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Trial registered on ANZCTR


Registration number
ACTRN12623001188628
Ethics application status
Approved
Date submitted
28/06/2023
Date registered
17/11/2023
Date last updated
17/11/2023
Date data sharing statement initially provided
17/11/2023
Type of registration
Prospectively registered

Titles & IDs
Public title
Identifying and Reaching Individuals who have not sought Help for Suicide using Google Ads
Scientific title
A Trial measuring Engagement with an ad and landing page designed for suicide prevention using Google Adwords for participants in Australia and Indonesia, targetting Individuals who have not sought Help
Secondary ID [1] 309877 0
Nil
Universal Trial Number (UTN)
Trial acronym
Linked study record
This is a follow up study to ACTRN12623000084684

Health condition
Health condition(s) or problem(s) studied:
Suicide 330334 0
Condition category
Condition code
Mental Health 327183 327183 0 0
Suicide

Intervention/exposure
Study type
Interventional
Description of intervention(s) / exposure
The study is conducted in Australia and Indonesia, and all messages in Indonesia will be in Bahasa Indonesia. Below, we describe them in English.

The key research question is whether we can promote help seeking among individuals who have not previously sought help through an online digital advertising intervention using Google Ads by a) addressing possible barriers to help seeking in our messaging and b) providing easy access to help seeking in the interface. .

Participants would receive a landing page on the Google search page when searching for suicide related keywords. Participants were not instructed to search for suicide related keywords, the sample was drawn from individuals who searched for these keywords in Australia and Indonesia.

On the landing page, participants would be first shown a pop up, asking if they had seen a professional, such as a counsellor, psychologist, or psychiatrist for their suicidality. If they hadn't, they would be asked if they had spoken to anyone about their suicidality. If they responded no to either question, they will be entered into one of three arms including one control arm, with the remainder sent straight to the main site with help seeking resources.

Arm 1:

The individual would be presented with messaging and a video addressing possible barriers to help seeking, encouraging them to seek help e.g., having sought help before but met with something unhelpful, or feeling that help seeking is weak. Below, there are help seeking options immediately in the pop up - buttons to call a hotline, open a chat app, or listen to stories of those with lived experience. It would take approximately 3 minutes to explore this page and watch the video.

Arm 2:

The first is an identical page in which a video and messaging is presented, but rather than addressing barriers to help seeking, the messaging revolves around generic messages encouraging help seeking and presentation of statistics. The same help seeking options as above are presented. It would take approximately 3 minutes to explore this page and watch the video.

The third arm is described below in the control treatment.

Upon closing the popup from any of the three arms, they are free to explore the landing page, which provides links to helplines, lived experience stories, relaxation and calming modules. The anticipated time for individuals to complete a module or watch a video is approximately 3 minutes; to consume all the content will need approximately 40 minutes. The landing page was designed for this study, but may link to preexisting content. We tracked their activity using Google analytics accessed through the Google Ads platform. Individuals were randomly assigned to one group or another using Google Experiments feature, which enabled us to randomly show on ads and landing pages from one set of campaigns or another.

The secondary research question, that is observational by nature, is whether we are able to reach individuals who have not sought help, by assessing what proportion of individuals who answer the first two questions say no to either.
Intervention code [1] 326410 0
Prevention
Comparator / control treatment
The control condition; Arm 3:

The control condition is identical to Arm 2, but the help seeking options are not present, and instead the individual must close the popup and explore the main site to seek help. This is to investigate whether having the options present, making it easy to access help, increases help seeking.

These pages were designed specifically for this study, and we will analyse people's behaviours on these control condition pages using Google analytics.
Control group
Active

Outcomes
Primary outcome [1] 335206 0
Engagement with help seeking options. A single unit of engagement, or 'conversion' is counted with the individual performs one of these behaviours on the pop up or main website, including:

1. To call a hotline
2. Open a chat app with the intention to share
3. Listens to stories of individuals with lived experience of suicide, or watches any other video on the site
4. Open a psychologist directory
5. Spends more than 5 minutes on the site
6. Completes a self help module
7. Opens urgent support directory

These behaviours are all determined through co-design as activities beneficial in reducing suicidal distress or promoting help seeking, and counted as two groups: Calling a hotline or seeking psychologist help counts as seeking professional help, while opening Whatsapp is counted as seeking peer help. Engagement with site will be assessed as a composite outcome.
Timepoint [1] 335206 0
These outcomes are measured as the individual interacts with the webpage. Thus, there is no lag between the intervention and measurement, as we are measuring engagement, and not other health related outcomes.
Secondary outcome [1] 428535 0
The secondary outcome is obtaining what proportion of individuals who have not sought social help the campaign reaches.

By asking individuals if they have spoken to anyone at all, we can obtain the proportion of individuals who have and have not sought social help, that our campaign is reaching.
Timepoint [1] 428535 0
These outcomes are measured as the individual interacts with the webpage. Thus, there is no lag between the intervention and measurement.
Secondary outcome [2] 428536 0
The secondary outcome is obtaining what proportion of individuals who have not sought professional help the campaign reaches.

By asking individuals if they have sought professional help, we can obtain the proportion of individuals who have and have not sought professional help, that our campaign is reaching.
Timepoint [2] 428536 0
These outcomes are measured as the individual interacts with the webpage. Thus, there is no lag between the intervention and measurement.

