Table 2 Summary table of studies included in the systematic review of the literature

Bendtsen et al. 2020 [24]

Sweden

Title—A Mobile Health Intervention for Mental Health Promotion Among University Students: Randomised Controlled Trial

Participants – N = 654. University students, who could read and understand Swedish; and had access to a mobile phone (intervention group: N = 348; control group: N = 306; mean age: 25 years)

To estimate the effect of a fully automated mHealth intervention on positive mental health, and anxiety and depression symptomatology among Swedish university students using a randomised controlled trial design

Randomised control trial. A 2-arm, single-blind (researcher), parallel groups. The programme lasted 10 weeks. A new topic was introduced each week

Intervention group exposed to a mHealth positive psychology programme

Control group exposed to relevant online mental health information

The intervention was a fully automated mHealth positive psychology multi-component programme. The programme included wellbeing information, validated self-help exercises, short tips, self-monitoring and personalised feedback. Text messages were sent to users throughout the programme, with an average of one text message per day, containing text and links to interactive exercises and further reading

Using an automated mobile phone format improved positive mental health. The mHealth intervention was estimated to be superior to usual care in increasing positive mental health among university students

The intervention also had a protective effect on depressive and anxiety symptoms. These findings demonstrate the feasibility of using an automated mobile phone format to improve positive mental health, which holds promise for the use of mHealth solutions in public mental health promotion

Hall et al. 2018 [25]

China

Title – An evaluation of a low intensity mHealth enhanced mindfulness intervention for Chinese university students: A randomised controlled trial

Participants— N = 101. University students (intervention group: N = 76; control group: N = 25; mean age: 22.3 years)

To evaluate a low-cost scalable mindfulness intervention programme to improve psychological health and sleep quality in Chinese university students

Randomised controlled trial. Participants were randomised to 4 groups: Group 1: control group (N = 25), Group 2: (N = 27), Group 3: (N = 24), and Group 4: (N = 25)

Low-cost, scalable mindfulness intervention programme to improve mental health and sleep quality

Intervention groups consisted of: group 2—mindfulness only; group 3—mindfulness with plain-text reminders; group 4—mindfulness with enhanced text reminders featuring animal memes

The mindfulness intervention included two in-person guided sessions and seven weeks of weekly self-guided practice

The findings suggest that low-intensity mindfulness interventions may be a useful programme in university settings

Wong et al. 2021 [26]

China

Title – An Interactive Web-Based Sexual Health Literacy Program for Safe Sex Practice for Female Chinese University Students: Multicenter Randomised Controlled Trial

Participants— N = 746. Female Chinese university students at 5 dormitories in Hong Kong (intervention group: N = 362; control group: N = 384; mean age: 21.5 years)

Describes the development and systematic evaluation of a web-based sexual health literacy intervention called “Smart Girlfriend” for female Chinese university students

Multicentre randomised controlled trial. Participants were randomised to 2 groups

The development and systematic evaluation of a web-based sexual health literacy intervention called "Smart Girlfriend"

Intervention group—received an interactive web-based sexual health literacy intervention

Control group—received a single web page of online information about condom use

The intervention content was based on the Health Belief Model and the Continuum of Conflict and Control theory

An interactive web-based sexual health literacy programme did not significantly increase condom use consistency compared to a single webpage of condom use information, but it did temporarily improve knowledge, attitudes, norms and self-efficacy regarding condom use

Saleh et al. 2021 [27]

France

Title – Can we learn to manage stress? A randomised controlled trial carried out on university students

Participants— N = 128. University students (intervention group: N = 64; control group: N = 64; mean age: 21.54 years)

Measure the efficacy of an online stress management program for university students based on several mental health variables: self-esteem, perceived stress and its two subfactors (perceived helplessness and perceived self-efficacy), psychological distress and its four subfactors (somatic symptoms, anxiety/insomnia, social dysfunction, severe depression) and satisfaction with studies

Randomised controlled trial. Subjects were randomly assigned to one of two groups

Online stress management programme called “I’m managing my stress”

Intervention group: online programme consisted of four sessions of 20 min each, including psychoeducation, practical exercises and one to two weekly activities that the participant is asked to complete (task prescription as in cognitive behavioural techniques). The aim was for the participants to learn simple techniques to help them cope better with stressful situations

Control group: did not follow the programme

This type of internet-based programme has the potential to reach many students due to its relatively short format and accessibility. It has already shown improvements in levels of perceived stress, psychological distress and satisfaction with study

The option of online interventions could appeal specifically to students who do not seek professional help

Apolinário-Hagen et al. 2021 [28]

Germany

Title – Exploring the influence of testimonial sources on attitudes towards e-mental health interventions among university students: Four-group randomised controlled trial

Participants – N = 451. University students (intervention group: N = 339; control group: N = 112, mean age: 32.6 years)

To explore the extent to which different ways of targeting students with information affect their attitudes towards eMHS for stress prevention and treatment, and to identify potential determinants of attitude change

Randomised controlled trial

Transmission of only general information on the eMHS to the participants

Control group: arm 1—participants only received general information about electronic mental health services

Intervention groups: arm 2: transmission of general information to participants about SSME's and non-specific testimonies; arm 3: participants received general information about eMHSs and work-related testimonials; arm 4: transmission of general information to participants about SSME's and testimonies directed at student workers

