Trial Outcomes & Findings for Testing a Wellness App for First Responders, Military Personnel and Veterans (NCT NCT06336967)

NCT ID: NCT06336967

Last Updated: 2025-06-26

Results Overview

The PERMA-Profiler is designed to measure the general wellbeing of adults; specifically this questionnaire measures positive and negative emotions, engagement, relationships, meaning, accomplishment, and health. Participants respond to 23 items on an 11-point Likert scale, from 0 to 10. Scores are calculated as the average of the items comprising each factor. Lower scores indicate lower flourishing, and higher scores indicate higher flourishing.

• Recruitment status: COMPLETED
• Study phase: NA
• Target enrollment: 115 participants
• Primary outcome timeframe: assessed at Baseline and post-trial (over 4 weeks), post-trial (week 4) reported
• Results posted on: 2025-06-26

Participant Flow

Recruitment opened on April 22, 2024 and continued through August 31, 2024. Participants were recruited through email distribution lists, GUIDE partnerships, social media posts and in-person events with the population.

Participants who signed the informed consent, but did not attend an introductory Zoom meeting with the clinical research coordinator, were not assigned a treatment group. Participants received app access and instructions during the introductory meeting at the meeting, which finalized their enrollment in the study.

Participant milestones

Measure	GUIDE With Incentives Immediate access to the GUIDE App smartphone application for 4 weeks with the opportunity to earn additional compensation, up to $100 in total, based on app engagement.	GUIDE Without Incentives Immediate access to the GUIDE App for 4 weeks without the opportunity to earn additional compensation.	Waitlist Waitlisted with delayed access to the GUIDE App without the opportunity to earn additional compensation.
Overall Study STARTED	39	37	39
Overall Study COMPLETED	34	35	38
Overall Study NOT COMPLETED	5	2	1

