Daily Calm, a Malay-Language Mobile Application, for Reducing Perceived Stress among Secondary School Students in Melaka, Malaysia: A School-Based Cluster-Randomized Controlled Study

A total of 298 students completed both baseline and 8-week assessments, comprising 146 students in the intervention group and 152 in the control group. The median age for both groups was 14.00 (IQR = 3.00) years, with no significant differences in the reported sociodemographic characteristics between groups. The mean frequency of DailyCalm video use over eight weeks was 9.63 (SD 13.04) sessions. In the intervention group, mean PSS-10 scores decreased from 13.60 (SD 5.60) at baseline to 11.38 (SD 5.31) at 8 weeks (p < 0.001; r = 0.49). In the control group, mean PSS-10 scores decreased from 15.57 (SD 6.53) to 15.20 (SD 6.86), which was not statistically significant (p = 0.566; r = 0.05). The proportion of students with low perceived stress increased from 46.58% to 65.75% in the intervention group, while the proportion with moderate perceived stress decreased from 50.68% to 32.88%.

adolescent, effectiveness, mobile phone, application, stress

1. World Health Organization (WHO). Mental health of adolescents [Internet]. 2025 [cited 2025 Aug 18]. Available from: https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health [Google Scholar] [Crossref]

2. GBD 2021 ASEAN Mental Disorders Collaborators (2025). The epidemiology and burden of ten mental disorders in countries of the Association of Southeast Asian Nations (ASEAN), 1990-2021: findings from the Global Burden of Disease Study 2021. The Lancet. Public health, 10(6), e480–e491. https://doi.org/10.1016/S2468-2667(25)00098-2 [Google Scholar] [Crossref]

3. Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia. National Health and Morbidity Survey (NHMS) 2022: Adolescent Health Survey 2022. Kuala Lumpur: Institute for Public Health, National Institutes of Health, Ministry of Health Malaysia; 2022. [Google Scholar] [Crossref]

4. De Figueiredo CS, Sandre PC, Portugal LCL, Mázala-de-Oliveira T, da Silva Chagas L, Raony Í, et al. COVID-19 pandemic impact on children and adolescents’ mental health: Biological, environmental, and social factors. Prog Neuropsychopharmacol Biol Psychiatry 2021;106:110171. doi:10.1016/j.pnpbp.2020.110171 [Google Scholar] [Crossref]

5. Amran MS, Jamaludin KA. The impact of unplanned school closures on adolescent behavioral health during the COVID-19 pandemic in Malaysia. Front Public Health 2021;9:639041. doi: 10.3389/fpubh.2021.639041 [Google Scholar] [Crossref]

6. Singh S, Mani Pandey N, Datta M, Batra S. Stress, internet use, substance use and coping among adolescents, young adults and middle-aged adults amid the 'new normal' pandemic era. Clin Epidemiol Glob Health 2021;12:100885. doi:10.1016/j.cegh.2021.100885 [Google Scholar] [Crossref]

7. Fernandes B, Biswas UN, Tan-Mansukhani R, Vallejo A, Essau CA. The impact of COVID-19 lockdown on internet use and escapism in adolescents. Rev. Psicol. Clin. con Ninos Adolesc 2020;7:59-65. doi: 10.21134/rpcna.2020.mon.2056 [Google Scholar] [Crossref]

8. Toussaint L, Shields GS, Dorn G, Slavich GM. Effects of lifetime stress exposure in mental and physical health in young adulthood: How stress degrades and forgiveness protects health. J Health Psychol 2016;21:1004-14. doi:10.1177/1359105314544132 [Google Scholar] [Crossref]

9. Mandreş CM, Crăciun A. The effectiveness of relaxation techniques in stress reduction and coping optimization strategies for teenagers. Rom J Cogn Behav Ther Hypn 2015;2:31-41. [Google Scholar] [Crossref]

10. Foret MM, Scult M, Wilcher M, Chudnofsky R, Malloy L, Hasheminejad N, et al. Integrating a relaxation response-based curriculum into a public high school in Massachusetts. J Adolesc 2012;35:325-32. doi:10.1016/j.adolescence.2011.08.008 [Google Scholar] [Crossref]

11. Burkhart K, Mason E, Lazebnik R. Stress management intervention: A pilot evaluation in an urban adolescent medicine clinic. Clin Pediatr (Phila). 2018;57:700-5. doi:10.1177/0009922817733704 [Google Scholar] [Crossref]

