Helping farmers to better cope with things beyond their control

We will test whether a low cost, self-help intervention based on Acceptance and Commitment Therapy (ACT), is perceived as acceptable and helpful by Australian farmers, improves their wellbeing, and leads to effective coping when faced with future challenges. The intervention was developed in close collaboration with Australian farmers and a range of organisations from across the academic, agricultural, health and financial sectors. It has a particular focus on teaching farmers skills to cope more effectively with things beyond their control (e.g. droughts, fluctuating markets, disease outbreaks, government regulations). The program is being developed in the Sansom Institute for Health Research at the University of South Australia in collaboration with the University of Adelaide, the National Centre for Farmer Health, the Freemasons Foundation Centre for Men's Health, Livestock SA and the Freemasons Foundation. MATERIALS The intervention was developed based on ACT by a clinical psychologist with consumer input. All content has been reviewed by an independent clinical psychologist and a social worker with knowledge of rural and drought-related issues. The intervention website contains five ACT-based modules that include strategies to foster the key ACT processes of defusion, acceptance, values, here and now and psychological flexibility. Users will create a profile (using a pseudonym if preferred) upon first logon. The content starts off with a quiz and practical psychoeducation information sheets. Users are then given carefully tailored feedback and advice, based on their results. Users are given the option of printing off the results of their online assessment and a script that will guide a conversation about their mental health with their GP. Users will also be presented with a short video that will show someone else having that conversation with their GP. Users are able to log on at any time of the day or night. The intervention is a free, password protected resource written for a low reading age, in a friendly way with appropriate humor and farming related metaphors and examples, and fits with farmers’ ethos of stoicism and determination to help themselves. Features include automated text message reminders and messages of support, and a very simple website navigation design suitable for use on desktop, laptops, iPads/tablets and mobile devices. At the end of each module, the program will put together a list of strategies that users can choose to save to their profile or 'toolbox'. PROCEDURES People who are interested in participating will access the website and will then be presented with an online information sheet and a consent form including screening questionnaire. Consenting participants will then proceed to a page to set up a profile/login, then move on to a suite of validated measures (see 'Outcomes') online and proceed to the online intervention. As detailed above, the first stage of the intervention will provide participants with feedback on their current levels of well­-being and inform them if their scores suggest that they should seek professional face-to-face mental health help. More specifically, based on their distress score, they will be advised whether they are experiencing what is considered a low, medium, or high level of distress. They will also be given information on how to seek professional help and be reminded about how to return to their online intervention profile at any time. Participants will be contacted by a suitably qualified member of the research team (clinical psychologist) via phone if their results show that they are highly distressed. All participants will then work through the intervention modules, which are designed to be transdiagnostic (useful for people experiencing a range of problems/conditions and for people who simply want to improve their wellbeing). At the completion of the five modules, participants will be asked to complete the outcome measures. After 6 months, participants will be emailed a reminder and asked to log in and complete the measures again. Once participants have completed all study-related procedures, they will be eligible for a $100 voucher as partial reimbursement for their time and internet expenses. Participants who choose to complete optional additional measures, comprising 34 items, at each of the three time points (baseline, after the completion of the five modules, and after 6 months) will be eligible for an additional $20 voucher as partial reimbursement of the additional time taken. Approximately 20 participants will also be invited to participate in an interview about their participation in the program. Some participants who indicated willingness to be followed up may also be contacted at a later date (e.g. a period of drought) and asked to re­-complete the measures online. Website usage, usability, and acceptability will also be evaluated through website usage data and additional measures. DELIVERY The intervention is delivered online to individuals. Participants complete five modules approximately fortnightly for five weeks, and each module is expected to take approximately 30-40 minutes to complete. Participants can access the intervention anywhere with an internet connection (e.g. laptop, desktop, tablet, mobile). Adherence will be assessed with website usage statistics. Individual-tailored content is embedded within the website. Tailored content is delivered throughout the intervention based on participant responses and demographic variables. For example, in doing the baseline assessment, a user may flag that they are having trouble sleeping so they will be provided with a list of practical things to try to improve the quality of their sleep (e.g. sleep hygiene techniques).