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

Testing a Wellness App for First Responders, Military Personnel and Veterans

Baseline characteristics by cohort

Measure	GUIDE With Incentives n=39 Participants Immediate access to the GUIDE App smartphone application for 4 weeks with the opportunity to earn additional compensation, up to $100 in total, based on app engagement.	GUIDE Without Incentives n=37 Participants Immediate access to the GUIDE App for 4 weeks without the opportunity to earn additional compensation.	Waitlist n=39 Participants Waitlisted with delayed access to the GUIDE App without the opportunity to earn additional compensation.	Total n=115 Participants Total of all reporting groups
Age, Categorical <=18 years	0 Participants n=5 Participants	0 Participants n=7 Participants	0 Participants n=5 Participants	0 Participants n=4 Participants
Age, Categorical Between 18 and 65 years	38 Participants n=5 Participants	36 Participants n=7 Participants	39 Participants n=5 Participants	113 Participants n=4 Participants
Age, Categorical >=65 years	1 Participants n=5 Participants	1 Participants n=7 Participants	0 Participants n=5 Participants	2 Participants n=4 Participants
Sex: Female, Male Female	12 Participants n=5 Participants	9 Participants n=7 Participants	12 Participants n=5 Participants	33 Participants n=4 Participants
Sex: Female, Male Male	27 Participants n=5 Participants	28 Participants n=7 Participants	27 Participants n=5 Participants	82 Participants n=4 Participants
Race/Ethnicity, Customized White	34 Participants n=5 Participants	32 Participants n=7 Participants	36 Participants n=5 Participants	102 Participants n=4 Participants
Race/Ethnicity, Customized Black or African American	4 Participants n=5 Participants	3 Participants n=7 Participants	1 Participants n=5 Participants	8 Participants n=4 Participants
Race/Ethnicity, Customized American Indian/Alaska Native	1 Participants n=5 Participants	0 Participants n=7 Participants	0 Participants n=5 Participants	1 Participants n=4 Participants
Race/Ethnicity, Customized Hispanic/Latino	2 Participants n=5 Participants	4 Participants n=7 Participants	0 Participants n=5 Participants	6 Participants n=4 Participants
Race/Ethnicity, Customized Asian	0 Participants n=5 Participants	0 Participants n=7 Participants	2 Participants n=5 Participants	2 Participants n=4 Participants
Race/Ethnicity, Customized Refused to Answer	0 Participants n=5 Participants	1 Participants n=7 Participants	0 Participants n=5 Participants	1 Participants n=4 Participants
PERMA Overall Score	6.57 units on a scale STANDARD_DEVIATION 1.43 • n=5 Participants	7.16 units on a scale STANDARD_DEVIATION 1.65 • n=7 Participants	6.45 units on a scale STANDARD_DEVIATION 1.43 • n=5 Participants	6.72 units on a scale STANDARD_DEVIATION 1.52 • n=4 Participants
Personal Wellbeing Score (PWS)	67.52 score on a scale STANDARD_DEVIATION 22.52 • n=5 Participants	77.25 score on a scale STANDARD_DEVIATION 21.57 • n=7 Participants	60.90 score on a scale STANDARD_DEVIATION 24.04 • n=5 Participants	68.41 score on a scale STANDARD_DEVIATION 23.53 • n=4 Participants
WHO-5 Wellbeing	53.03 score on a scale STANDARD_DEVIATION 21.32 • n=5 Participants	57.30 score on a scale STANDARD_DEVIATION 21.87 • n=7 Participants	52.21 score on a scale STANDARD_DEVIATION 20.66 • n=5 Participants	54.12 score on a scale STANDARD_DEVIATION 21.21 • n=4 Participants
PERMA Positive emotion	6.07 units on a scale STANDARD_DEVIATION 1.81 • n=5 Participants	6.61 units on a scale STANDARD_DEVIATION 2.09 • n=7 Participants	5.89 units on a scale STANDARD_DEVIATION 1.64 • n=5 Participants	6.18 units on a scale STANDARD_DEVIATION 1.86 • n=4 Participants
PERMA Engagement	6.46 units on a scale STANDARD_DEVIATION 1.56 • n=5 Participants	6.39 units on a scale STANDARD_DEVIATION 1.55 • n=7 Participants	6.72 units on a scale STANDARD_DEVIATION 1.39 • n=5 Participants	6.52 units on a scale STANDARD_DEVIATION 1.50 • n=4 Participants
PERMA Relationships	6.56 units on a scale STANDARD_DEVIATION 2.07 • n=5 Participants	7.43 units on a scale STANDARD_DEVIATION 2.1 • n=7 Participants	6.14 units on a scale STANDARD_DEVIATION 1.94 • n=5 Participants	6.70 units on a scale STANDARD_DEVIATION 2.09 • n=4 Participants
PERMA Meaning	6.91 units on a scale STANDARD_DEVIATION 2.03 • n=5 Participants	7.77 units on a scale STANDARD_DEVIATION 1.95 • n=7 Participants	6.74 units on a scale STANDARD_DEVIATION 1.88 • n=5 Participants	7.13 units on a scale STANDARD_DEVIATION 1.99 • n=4 Participants
PERMA Accomplishment	6.83 units on a scale STANDARD_DEVIATION 1.6 • n=5 Participants	7.6 units on a scale STANDARD_DEVIATION 1.44 • n=7 Participants	6.74 units on a scale STANDARD_DEVIATION 1.6 • n=5 Participants	7.05 units on a scale STANDARD_DEVIATION 1.59 • n=4 Participants
PERMA Happiness	6.64 units on a scale STANDARD_DEVIATION 1.91 • n=5 Participants	6.89 units on a scale STANDARD_DEVIATION 1.90 • n=7 Participants	6.31 units on a scale STANDARD_DEVIATION 1.81 • n=5 Participants	6.61 units on a scale STANDARD_DEVIATION 1.87 • n=4 Participants
PERMA Health	6.01 units on a scale STANDARD_DEVIATION 1.69 • n=5 Participants	6.80 units on a scale STANDARD_DEVIATION 1.83 • n=7 Participants	5.54 units on a scale STANDARD_DEVIATION 1.77 • n=5 Participants	6.10 units on a scale STANDARD_DEVIATION 1.82 • n=4 Participants
PERMA Negative emotion	4.45 units on a scale STANDARD_DEVIATION 2.18 • n=5 Participants	3.81 units on a scale STANDARD_DEVIATION 1.93 • n=7 Participants	4.22 units on a scale STANDARD_DEVIATION 1.74 • n=5 Participants	4.17 units on a scale STANDARD_DEVIATION 1.96 • n=4 Participants
PERMA Loneliness	3.69 units on a scale STANDARD_DEVIATION 2.99 • n=5 Participants	3.57 units on a scale STANDARD_DEVIATION 2.77 • n=7 Participants	5.13 units on a scale STANDARD_DEVIATION 3.10 • n=5 Participants	4.14 units on a scale STANDARD_DEVIATION 3.02 • n=4 Participants
DERS-SF	36.54 units on a scale STANDARD_DEVIATION 12.59 • n=5 Participants	31.19 units on a scale STANDARD_DEVIATION 10.17 • n=7 Participants	39.00 units on a scale STANDARD_DEVIATION 12.46 • n=5 Participants	35.65 units on a scale STANDARD_DEVIATION 12.16 • n=4 Participants
Anxiety (GAD-7)	13.36 units on a scale STANDARD_DEVIATION 5.73 • n=5 Participants	11.00 units on a scale STANDARD_DEVIATION 4.34 • n=7 Participants	13.54 units on a scale STANDARD_DEVIATION 4.32 • n=5 Participants	12.66 units on a scale STANDARD_DEVIATION 4.95 • n=4 Participants
Depression (PHQ-8)	7.36 units on a scale STANDARD_DEVIATION 5.15 • n=5 Participants	5.14 units on a scale STANDARD_DEVIATION 5.05 • n=7 Participants	7.51 units on a scale STANDARD_DEVIATION 5.19 • n=5 Participants	6.70 units on a scale STANDARD_DEVIATION 5.20 • n=4 Participants

