Counting On U: Towards Better Mental Health

The RE-AIM framework will be used to guide our evaluation of the intervention (Counting on U) (Glasgow 1999). RE-AIM stands for Reach, Effectiveness, Adoption, Implementation, and Maintenance. Field notes will be recorded, and structured interviews will be conducted with various stakeholders, including the business advisors, SME owners, trainers, and accounting/bookkeeper member bodies who will assist with the recruitment of business advisors. Process evaluation of Counting on U will help inform: 1) the future expansion and implementation of this program to various populations and 2) reveal both strengths and areas for improvement of the program strategies.

Psychological Distress of the SME owners and business advisors will be measured using the Kessler 6 (K6) (Kessler et al 2002). This non-specific scale screens individuals for severe mental illness as defined as a K6 score ≥13. The K6 asks respondents, in the past four weeks how often did they feel the following: nervous, hopeless, restless or fidgety, worthless, depressed and felt that everything was an effort. For each question, a value of zero to four is assigned (0 none of the time, 4 all of the time), and a total score summed out of 24. The scale has demonstrated excellent internal consistency and reliability (Cronbach's alpha = 0.89) (Kessler et al 2002).

Knowledge about mental health problems will be assessed using 18 questions adapted by Jorm et al (2010) that reviews information taught on day 1 and 2 of the Mental Health First Aid course. Questions consist of statements rated as Agree, Disagree or Unsure. The total score will be the number of questions answered correctly. An examples question is: "Half of all people who experience a mental illness have their first episode by age 18".

Provision of Mental Health First Aid questions will include whether the business advisor had talked to a SME owner about their mental health problems over the past month using a 4-point Likert scale (1 never, 4 many times) (Jorm et al 2010). If they have talked with a SME owner client, they will be asked to indicate how many out of 12 actions they had taken. A score of 1 will be allocated to any action they have taken A Few or Many Times and summing these scores.

Stigmatising attitude of the business advisors will be measured using six statements that queries their opinion of a person described in a vignette (personal stigma) (Reavley 2011). The modified vignette (Yap et al 2015) portrays a 35-year-old business owner who is showing signs of depression. An example of a personal stigma item is: "A problem like John's is a sign of personal weakness". Each item is scored on 5-point Likert scale (1 strongly agree, 5 strongly disagree) and the total score will be the number of items answered Agree or Strongly Agree.

Actual Health Seeking Behaviour questions will assess the SME owners and business advisor's behaviour of actively seeking assistance for mental health problems (Rickwood et al. 2005). The scale covers the informal, formal as well as physical and emotional aspect of help-seeking behaviour. The participant is asked to select from a list of people they have gone to for advice or help in the past two weeks.

Quality of Life questions will measure the general health of the business advisors and SME owners. The Short Form-12 questionnaire (SF-12) produces two summary scores - a mental component score (MCS-12) and a physical component score (PCS-12). This questionnaire has a test re-test reliability of 0.76 to 0.89 for the mental (MCS-12) and physical (PCS-12) health components (Ware 1996). Both components can discriminate among groups known to differ in their physical and mental conditions, yielding relative validities of 0.63 to 1.07 (Ware 1996). The answers are weighted, and the results are presented in reference to the United States population profile at the time of the original publication in 1994. A higher score for MCS and PCS indicates a better health state.

Financial Wellbeing Questionnaire (Prawitz 2006) consists of 8 items designed to gather information on how positively the SME owners view their financial situation. Each answer is scored from 1 to 10, and the total is summed and divided by 8. A higher score indicates no financial distress/ high financial well-being. The internal reliability of the scale is robust with a Cronbach's alpha of 0.956 indicating that the items contributing to the measurement of financial well-being, consistently yielded similar results. Factor loadings ranged from 0.83 to 0.93, indicating the measurement of only one latent construct.

Trust in Business Advisor Questionnaire measures the three elements of trust defined by Cherry et al. (2018): confidence, acting proactively and not exploiting vulnerabilities. In addition, the SME owner's confidence in the services (i.e., beyond compliance services) offered by the business advisor will be measured. Eleven questions will assess trust on a 5-point Likert scale (1 strongly disagree, 5 strongly agree) with a higher total score indicating a more trusting relationship. Factor loading for the items range from 0.43 to 0.95 and shows good reliability, with a Cronbach's alpha of 0.931 to 0.937.

Perceived Financial Wellbeing questions developed by Netemeyer et al 2018, asks the SME owners to consider how much they agree with 5 statements such as "I am behind with my finances". Their answers will be scored on a 5-point Likert scale (1 strongly agree, 5 strongly disagree) and a lower total mean score will indicate a more positive outlook. Perceived financial wellbeing is a strong predictor of overall well-being and has a Cronbach's alpha of 0.86 to 0.94 (Netemeyer et al. 2018).

Autonomy will be measured using a 3-item scale that asks how much control the business advisor feels they have over their work and scored on a 5-point Likert scale (1 strongly disagree, 5 strongly agree) (Bakker et al, 2004, Karasek 1985). A mean score will be generated and a higher score indicating greater autonomy. The Cronbach's alpha is 0.68.

Emotional Demands on the business advisors will be measured using the second version of the Copenhagen Psychosocial Questionnaire (Pejtersen et al, 2010). There are four items exploring how emotionally demanding they find their work, two items are measured on one 5-point Likert scale (1 never, hardly, 5 always) and two on a different 5-point Likert scale (1 to a very small extent, 5 to a large extent). The Cronbach's alpha is 0.87.

Workload of the business advisors will be measuring using 3 items on a 5-point scale (1, not at all, 5 to a great extent) (Albrecht 2015, Karasek 1979). They will be asked their thoughts on statements such as "to what extent is there not enough time for you to do your job?" A mean score will be generated, and a higher score indicates a more demanding workload. The Cronbach's alpha is: 0.85 to 0.88.

Psychological Capital Short Form (PCQ-12) questionnaire measures wellbeing as a function of four emotions, two of which will be measured in the SME owners and business advisors: resilience and self-efficacy (Kamei et al 2018). Participants will respond to six statements on a 6-point Likert scale (1 strongly disagree, 6 strongly agree). PCQ-12 is designed for working adults and both resilience and self-efficacy statements are significantly correlated with measures of satisfaction with life, happiness and perceived stress (-0.36 to 0.50). The factor loadings of the questions range from 0.30 to 0.87.

Social Support questions assess the extent of emotional social support the participant receives from clients, family and friends, or colleagues and peers (Totterdal et al. 2006). The business advisors and SME owners will be asked two questions about each source: how easy is to talk to the people concerned and are the people concerned willing to listen to your problems. Responses are recorded on a 5-point Likert scale (1 not at all, 5 a great deal). The higher the score, the higher the social support. The Cronbach's alpha is 0.81.