Implementing university wellness program for mental wellbeing among health science students: A protocol for implementing an intervention program in higher educational institutions Chennai Tamil Nadu

Abstract

BACKGROUND:

University students, especially those in the health sciences, face significant mental health challenges due to demanding academic schedules and personal stressors. The University Wellness Programme (UWP) is committed to enhancing mental health and overall well-being by implementing comprehensive interventions.

METHODS AND MATERIALS:

The pilot study was conducted at a private higher educational institution in Chennai, Tamil Nadu, with 200 health science students participating. The study is expected to expanded to include 600 participants. A quasi-experimental field study with a control group and a cross-sectional design was implemented. Interventions included recreational clubs, life skills and mindfulness training, and counselling services tailored to students. Data were collected using a validated wellness assessment tool with high reliability (Cronbach’s alpha = 0.912). Pre- and post-intervention evaluations were conducted over a six-month period.

RESULTS:

In the pilot study, 55% of students reported excellent overall wellness, while 15% reported poor wellness. Additionally, 20% of students reported experiencing high levels of depression, while 25% reported high levels of stress. Substantial improvements in students’ mental health were observed, with reductions in anxiety, depression, and stress. The stress management sessions were found to be beneficial by 80% of students, while life skills training and recreational clubs received high participation rates and positive feedback.

CONCLUSION:

The UWP’s comprehensive, multimodal approach effectively improves mental health and reduces stress among health science students. The program’s success highlights the importance of integrating mental health promotion into higher education. In order to enhance the well-being of students, future implementations should prioritize expanding counselling services, life skills development, and recreational activities. The results underscore the need for tailored interventions to address the unique stressors faced by students, advocating for policy development and dedicated funding for wellness programs in universities.

Introduction

The University Wellness Programme (UWP) is an immersive learning platform designed to encourage students to reflect, strategize, and carry out interdisciplinary projects aimed at enhancing the campus community.[1] University students often experience a significant life transition, as many must make substantial lifestyle adjustments when moving from a structured environment like high school to a more unstructured one, such as university.[2] This period can be among the most stressful in a person’s life. College life introduces new responsibilities, unfamiliar situations, and more demanding academic tasks.[3]

Mental Health issues are common among university students research indicating a significantly higher incidence of depressive disorders among those students studying health sciences.[4,5] Studies has shown that early life experiences, even those occurring before conception, influence a person’s development and affect their health, well-being, or illness progression throughout their life.[6] Implementing an intervention program suggests that the most effective pre-prevention methods for promoting public health and human development are those introduced during the teenage years.[7]

Research demonstrating the positive impact of strong mental health on recovery and resilience against physical and mental disease has brought significant attention to the concept of well-being in mental health.[8] The notably high incidence of depression and anxiety among undergraduate health science students is likely due to their demanding academic curriculum, clinical rotations, and personal stressors.[8] Enhancing mental health education within higher education institutions has been recognized as a critical aspect of educational administration.[9]

Individuals who engage in preventive health behaviors can take proactive steps to avoid the onset of various illnesses and diseases. College students often do not place excessive academic pressure on themselves, which can promote healthier preventative behaviors.[10] This protocol study involves an initiative under the University Wellness Program to develop tools for assessing mental wellness among students. The protocol also aims to showcase the various implementation activities and assess their impact.

The university has allocated a substantial budget for promoting mental wellness among students. This implementation research consists of three main components: the development of tools for mental wellness, the research and implementation process, and the assessment of the implementation’s impact. We conducted a pilot study with 200 students and plan to replicate it with 600 students from various medical and health science colleges. The program includes several interventions aimed at to improving students’ the mental health.

Students, known as University Wellness Programme champions, manage the initiative independently with the institution providing a modest honorarium. This new research aims to enhance student engagement by analyzing the mental well-being of health science students and proposing an intervention program for the institution. The study carefully evaluates the efficacy of the intervention using pre- and post-evaluations.

Mental Health issues and perceived stress are highly prevalent among students studying in higher education institutions, largely due to their demading academic schedules. It is the institution’s responsibility to address these issues by implementing mental health initatives targeted at the student community. This study will provide empirical data on the mental health status and stress levels of the students, specific interventions in place and the impact will be assessed.

• (i)To assess the mental health status and perceived stress levels of health science students enrolled in a private higher educational institution in Chennai, Tamil Nadu.
• (ii)To implement mental wellness initiatives within the University Wellness Program, specifically tailored for health science students.
• (iii)To evaluate the effectiveness of the intervention program in improving mental well-being and reducing stress levels among students.

Materials and Methods

Study design and setting

This study employs a cross-sectional design study within a quasi-experimental field study framework. The proposed research and interventions will be conducted at a higher educational institution in Chennai, Tamil Nadu, with students actively participating in wellness activities. Using simple random sampling, both the intervention and control groups were selected, each consisting of 300 members. The wellness program will be implemented over a six-month period. Both groups will be measured at two points: before the intervention, and six months after its completion.