PRIMARY outcome

Timeframe: assessed at Baseline and post-trial (over 4 weeks), post-trial (week 4) reported

Population: Analyzed data for all participants who completed the post-trial assessment.

The PERMA-Profiler is designed to measure the general wellbeing of adults; specifically this questionnaire measures positive and negative emotions, engagement, relationships, meaning, accomplishment, and health. Participants respond to 23 items on an 11-point Likert scale, from 0 to 10. Scores are calculated as the average of the items comprising each factor. Lower scores indicate lower flourishing, and higher scores indicate higher flourishing.

Outcome measures

Measure	GUIDE With Incentives n=34 Participants Immediate access to the GUIDE App smartphone application for 4 weeks with the opportunity to earn additional compensation, up to $100 in total, based on app engagement. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	GUIDE Without Incentives n=35 Participants Immediate access to the GUIDE App for 4 weeks without the opportunity to earn additional compensation. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	Waitlist n=38 Participants Waitlisted with delayed access to the GUIDE App without the opportunity to earn additional compensation.
PERMA-Profiler Overall Wellbeing Score	6.99 score on a scale Standard Deviation 1.47	7.46 score on a scale Standard Deviation 1.62	6.49 score on a scale Standard Deviation 1.58

PRIMARY outcome

Timeframe: assessed at Baseline and post-trial (over 4 weeks), post-trial (week 4) reported

Population: Analysis includes all participants who completed their post-trial assessment.

The PHQ-8 is a self-reported measure of depressive symptoms composed of 8 Likert type items with a response scale ranging from 0 (Not at all) to 3 (Nearly every day), that refer to the presence of that symptom during the previous 2 weeks. Each item corresponds to the first 8 symptoms of the 4th edition of the DSM-IV diagnostic criteria for major depressive disorder. The PHQ-8 final score is obtained by adding the score for each of the items, ranging from 0 to 24 (higher scores corresponding to higher levels of depression).

Outcome measures

Measure	GUIDE With Incentives n=34 Participants Immediate access to the GUIDE App smartphone application for 4 weeks with the opportunity to earn additional compensation, up to $100 in total, based on app engagement. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	GUIDE Without Incentives n=35 Participants Immediate access to the GUIDE App for 4 weeks without the opportunity to earn additional compensation. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	Waitlist n=38 Participants Waitlisted with delayed access to the GUIDE App without the opportunity to earn additional compensation.
Patient Health Questionnaire for Depression Symptoms (PHQ-8)	5.15 units on a scale Standard Deviation 3.509	3.86 units on a scale Standard Deviation 3.844	6.29 units on a scale Standard Deviation 4.667

PRIMARY outcome

Timeframe: assessed at Baseline and post-trial (over 4 weeks), post-trial (week 4) reported

Population: Analyzed for all participants who completed a post-trial assessment.

GAD-7 consists of seven items measuring worry and anxiety symptoms. Each item is scored on a four-point Likert scale (0-3) with total scores ranging from 0 to 21 with higher scores reflecting greater anxiety severity. Scores above 10 are considered to be in the clinical range. The GAD-7 has shown good reliability and construct validity.

Outcome measures

Measure	GUIDE With Incentives n=34 Participants Immediate access to the GUIDE App smartphone application for 4 weeks with the opportunity to earn additional compensation, up to $100 in total, based on app engagement. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	GUIDE Without Incentives n=35 Participants Immediate access to the GUIDE App for 4 weeks without the opportunity to earn additional compensation. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	Waitlist n=38 Participants Waitlisted with delayed access to the GUIDE App without the opportunity to earn additional compensation.
Generalized Anxiety Disorder (GAD-7)	12.53 units on a scale Standard Deviation 5.089	10.34 units on a scale Standard Deviation 3.235	13.42 units on a scale Standard Deviation 4.665

PRIMARY outcome

Timeframe: assessed at Baseline and post-trial (over 4 weeks), post-trial (week 4) reported

Population: Analysis includes all participants who completed their post-trial assessment.

