Applying the Theory of Planned Behaviour to investigate mental health help-seeking among older adults in Australia

Participants in the intervention group will received a brochure aimed at promoting mental health help-seeking based on the Theory of Planned Behaviour (TPB). The intervention was developed specifically for this study by the primary researcher, who is a registered psychologist, with support from the research team. During the development phase, a consultative group of key stakeholders were interviewed to inform the design, layout and content of the intervention, including primary health care providers, mental health professionals, health care executives, representatives from community organisations, and consumers. The intervention includes behaviour change messages targeting the three main components of the TPB: attitudes, subjective norms, and perceived behavioural control. Messages designed to promote favourable attitudes towards help-seeking aim to communicate that help-seeking is a good and useful thing to do. Examples include ‘speaking about your concerns is the best thing to do’, ‘mental health problems can be prevented and treated’, and ‘it will be useful for you and for others if you speak about your concerns’. Messages to promote favourable subjective norms aim to increase perceived social support and reduce mental health-related stigma. Examples include ‘we all have fears and concerns from time to time’, ‘when you experience such concerns you are not alone’, and ‘your doctor expects you to talk about your concerns.’ Messages to promote perceived behavioural control aim to strengthen self-efficacy and reinforce personal choice in help-seeking. Examples include ‘speaking with a doctor about your concerns helps you to take control of your health,’ and ‘it is important to find a doctor who you can trust, and who will work with you to choose the services and treatments that suit your needs’. The intervention also addresses barriers to help-seeking and includes mental health literacy messages as suggested by previous research and stakeholders. Key barriers to help-seeking identified and addressed include normalisation of the problem, perceived need, and burdening others. Examples of messages targeting perceived barriers include ‘sometimes people don’t want to speak with their doctor, because they think that its normal to get less enjoyment from life as they get older. There is little evidence to suggest this is the case,’ ‘it doesn’t matter how mild or severe your symptoms are’, and ‘you are not burdening others by talking about your mental health’. Mental health literacy information includes details on how and where to seek help, and what treatment options are available. For example, ‘talk to your doctor when you are experiencing symptoms such as headaches and pain, or feel unhappy or down,’ ‘options may include changes to your diet, exercise, day to day activities, medication, or referral to a mental health professional, and ‘the following organisations provide information and support…’. The brochure will be presented to participants as part of an online survey. Graphic images of each page of the brochure will be presented to participants in the intervention group, and participants will be asked to download a pdf copy of the brochure to read and retain. Participants will be able to read the brochure at their own pace. Whilst we are not monitoring adherence, time spent reviewing the brochure will be used as a proxy measure.