Participants and sampling

Approximately 600 health science students will be targeted for the study. Participants will be recruited through active engagement in wellness activities, with 300 students randomly assigned to the intervention group and 300 to the control group. Eligible students will be those who attend all intervention sessions and have no prior history of severe mental or chronic diseases. Stratified random sampling will ensure representation across various demographic variables of the student population.

Tool for data collection and methodology

Data collection will be conducted using standardized self-administered mental health questionnaires. The tool will assess various factors including mental health, physical health, nutrition, sexual health, and drug misuse. Validated tools such as the DASS-21 will provide the questionnaire items. Quantitative data collection will be at baseline and six months after the intervention. Attendance sheets will be used to track participation, while focus group discussions (FGDs) or interviews will supplement the quantitative findings. All participants will complete the full wellness assessment questionnaire and provide feedback on the clarity and relevance of the intervention questions. Students will also engage in life skills training and recreational groups. The validated mental health questionnaire demonstrated excellent reliability, with a Cronbach’s alpha = 0.912, as shown in Figure 1.

Figure 1.

Domains framed with the help of experts related to psychology and psychiatry

Sample size calculation

Using a sample size of 300 for each group, we can estimate the prevalence with a margin of error of roughly 4.04% with a 95% confidence level. The equation Z2 = E2 Z2 = n = Z2 p ⋅ (1 - p) represents the relationship between Z2, E2, n, and p. To achieve a total sample size of 600 for the study, we established a target of 300 participants for both the intervention group and the control group.

Ethical consideration

The research received approval from the Institutional Review Board (IRB) at the School of Public Health, SRMIST, Chengalpattu, Tamil Nadu. The IEC protocol number for the study is PO/2020/10/02.

Four health science departments will be randomly selected; two departments will serve as the intervention group and the other two will be used as the control group. Students will be randomly assigned to both intervention and control groups, with measures taken to ensure similar environmental and educational backgrounds across both groups.

Activity 1 - Student-friendly counselling services

Since February 2024, many medical and health science students have received mental health services from this facility, which offers both daytime and nighttime counseling. To increase awareness and student engagement, IEC materials have been displayed throughout the Health Science College. Four counselors currently employed, with two therapists available for oline counseling from 8 a.m. to 4 p.m. and 6 p.m. to 9 p.m. The Counseling programs focus on student mental health and suicide prevention.

Activity 2 - Life skills and mindfulness training for students

Student trainers from the psychology department provide life skills training to all students. Life skills training will be offered to students from all departments, with two days dedicated to this training each week. Each session will include two hours of instructions. The pilot study revealed various student needs including stress management, emotional control, self-esteem, relational resilience, goal setting, and achievement.

Activity 3 - Recreational clubs

Based on the pilot study and student demand, we established clubs for meditation, Zumba, yoga, aerobic activity, martial arts, dance (both western and classical), and swimming. Most of the club trainers are national-level athletes or experts in their respective fields. Club activities will take place from 4:00 p.m. to 5:30 p.m. These services are provided free of charge, and students will receive updates about training sessions and other relevant information via WhatsApp groups. Instructors will monitor student attendance. The program activities are outlined in Table 1.

Table 1.

Time line activities

List of Activities		Day		Time
Students friendly counseling Services		All Day		8 AM to 9 PM
Life skill and Mindfulness training for students		Monday, Wednesday, and Friday		2.30 PM to 4.00 PM
Meditation		Monday and Friday		4 PM TO 5.30 PM
Yoga		Tuesday and Thursday		4 PM TO 5.30 PM
Mentor-Mentee discussion		Wednesday		4 PM TO 5.30 PM

The face validity of the depression assessment tool was evaluated by five professionals: two psychiatrists, two psychologists, and one experienced human resource manager. They were provided with the quantitative instrument specifically designed to assess depression.

Pilot Study Results: The study was conducted among 200 health science students from various departments within the institution, with a research duration of one month. Some refinements were made to the intervention activities based on the pilot study, and potential logistical and practical issues were identified. These issues will be addressed in the main research.

About 55% of the students were female, and 60% were in the 18 to 22-year age group. Students from various years of study was selected, as shown in Table 2.

Table 2.

Demographic characteristics of the respondents

Characteristics		Character		Frequency		Percentage
Gender		Male		90		45
		Female		110		55
Age Classification		18-22 years		120		60
		23-27 years		50		25
		28-32 years		20		10
		33+years		10		5
Year of Study		1st Year		50		25
		2nd Year		60		30
		3rd Year		40		20
		4th Year		30		15
		Postgraduate		20		10

In terms of mental wellness 55% of students reported excellent wellness, while 15% of reported poor wellness. Approximately 25% of the respondents experienced high stress levels, and 20% reported have high depression levels. About 20% of the respondents have high stress levels. The pilot study showed 83.3% response rate.

