The issue
A recent survey of UK higher education institutions reported that the demand for mental health provision within the student population has significantly increased over 5 years, (Gallagher, 2009), yet the proportion who did not receive ‘well-being’ services has been reported to have ranged from 37% to 84%, (Eisenberg, Golberstein & Gollust, 2007). Moreover, the perceived public stigma associated with mental health troubles posses a persistent problem for both students and staff; high public and personal stigma was negatively associated with measures of ‘help seeking’, (Eisenberg et al, 2009). It seems although mental health suffering is on the rise, both internal and external factors are preventing students getting the help they need.
University students can be considered as more vulnerable than other young people in terms of suffering from poor mental health; as reported by Hunt and Eisenberg (2009, pg. 3), “they are not immune to the suffering and disability associated with mental illness”. This is likely due to the high stress environment in which university creates along with the new ways of learning. Similarly, there is added pressure on students to gain good degrees (Kessler, Foster & Saunders, 1995) and in addition, to show evidence of attainment in other areas such as societies and sports clubs, or participation in voluntary work. With the onset of most mental disorders beginning before 24 yrs, (Kessler et al, 2005) it is not surprising student populations are affected disproportionately. Not only this, but the huge financial stress that can come with university can often require students to take up a part time job in addition to their studies, adding extra pressure (Royal College of Psychiatrists, 2011).
In sum, with the combination of variables including students hiding their mental health condition, (Martin, 2010), university requirements and extracurricular stressors, a transformation in services is a necessity.
The starting point
We met with Janet Winters who is part of Warwick Wellbeing team to discuss the issue of student mental health further. She felt that a large issue in terms of student mental health is the need to ‘power through’ - that is, carrying on with academic requirements, like essays and coursework without considering the negative effect on mental health. Combined with ignoring warning signs and letting the issue become serious, Janet’s job was to prevent student engaging in this detrimental. In addition to this, she suggested that when a students mental health starts to decline, their self care is often one of the first things to be forgotten about. It was very clear throughout the literature and whilst talking to Janet, that is it key to keep up with regular self care in order to stay on top of your mental health; self care seems to be the precursor step before medical intervention, but as Janet agreed, it can be easy and simple to implement.
Following this meeting we created a poll via Instagram to look at how important people feel self care is, and if they regularly incorporate it into their routines. We received over 150 responses, most of which being UK students. Results found that only 50% engage in self care regularly although over 90% agree its important for mental wellbeing (See Figure 1). This confirms what we spoke about with Janet Winter, in that people know its important, but in a lot of cases people do not engage in regular self care activities, and it is likely that they only do incorporate self care into their routine once their mental health starts becoming debilitating to their everyday life.
Figure 1 - instagram poll results
In summary, we felt that in order to improve students mental wellbeing, a topic we are both passionate about, a campaign on the importance of regular self care would be beneficial.
Previous research has demonstrated that mental health issues in the student population are rising, (Gallagher, 2009). The primary aim of our project was therefore to help improve student wellbeing by encouraging them to incorporate self care behaviours into their daily/weekly routines, depending on the individual.
Poster
We created a poster based around behaviour intentions with a What, Why, How structure. Our list of possible self care ideas that was compiled from talking to friends and asking them what they felt helped them feel less stressed as well as looking at online resources. We also had a QR code for people to scan that linked them to our facebook page for more self care information and tips, to make it more interactive (See Figure 2).
This poster was distributed around the University of Warwick campus during week 7; an ideal week as it was the University mental health awareness week (see Figure 3). During this week, many events promoting good mental health were going on so we felt that this would be the optimal time to get students to question, and improve their self care. Posters were placed in department common rooms, outside the library, on public notice boards and on toilet doors around campus. This poster was also distributed to friends who attended universities for them to share on their campus; since the issue is not localised to Warwick, it is important to spread the word throughout our target population. We had photo submissions that can be seen below in figure 4.
Our project aim
Previous research has demonstrated that mental health issues in the student population are rising, (Gallagher, 2009). The primary aim of our project was therefore to help improve student wellbeing by encouraging them to incorporate self care behaviours into their daily/weekly routines, depending on the individual.
How did we do it?
Poster
We created a poster based around behaviour intentions with a What, Why, How structure. Our list of possible self care ideas that was compiled from talking to friends and asking them what they felt helped them feel less stressed as well as looking at online resources. We also had a QR code for people to scan that linked them to our facebook page for more self care information and tips, to make it more interactive (See Figure 2).
