The Effects of Internet-Based Storytelling Programs (Amazing Adventure Against Stigma) in Reducing Mental Illness Stigma With Mediation by Interactivity and Stigma Content: Randomized Controlled Trial

Background Mental illness stigma has been a global concern, owing to its adverse effects on the recovery of people with mental illness, and may delay help-seeking for mental health because of the concern of being stigmatized. With technological advancement, internet-based interventions for the reduction of mental illness stigma have been developed, and these effects have been promising. Objective This study aimed to examine the differential effects of internet-based storytelling programs, which varied in the levels of interactivity and stigma content, in reducing mental illness stigma. Methods Using an experimental design, this study compared the effects of 4 storytelling websites that varied in the levels of interactivity and stigma content. Specifically, the conditions included an interactive website with stigma-related content (combo condition), a noninteractive website with stigma-related content (stigma condition), an interactive website without stigma-related content (interact condition), and a noninteractive website without stigma-related content (control condition). Participants were recruited via mass emails to all students and staff of a public university and via social networking sites. Eligible participants were randomized into the following four conditions: combo (n=67), stigma (n=65), interact (n=64), or control (n=67). The participants of each group viewed the respective web pages at their own pace. Public stigma, microaggression, and social distance were measured on the web before the experiment, after the experiment, and at the 1-week follow-up. Perceived autonomy and immersiveness, as mediators, were assessed after the experiment. Results Both the combo (n=66) and stigma (n=65) conditions were effective in reducing public stigma and microaggression toward people with mental illness after the experiment and at the 1-week follow-up. However, none of the conditions had significant time×condition effects in reducing the social distance from people with mental illness. The interact condition (n=64) significantly reduced public stigma after the experiment (P=.02) but not at the 1-week follow-up (P=.22). The control condition (n=67) did not significantly reduce all outcomes associated with mental illness stigma. Perceived autonomy was found to mediate the effect of public stigma (P=.56), and immersiveness mediated the effect of microaggression (P=.99). Conclusions Internet-based storytelling programs with stigma-related content and interactivity elicited the largest effects in stigma reduction, including reductions in public stigma and microaggression, although only its difference with internet-based storytelling programs with stigma-related content was not statistically significant. In other words, although interactivity could strengthen the stigma reduction effect, stigma-related content was more critical than interactivity in reducing stigma. Future stigma reduction efforts should prioritize the production of effective stigma content on their web pages, followed by considering the value of incorporating interactivity in future internet-based storytelling programs. Trial Registration ClinicalTrials.gov NCT05333848; https://clinicaltrials.gov/ct2/show/NCT05333848

The CONSORT-EHEALTH checklist is intended for authors of randomized trials evaluating web-based and Internet-based applications/interventions, including mobile interventions, electronic games (incl multiplayer games), social media, certain telehealth applications, and other interactive and/or networked electronic applications. Some of the items (e.g. all subitems under item 5 -description of the intervention) may also be applicable for other study designs.
The goal of the CONSORT EHEALTH checklist and guideline is to be a) a guide for reporting for authors of RCTs, b) to form a basis for appraisal of an ehealth trial (in terms of validity) CONSORT-EHEALTH items/subitems are MANDATORY reporting items for studies published in the Journal of Medical Internet Research and other journals / scientific societies endorsing the checklist.
As the CONSORT-EHEALTH checklist is still considered in a formative stage, we would ask that you also RATE ON A SCALE OF 1-5 how important/useful you feel each item is FOR THE PURPOSE OF THE CHECKLIST and reporting guideline (optional).