The World Health Organisation- Five Well-Being Index (WHO-5) is a short self-reported measure of current mental wellbeing. The WHO-5 consists of five statements, which respondents rate according to the scale below (in relation to the past two weeks).

All of the time = 5 Most of the time = 4 More than half of the time = 3 Less than half of the time = 2 Some of the time = 1 At no time = 0.

The total raw score, ranging from 0 to 25, is multiplied by 4 to give the final score, with 0 representing the worst imaginable well-being and 100 representing the best imaginable well-being.

Outcome measures

Measure	GUIDE With Incentives n=34 Participants Immediate access to the GUIDE App smartphone application for 4 weeks with the opportunity to earn additional compensation, up to $100 in total, based on app engagement. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	GUIDE Without Incentives n=35 Participants Immediate access to the GUIDE App for 4 weeks without the opportunity to earn additional compensation. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	Waitlist n=38 Participants Waitlisted with delayed access to the GUIDE App without the opportunity to earn additional compensation.
WHO Well-being Index (WHO-5)	57.41 units on a scale Standard Deviation 19.394	65.71 units on a scale Standard Deviation 19.239	52.95 units on a scale Standard Deviation 21.838

PRIMARY outcome

Timeframe: assessed at Baseline and post-trial (over 4 weeks), post-trial (week 4) reported

Population: Analysis includes all participants who completed post-trial assessment.

The Personal Wellbeing Score (PWS) is based on the Office of National Statistics (ONS) four subjective well-being questions (ONS4) and thresholds. It evaluates life satisfaction, sense of purpose, happiness, and anxiety. Each PWS item is scored as follows: Disagree=0, Neutral=1, Agree=2 and Strongly Agree=3. Summary scores are calculated by aggregating all items and transforming to a scale of 0 to 100, with higher scores indicating greater well-being.

Outcome measures

Measure	GUIDE With Incentives n=34 Participants Immediate access to the GUIDE App smartphone application for 4 weeks with the opportunity to earn additional compensation, up to $100 in total, based on app engagement. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	GUIDE Without Incentives n=35 Participants Immediate access to the GUIDE App for 4 weeks without the opportunity to earn additional compensation. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	Waitlist n=38 Participants Waitlisted with delayed access to the GUIDE App without the opportunity to earn additional compensation.
Personal Wellbeing Score (PWS)	73.04 units on a scale Standard Deviation 24.11	77.62 units on a scale Standard Deviation 18.72	62.28 units on a scale Standard Deviation 22.24

PRIMARY outcome

Timeframe: assessed at Baseline and post-trial (over 4 weeks), post-trial (week 4) reported

Population: Analysis includes all participants who completed a post-trial assessment.

The Difficulties in Emotion Regulation Scale Short Form (DERS-SF) is an 18-item measure used to identify emotional regulation issues in adults. The measure uses 6 subscales to measure 4 dimensions of emotional regulation: awareness; acceptance; the ability to engage in goal-directed behavior and refrain from impulsive behavior when experiencing negative emotions; and access to emotion regulation strategies perceived as effective. Respondents indicate how often each statement applies to them on a 5 point scale, where 1=Almost Never (0-10%), 2=Sometimes (11-35%), About Half of the Time (36-65%), Most of the Time (66-90%), Almost Always (91-100%). Scores range from 18 to 90, with higher scores indicating greater difficulties in emotion regulation. The DERS-SF Total Score is computed by summing responses across all items. Lower scores represent better emotion regulation outcomes.

Outcome measures

Measure	GUIDE With Incentives n=34 Participants Immediate access to the GUIDE App smartphone application for 4 weeks with the opportunity to earn additional compensation, up to $100 in total, based on app engagement. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	GUIDE Without Incentives n=35 Participants Immediate access to the GUIDE App for 4 weeks without the opportunity to earn additional compensation. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	Waitlist n=38 Participants Waitlisted with delayed access to the GUIDE App without the opportunity to earn additional compensation.
Difficulties in Emotion Regulation Scale Short Form (DERS-SF)	32.82 units on a scale Standard Deviation 9.974	32.06 units on a scale Standard Deviation 9.825	36.89 units on a scale Standard Deviation 11.795

SECONDARY outcome

Timeframe: assessed at Baseline and post-trial (over 4 weeks), post-trial (week 4) reported

Population: Analysis includes all participants who completed post-trial assessment.