This poster was distributed around the University of Warwick campus during week 7; an ideal week as it was the University mental health awareness week (see Figure 3). During this week, many events promoting good mental health were going on so we felt that this would be the optimal time to get students to question, and improve their self care. Posters were placed in department common rooms, outside the library, on public notice boards and on toilet doors around campus. This poster was also distributed to friends who attended universities for them to share on their campus; since the issue is not localised to Warwick, it is important to spread the word throughout our target population. We had photo submissions that can be seen below in figure 4.
Figure 2 - Our poster
Figure 3 - Images of our poster at up at The University of Warwick
Figure 4 - photo submissions from universities who distributed our self care poster. Top Left - Royal Holloway, Top Right- University of Birmingham, Bottom Left- University East Anglia, Bottom Right- University of Coventry.
Self care tips
On top of the poster, we decided to directly engage our target audience with ‘self-care sweet’. Experts in the field of student self care explained that direct engagement with our target audience is one of the most effective ways of presenting our message, (Myers, 2012), hence the idea of ‘self care sweets’ emerged. We decided to attach self care tips and questions to sweets and healthy snacks and hand them out on campus. We created over 100 labels which had a question on one side (with the purpose of challenging faulty, but ingrained, thinking) and a self care tip on the other. Example questions include -
When did you last make your bed?
When was the last time you had a good night's sleep?
When did you last cook yourself a meal?
The self care tips were taken from our poster and included things like spending time outdoors, meeting up with an old friend for coffee and joining a new club; all popular suggestions within a student population.
These treats were delivered outside the Library on the 22nd of February 2018 (See Figure 5). Overall, we feel this activity generated some good discussions among the students. We noted people comparing what tips and ideas they had received in the lucky dip and making suggestions to each other. There was a large interest in the project and what we were doing, having spoken to some of the students, many felt self care was underrated.
On top of the poster, we decided to directly engage our target audience with ‘self-care sweet’. Experts in the field of student self care explained that direct engagement with our target audience is one of the most effective ways of presenting our message, (Myers, 2012), hence the idea of ‘self care sweets’ emerged. We decided to attach self care tips and questions to sweets and healthy snacks and hand them out on campus. We created over 100 labels which had a question on one side (with the purpose of challenging faulty, but ingrained, thinking) and a self care tip on the other. Example questions include -
When did you last make your bed?
When was the last time you had a good night's sleep?
When did you last cook yourself a meal?
The self care tips were taken from our poster and included things like spending time outdoors, meeting up with an old friend for coffee and joining a new club; all popular suggestions within a student population.
These treats were delivered outside the Library on the 22nd of February 2018 (See Figure 5). Overall, we feel this activity generated some good discussions among the students. We noted people comparing what tips and ideas they had received in the lucky dip and making suggestions to each other. There was a large interest in the project and what we were doing, having spoken to some of the students, many felt self care was underrated.
Figure 5 - Giving out our ‘self care sweets’.
Facebook page
We created a facebook page that was accessible via our QR code on our poster. We also shared this page with friends and family for them to look at. We posted regularly for a number of weeks with links to other sites that gave information about self care, scientific articles and quotes.
Figure 6 - Our Facebook Page
https://www.facebook.com/selfcarelesson/
We shared some of our own posts to the facebook profile and ‘Warwick Mind Aware’, the universities society for raising awareness and promoting mental health, also shared some posts to their facebook page, these posts would have reached an audience of over 1000.
The Elaboration likelihood model (Petty & Cacioppo, 1986) tells us that there are two ways to persuade people which is based on their ability and motivation to pay attention. If the individual is able to, and motivated, to think about the message, the central route is taken, and if not, the peripheral route. This relates to the heuristic- systematic model whereby a person undertakes systematic processing of information, which is more effortful and detail focused if they are taking the central route, and heuristic processing based on cue reliance if they are taking the peripheral route (Chaiken, 1980). In sum, the central route is related aspects of the message that are hard to process, for example the strength of the argument, and the peripheral is based on associations such as animations, colour and celebrity endorsement (Petty & Cacioppo, 1984). We used both the central and peripheral route in order to persuade our viewer, for example the central route was accessed by using the statistics on student mental health and self care on our poster, whereas the peripheral route was demonstrated among the poster structure, (‘what, why, how’) and the animations throughout.
In order to help motivate our readers (key in the ELM), we focused directly on the increase in student mental health problems as a reason for why they should ensure they are utilizing self care. This was an issue being spoken about in their environment, particularly due to the timing of poster distribution on campus during mental health awareness week, furthermore the audience was personally identifiable as they were also students.