In the life skills training sessions, 80% of the students found the stress managements and emotional support sessions useful. High participation rates were observed in the yoga and dance clubs, as shown in Table 3.

Table 3.

Mental wellness assessment results

Wellness Dimensions		Character		Frequency (n=200)		Percentage (%)
Overall Wellness		Excellent		30		15
		Good		80		40
		Fair		60		30
		Poor		30		15
Stress Levels		Low		50		25
		Moderate		100		50
		High		50		25
Anxiety Levels		Low		60		30
		Moderate		100		50
		High		40		20
Depression Levels		Low		70		35
		Moderate		90		45
		High		40		20

Safety considerations

All the participant data will be maintained with the highest level of confidentiality and privacy. The data will be stored in a secure database. Counseling services will support the psychological well-being of students and help prevent self-harm or suicide. Ethical approval for the study was obtained from the Institutional Ethics Committee.

Follow-up process

Regular monitoring of the students’ activities, progress, and challenges will be conducted. Weakly review meetings will be held to address concerns and gather feedback from students. An impact assessment will be performed to evaluate the effectiveness of the program.

Study status and timeline

An initial evaluation will be conducted at the start, followed by a six-month intervention program, and concluding with a post-intervention assessment. The pilot study confirmed the feasibility and applicability of the study. The timetable for the intervention activities is provided below in Table 3.

Discussion

The results of our research will provide a valuable insights into the psychological well-being of health science students and the potential benefits of targeted therapeutic interventions. Our findings support previous research, which indicates that anxiety problems that begin at an early age are associated to more severe and persistent symptoms. College students, in particular, have a higher propensity to experience mental health disorders, such as depression and anxiety.[11] This underscores the urgent need to address the welfare of those students promptly.

The use of UWP’s multimodal strategy is expected to result in significant improvements in participants’ subjective stress levels and overall mental wellness. By fostering the development of effective coping mechanisms, the program can reduce the likelihood of serious mental health consequences such as suicidal tendencies. Enhancing self-regulation and self-guidance through readily accessible counselling services can play a key role in this prevention[12].

The University Wellness Program’s recreational clubs not only promote physical well-being but also provide students with opportunities to socialize and relax. A study supporting dance as a recreational activity shows that it enhances social well-being by transforming cognitive and behavioral processes that regulate human social connections.[13] Additionally, studies have demonstrated a link between improved psychological well-being and participation in activities such as yoga and meditation. These activities help reduce stress, anxiety, and depression, while also improving flexibility, cardiovascular health, and overall fitness.[14] Together, these findings highlight the interconnectedness of mental and physical health, suggesting that activities can foster social welfare through the development of new social relationships.

The results of our study will have important implications for the implementation and formulation of strategies in higher education. Our findings underscore the need for funding comprehensive wellness programs that address the diverse needs of students. According to the National Academy of Medicine, life skills development should be integrated across college departments including residential life, student clubs, health promotion, and fitness/recreation, both in and out of the classroom[15]. Universities and colleges must prioritize mental health promotion programs and allocate funds for leisure activities, life skill development, and counselling services.

Limitation and recommendation

The relatively short duration of this study may not fully capture the long-term impact of the intervention on the participants’ mental health. The control group will consist of students who do not engage in any health-related activities, but, comparative interference may arise from external factors, such as other mental health challenges not addressed in this study.

To assess the long-term effects of wellness programs on the students’ mental health, future studies should measure outcomes over extended periods. This would provide a clearer picture of how the program impacts students in real-world scenarios. To ensure the generalizability of the findings, similar studies should be conducted in various colleges and universities with diverse student populations. For future research, incorporating more frequent follow-ups, incentive, or engaging program elements could help reduce participant dropout and maintain sample size and quality.

Conclusion

Few studies have addressed the importance of implementing comprehensive mental health programs to manage the psychological distress among the students, emphasizing the need for accessible counseling services and the promotion of mental wellness awareness.[16] Our program goes further by incorporating counselling services, students-led initiatives, recreational activities, ultimately having a positive impact on students’ psychological wellbeing.[17]

A study highlighted the need for tailored mental health interventions in universities to address the unique stressors faced by students.[18] Our UWP program specifically targets health science students, who experience higher levels of stress and anxiety due to their heavy academic responsibility.[19] Another study focused on providing online mental health counselling and support for the pears[20], while our UWP program offers both daytime and evening face to face counselling. This multifaceted approach aligns with the findings of a study[21] which suggest that incorporating various interventions is effective in reducing stress and improving mental health among the students.

The pilot study suggested that the UWP received high participation rates, with many students providing positive feedback. Participants felt motivated by various activities, such as life skill training and recreation clubs.[22] The inclusion of physical activities, such as dance and yoga, as part of University Wellness Program[23] significantly contributed to reducing the symptoms of depression and anxiety among students.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

All financial support was provided by the department of Medicine and Health Sciences, SRM Institute of Science and Technology, Kattankulathur.