Mandatory reporting items are marked with a red *. In the textboxes, either copy & paste the relevant sections from your manuscript into this form -please include any quotes from your manuscript in QUOTATION MARKS, or answer directly by providing additional information not in the manuscript, or elaborating on why the item was not relevant for this study. yes: all primary outcomes were significantly better in intervention group vs control partly: SOME primary outcomes were significantly better in intervention group vs control no statistically significant difference between control and intervention potentially harmful: control was significantly better than intervention in one or more outcomes inconclusive: more research is needed Other: Identify the mode of delivery. Preferably use "web-based" and/or "mobile" and/or "electronic game" in the title. Avoid ambiguous terms like "online", "virtual", "interactive". Use "Internet-based" only if Intervention includes non-web-based Internet components (e.g. email), use "computer-based" or "electronic" only if offline products are used. Use "virtual" only in the context of "virtual reality" (3-D worlds). Use "online" only in the context of "online support groups". Complement or substitute product names with broader terms for the class of products (such as "mobile" or "smart phone" instead of "iphone"), especially if the application runs on different platforms. Copy and paste relevant sections from manuscript title (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study The non-web based components are involved in the INTERACT and CONTROL condition only.  e  a  t  u  r  e  s  /  f  u  n  c  t  i  o  n  a  l  i  t  i  e  s  /  c  o  m  p  o  n  e  n  t  s  o  f  t  h  e  i  n  t  e  r  v  e  n  t  i  o  n  a  n  d  c  o  m  p  a  r  a  t  o  r  i  n  t  h  e  M  E  T  H  O  D  S  s  e  c  t  i  o  n  o  f  t  h  e  A  B  S  T  R  A  C  T Mention key features/functionalities/components of the intervention and comparator in the abstract. If possible, also mention theories and principles used for designing the site. Keep in mind the needs of systematic reviewers and indexers by including important synonyms. Copy and paste relevant sections from the manuscript abstract (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "This study compared the effects of four storytelling websites varied on levels of interactivity and stigma content using an experimental design. Specifically, the conditions included an interactive website with stigma-related content (COMBO condition), a noninteractive website with stigma content (STIGMA condition), an interactive website without stigma-related content (INTERACT condition) and a non-interactive website without stigmarelated content (CONTROL condition). Participants were recruited via mass emails to all students and staff of a public university and social networking sites. Eligible participants were randomized into four conditions: COMBO (n=67), STIGMA (n=65), INTERACT (n=64) or CONTROL (n=67). Participants viewed the respective Web page at their own pace. Public stigma, microaggression, and social distance were measured online at pre-experiment, postexperiment, and 1-week follow-up. Perceived autonomy and immersiveness as mediators were assessed at post-experiment." Clarify the level of human involvement in the abstract, e.g., use phrases like "fully automated" vs. "therapist/nurse/care provider/physician-assisted" (mention number and expertise of providers involved, if any).  t  o  -f  a  c  e  a  s  s  e  s  s  m  e  n  t  s  i  n  t  h  e  M  E  T  H  O  D  S  s  e  c  t  i  o  n  o  f  t  h  e  A  B  S  T  R  A  C  T Mention how participants were recruited (online vs. offline), e.g., from an open access website or from a clinic or a closed online user group (closed usergroup trial), and clarify if this was a purely web-based trial, or there were face-to-face components (as part of the intervention or for assessment). Clearly say if outcomes were self-assessed through questionnaires (as common in web-based trials Copy and paste relevant sections from the manuscript abstract (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Participants were recruited via mass emails to all students and staff of a public university and social networking sites." "Participants viewed the respective Web page at their own pace." "Public stigma, microaggression, and social distance were measured online at preexperiment, post-experiment, and 1-week follow-up. Perceived autonomy and immersiveness as mediators were assessed at post-experiment." Copy and paste relevant sections from the manuscript abstract (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Both COMBO (n=66) and STIGMA (n=65) conditions were efficacious in reducing public stigma and microaggression towards people with mental illness at post-and 1-week followup. However, none of the conditions had significant time x condition effects in reducing social distance from people with mental illness. INTERACT condition (n=64) can significantly reduce public stigma at post-but not 1-week follow-up. CONTROL condition (n=67) was not significant in reducing all mental illness stigma outcomes. Perceived autonomy was found to mediate the effect of public stigma, and immersiveness mediated the effect of microaggression." Conclusions/Discussions in abstract for negative trials: Discuss the primary outcome -if the trial is negative (primary outcome not changed), and the intervention was not used, discuss whether negative results are attributable to lack of uptake and discuss reasons. Copy and paste relevant sections from the manuscript abstract (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Internet-based storytelling program with stigma-related content and interactivity elicited the largest effects in stigma reduction, including reductions in public stigma and microaggression, although its difference with Internet-based storytelling programs with stigma-related content only was not statistically significant. In other words, although interactivity could strengthen the stigma reduction effect, stigma-related content was a more critical element than interactivity in reducing stigma. Future stigma reduction efforts should place higher priority in producing effective stigma content in a Web page, followed by considering the value of incorporating interactivity in future Internet-based storytelling programs." Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Mental illness stigma is a globally concerning issue due to its detrimental effects imposed on people with mental illness across various life domains (e.g., education, housing, employment, healthcare) during their recovery and their willingness to seek help [1-3]." "However, the content and design of these Internet-based stigma reduction programs varied largely and limited efforts have been put to investigate the common factors contributing to their effectiveness." "Apart from incorporating the critical determinants, namely education and contact, in stigma reduction, many Internet-based interventions have made use of interactivity and storytelling in their designs and have demonstrated positive results in reducing mental illness stigma [24][25][26][27][28]. Yet, the types of interactivity are diverse and it is unknown whether the addition of interactivity induces significant positive attitudinal changes that should be valued." Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Recently, Internet-based programs tackling mental illness stigma have been established across the globe due to their low cost, accessibility, and scalability [12][13][14]." "Research has also shown that Internet-based and face-to-face stigma reduction programs are equally effective [20,21]." "According to the Systemic Thinking Model, in interactive environments, interactivity allows individuals to be the agent and effect physical environmental changes that best align with their thinking needs and flow [36]." "Research has found interactivity to have a significant role in improving information processing through enhanced motivation, which facilitates stigma reduction [26]. Perceived autonomy and immersiveness have been found to enhance motivation [43,44]" Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "The present experimental study aimed to investigate the effect of Internet-based storytelling programs with the manipulation of stigma-related content and interactivity. In the present study, we hypothesized that an Internet-based storytelling program with a combination of interactivity and stigma content would lead to the most significant reduction in public stigma, microaggression, and social distance from people with mental illnesses, followed by Internet-based storytelling program with stigma content-only and interactivityonly, compared with control. Second, we hypothesized that the effects observed in stigma reduction would be mediated by perceived autonomy and immersiveness due to the presence of interactivity." Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Recruitment was done through sending mass emails to students and staff at a public university in Hong Kong and by posting advertisements on social media." As the whole recruitment procedure was done online, participants successful registered were considered as having an adequate level of computer literacy. Open vs. closed, web-based vs. face-to-face assessments: Mention how participants were recruited (online vs. offline), e.g., from an open access website or from a clinic, and clarify if this was a purely webbased trial, or there were face-to-face components (as part of the intervention or for assessment), i.e., to what degree got the study team to know the participant. In online-only trials, clarify if participants were quasi-anonymous and whether having multiple identities was possible or whether technical or logistical measures (e.g., cookies, email confirmation, phone calls) were used to detect/prevent these. Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Individuals who were interested in participating in the study visited the registration link where they were screened by completing a Web-based survey on basic contact information and age. The experimenter then provided eligible individuals a Zoom appointment link, where individuals indicated their preferred experiment day and time. A Zoom link was given to individuals upon their completion of booking. At the scheduled Zoom experimental session, participants were given detailed information about the study aims, length of the program, and participant involvement. Participants provided informed consent by checking the "I agree" button at the end of the study description page. Afterwards, participants received another Web-based questionnaire link to complete the pre-experiment questionnaire. Participants were then randomly assigned to one of the four experimental conditions through block randomization. Participants completed the pre-, post-, and 1-week follow-up questionnaires on the Web." Information given during recruitment. Specify how participants were briefed for recruitment and in the informed consent procedures (e.g., publish the informed consent documentation as appendix, see also item X26), as this information may have an effect on user self-selection, user expectation and may also bias results. Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "At the scheduled Zoom experimental session, participants were given detailed information about the study aims, length of the program, and participant involvement. Participants provided informed consent by checking the "I agree" button at the end of the study description page." Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Participants completed the pre-, post-, and 1-week follow-up questionnaires on the Web." Clearly report if outcomes were (self-)assessed through online questionnaires (as common in web-based trials) or otherwise. Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "At the end of each Web page experience, participants were provided with a questionnaire link, of which measures microaggression, public stigma, social distance from people with mental illness, perceived autonomy, and immersiveness. One week after the experimental session, participants completed the follow-up questionnaire assessing microaggression, public stigma, and social distance from people with mental illness."  Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Recruitment was done through sending mass emails to students and staff at a public university in Hong Kong and by posting advertisements on social media." This is irrelevant for the study as information related to the institution was only displayed during recruitment. Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study No developers were involved in the study.

