The Zen Buddies Initiative BACKGROUND : Primary research from universities around the world has shown that postgraduate students experience significant amounts of stress and anxiety which negatively impacts their mental health ( 1 ) This is even worse among international postgraduate students who frequently have to also deal with social isolation ( 2 , 3 ) AIM : Using the Nutbeam et al planning model ( 4 ), this multi - pronged initiative is designed to improve the mental health of international postgraduate students by applying evidence - based techniques of combating stress , anxiety and loneliness SOLUTION PLANNING This is the second stage of the Nutbeam planning model In order to ensure its effectiveness, the Zen Buddies initiative is grounded in a behavioural change theory – the Integrated Theory of Health Behaviour Change ( 5 ) This theory states that health behaviour change can be achieved by : ❑ Fostering knowledge about the problem ❑ Increasing self - regulation skills ❑ Enhancing social facilitation Accordingly, this initiative consists of elements that address each of these 3 cardinal points : 1. Knowledge : The initiative features a n 8 - week online course on evidence - based methods of coping with stress, to be developed in collaboration with NHS 2. Self - regulation : Participants will practice effective time - management, proper diet and the use of a stress ball (to be provided for free) 3. Social facilitation : this is the buddy component of the intervention where participants will provide social support to one another, in groups of 3 students living in the same hall THE SIX BENCHMARKS OF SOCIAL MARKETING ( 9 ) 1. Behaviour change : The Zen Buddies initiative aims to help participants adopt personal and social behaviours that are beneficial to their mental health 2. Audience research was carried out among international PG students in the University of Glasgow to identify mental health as a pertinent concern It also informed the choice of residence halls for convenient participation, as students are already busy enough as it is 3. Audience segmentation : For maximal efficiency, the initiative is targeted at the specific niche of international postgraduate students living in halls of residence 4. Exchanges : In exchange for their time and involvement, participants are offered social support and an improved mental health The stress ball is an additional tangible incentive 5. Marketing Mix : Product – social support, stress management & improved mental health Price – the cost of participation is minimal (mostly time) Place – the venue of the exchange is at participants` halls of residence, enabling convenient participation Promotion – stress management messages will be communicated to participants through online videos, a medium popular with students 6. Competition : The course will include messages about the inappropriateness of unhealthy alternative ways of managing stress, such as smoking, drinking and the use of drugs METHODOLOGY This includes the 3 rd and 4 th stages of the Nutbeam planning model (4) – program design and implementation strategy SETTING For ease of delivery and participation, this initiative is aimed at international postgraduate students living in university halls of residence. SELECTION Adverts will be posted in target accommodations, on campus, and via email to all postgraduate students. (See sample social marketing poste r to the left). Selection criteria : International postgraduate students living in halls of residence for the next 8 weeks at least. Three popular halls will be used for this pilot study: Maclay residence, Kelvinaugh street and Firhill court. A paired samples t - test will be used for analysis. This will require 34 participants to detect a medium effect size (E = 0.50) at α = 0.05 and a power of 80%. To account for loss to follow up, the study will recruit 39 participants (13 groups of 3 buddies per group) IMPLEMENTATION The initiative is based on the 3 components of the Ryan Polly`s Integrated Theory of Health Behaviour Change ( 5 ) : Knowledge improvement , Self - regulation and Social facilitation 1. Knowledge : An 8 - week course on methods of coping with stress This will be developed in collaboration with the NHS and delivered in the form of weekly 2 - hour online videos for convenient participation The training will help participants develop two evidence - based practical skills for coping with stress and anxiety ( 6 ) : ▪ E ffective Relaxation (using meditation, breathing exercises & music), and ▪ C ognitive R eappraisal of potential stressors 2. Self - regulation : In addition to the taught coping skills, participants will practice ▪ Effective time - management ▪ Balanced diet, and ▪ U se of a stress ball (free ) Although the body of evidence for the use of stress balls is rather underwhelming ( 7 ), it is a fun and attractive addition to the toolkit A diary will be provided for participants to record their thoughts and activities 3. Social facilitation : this is the buddy component of the intervention, where participants will provide social support to one another – an established method of combating loneliness and stress ( 8 ) Participants will be randomly assigned to groups of 3 buddies living in the same hall of residence Buddies will jointly carry out two activities : ▪ Socialize for 2 hours at a venue of their choosing, twice weekly This could be at the common room, at a buddy`s living room, or at a nearby recreational park ▪ As physical activity has been shown to improve mental health, buddies will carry out some form of physical activity together, twice weekly This could be playing table - tennis in the hall sports centre or jogging together around the block EVALUATION This is the final phase of the Nutbeam planning model This will involve both process and outcome evaluation Process evaluation will be done for the purpose of quality assurance and to inform the upscaling of this initiative across campus Participants will indicate how convenient they found they process, if the frequency of socialization and exercises was appropriate, possible unintended consequences, and any other pertinent feedback Outcome evaluation will be carried out to quantify the effectiveness of the initiative At the start of the study, participants` mental health status will be assessed by having them fill the Depression, Anxiety & Stress (DAS) scale, a validated 42 - item questionnaire used to assess mental health states ( 10 ) The questionnaire will be filled again after the completion of the study Then the paired samples t - test will be used to evaluate the effectiveness of the intervention REFERENCES 1 Garcia - Williams AG, Moffitt L, Kaslow NJ Mental health and suicidal behavior among graduate students Acad Psychiatry 2014 ; 38 ( 5 ) : 554 - 60 2 Hyun J, Quinn B, Madon T, Lustig S Mental Health Need, Awareness, and Use of Counseling Services Among International Graduate Students Journal of American College Health 2007 3 Forbes - Mewett H, Sawyer A - M International students and mental health Journal of International Students, 2016 Vol 6 ( 3 ) 2019 ; 6 ( 3 ) : 661 - 77 4 Nutbeam D, Harris E, Wise W Theory in a nutshell : a practical guide to health promotion theories 2010 5 Ryan P Integrated Theory of Health Behavior Change : background and intervention development Clin Nurse Spec 2009 ; 23 ( 3 ) : 161 - 72 6 Galbraith ND, Brown KE Assessing intervention effectiveness for reducing stress in student nurses : quantitative systematic review J Adv Nurs 2011 ; 67 ( 4 ) : 709 - 21 7 Kasar KS, Erzincanli S, Akbas NT The effect of a stress ball on stress, vital signs and patient comfort in hemodialysis patients Complement Ther Clin Pract 2020 ; 41 : 101243 8 Hefner J, Eisenberg D Social support and mental health among college students Am J Orthopsychiatry 2009 ; 79 ( 4 ) : 491 - 9 9 Andreasen AR Marketing Social Marketing in the Social Change Marketplace Journal of Public Policy & Marketing 2002 ; 21 ( 1 ) : 3 - 13 10 Lovibond S H LPF Manual for the Depression Anxiety & Stress Scales 2 ed Sydney : Psychology Foundation ; 1998 FOLLOW - UP Will be carried out for up to 2 years after completion of the intervention, to provide further support and monitor progress. Knowledge Participants will be taught: • Effective relaxation • Cognitive reappraisal Self - regulation Participants will practice • Time management • Balanced diet • Use of stress ball Social Facilitation In groups of 3 buddies, participants will: • Socialize • Exercise Improved Mental Health Status Participants adopt and practice mental health - friendly behaviour LOGIC MODEL (Based on the Integrated Theory of Health Behaviour Change) ID 2589302 University of Glasgow Proximal Outcome Distal Outcome