The PERMA-Profiler is a 23-item measure that assesses wellbeing across five domains (positive emotion, engagement, relationships, meaning, accomplishment). The instrument was constructed so that each domain can be defined and measured as separate but correlated constructs. This study will use the Positive Emotion subscale of the PERMA. This subscale includes 3 items on an 11-point Likert scale, from 0 to 10. Scores are calculated as an average of these items, with lower scores indicating less positive emotion and high scores indicating more positive emotion.

Outcome measures

Measure	GUIDE With Incentives n=34 Participants Immediate access to the GUIDE App smartphone application for 4 weeks with the opportunity to earn additional compensation, up to $100 in total, based on app engagement. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	GUIDE Without Incentives n=35 Participants Immediate access to the GUIDE App for 4 weeks without the opportunity to earn additional compensation. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	Waitlist n=38 Participants Waitlisted with delayed access to the GUIDE App without the opportunity to earn additional compensation.
Positive Emotion (Positive Emotion Subscale of the PERMA-Profiler)	6.65 units on a scale Standard Deviation 1.65	7.20 units on a scale Standard Deviation 1.89	5.96 units on a scale Standard Deviation 1.87

SECONDARY outcome

Timeframe: assessed at Baseline and post-trial (over 4 weeks), post-trial (week 4) reported

Population: Analysis includes all participants who completed a post-trial assessment.

The PERMA-Profiler is a 23-item measure that assesses wellbeing across five domains (positive emotion, engagement, relationships, meaning, accomplishment). The instrument was constructed so that each domain can be defined and measured as separate but correlated constructs. This study will use the Engagement and Relationship subscales of the PERMA. These subscales include 3 items each, ranked on an 11-point Likert scale, from 0 to 10. Scores are calculated as an average of these items for each subscale, with lower scores indicating less flourishing in respect to engagement/relationships and high scores indicating better engagement/relationships.

Outcome measures

Measure	GUIDE With Incentives n=34 Participants Immediate access to the GUIDE App smartphone application for 4 weeks with the opportunity to earn additional compensation, up to $100 in total, based on app engagement. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	GUIDE Without Incentives n=35 Participants Immediate access to the GUIDE App for 4 weeks without the opportunity to earn additional compensation. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	Waitlist n=38 Participants Waitlisted with delayed access to the GUIDE App without the opportunity to earn additional compensation.
Social Connectedness (Engagement Subscale of PERMA-Profiler)	6.66 units on a scale Standard Deviation 1.43	6.70 units on a scale Standard Deviation 1.77	6.68 units on a scale Standard Deviation 1.53

SECONDARY outcome

Timeframe: assessed at Baseline and post-trial (over 4 weeks), post-trial (week 4) reported

Population: Analysis includes all participants who completed a post-trial assessment.

The PERMA-Profiler is a 23-item measure that assesses wellbeing across five domains (positive emotion, engagement, relationships, meaning, accomplishment). The instrument was constructed so that each domain can be defined and measured as separate but correlated constructs. This study will use the Engagement and Relationship subscales of the PERMA. These subscales include 3 items each, ranked on an 11-point Likert scale, from 0 to 10. Scores are calculated as an average of these items for each subscale, with lower scores indicating less flourishing in respect to engagement/relationships and high scores indicating better engagement/relationships.

Outcome measures

Measure	GUIDE With Incentives n=34 Participants Immediate access to the GUIDE App smartphone application for 4 weeks with the opportunity to earn additional compensation, up to $100 in total, based on app engagement. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	GUIDE Without Incentives n=35 Participants Immediate access to the GUIDE App for 4 weeks without the opportunity to earn additional compensation. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	Waitlist n=38 Participants Waitlisted with delayed access to the GUIDE App without the opportunity to earn additional compensation.
Social Connectedness (Relationship Subscale of PERMA-Profiler)	7.03 units on a scale Standard Deviation 2.03	7.81 units on a scale Standard Deviation 2.03	6.14 units on a scale Standard Deviation 1.93

SECONDARY outcome

Timeframe: assessed at Baseline and post-trial (over 4 weeks), post-trial (week 4) reported

Population: Analysis includes participants who completed their post-trial assessment.

The PERMA-Profiler is a 23-item measure that assesses wellbeing across five domains (positive emotion, engagement, relationships, meaning, accomplishment). The instrument was constructed so that each domain can be defined and measured as separate but correlated constructs. This study will use the Meaning and Accomplishment subscales of the PERMA. These subscales include 3 items each, ranked on an 11-point Likert scale, from 0 to 10. Scores are calculated as an average of these items for each subscale, with lower scores indicating less flourishing in respect to meaning/accomplishment and high scores indicating more meaning/accomplishment.

