Background: Adolescents often face barriers in seeking mental health support due to stigma, lack of awareness, and limited help-seeking skills. Despite growing mental health needs among secondary school students in Malaysia, many remain reluctant to access available services. Behavioral insights approaches, such as nudging and boosting, may reduce stigma and increase help-seeking intentions cost-effectively. This study applies an integrative behavioral science framework, drawing on the Social Ecological Model (SEM), the Capability, Opportunity, Motivation, and Behavior (COM-B) model, and Plans, Responses, Impulses, Motives, and Evaluations (PRIME) theory, to design and test a multilevel intervention addressing individual, social, and contextual drivers of secondary school students’ help-seeking behavior. This study aims to evaluate the effectiveness of combined nudging and boosting interventions in improving mental health help-seeking behaviors and related competencies among secondary school students.
Methods: A three-arm randomized controlled pilot trial was conducted in selected Malaysian secondary schools with students aged 13–16 years. Participants were randomly allocated to one of three groups: (I) control—no exposure to behavioral nudges; (II) basic nudge—exposure to strategically placed visual and educational posters for 4 weeks; or (III) enhanced nudge—exposure to the same posters plus an additional interactive skill-building session designed to strengthen mental health communication skills and self- efficacy. Guided by SEM, COM-B model, and PRIME theory, outcomes were analyzed using a validated self-administered questionnaire (Cronbach’s α=0.89), with descriptive and comparative analyses conducted in SPSS. Ethical approval has been obtained from the Medical Review & Ethics Committee [No. NMRR ID-25-02340-U1L (IIR)] and Educational Research Application System by Ministry of Education.
Results: Expected to show that behaviorally informed nudges and boosting strategies can significantly improve students’ help-seeking intentions, awareness of mental health resources, and confidence while reducing internal stigma. Findings will generate empirical evidence for scalable, school-based interventions and inform future strategies to strengthen adolescent mental health support systems.
Conclusions: By integrating SEM, COM-B model, and PRIME theory, the study is positioned to assess implementation practicality, intervention acceptability, and outcome responsiveness across behavioral domains. The findings will inform refinement of intervention components, measurement strategies, and sample size estimation, supporting the design of a robust, fully powered trial and scalable school-based mental health interventions.
