Wellness4Teachers Supportive Text Messaging Program Association with Observed Improvement in Psychological Symptoms Among Teachers in Canada: A Single-arm Prospective Longitudinal and Naturalistic Controlled Study.

BACKGROUND: Wellness4Teachers is a daily supportive text messaging program implemented to mitigate psychological distress and support the wellbeing of teachers in Canada.

OBJECTIVE: To assess whether Wellness4Teachers can reduce the severity and prevalence of psychological issues and improve resilience among teachers in Alberta, Newfoundland and Labrador, and Nova Scotia.

METHODS: This study used a single-arm prospective longitudinal design with a secondary exploratory naturalistic contemporaneous comparison. Teachers self-subscribed to Wellness4Teachers text messaging program for six months, and completed web-based surveys. The program was launched at the beginning of the 2022-2023 academic year. Longitudinal outcomes were assessed at baseline, six weeks, three months, and six months. The naturalistic comparison included an intervention group (IG) who received messages for six months and completed six-month assessments between March 1 and June 30, 2023, and a comparison group (CG) who enrolled and completed baseline assessments during the same period before receiving messages. Standardized scales were used for assessing psychological symptoms. Likely Generalized Anxiety Disorder (GAD), likely Major Depressive Disorder (MDD), resilience, burnout, and stress were assessed using the GAD-7 scale, the Patient Health Questionnaire (PHQ)-9, the Brief Resilience Scale, the Maslach Burnout Inventory-Educator Survey (MBI-ES) and the Perceived Stress Scale (PSS-10) respectively. Data analysis was conducted using SPSS (version 28.0). Paired-samples t-tests assessed longitudinal changes, while independent-samples t-tests compared groups. McNemar and chi-square tests examined categorical variables. Missing follow-up data were addressed using last observation carried forward, with sensitivity analyses comparing baseline scores with those at 6 weeks, 3 months, and 6 months. Independent-samples t-tests and chi-square tests compared baseline psychological scores and categorical characteristics between follow-up completers and non-completers.

RESULTS: In the longitudinal analysis, PSS-10, MBI-EE subscale, PHQ-9, PHQ-9 Item 3 (sleep disturbance), PHQ-9 Item 9 (suicidal ideation/self-harm), and GAD-7 scores decreased significantly at six months by 5.50% (MD=1.29, 95% CI:0.86-1.72), 4.48% (MD=1.67, 95% CI:0.43-2.92), 18.58% (MD=2.10, 95% CI:1.39-2.80), 17.54% (MD=0.30, 95% CI:0.15-0.44), 37.50% (MD=0.09, 95% CI:0.02-0.17), and 13.52% (MD=1.30, 95% CI:0.62-1.99), respectively. Likely MDD decreased from 55.2% (n=116) to 41.0% (n=86), a 14.2% reduction. In the exploratory contemporaneous comparison, the IG (n=166) had lower PSS-10 (6.04%; MD= -1.41, 95% CI: -2.17 to -0.65), PHQ-9 (21.16%; MD= -2.33, 95% CI: -3.59 to -1.06), and GAD-7 (22.48%; MD= -2.19, 95% CI: -3.39 to -0.98) scores than the CG (n=152). Likely MDD and GAD prevalence were 20.6% and 20.3% lower, respectively. Adjusted analyses showed intervention-group status was associated with lower odds of high stress (OR=0.42, 95% CI:0.19-0.95), likely MDD (OR=0.47, 95% CI:0.28-0.81), and likely GAD (OR=0.37, 95% CI:0.21-0.64).

CONCLUSIONS: Wellness4Teachers was associated with improvements in several psychological outcomes over six months and may offer a promising approach to support teachers' psychological wellbeing.

INTERNATIONAL REGISTERED REPORT: RR2-10.2196/37934.