Outcome measures

Measure	GUIDE With Incentives n=34 Participants Immediate access to the GUIDE App smartphone application for 4 weeks with the opportunity to earn additional compensation, up to $100 in total, based on app engagement. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	GUIDE Without Incentives n=35 Participants Immediate access to the GUIDE App for 4 weeks without the opportunity to earn additional compensation. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	Waitlist n=38 Participants Waitlisted with delayed access to the GUIDE App without the opportunity to earn additional compensation.
Personal Growth (Meaning Subscale of the PERMA-Profiler)	7.33 units on a scale Standard Deviation 1.92	7.86 units on a scale Standard Deviation 1.88	6.74 units on a scale Standard Deviation 2.10

SECONDARY outcome

Timeframe: assessed at Baseline and post-trial (over 4 weeks), post-trial (week 4) reported

Population: Analysis includes participants who completed their post-trial assessment.

The PERMA-Profiler is a 23-item measure that assesses wellbeing across five domains (positive emotion, engagement, relationships, meaning, accomplishment). The instrument was constructed so that each domain can be defined and measured as separate but correlated constructs. This study will use the Meaning and Accomplishment subscales of the PERMA. These subscales include 3 items each, ranked on an 11-point Likert scale, from 0 to 10. Scores are calculated as an average of these items for each subscale, with lower scores indicating less flourishing in respect to meaning/accomplishment and high scores indicating more meaning/accomplishment.

Outcome measures

Measure	GUIDE With Incentives n=34 Participants Immediate access to the GUIDE App smartphone application for 4 weeks with the opportunity to earn additional compensation, up to $100 in total, based on app engagement. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	GUIDE Without Incentives n=35 Participants Immediate access to the GUIDE App for 4 weeks without the opportunity to earn additional compensation. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	Waitlist n=38 Participants Waitlisted with delayed access to the GUIDE App without the opportunity to earn additional compensation.
Personal Growth (Accomplishment Subscale of the PERMA-Profiler)	7.29 units on a scale Standard Deviation 1.46	7.74 units on a scale Standard Deviation 1.49	6.95 units on a scale Standard Deviation 1.65

SECONDARY outcome

Timeframe: assessed at Baseline and post-trial (over 4 weeks), post-trial (week 4) reported

Population: Analysis includes all participants who completed post-trial assessment.

The Utrecht Work Engagement Scale-17 assesses work engagement, or a positive, fulfilling, work-related state of mind characterized by vigor, dedication, and absorption. It is intended to measure the 'opposite' of burnout in both university students and employees. Items were developed to reflect three underlying dimensions: "Vigor" (VI); "Dedication" (DE), and "Absorption" (AB). The subscales were found to be internally consistent but relatively strongly correlated. Items are scored along a 6-point Likert-type scale (0 = Never to 6 = Always or Every day). Scores are calculated by summing item scores. The total score ranges from 0 to 102 points. A higher score indicates greater worker engagement.

Outcome measures

Measure	GUIDE With Incentives n=34 Participants Immediate access to the GUIDE App smartphone application for 4 weeks with the opportunity to earn additional compensation, up to $100 in total, based on app engagement. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	GUIDE Without Incentives n=35 Participants Immediate access to the GUIDE App for 4 weeks without the opportunity to earn additional compensation. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	Waitlist n=38 Participants Waitlisted with delayed access to the GUIDE App without the opportunity to earn additional compensation.
Utrecht Work Engagement Scale (UWES-17)	61.74 units on a scale Standard Deviation 17.647	62.49 units on a scale Standard Deviation 14.496	58.61 units on a scale Standard Deviation 16.668

SECONDARY outcome

Timeframe: assessed at Baseline and post-trial (over 4 weeks), post-trial (week 4) reported

Population: Analysis includes all participants who completed post-trial assessment.

The Maslach Burnout Inventory - Emotional Exhaustion (MBI-EE) is a validated self-report measure assessing feelings of emotional depletion and fatigue due to work-related stress. It is part of the Maslach Burnout Inventory (MBI), which evaluates burnout across three domains. Scores range from 0 to 54, with higher scores indicating greater emotional exhaustion. The Emotional Exhaustion Score is computed by summing responses to nine Likert-type items. Lower scores represent better well-being outcomes.

Outcome measures

Measure	GUIDE With Incentives n=34 Participants Immediate access to the GUIDE App smartphone application for 4 weeks with the opportunity to earn additional compensation, up to $100 in total, based on app engagement. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	GUIDE Without Incentives n=35 Participants Immediate access to the GUIDE App for 4 weeks without the opportunity to earn additional compensation. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	Waitlist n=38 Participants Waitlisted with delayed access to the GUIDE App without the opportunity to earn additional compensation.
Maslach Burnout Inventory (MBI) - Emotional Exhaustion	21.24 units on a scale Standard Deviation 12.015	19.06 units on a scale Standard Deviation 10.287	19.97 units on a scale Standard Deviation 11.507

SECONDARY outcome

Timeframe: assessed at Baseline and post-trial (over 4 weeks), post-trial (week 4) reported

Population: Analysis includes all participants who completed post-trial assessment.