Overall, this study found no significant effect of information on attitudes and limited evidence for the benefits of tailored narrative messages

Heeren et al. 2017 [29]

United States of America

Title – Health-Promotion Intervention Increases Self-Reported Physical Activity in Sub-Saharan African University Students: A Randomised Controlled Pilot Study

Participants – N = 176. University students (intervention group: N = 85; control group: N = 91, mean age: 20.84 years)

To evaluate the efficacy of a health-promotion intervention in increasing self-reported physical activity among university students in Sub-Saharan Africa

Randomised control trial

Each intervention consisted of 8, 45-min modules, with 2 modules implemented during each of 4 weekly sessions. Each intervention was highly structured and involved interactive exercises, games, brainstorming, role-playing, videos, and group discussions implemented in mixed-gender groups of 7 to 11 participants (mean group size = 8.8) led by co-facilitator pairs using standardised intervention manuals

The health-promotion intervention was designed to increase knowledge, attitudes, self-efficacy, and skills to prevent NCDs by increasing physical activities, choosing healthy diets, and limiting alcohol use

Control group: participants exposed to an intervention to reduce the risk of HIV, with the reduction of unprotected sex and multiple sexual partners, with 8 modules

The findings suggest that theory-based, contextually appropriate interventions may increase physical activity among university students in Sub-Saharan Africa

Participants in the health promotion intervention were more likely to meet physical activity guidelines

Health promotion participants reported a greater number of days of vigorous-intensity and moderate-intensity aerobic activity, but not of muscle-strengthening activity. The intervention reduced self-reported servings of fried foods

Kim et al. 2018 [30]

United States of America

Title – Promoting physical activity using a wearable activity tracker in college students: A cluster randomised controlled trial

Participants – N = 187. College students (intervention group: N = 101; control group: N = 86, mean age: 20.09 years)

To investigate the effects of using a wearable activity tracker in a credit-based physical activity instruction programme (PAIP) to promote physical activity (PA) in college students

Randomised controlled trial in which students from fourteen courses of the Physical Activity Instruction Programme (PAIP) at a large public university

Participants in the intervention groups were provided with a small, lightweight activity tracker, the Misfit Flash, which can be worn with a clasp or wristband. A handout was provided with step-by-step instructions on how to use the activity tracker with the Misfit app on smartphone

The detailed features of the Misfit app include: activity tracking (total steps, calories burned, distance run and/or walked, and activity points calculated from these three measures), personalised goal setting, standardised behavioural feedback, and social community support, which are the essential components facilitating self-directed behavioural change. Control group participants received no additional instruction beyond the scheduled classroom activities based on the standardised PAIP core curriculum

Taken together, the present study found null effects of using the wearable activity tracker to promote physical activity in college students, suggesting that primary intervention using the wearable activity tracker as a behaviour change strategy may not be effective in increasing physical activity in this setting

Rosenberg & Hamiel 2018 [31]

Israel

Title—Reducing Test Anxiety and Related Symptoms Using a Biofeedback Respiratory Practice Device: A Randomised Control Trial

Participants – N = 22. University students (intervention group: N = 17; control group: N = 5, mean age: 25.10 years)

Investigate simple self-help interventions to reduce test anxiety

Randomised controlled trial. It investigated a simple behavioural intervention—the use of breathing tools—as an exclusive therapy for test anxiety. Specifically, the effectiveness of a biofeedback breathing training device was investigated

Behavioural and psychoeducational interventions. Intervention groups: 2 intervention groups were created: the biofeedback device group and the self-directed breathing exercise group

Participants completed the Test Anxiety Inventory (TAI) and were given the CalmiGo® device to use for two weeks, after which they were told they would take part in a simulation of an intelligence test. Control group: participants who received the same psychoeducation and general instructions as the other 2 groups

The findings support the notion that the use of biofeedback respiratory devices can reduce students' test anxiety symptoms

Viskovich & Pakenham 2019 [32]

Australia

Title – Randomised controlled trial of a web‐based Acceptance and Commitment Therapy (ACT) program to promote mental health in university students

Participants – N = 437. University students (intervention group: N = 249; control group: N = 188, mean age: 26.85 years)

To evaluate the effectiveness of a web‐based ACT mental health promotion intervention, called YOLO (You Only Live Once)

Randomised controlled trial, in which participants were randomised to the intervention or to the waiting list

Intervention group: exposure to the web-based mental health promotion programme called YOLO for 4 weeks. The web-based intervention for college students (animated presentations, video clips, audio files, and written exercises) consisted of four 30- to 45-min sessions of 4 modules, each targeting one or two of the six core processes of Acceptance and Commitment Therapy (ACT). There was no face-to-face contact with the programme facilitators. The topics of the modules were: Module 1—Values and Commitment, Module 2—Cognitive Defusion, Module 3—Acceptance, and Module 4—Mindfulness and 'I as Context'. The exercises in the programme lasted from 5 to 15 min

Control group: participants on the waiting list (completed the assessment instruments at the same time as those in the intervention group). They did not receive any intervention

The results support a web-based ACT intervention to promote mental health in university students

Analyses showed significant improvements from pre- to post-intervention compared to wait-list control on all primary outcomes and ACT processes. All intervention gains were maintained at follow-up. Improvements in all primary outcomes were mediated by three or more ACT processes in both samples. Intervention effects were consistent in both sample groups