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The goal of this clinical trial is to learn if the daily Three Good Thing intervention can prevent negative mental health outcomes like stress and burnou, and promote Gratitude and Psychological Wellbeing in undergraduate Nursing Students.
The main questions it aims to answer are:
Does the daily Three Good Things intervention effective in promoting gratitude and psychological wellbeing among nursing students?
Researchers will compare four different arms from Solomon Four Group Design to see if the increase in Gratitude and Psychological Wellbeing scores is significantly greater in the groups that received the 3GT intervention.
Participants will be randomly assigned to one of the four groups, and those in the intervention groups will:
Research Design: Experimental research using the Solomon Four Group Design approach. This design is used to measure the effectiveness of interventions while specifically controlling and analyzing the potential interaction effects between pre-tests and interventions (testing effect). Population & Sample: The population of this study consisted of all first- and second-year students of the D-III Nursing Study Program at Subang State Polytechnic, totaling 277 people. Intervention Duration: The Three Good Things intervention was carried out for 7 consecutive days.
Independent Variable: Three Good Things Daily Intervention.
Dependent Variables:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group 1 (Pre-test, 3GT, post-test) | Experimental | This group received measurements of the dependent variables (Gratitude and Psychological Well-being) through a pre-test, followed by a Three Good Things (3GT) intervention for 7 days, and ended with the same measurements for the post-test. |
|
| Group 2 (pre-test and post-test) | No Intervention | This group received measurements of dependent variables (Gratitude and Psychological Wellbeing) through a pre-test, did not receive the 3GT intervention, and ended with the same measurements. This group aimed to measure the natural effects of the passage of time and the potential influence of the pre-test itself without any intervention. | |
| Group 3 (3GT and post-test) | Experimental | This group does not receive a pre-test to eliminate testing bias, but receives the Three Good Things (3GT) Intervention for 7 days, and ends with only dependent variable measurements (post-test). This group tests the effectiveness of the intervention without the interaction effect of the pre-test. |
|
| Group 4 (Post Test only) | No Intervention | This group did not receive a pre-test or the 3GT Intervention. They only received a measurement of the dependent variable through a post-test at the end of the study period. This group served as the baseline measurement to isolate the pure effect of the intervention. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Three Good Things | Behavioral | The Three Good Things intervention was self-administered daily for seven days. Participants are required to record three positive things that happened that day and add a brief summary of the reasons behind these events using a Google form prepared by the researchers. |
| Measure | Description | Time Frame |
|---|---|---|
| The Change in Psychological Well-Being | Measurement of changes in psychological well-being scores from pre-test to post-test in participants using the 18-item Indonesian adaptation of the Ryff Psychological Well-Being Scale. These changes will compare the effectiveness of the Three Good Things (3GT) intervention with the control group. Psychological well-being here refers to six dimensions : self-acceptance, positive relationships with others, autonomy, mastery of the environment, life purpose, and personal growth. The total score ranges from 18 to 72 using a 1-4 Likert scale (strongly disagree-strongly agree), where a higher score indicates a higher level of psychological well-being. Reverse scoring is used for favorable items 4, 5, 6, 7, 10, 14, 15, and 16. | 7 days (Measured immediately after completion of the one-week daily intervention) |
| The Change in Gratitude Levels | Measurement of changes in gratitude scores from pre-test to post-test in participants using the 11-item Indonesian adaptation of the Gratitude Questionnaire. These changes will assess the ability of the Three Good Things (3GT) intervention to increase participants' tendency to feel and express gratitude in their daily lives using two dimensions : Appreciation for ongoing life experiences and Appreciation for individuals involved in one's life. The total score ranges from 11 to 77 using a 1-7 Likert scale (strongly disagree-strongly agree), where a higher score indicates a higher level of gratitude. Reverse scoring applies to unfavorable item number 3. | 7 days (Measured immediately after completion of the daily intervention for one week) |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Wardah Fauziah, msn | Contact | 082218160048 | wardahfauziah7@gmail.com | |