The Maslach Burnout Inventory - Personal Accomplishment (MBI-PA) is a validated self-report measure assessing feelings of competence and achievement in one's work. It is part of the Maslach Burnout Inventory (MBI), which evaluates burnout across three domains. Scores range from 0 to 48, with higher scores indicating greater personal accomplishment and lower scores suggesting burnout-related inefficacy. The Personal Accomplishment Score is computed by summing responses to eight Likert-type items.

Outcome measures

Measure	GUIDE With Incentives n=34 Participants Immediate access to the GUIDE App smartphone application for 4 weeks with the opportunity to earn additional compensation, up to $100 in total, based on app engagement. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	GUIDE Without Incentives n=35 Participants Immediate access to the GUIDE App for 4 weeks without the opportunity to earn additional compensation. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	Waitlist n=38 Participants Waitlisted with delayed access to the GUIDE App without the opportunity to earn additional compensation.
Maslach Burnout Inventory (MBI) - Personal Accomplishment	31.38 units on a scale Standard Deviation 8.739	32.00 units on a scale Standard Deviation 6.924	30.42 units on a scale Standard Deviation 7.866

SECONDARY outcome

Timeframe: assessed at Baseline and post-trial (over 4 weeks), post-trial (week 4) reported

Population: Analysis includes all participants who completed post-trial assessment.

The Maslach Burnout Inventory - Depersonalization (MBI-DP) is a validated self-report measure assessing feelings of detachment and impersonal responses toward others in a work setting. It is part of the Maslach Burnout Inventory (MBI), which evaluates burnout across three domains. Scores range from 0 to 30, with higher scores indicating greater depersonalization and emotional distancing. The Depersonalization Score is computed by summing responses to five Likert-type items. Lower scores represent better well-being outcomes.

Outcome measures

Measure	GUIDE With Incentives n=34 Participants Immediate access to the GUIDE App smartphone application for 4 weeks with the opportunity to earn additional compensation, up to $100 in total, based on app engagement. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	GUIDE Without Incentives n=35 Participants Immediate access to the GUIDE App for 4 weeks without the opportunity to earn additional compensation. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	Waitlist n=38 Participants Waitlisted with delayed access to the GUIDE App without the opportunity to earn additional compensation.
Maslach Burnout Inventory (MBI) - Depersonalization	8.79 units on a scale Standard Deviation 6.285	8.86 units on a scale Standard Deviation 6.335	9.13 units on a scale Standard Deviation 6.156

SECONDARY outcome

Timeframe: assessed at Baseline and post-trial (over 4 weeks), post-trial (week 4) reported

Population: Only included participants who completed their post-trial assessment.

Whether the participant still has their job at the end of the 4-week trial period.

Outcome measures

Measure	GUIDE With Incentives n=34 Participants Immediate access to the GUIDE App smartphone application for 4 weeks with the opportunity to earn additional compensation, up to $100 in total, based on app engagement. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	GUIDE Without Incentives n=35 Participants Immediate access to the GUIDE App for 4 weeks without the opportunity to earn additional compensation. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	Waitlist n=38 Participants Waitlisted with delayed access to the GUIDE App without the opportunity to earn additional compensation.
Number of Participants Still Employed	34 Participants	35 Participants	38 Participants

SECONDARY outcome

Timeframe: assessed at post-trial (4 weeks)

Population: Included participants from two groups that used GUIDE during the trial, only if they completed their post-trial assessment survey.

The Feasibility of Intervention Measure (FIM) is used to measure the feasibility of an intervention. The scale consists of 4 items rated on a 5-point Likert Scale from 1 ("Completely disagree") to 5 ("Completely agree"). The score consists of the average of the items, ranging from 1 to 5, with higher scores indicating greater feasibility of the intervention.

Outcome measures

Measure	GUIDE With Incentives n=34 Participants Immediate access to the GUIDE App smartphone application for 4 weeks with the opportunity to earn additional compensation, up to $100 in total, based on app engagement. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	GUIDE Without Incentives n=35 Participants Immediate access to the GUIDE App for 4 weeks without the opportunity to earn additional compensation. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	Waitlist Waitlisted with delayed access to the GUIDE App without the opportunity to earn additional compensation.
Feasibility of Intervention Measure (FIM)	3.941176471 units on a scale Standard Deviation 0.89200749	4.078571429 units on a scale Standard Deviation 0.638159776	—

SECONDARY outcome

Timeframe: 4 weeks post-trial

Population: Includes: 1) participants from groups who used GUIDE during the trial, 2) participants who completed their post-trial assessment.

