Evaluating a mobile health intervention (GUIDE app) for first responders, military personnel, and Veterans: Randomized controlled trial

Abstract: Background: First responders, military personnel, and veterans face disproportionate risk for mental health and wellness issues. Stigma and confidentiality are common barriers to traditional services. Mobile health interventions offer anonymous, convenient, and cost-effective alternatives. Objective: This study aimed to evaluate the impact of GUIDE, a mobile health intervention, on wellness, emotional well-being, mental health, social connectedness, and personal growth in first responders, military personnel, and veterans. Methods: In this unblinded, randomized, waitlist-controlled trial, 115 participants recruited online and offline were virtually enrolled and allocated into 3 groups: GUIDE with financial incentives (GUIDE+incentives, n=37), GUIDE-only (n=39), or waitlist control (n=39). Web-based surveys assessed baseline and posttrial wellness (PERMA [Positive Emotion, Engagement, Relationships, Meaning, Accomplishment] Overall, World Health Organization 5-item Well-being Index, Personal Well-being Score, and PERMA Health), emotional well-being (PERMA Positive Emotion, Negative Emotion, and Happiness; and Difficulties in Emotion Regulation Scale), mental health (Patient Health Questionnaire-8 [depression] and Generalized Anxiety Disorder-7 [anxiety]), social connectedness (PERMA Relationships and Loneliness), and personal growth (PERMA Accomplishment, Meaning, and Engagement). App engagement and technical merit were also evaluated. Results: Among the participants, 93.0% (107/115) completed the posttrial assessment and were included in the main analysis. In repeated measures ANOVAs, there were no significant group×time interactions for wellness (ηp2=0.02-0.04), emotional well-being (ηp2=0.01-0.12), mental health (ηp2=0.01-0.02), social connectedness (ηp2=0.03-0.04), and personal growth (ηp2=0.01-0.02) (P≥.05). In post hoc pairwise comparisons of pre-post deltas per group, the GUIDE-only group showed significant improvements over the waitlist control group in wellness (d=0.05-0.31), emotional well-being (d=0.06-0.31), depression (d=–0.30), and anxiety (d=–0.29) (P<.05). No group differences were significant for social connectedness (d=–0.20 to 0.20) or personal growth (d=–0.04 to 0.06) (P≥.05). Among participants allocated to GUIDE interventions, 67% (51/76) completed at least three activities weekly. Compared to the GUIDE-only group, the GUIDE+incentives group completed significantly more activities (t72=2.01; P=.05), posts (t72=2.15; P=.04), and replies (t72=3.40; P=.001) but not lessons (t72=0.73; P=.47), likes (t72=1.22; P=.23), or mood surveys (t72=0.48; P=.63). App engagement correlated with improvements in wellness, emotional well-being, mental health, and personal growth measures, driven by educational and peer-support features. Participants who engaged more felt more accomplished, regardless of the features used (r=0.23-0.36). GUIDE had good appropriateness (mean 4.01) and feasibility (mean 4.01) scores, and satisfactory acceptability (mean 3.81) and usability (mean 70.62) scores. Exploratory subgroup analyses suggested that GUIDE may be most beneficial to military-affiliated and male individuals. Conclusions: GUIDE is a feasible and appropriate intervention with the potential to improve the mental health and well-being of first responders, veterans, and military personnel. Financial incentives increased engagement with peer-support features but did not lead to significant improvements over waitlist controls. Future research should assess whether improvements are sustained in the long term. Trial Registration: ClinicalTrials.gov NCT06336967; https://clinicaltrials.gov/study/NCT06336967