants with social competence deficits demonstrated greater knowledge improvement (t=7.12; P<.001; d=0.60). Participants with sleep deficits showed smaller but significant gains (t=2.43; P=.02; d=0.20). No significant differences in knowledge gain were found between video and text formats. Confidence in correct answers increased significantly in the experimental group (mean 42.82, 95% CI 41.15-44.50 to mean 51.67, 95% CI 49.28-54.04), with larger gains for social competence than sleep. Confidence in the control group remained unchanged.

CONCLUSIONS

Both video and text formats effectively facilitated knowledge gain in e-mental health interventions, with no clear advantage of one medium over the other. Participants with prior deficits learned more in areas where they initially lacked knowledge. Confidence in correct answers increased alongside knowledge, highlighting psychoeducation's role in promoting self-efficacy. Future research should explore multimedia integration to enhance adherence and symptom improvement.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00026722; https://drks.de/search/en/trial/DRKS00026722.