12. Mason EB, Burkhart K, Lazebnik R. Adolescent stress management in a primary care clinic. J Pediatr Health Care. 2019;33:178-85. doi:10.1016/j.pedhc.2018.08.001 [Google Scholar] [Crossref]

13. Admiraal W. A typology of student-teachers’ coping with stressful classroom events. Eur J Educ 2020;3:6-17. doi:10.26417/ejed.v3i1.p6-17 [Google Scholar] [Crossref]

14. Malaysian Communication and Multimedia Commission (MCMC). Internet users survey 2022 [Internet]. Cyberjaya: MCMC; 2022 [cited 2025 Aug 15]. Available from: https://www.mcmc.gov.my/skmmgovmy/media/General/IUS-2022.pdf [Google Scholar] [Crossref]

15. Harrer M, Adam SH, Fleischmann RJ, Baumeister H, Auerbach R, Bruffaerts R, et al. Effectiveness of an internet- and app-based intervention for college students with elevated stress: Randomized controlled trial. J Med Internet Res 2018;20:e136. doi:10.2196/jmir.9293 [Google Scholar] [Crossref]

16. Coelhoso CC, Tobo PR, Lacerda SS, Lima AH, Barrichello CR, Amaro E Jr, et al. A new mental health mobile app for well-being and stress reduction in working women: Randomized controlled trial. J Med Internet Res 2019;21:e14269. doi:10.2196/14269 [Google Scholar] [Crossref]

17. Yang E, Schamber E, Meyer RML, Gold JI. Happier healers: Randomized controlled trial of mobile mindfulness for stress management. J Altern Complement Med. 2018;24:505-13. doi:10.1089/acm.2015.0301 [Google Scholar] [Crossref]

18. Kenny R, Dooley B, Fitzgerald A. Developing mental health mobile apps: Exploring adolescents’ perspectives. Health Inform J 2016;22:265-75. doi:10.1177/1460458214555041 [Google Scholar] [Crossref]

19. Noor Azimah M, Reiko W, Muhammad Aziq A, Nurfitri Izzati ZF, Nur Afifah AM, Kuganeswari A, et al. The usability and feasibility of DailyCalm application in reducing stress among adolescents during COVID-19 pandemic. Med Health. 2021;16:216-26. doi:10.17576/MH.2021.1602.16 [Google Scholar] [Crossref]

20. Campbell, M. K., Elbourne, D. R., Altman, D. G., & CONSORT group (2004). CONSORT statement: extension to cluster randomised trials. BMJ (Clinical research ed.), 328(7441), 702–708. https://doi.org/10.1136/bmj.328.7441.702 [Google Scholar] [Crossref]

21. Al-Dubai SA, Alshagga MA, Rampal KG, Sulaiman NA. Factor structure and reliability of the Malay version of the perceived stress scale among Malaysian medical students. Malays J Med Sci. 2012;19:43-9. [Google Scholar] [Crossref]

22. Aschentrup L, Steimer PA, Dadaczynski K, McCall T, Fischer F, Wrona K.J. Effectiveness of gamified digital interventions in mental health prevention and health promotion among adults: a scoping review. BMC Public Health 2024;69(2024). doi:10.1186/s12889-023-17517-3. [Google Scholar] [Crossref]

23. Mohler-Kuo M, Dzemaili S, Foster S, Werlen L, Walitza S. Stress and mental health among children/adolescents, their parents, and young adults during the first COVID-19 lockdown in Switzerland. Int J Environ Res Public Health 2021;18:4668. doi:10.3390/ijerph18094668 [Google Scholar] [Crossref]

24. Ebbert AM, Kumar NL, Luthar SS. Complexities in adjustment patterns among the “best and the brightest”: Risk and resilience in the context of high-achieving schools. Res Hum Dev 2019;16:21-34. doi:10.1080/15427609.2018.1541376 [Google Scholar] [Crossref]

25. Thornton L, Gardner LA, Osman B, Green O, Champion KE, Bryant Z, et al. A multiple health behavior change, self-monitoring mobile app for adolescents: Development and usability study of the Health4Life app. JMIR Form Res 2021;5:e25513. doi:10.2196/25513 [Google Scholar] [Crossref]

26. Krebs P, Duncan DT. Health app use among US mobile phone owners: A national survey. JMIR Mhealth Uhealth 2015;3:e101. doi:10.2196/mhealth.4924. [Google Scholar] [Crossref]

27. Lauricella S. Mindfulness meditation with undergraduates in face-to-face and digital practice: A formative analysis. Mindfulness. 2014;5:682-688. doi:10.1007/s12671-013-0222-x [Google Scholar] [Crossref]

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