The Acceptability of Intervention Measure (AIM) is used to measure the acceptability of an intervention. The scale consists of 4 items rated on a 5-point Likert Scale from 1 ("Completely disagree") to 5 ("Completely agree"). The score consists of the average of the items, ranging from 1 to 5, with higher scores indicating greater acceptability of the intervention.

Outcome measures

Measure	GUIDE With Incentives n=34 Participants Immediate access to the GUIDE App smartphone application for 4 weeks with the opportunity to earn additional compensation, up to $100 in total, based on app engagement. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	GUIDE Without Incentives n=35 Participants Immediate access to the GUIDE App for 4 weeks without the opportunity to earn additional compensation. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	Waitlist Waitlisted with delayed access to the GUIDE App without the opportunity to earn additional compensation.
Acceptability of Intervention Measure (AIM)	3.757352941 units on a scale Standard Deviation 1.00469597	3.878571429 units on a scale Standard Deviation 0.777371676	—

SECONDARY outcome

Timeframe: 4 weeks post-trial

Population: Includes participants who: 1) assigned to a group that used GUIDE during the trial, 2) completed post-trial assessment.

The Intervention Appropriateness Measure (IAM) is used to measure the appropriateness of an intervention. The scale consists of 4 items rated on a 5-point Likert Scale from 1 ("Completely disagree") to 5 ("Completely agree"). The score consists of the average of the items, ranging from 1 to 5, with higher scores indicating greater appropriateness of the intervention.

Outcome measures

Measure	GUIDE With Incentives n=34 Participants Immediate access to the GUIDE App smartphone application for 4 weeks with the opportunity to earn additional compensation, up to $100 in total, based on app engagement. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	GUIDE Without Incentives n=35 Participants Immediate access to the GUIDE App for 4 weeks without the opportunity to earn additional compensation. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	Waitlist Waitlisted with delayed access to the GUIDE App without the opportunity to earn additional compensation.
Intervention Appropriateness Measure (IAM)	3.933823529 units on a scale Standard Deviation 0.817212612	4.085714286 units on a scale Standard Deviation 0.69118094	—

SECONDARY outcome

Timeframe: 4 weeks post-trial

Population: Analysis includes participants who: 1) used GUIDE for the trial period, 2) completed their post-trial assessment.

The System Usability Scale (SUS) measures perceptions of usability of a given system, in this case, the GUIDE App. The scale consists of 10 items, each rated on a 5-point Likert Scale from 1 ("Strongly disagree") to 5 ("Strongly agree"). Responses are transformed to get a total range of possible values from 0-100, with higher scores indicating higher perceptions of usability. Typically, a score above 68 is regarded as a good score.

Outcome measures

Measure	GUIDE With Incentives n=34 Participants Immediate access to the GUIDE App smartphone application for 4 weeks with the opportunity to earn additional compensation, up to $100 in total, based on app engagement. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	GUIDE Without Incentives n=35 Participants Immediate access to the GUIDE App for 4 weeks without the opportunity to earn additional compensation. GUIDE: The GUIDE App is a wellbeing app designed for first responders and veterans that uses small group support, a learning management system, drivers of behavior change, and an anonymous member experience safeguarded by a leader in identity and login privacy, Okta (okta.com). It includes three main features: 1) Community, 2) Wisdom, and 3) Daily Practice. The Community feature connects app users with an online community of like folks, allowing for human support, encouragement, accountability and coaching. Online communities are moderated by GUIDE employees. The Wisdom feature includes tools and interactive media for personal growth. The Daily Practice feature includes simple, daily routines to maintain mental and emotional wellness.	Waitlist Waitlisted with delayed access to the GUIDE App without the opportunity to earn additional compensation.
System Usability Scale (SUS)	70.07352941 units on a scale Standard Deviation 19.0442596	71.14285714 units on a scale Standard Deviation 18.85843992	—

Adverse Events

Intervention: GUIDE With Incentives

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Intervention: GUIDE Without Incentives

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Waitlist: No Intervention

Serious events: 0 serious events

Other events: 0 other events

Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Adverse event data not reported

Additional Information

Dr. Heather Nuske, PI

University of Pennsylvania

Phone: (215) 746-6041

Email: heather.nuske@pennmedicine.upenn.edu

Results disclosure agreements

• Principal investigator is a sponsor employee
• Publication restrictions are in place