| Eva Riantika Ratna Palupi, msn | Contact | eva.riantikarp@gmail.com |
| Name | Affiliation | Role |
|---|---|---|
| Yudisa Diaz Lutfi Sandi RN, MSN, RN., PhD | School of Health Science, Politeknik Negeri Subang | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Subang State Polytechnic | Subang | West Java | 41211 | Indonesia |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 34324593 | Background | Zhan D, Xu L, Ouyang Y, Sawatzky R, Wong H. Methods for dealing with unequal cluster sizes in cluster randomized trials: A scoping review. PLoS One. 2021 Jul 29;16(7):e0255389. doi: 10.1371/journal.pone.0255389. eCollection 2021. | |
| 40598211 | Background | Yosep I, Hikmat R, Mardhiyah A, Zamroni AH, Pranata Y, Saputra RL. Nursing interventions to reduce mental health problems in nursing students: a scoping review. BMC Nurs. 2025 Jul 1;24(1):780. doi: 10.1186/s12912-025-03329-w. |
| Label | URL |
|---|---|
| Reducing Stress, Anxiety and Depression in Undergraduate Nursing Students: Systematic Review | View source |
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Participant data will not be shared to maintain participant confidentiality and to comply with the ethical guidelines. Furthermore, the study protocol and informed consent process do not include provisions for sharing participant data with external parties.
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| ID | Term |
|---|---|
| D000092862 | Psychological Well-Being |
| ID | Term |
|---|---|
| D010549 | Personal Satisfaction |
| D001519 | Behavior |
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This study used the Solomon Four Group Design, which involved four separate groups to test the effects of the intervention while simultaneously controlling and measuring the interaction effects of the pre-test (testing effect).
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| Why Do Nursing Students Leave Bachelor Program? Findings from a Qualitative Descriptive Study | View source |
| The Effect of Laughter Yoga Applied Before Simulation Training on State Anxiety, Perceived Stress Levels, Self-Confidence and Satisfaction in Undergraduate Nursing Students: A Pragmatic Randomized Controlled Trial | View source |
| Gratitude, Life Satisfaction And Forgiveness Among Acid Attack Victims: Rehabilitation Through Three Good Things Intervention | View source |
| The Prevalence of Mental Health Issues Among Nursing Students: An Umbrella Review Synthesis of Meta-Analytic Evidence | View source |
| Prevalence of Adolescent Mental Disorders in Kenya, Indonesia, and Viet Nam Measured by the National Adolescent Mental Health Surveys (NAMHS): A Multi-National Cross-Sectional Study | View source |
| The SAGE Encyclopedia of Educational Research, Measurement, and Evaluation | View source |
| The 18-Item Swedish Version of Ryff's Psychological Wellbeing Scale: Psychometric Properties Based on Classical Test Theory and Item Response Theory | View source |
| Factors Affecting Academic Stress in Students in Indonesia: A Literature Study | View source |
| Second-Year Undergraduate Nursing Students' Experiences with Clinical Simulation Training in Mental Health Clinical Practice: A Focus Group Study | View source |
| the Influence of Work Values on Innovative Work Behaviour and Psychological Well-Being: The Psychological Capital as a Mediator | View source |
| Indonesia-National Adolescent Mental Health (I-NAMHS) | View source |
| Why Do Children and Adolescents (not) Seek and Access Professional Help for Their Mental Health Problems? A Systematic Review of Quantitative and Qualitative Studies | View source |
| Group Counseling to Reduce Academic Stress in Final Year Students | View source |
| Experimental Approaches in Communication Research | View source |
| Understanding Mental Health and Its Determinants from the Perspective of Adolescents: A Qualitative Study Across Diverse Social Settings in Indonesia | View source |
| Mental Health of Adolescents | View source |
| The Benefits of Probability-Proportional-to-Size Sampling in Cluster-Randomized Experiments | View source |
| Nursing Interventions to Reduce Mental Health Problems in Nursing Students: A Scoping Review | View source |
| Methods for Dealing with Unequal Cluster Sizes in Cluster Randomized Trials: A Scoping Review | View source |