Partial Digitalization of Mission ReST

INTRODUCTION

Resilience is a well-established protective factor against stress and the development of mental health problems in young people. Prior work suggests that resilient responses to stressors are shaped, in part, by earlier experiences of navigating challenges and adversity in childhood. To address the limitations of one-size-fits-all resilience interventions, our research team developed Mission ReST, a person-specific, context-dependent program that tailors resilience-building strategies to individuals' response typologies to adversity.

Mission ReST is a three-session, face-to-face, gamified intervention that combines psychoeducation, skill practice, and experiential learning. Session 1 is a 60-minute individual self-discovery meeting with a trained facilitator, during which personalized recommendations for resilience-building strategies are introduced. Sessions 2 and 3 are 90-minute group sessions that use game-based challenges to help participants consolidate and apply resilience skills.

Preliminary findings suggest that the program is effective as a universal intervention and may be particularly beneficial for students with lower resilience or higher distress, with strongly positive student feedback. To further improve accessibility and engagement, this study digitalizes Session 1 into an interactive online component to scale up Mission ReST and support broader dissemination in other youth-serving settings.

AIMS AND OBJECTIVES

This study aims to (1) Develop a digitalized individual component of an existing personalized resilience-building program for university students, namely Session 1 of Mission ReST, with an AI-based recommendation system embedded, (2) Assess the feasibility, acceptability, and appropriateness of the digitalized individual component, and (3) Compare recruitment, adoption, rates of full program completion, and student outcomes between digital versus in-person delivery of the individual component over a 6-month implementation period.

METHOD

1. INTERVENTION CONDITIONS Mission ReST is a psychoeducational intervention grounded in socialization to the resilience model and a library of 29 evidence-based resilience-building strategies targeting three core domains: negative self-concept, emotional dysregulation, and interpersonal functioning. In the experimental arm, these materials are delivered through an interactive web app. Based on users' assessment responses (i.e., multiple choice and free-text questions), an integrated AI-based recommender system using a hybrid filtering approach will identify and deliver suitable strategies. The active comparator arm involves in-person delivery of structurally and time-equivalent modules. Instead of AI-based recommendation, a trained facilitator will deliver the strategies after hearing the user's concerns.
2. STUDY DESIGN Effectiveness of the digitalized version will be evaluated against the in-person delivery mode using a pragmatic, preference-based, open-label, non-randomized trial over a 6-month implementation period. This design prioritizes external validity and provides insight into program effectiveness, system capacity, dissemination, and scalability. The preference-based approach also allows assessment of delivery preferences and participation trends, aligns with evidence supporting flexible delivery modes for young people's mental health interventions, and reflects the trauma-informed care principle of offering choice.
3. PARTICIPANTS AND PROCEDURES Undergraduates at PolyU between ages 18-24 years meeting the eligibility criteria will be recruited. Consistent with pragmatic trial methodology, which supports broad inclusion, ongoing recruitment efforts, and the scalability of digital delivery of Session 1, at least 400 students will be recruited during the implementation period. After providing consent to participate, students will provide baseline data on demographic information (age, gender, study discipline), current mental health status (DASS-21 for anxiety, depression, and stress), perceived resilience (BRS), and disturbances in self-organization (ITQ-DSO). Students may then choose to complete Session 1 either in person with a Mission ReST trainer or through the online digital component. Delivery-mode preference and Session 1 completion will be recorded, after which both arms of students will proceed to the two subsequent in-person group sessions. Three attempts will be made to contact and schedule the students to join the group sessions; non-response from three attempts is considered loss to dropout. Students will complete the outcome measures again immediately after full program completion (i.e., end of Session 3). All surveys will be completed online using Qualtrics.
4. OUTCOME MEASURES Primary outcomes include implementation and feasibility metrics (recruitment and retention rate and satisfaction for both delivery mode over the implementation period). Secondary outcomes include baseline and post-intervention data on resilience (BRS), depression, anxiety, and stress (DASS-21), and disturbances in self-organization (ITQ-DSO). Baseline demographic information and adverse childhood experiences (ACEs) will also be collected to characterize the sample.
5. DATA ANALYSIS Implementation and feasibility metrics will be summarized using descriptive statistics, including characteristics of screened and enrolled students, and their preference for and adoption of digital versus in-person delivery of Mission ReST Session 1. Completion, attrition, and group differences will be analyzed using t-tests, ANOVA, or chi-square tests as appropriate. To assess effectiveness between groups, changes in BRS, DASS-21 and ITQ-DSO scores from pre- to post-intervention will be examined using factorial repeated-measures ANOVA. Differences by delivery mode will be further explored using multiple linear regression with gain scores, adjusting for age, gender, and baseline scores. Intention-to-treat principles will be applied, with missing data addressed through multiple imputation. Sensitivity analyses will test alternative imputation methods, complete-case analysis, and subgroup effects by student characteristics.

ETHICAL CONSIDERATIONS

Approval has been obtained from the Human Subjects Ethics Sub-Committee of the University (HSEARS20251216001). Students will provide written informed consent to participate and will also sign the Confidentiality and Service Agreements. All Mission ReST trainers have received training in trauma-informed care and in identifying and supporting students experiencing mental distress. ReST Hub has an established crisis management protocol and works closely with University Health Services and PolyU Counselling and Wellness. Students at imminent risk will be immediately referred for professional support through the existing response system, and the PI will be notified. Data confidentiality will be strictly protected, with identifiable information stored separately from research data and all files kept securely in encrypted and locked storage. Only research team members will have access to the raw data.