Our project is also largely associated to the theory of planned behaviour (Azjen, 1991), This is the idea that attitudes, subjective norms, and perceived behavioural control create intentions which in turn, lead to actions. This theory has previously been used to improve the predictability of intention in fields such as exercise and diet, which are difficult to influence (Godin & Kok, 1996). We applied this method to encourage people to engage in self care behaviours. For example, we used behavioural intentions in our poster, by getting people to pick a self care behaviour, a day and a time to do it and then write it down.
The mere exposure effect is the idea that exposing people to information, even for a split second, will develop a preference for the same information in the future, (Monahan, Murphy & Zajonc, 2000). Zajonc (1968) suggests that we prefer what we are exposure to more; the familiarity effect. In line with this, by exposing people to information about self care and advice via our facebook page and ‘self-care sweets’, means people are more likely to remember the information, and therefore encode it for later use.
Measuring behaviour change/ project impact
Due to the difficulty in gathering an exact measure of behaviour change with regards to self care in students, as it would require extensive data collection over time, with a lapse in between; a method out time restrictions ruled out, we looked at other measures.
One of our main aims was to promote and normalise self care behaviours, so just by getting our message out to people, motivates communication about what they do for self care, which in turn, can improve people’s attitudes towards self care and reduce the associated stigma.
The 100 ‘self-care sweets’ were all given out within 40 minutes, promoting interest about aims of the campaign and how student can support it, as well as communication between themselves, a crucial step forward. Therefore, we feel a good impact was made.
A measurable outcome was obtained from our facebook page which people could find by using the poster QR code or from links shared on our personal facebook accounts, the number of likes has been increasing over time and some of our posts have reached over 400 people. Therefore, from this measure we feel we encouraged people to think more about what they do for self care to ensure they are keeping their mental health in check. Lastly, we received some testimonies and feedback from family and friends who had followed our page. Many of which said they had thought more about what they do for self care and had made more of an effort to do something self care related on a more regular basis. All of these individuals said that this project had helped them understand the importance of self care and changing their routines to include more had resulted in them feeling a lot happier day to day.
Testimonies
“I incorporated more self care behaviours into my daily routine and made a diary during this period. I chose to focus on these behaviours- reading for pleasure, listening to music and spending more time outdoors. I adhered to this, and monitored my mood for two weeks. Overall I feel I was more relaxed and less stressed, especially when I engaged in the the self care behaviour in the morning Additionally, I feel during this period I was more able to deal with negative life events when they occured.”
“I don't usually engage in regular self care due to being too busy, however I set myself a challenge to have at least 30 minutes a day dedicated to self care for at least a week. After seeing this poster and realising how important self care can really be. At the end of the week, I discovered that really 30 minutes a day isn't a lot, and if i took the time out to do these things when I started to feel unproductive, I actually felt a lot more focused and motivated after which improved my productivity. This is definitely something I will consider doing more often in the future, especially during exams ”
References
By Hannah Butler and Becky Davies
We shared some of our own posts to the facebook profile and ‘Warwick Mind Aware’, the universities society for raising awareness and promoting mental health, also shared some posts to their facebook page, these posts would have reached an audience of over 1000.
Persuasion techniques
The Elaboration likelihood model (Petty & Cacioppo, 1986) tells us that there are two ways to persuade people which is based on their ability and motivation to pay attention. If the individual is able to, and motivated, to think about the message, the central route is taken, and if not, the peripheral route. This relates to the heuristic- systematic model whereby a person undertakes systematic processing of information, which is more effortful and detail focused if they are taking the central route, and heuristic processing based on cue reliance if they are taking the peripheral route (Chaiken, 1980). In sum, the central route is related aspects of the message that are hard to process, for example the strength of the argument, and the peripheral is based on associations such as animations, colour and celebrity endorsement (Petty & Cacioppo, 1984). We used both the central and peripheral route in order to persuade our viewer, for example the central route was accessed by using the statistics on student mental health and self care on our poster, whereas the peripheral route was demonstrated among the poster structure, (‘what, why, how’) and the animations throughout.
In order to help motivate our readers (key in the ELM), we focused directly on the increase in student mental health problems as a reason for why they should ensure they are utilizing self care. This was an issue being spoken about in their environment, particularly due to the timing of poster distribution on campus during mental health awareness week, furthermore the audience was personally identifiable as they were also students.
Our project is also largely associated to the theory of planned behaviour (Azjen, 1991), This is the idea that attitudes, subjective norms, and perceived behavioural control create intentions which in turn, lead to actions. This theory has previously been used to improve the predictability of intention in fields such as exercise and diet, which are difficult to influence (Godin & Kok, 1996). We applied this method to encourage people to engage in self care behaviours. For example, we used behavioural intentions in our poster, by getting people to pick a self care behaviour, a day and a time to do it and then write it down.