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Describe the history/development process of the application and previous formative evaluations (e.g., focus groups, usability testing), as these will have an impact on adoption/use rates and help with interpreting results. Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study There was no previous attempts to evaluate the effect of the intervention. Adoption/ use rate was not applicable as it was a one-off intervention.

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Revisions and updating. Clearly mention the date and/or version number of the application/intervention (and comparator, if applicable) evaluated, or describe whether the intervention underwent major changes during the evaluation process, or whether the development and/or content was "frozen" during the trial. Describe dynamic components such as news feeds or changing content which may have an impact on the replicability of the intervention (for unexpected events see item 3b Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study There were no revisions and updating after the trial commencement. Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "The presence or absence of interactivity and the presence or absence of stigma content were manipulated in the four Web pages. All Web pages involved a story. For the COMBO and STIGMA conditions, the story was identical, which was about the journey of a person experiencing mental illness stigma. The COMBO condition utilized the Amazing Adventure Against Stigma website (https://antistigma.psy.cuhk.edu.hk/). For the INTERACT and CONTROL conditions, the story was also identical and non-stigma related, illustrating a typical day of a person." Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Please refer to Multimedia Appendix 1.

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Digital preservation: Provide the URL of the application, but as the intervention is likely to change or disappear over the course of the years; also make sure the intervention is archived (Internet Archive, webcitation.org, and/or publishing the source code or screenshots/videos alongside the article). As pages behind login screens cannot be archived, consider creating demo pages which are accessible without login. Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Each Web page took approximately 20 minutes to browse through." Clarify the level of human involvement (care providers or health professionals, also technical assistance) in the e-intervention or as co-intervention (detail number and expertise of professionals involved, if any, as well as "type of assistance offered, the timing and frequency of the support, how it is initiated, and the medium by which the assistance is delivered". It may be necessary to distinguish between the level of human involvement required for the trial, and the level of human involvement required for a routine application outside of a RCT setting (discuss under item 21 -generalizability). Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Afterwards, participants received another Web-based questionnaire link to complete the pre-experiment questionnaire." "At the end of each Web page experience, participants were provided with a questionnaire link, which measures microaggression, public stigma, social distance from people with mental illness, perceived autonomy, and immersiveness. One week after the experimental session, participants completed the follow-up questionnaire assessing microaggression, public stigma, and social distance from people with mental illness." "To assess one's previous experience with mental illness, the Level of Contact Report [55] was employed, where participants indicated whether they had the experiences reported in the 12 items such as "I have watched a movie or television show in which a character depicted a person with mental illness" and "I have observed persons with a severe mental illness on a frequent basis". Higher scores indicate higher levels of previous contact with people having mental illness." "The 21-item Public Stigma Scale-Mental Illness-Short Version (PSSMI) [56] was used to assess mental illness public stigma and personal advocacy. Each item was rated on a 6point Likert scale from 1 (strongly disagree) to 6 (strongly agree). Sample items included "People with mental illness are a burden to society." (public stigma), and "I wholeheartedly fight for the rights of people with mental illness." (personal advocacy). Reverse scoring was done for personal advocacy items. Higher scores indicate higher levels of public stigma. In this study, its Cronbach alphas were .93, .95, and .94, at baseline, post, and 1-week followup, respectively." "Microaggression was measured by the 17-item Mental Illness Microaggressions Scale (MIMS-P) [57], which covers assumption of inferiority, patronization, and fear of mental illness. Each item was rated on a 4-point Likert scale from 1 (strongly disagree) to 4 (strongly agree). Sample items included "If someone I'm close to told me that they had a mental illness diagnosis, I would expect them to have trouble understanding some things" (assumption of inferiority), "If someone I'm close to told me that they had a mental illness diagnosis, I would give them advice on how to remain