Eligibility
Key inclusion criteria
Living in Australia or Indonesia, having clicked on the ad, and answered the first question on the pop up, as described in the intervention section.
Minimum age
13 Years
Maximum age
No limit
Sex
Both males and females
Can healthy volunteers participate?
Yes
Key exclusion criteria
None.

Study design
Purpose of the study
Prevention
Allocation to intervention
Randomised controlled trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Allocation is concealed centrally by using Typeform randomisation, in which if they indicate 'no' to either initial question, they will be allocated randomly to Arms 1,2 or 3. The individual will not know that there is more than one version of the campaign, and thus allocation is concealed. Each individual will only be exposed to one condition.
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Sequence generation and random allocation is done using Google Experiments, which allows us to randomly show landing pages from one or more sets (also known as A/B testing).
Masking / blinding
Blinded (masking used)
Who is / are masked / blinded?
The people receiving the treatment/s
The people administering the treatment/s
The people assessing the outcomes
Intervention assignment
Parallel
Other design features
Phase
Not Applicable
Type of endpoint/s
Statistical methods / analysis
To analyse help seeking in this study, we will compare rates (eg, click-through rates or conversion rates), and we will use the MedCalc software (MedCalc Software Ltd), which uses a chi-square test to test a significant incidence rate difference (IRD), set to a significance rate of .05.

To compare proportion of individuals reached who have not sought help we will conduct significance tests comparing the proportion with pre set values. The literature estimates 50 - 60% of individuals having not sought help prior. We define the categories as follows: 0% - 20% (not reaching individuals who have not sought help), 20% - 50% (underrepresentation of people who have not sought help), 50% - 60% (representative, and reaching people who have not sought help), 60 - 70% (over representation of people who have not sought help), 70% + (primarily reaching people who have not sought help). We will do this separately for those who have not sought professional help, and have not sought social help.



Recruitment
Recruitment status
Not yet recruiting
Date of first participant enrolment
Anticipated
30/11/2023
Actual
Date of last participant enrolment
Anticipated
29/12/2023
Actual
Date of last data collection
Anticipated
29/12/2023
Actual
Sample size
Target
800
Accrual to date
Final
Recruitment in Australia
Recruitment state(s)
ACT,NSW,NT,QLD,SA,TAS,WA,VIC
Recruitment outside Australia
Country [1] 25614 0
Indonesia
State/province [1] 25614 0

Funding & Sponsors
Funding source category [1] 314062 0
Government body
Name [1] 314062 0
Australia Indonesia Institute, Department of Foreign Affairs and Trade
Country [1] 314062 0
Australia
Primary sponsor type
University
Name
UNSW Sydney
Address
UNSW Sydney, High Street, Kensington, NSW 2052, Australia
Country
Australia
Secondary sponsor category [1] 316088 0
None
Name [1] 316088 0
None
Address [1] 316088 0
None
Country [1] 316088 0
Other collaborator category [1] 282723 0
Charities/Societies/Foundations
Name [1] 282723 0
Emotional Health for All Foundation
Address [1] 282723 0
IIM Center, Jl. Radio Dalam Raya No.9A, RT.6/RW.4, North Gandaria, Kebayoran Baru, South Jakarta City, Jakarta 12140, Indonesia
Country [1] 282723 0
Indonesia

Ethics approval
Ethics application status
Approved
Ethics committee name [1] 313198 0
The University of New South Wales Committee B
Ethics committee address [1] 313198 0
Research Ethics & Compliance SupportUNSW SydneySydney NSW 2052 Australia
Ethics committee country [1] 313198 0
Australia
Date submitted for ethics approval [1] 313198 0
05/10/2021
Approval date [1] 313198 0
26/11/2021
Ethics approval number [1] 313198 0

Summary
Brief summary
Research has revealed that 50% - 60% of individuals do not seek help prior to a suicide attempt, thus it is imperative we find new ways to reach them. One way to reach them is to use a Google Ads campaign, in which a person visiting the website is asked if they have previously sought help before, with the intention of providing more relevant offerings. In this study, we assess the impact of reducing the effort needed by individuals to seek help on help seeking.
Trial website
Trial related presentations / publications
Public notes

Contacts
Principal investigator
Name 127318 0
Dr Sandersan Onie
Address 127318 0
Black Dog Institute, Hospital Road, NSW 2031, Sydney, Australia
Country 127318 0
Australia
Phone 127318 0
+61 2 9065 9181
Fax 127318 0
Email 127318 0
s.onie@blackdog.org.au
Contact person for public queries
Name 127319 0
Dr Sandersan Onie
Address 127319 0
Black Dog Institute, Hospital Road, NSW 2031, Sydney, Australia
Country 127319 0
Australia
Phone 127319 0
+61 2 9065 9181
Fax 127319 0
Email 127319 0
s.onie@blackdog.org.au
Contact person for scientific queries
Name 127320 0
Dr Sandersan Onie
Address 127320 0
Black Dog Institute, Hospital Road, NSW 2031, Sydney, Australia
Country 127320 0
Australia
Phone 127320 0
+61 2 9065 9181
Fax 127320 0
Email 127320 0
s.onie@blackdog.org.au

Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
No
No/undecided IPD sharing reason/comment
We will not be collecting individual level data.


What supporting documents are/will be available?

No Supporting Document Provided



Results publications and other study-related documents

Documents added manually
No documents have been uploaded by study researchers.

Documents added automatically
No additional documents have been identified.