Hi Håkon, thank you for these questions!
Pilots typically are meant to indicate whether the intervention may have potential, mainly in terms of feasibility; ours certainly isn’t the definitive assessment of its causal effect. For this we will need to run an RCT. I intended it to be clear from the post that there was no control group but rereading the executive summary, I can see that indeed this was not clear in this first section given that I mention estimated effect size. I have revised accordingly, thanks for pointing this out. We decided not to have a control group for the initial pilot given the added logistics and timeline as well as it being so early on with a lot of things not figured out yet. I’ve removed the how to donate section from the summary section to avoid the impression that is the purpose of this post, as it is not. The spontaneous remission seen in the WHO RCT is noted in “reasons to be skeptical,” but I’ve added this to the executive summary as well for clarity. There’s a lot to consider regarding the finding of a 50% spontaneous remission rate in high-income countries (this post does a good deep-dive into the complexities https://forum.effectivealtruism.org/posts/qFQ2b4zKiPRcKo5nn/strongminds-4-of-9-psychotherapy-s-impact-may-be-shorter), but it’s important to note that the landscape for mental healthcare is quite different in high-income contexts compared to LMIC contexts; people in high-income countries have alternative options for care, whereas our participants are unlikely to get any other form of help.
On the second point, it’s certainly possible that many people stopped engaging because they were not seeing improvements. I have shared the feedback we have so far. We are continuing to collect feedback from partial completers to learn more about their experiences and their reasons for deciding not to continue. It’s important to also understand the experiences of program completers and if/how they’ve benefited from the program, so we’ve shared the feedback.
On your third point, the justification is in the section “2025 Projected Cost-Effectiveness.” The figure is based on the cost-effectiveness estimate on the WHO RCT’s effect size and our projected budget for next year.
Regarding Joel’s assessment, Joel has said his availability doesn’t allow for a formalized public-facing assessment at this time, but the Happier Lives Institute is doing a much more in-depth analysis that they’ve said they aim to publish in 2024.
Thanks again for the critical read and input!
Hi Bruce! Our minimum target for this year is to help 1K people, so we’d be moving from at least 1K this year to 10K participants next year. Based on our budget projections, it should be feasible to help 10K people for a budget of approximately $300K per year. We believe it is feasible to raise this amount. If I understand correctly, I think when you say effective outreach, you’re referring to participant acquisition. If we maintain the acquisition cost of $0.96 per participant, it would cost around $10K to acquire 10K participants; spending this amount would be feasible. However, in addition, we are beginning to build out other recruitment pathways such as referrals from external organizations and partners, which can bring in many people without additional costs besides some staff time. We’re also optimistic that we’ll start to see organic growth beginning this year.
We’ve used a more conservative estimate for effect size next year. The estimated effect size for the pilot was 0.54 standard deviations but we believe this is an upper bound and don’t expect to maintain it, so we’ve used the WHO’s effect size of 0.48 standard deviations. We chose this effect size because it’s the best evidence we have. It may prove to be an overly optimistic estimate. Maybe the pilot results were a fluke and we won’t even get close.
It is a fair point that the statement about our confidence level might be too high; I’ve revised it to more accurately reflect the meaning I intended to get across (“The pilot outcomes suggest that this program can be implemented successfully on WhatsApp and may indicate that our adaptation of Step-by-Step has been effective, although much more data is required to confirm this”).
I agree with you that the main takeaway should be that the pilot demonstrates acceptability and feasibility, not that it’s a highly cost-effective intervention; there is not enough evidence for this. The purpose of the pilot was always to test acceptability and feasibility, while collecting data on end impacts to generate some early indicators of its effectiveness. On the note of donors- for funders who want to focus their charitable donations on interventions with well-established cost-effectiveness, I would not advise them to support us at this time. An organization in its second year is highly unlikely to be able to meet this bar. Supporting our work would be a prospect for donors who are interested in promising interventions that could potentially be very cost-effective, but need to grow to a point where there is enough data to confirm this.
I focused a lot of the content of the post on the tentative results we have on the end impact of the intervention because I know that is the primary interest of forum readers and the EA community in general. However, in retrospect, perhaps I should have focused the post mostly on acceptability and feasibility, with a lesser focus on the impact, given that testing A&F was the primary purpose of the pilot.
Thanks for the comments, these are all reasonable points you’ve made. Cheers!