stable" (patronization) and "If I saw a person who I thought had a mental illness in public, I would keep my distance from them" (fear of mental illness). Higher scores indicate higher levels of microaggression. In this study, the Cronbach alphas of the MIMS-P were .78, .86, and .87 at baseline, post, and 1week follow-up, respectively." "The 8-item Social Distancing Scale [56] was used to measure the behavioral intention to keep a social distance from people with mental illness. Participants rated the extent to which they endorsed each item from 1 (very willing) to 6 (very unwilling) on items such as "Assuming you have children, you will let persons with mental illnesses take care of your children" and "You will work with persons with mental illnesses in the same institution". In this study, its Cronbach alphas were .83, .88, and .86, at baseline, post, and 1-week followup, respectively." "To assess perceived autonomy of the Web page experience, the 10-item Self Determination Scale (SDS) [58] was used in the post-experiment questionnaire. Each item was a pair of opposite statements, in which participants rated their level of perceived choice and selfawareness with a slider from 1 (only A feels true) to 5 (only B feels true subitem not at all important 1 2 3 4 5 essential g (p ) g p g p , y sometimes seem alien to me. B. During this web page experience, my emotions always seem to belong to me" (self-awareness)". Reverse scoring was done for perceived choice items. In this study, its Cronbach alpha was .89 at post-experiment." "The 15-item Transportation Scale [59] was used to assess participants' immersiveness in the Web experience. It had a 4-point Likert scale from 1 (very much) to 4 (not at all) on items such as "I could picture myself in the scene of the events described in the Web page". The last four items were adapted to fit with the experimental conditions. In the COMBO and STIGMA conditions, the last four items included "While reading the Web page, I had a vivid image of the avatar representing me", "While reading the Web page, I had a vivid image of the host", "While reading the Web page, I had a vivid image of the journey" and "While reading the Web page, I had a vivid image of the dialogue". In the INTERACT and CONTROL conditions, the last four items were "While reading the Web page, I had a vivid image of the avatar representing me", "While reading the Web page, I had a vivid image of my home", "While reading the Web page, I had a vivid image of my breakfast" and "While reading the Web page, I had a vivid image of my office". Items 2, 5 and 9 were framed negatively. All the items are scored in the direction that higher scores indicate higher levels of immersiveness. In this study, its Cronbach alpha was .84 at post-experiment." Copy and paste relevant sections from manuscript title (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study The procedure of the study is illustrated in Figure 1. Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Participants provided informed consent by checking the "I agree" button at the end of the study description page. Afterward, participants received another Web-based questionnaire link for pre-experiment questionnaire. Participants were then randomly assigned to one of the four experimental conditions through block randomization." The block randomization was done by computer. Informed consent procedures (4a-ii) can create biases and certain expectations -discuss e.g., whether participants knew which intervention was the "intervention of interest" and which one was the "comparator". Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Participants were blinded while the researcher was not. Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "All analyses were conducted using SPSS version 27.0 (IBM Corporation) and the moderation and mediation plug-in PROCESS. Categorical chi-square and one-way ANOVA were used to examine baseline differences between experimental conditions. Repeated measures ANOVA analyses with Bonferroni adjustment and post-hoc analysis were conducted to detect significant interaction effects between condition and time to see if conditions showed significant reduction in all mental illness stigma outcomes across the three time points. Mediation analysis was conducted using PROCESS Model 4 to investigate the relationship between possible mediators, perceived autonomy, and immersiveness, with all outcomes at follow-up assessment." Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "A total of 263 participants were recruited in this study and completed the experimental session, pre-experiment questionnaire and post-experiment questionnaire. All but one participants (99.62%; 262/263) completed the 1-week follow-up questionnaire. The procedure of the study is illustrated in Figure 1. Demographics and baseline characteristics of 263 participants were analysed, and data from 262 participants were analysed with repeated measures ANOVA analyses and mediation analysis." Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "All analyses were conducted using SPSS version 27.0 (IBM Corporation) and the moderation and mediation plug-in PROCESS. Categorical chi-square and one-way ANOVA were used to examine baseline differences between experimental conditions. Repeated measures ANOVA analyses with Bonferroni adjustment and post-hoc analysis were conducted to detect significant interaction effects between condition and time to see if conditions showed significant reduction in all mental illness stigma outcomes across the three time points. Mediation analysis was conducted using PROCESS Model 4 to investigate the relationship between possible mediators, perceived autonomy, and immersiveness, with all outcomes at follow-up assessment." Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "At the scheduled Zoom experimental session, participants were given detailed information about the study aims, length of the program, and participant involvement. Participants provided informed consent by checking the "I agree" button at the end of the study description page." Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Everything was addressed in the informed consent form. Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "A total of 263 participants were recruited in this study and completed the experimental session, pre-experiment questionnaire and post-experiment questionnaire. All but one participants (99.62%; 262/263) completed the 1-week follow-up questionnaire. The procedure of the study is illustrated in Figure 1." * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "A total of 263 participants were recruited in this study and completed the experimental session, pre-experiment questionnaire and post-experiment questionnaire. All but one participants (99.62%; 262/263) completed the 1-week follow-up questionnaire. The procedure of the study is illustrated in Figure 1." Strongly recommended: An attrition diagram (e.g., proportion of participants still logging in or using the intervention/comparator in each group plotted over time, similar to a survival curve) or other figures or tables demonstrating usage/dose/engagement. Copy and paste relevant sections from the manuscript or cite the figure number if applicable (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "The procedure of the study is illustrated in Figure 1." Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "The procedure of the study is illustrated in Figure 1." Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study There were no secular events.  D  o  e  s  y  o  u  r  p  a  p  e  r  a  d  d  r  e  s  s  C  O  N  S  O  R  T  s  u  b  i  t  e  m  1  4  b ? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study The trial did not ended or stop early.
? * Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Other detailed demographics and baseline characteristics of the participants are displayed in Table 1 Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Other detailed demographics and baseline characteristics of the participants are displayed in Table 1." Report multiple "denominators" and provide definitions: Report N's (and effect sizes) "across a range of study participation [and use] thresholds" [1], e.g., N exposed, N consented, N used more than x times, N used more than y weeks, N participants "used" the intervention/comparator at specific pre-defined time points of interest (in absolute and relative numbers per group). Always clearly define "use" of the intervention. Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study Public Stigma towards People with Mental Illness: "Results from repeated measures ANOVA analyses indicated a significant time x condition effect (P=.002, η2 =.04) and a post-hoc analysis was conducted. In the COMBO condition, public stigma significantly decreased from baseline to post-assessment (mean difference=0.61, 95% CI 0.49 to 0.74, P<.001, η2 =.37) and the decrease was maintained at 1-week follow-up (mean difference=0.53, 95% CI 0.37 to 0.69, P<.001, η2 =.37). In the STIGMA condition, public stigma also significantly decreased from baseline to post-assessment (mean difference=0.42, 95% CI 0.30 to 0.55, P<.001, η2 =.22) and the decrease was maintained at 1-week follow-up (mean difference=0.34, 95% CI 0.18 to 0.50, P<.001, η2 =.22). In the INTERACT condition, public stigma significantly decreased from baseline to post-assessment (mean difference=0.14, 95% CI 0.02 to 0.26, P=.02, η2 =.03) but the effect cannot be sustained at 1-week follow-up (mean difference=0.12, 95% CI -0.04 to 0.28, P=.22, η2 =.03). In the CONTROL condition, the effect was not significant from baseline to post-assessment (mean difference=0.07, 95% CI -0.06 to 0.20, P=.56, η2 =.01) and from baseline to 1-week follow-up (mean difference=0.09, 95% CI -0.08 to 0.26, P=.57, η2 =.01). In terms of mean difference values, the results indicated that the effect was strongest in COMBO, followed by STIGMA and INTERACT conditions respectively. An additional post-hoc analysis was carried out to compare COMBO with STIGMA conditions, the interaction effect between interactivity and stigma content was not significant (P=.09)." Microaggression: "The results found a significant time x condition effect (P<.001, η2 =.06) and a post-hoc analysis was carried out. Microaggression significantly decreased from baseline to post-assessment in both COMBO (mean difference=0.34, 95% CI 0.25 to 0.42, P<.001, η2 =.31) and STIGMA conditions (mean difference=0.28, 95% CI 0.19 to 0.36, P<.001, η2 =.24). The effects were sustained and strengthened at 1-week follow-up in both