The mere exposure effect is the idea that exposing people to information, even for a split second, will develop a preference for the same information in the future, (Monahan, Murphy & Zajonc, 2000). Zajonc (1968) suggests that we prefer what we are exposure to more; the familiarity effect. In line with this, by exposing people to information about self care and advice via our facebook page and ‘self-care sweets’, means people are more likely to remember the information, and therefore encode it for later use.
Measuring behaviour change/ project impact
Due to the difficulty in gathering an exact measure of behaviour change with regards to self care in students, as it would require extensive data collection over time, with a lapse in between; a method out time restrictions ruled out, we looked at other measures.
One of our main aims was to promote and normalise self care behaviours, so just by getting our message out to people, motivates communication about what they do for self care, which in turn, can improve people’s attitudes towards self care and reduce the associated stigma.
The 100 ‘self-care sweets’ were all given out within 40 minutes, promoting interest about aims of the campaign and how student can support it, as well as communication between themselves, a crucial step forward. Therefore, we feel a good impact was made.
A measurable outcome was obtained from our facebook page which people could find by using the poster QR code or from links shared on our personal facebook accounts, the number of likes has been increasing over time and some of our posts have reached over 400 people. Therefore, from this measure we feel we encouraged people to think more about what they do for self care to ensure they are keeping their mental health in check. Lastly, we received some testimonies and feedback from family and friends who had followed our page. Many of which said they had thought more about what they do for self care and had made more of an effort to do something self care related on a more regular basis. All of these individuals said that this project had helped them understand the importance of self care and changing their routines to include more had resulted in them feeling a lot happier day to day.
Testimonies
“I incorporated more self care behaviours into my daily routine and made a diary during this period. I chose to focus on these behaviours- reading for pleasure, listening to music and spending more time outdoors. I adhered to this, and monitored my mood for two weeks. Overall I feel I was more relaxed and less stressed, especially when I engaged in the the self care behaviour in the morning Additionally, I feel during this period I was more able to deal with negative life events when they occured.”
“I don't usually engage in regular self care due to being too busy, however I set myself a challenge to have at least 30 minutes a day dedicated to self care for at least a week. After seeing this poster and realising how important self care can really be. At the end of the week, I discovered that really 30 minutes a day isn't a lot, and if i took the time out to do these things when I started to feel unproductive, I actually felt a lot more focused and motivated after which improved my productivity. This is definitely something I will consider doing more often in the future, especially during exams ”
References
Chaiken, S. (1980). Heuristic versus systematic information processing and the use of source versus message cues in persuasion. Journal of personality and social psychology, 39(5), 752.
Eisenberg, D., Downs, M. F., Golberstein, E., & Zivin, K. (2009). Stigma and help seeking for mental health among college students. Medical Care Research and Review, 66(5), 522-541.
Eisenberg, D., Golberstein, E., & Gollust, S. E. (2007). Help-seeking and access to mental health care in a university student population. Medical care, 45(7), 594-601.
Gallagher R. National Survey of Counseling Center Director, 2009. Available at http://www.iacsinc.org/2008%20National%20Survey%20of%20Counseling%20Center%20Directors.pdf
Godin, G., & Kok, G. (1996). The theory of planned behaviour: a review of its applications to health-related behaviours. American journal of health promotion, 11(2), 87-98.
Hunt, J., & Eisenberg, D. (2010). Mental health problems and help-seeking behavior among college students. Journal of Adolescent Health, 46(1), 3-10.
Kessler, R. C., Foster, C. L., Saunders, W. B., & Stang, P. E. (1995). Social consequences of psychiatric disorders, I: Educational attainment. The American journal of psychiatry, 152(7), 1026.
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of general psychiatry, 62(6), 593-602.
Martin, J. M. (2010). Stigma and student mental health in higher education. Higher Education Research & Development, 29(3), 259-274.
Monahan, J. L., Murphy, S. T., & Zajonc, R. B. (2000). Subliminal mere exposure: Specific, general, and diffuse effects. Psychological Science, 11(6), 462-466.
Myers, S. B., Sweeney, A. C., Popick, V., Wesley, K., Bordfeld, A., & Fingerhut, R. (2012). Self-care practices and perceived stress levels among psychology graduate students. Training and Education in Professional Psychology, 6(1), 55.
Petty, R. E., & Cacioppo, J. T. (1984). The effects of involvement on responses to argument quantity and quality: Central and peripheral routes to persuasion. Journal of personality and social psychology, 46(1), 69.
Royal College of Psychiatrists (2011) Mental health of students in higher education: college report CR16, London: Royal College of Psychiatrists. Retrieved from http://www.rcpsych.ac.uk/files/pdfversion/CR166.pdf.
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