conditions (COMBO: mean difference=0.39, 95% CI 0.29 to 0.49, P<.001, η2 =.31; STIGMA: mean difference=0.33, 95% CI 0.23 to 0.43, P<.001, η2 =.24). In the INTERACT condition, the effect was not significant from baseline to post-assessment (mean difference=0.03, 95% CI -0.05 to 0.12, P=1.00, η2 =.01) and from baseline to 1-week follow-up (mean difference=0.06, 95% CI -0.04 to 0.16, P=0.40, η2 =.01). In the CONTROL condition, the effect was also not significant from baseline to post-assessment (mean difference=0.03, 95% CI -0.06 to 0.12, P=1.00, η2 =.01) and from baseline to 1-week follow-up (mean difference=-0.04, 95% CI -0.15 to 0.07, P=1.00, η2 =.01). The results indicated that the effect of COMBO condition was stronger than that of STIGMA condition with regard to the mean difference values. No significant interaction effect between interactivity and stigma content was found (P=.58) after running the additional post-hoc analysis to compare COMBO and STIGMA conditions. Social Distance from People with Mental Illness: "The results showed a non-significant time x condition effect (P=.25, η2 =.02). The additional post-hoc analysis comparing COMBO and STIGMA showed no significant interaction effect between interactivity and stigma content (P=.46). Details of the repeated measures ANOVA analyses are shown in Table 2." Mediating Analysis: "To compare the mediation effect of perceived autonomy and immersiveness between conditions with public stigma and microaggression, mediation analyses were performed by putting both perceived autonomy and immersiveness into PROCESS Model 4. Table 3 showed the unstandardized and standardized factor loadings for the model. A mediation model of perceived autonomy and immersiveness between conditions with public stigma and microaggression is shown in Figure 2. Mediation analysis subitem not at all important 1 2 3 4 5 essential p g gg g y for social distance was not conducted because no interaction effect was observed in social distance across conditions." "Significant indirect effects of , .02]), and .02]) on public stigma through perceived autonomy were observed. The non-significant indirect effects of 0.00]), 0.00]), and INTERACT (b=-0.07, BCa CI [-0.16, 0.00]) on public stigma through immersiveness were observed. The results showed that perceived autonomy was a significant mediator between conditions and public stigma." "Non-significant indirect effects of COMBO (b=0.07,0.17 In addition to primary/secondary (clinical) outcomes, the presentation of process outcomes such as metrics of use and intensity of use (dose, exposure) and their operational definitions is critical. This does not only refer to metrics of attrition (13-b) (often a binary variable), but also to more continuous exposure metrics such as "average session length". These must be accompanied by a technical description how a metric like a "session" is defined (e.g., timeout after idle time) [1] (report under item 6a). Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Results supported our hypotheses that an Internet-based storytelling program with a combination of stigma content and interactivity was able to significantly reduce public stigma, microaggression immediately post-experiment and at 1-week follow-up assessment. Contrary to our hypotheses, an Internet-based storytelling program with a combination of stigma content and interactivity could not significantly reduce social distance from people with mental illness. In other words, the storytelling program was more effective in improving individuals' stigmatizing cognitions, sense of personal advocacy Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "Interestingly, Internet-based storytelling program with interactivity-only was also found to reduce public stigma at post-assessment although the effect could not be maintained after one week. It might support our assumption on the positive relationship between interactivity and positive affect and between positive affect and reduced prejudice [37,40]. Future studies need to examine these relationships." Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study "This study has some limitations that deserve attention. First, our sample mainly consisted of young university students. The findings may not be generalizable to different populations. That being said, in social marketing, segmentation of our target population is essential. The present study showed that Internet-based anti-stigma storytelling programs with interactivity may be an effective tool in reducing mental illness stigma for young, educated population in the community who are comfortable and skillful in accessing information over the Internet. Furthermore, due to the homogeneous nature of our sample, moderation analysis was not carried out in the present study. Future studies can explore possible moderators of the effect of Internet-based stigma reduction interventions, for example, gender, age, and education level...." Copy and paste relevant sections from the manuscript (include quotes in quotation marks "like this" to indicate direct quotes from your manuscript), or elaborate on this item by providing additional information not in the ms, or briefly explain why the item is not applicable/relevant for your study This was not mentioned as the major focus was on effectiveness.