Feasibility and acceptability of a culturally adapted psychological first aid training intervention (Preparing Me) to support the mental health and well-being of front-line healthcare workers in China: a feasibility randomized controlled trial

ABSTRACT

Background: Psychological first aid (PFA) training helps to prepare healthcare workers (HCWs) to manage trauma and stress during healthcare emergencies, yet evidence regarding its effectiveness and implementation is lacking.

Method: A two-arm feasibility randomized controlled trial design was conducted in a Chinese tertiary hospital. Participants were randomly allocated to receive either a culturally adapted PFA training (the intervention arm) or psychoeducation (the control arm). Feasibility indicators and selected outcomes were collected.

Results: In total, 215 workers who expressed an interest in participating in the trial were screened for eligibility, resulting in 96 eligible participants being randomly allocated to the intervention arm (n = 48) and control arm (n = 48). There was a higher retention rate for the face-to-face PFA training session than for the four online group PFA sessions. Participants rated the PFA training as very helpful (86%), with a satisfaction rate of 74.25%, and 47% reported being able to apply their PFA skills in responding to public health emergencies or providing front-line clinical care. Positive outcome changes were observed in PFA knowledge, skills, attitudes, resilience, self-efficacy, compassion satisfaction, and post-traumatic growth. Their scores on depression, anxiety, stress, and burnout measures all declined. Most of these changes were sustained over 3 months (p < .05). Repeated measures analysis of variance found statistically significant interaction effects on depression (F_2,232 = 2.874, p = .046, $\eta p^2$ = .031) and burnout (F_2,211 = 3.729, p = .018, $\eta p^2$ = .037), indicating a greater reduction in symptoms of depression and burnout with PFA compared to psychoeducation training.

Conclusion: This culturally adapted PFA training intervention was highly acceptable among Chinese HCWs and was feasible in a front-line care setting. Preliminary findings indicated positive changes for the PFA training intervention on knowledge, skills, attitudes, resilience, self-efficacy, compassion satisfaction, and post-traumatic growth, especially a reduction of depression and burnout. Further modifications are recommended and a fully powered evaluation of PFA training is warranted.

HIGHLIGHTS

• Psychological first aid (PFA) training was culturally adapted and evaluated to help prepare healthcare workers to manage trauma and stress during healthcare emergencies.

• This culturally adapted PFA training was highly acceptable among Chinese healthcare workers and was feasible in a front-line care setting.

• Preliminary findings show positive changes for the PFA training intervention on knowledge, skills, attitudes, resilience, self-efficacy, compassion satisfaction, and post-traumatic growth, especially a reduction of depression and burnout.

Antecedentes: La capacitación en primeros auxilios psicológicos (PFA, por sus siglas en inglés) ayuda a preparar a los trabajadores de la salud (TS) para manejar el trauma y el estrés durante emergencias de atención médica, pero falta evidencia sobre su efectividad e implementación.

Métodos: Se llevó a cabo un diseño de ensayo controlado aleatorizado de viabilidad de dos brazos en un hospital terciario chino. Los participantes fueron asignados aleatoriamente para recibir una capacitación en PFA adaptada culturalmente (el brazo de intervención) o para recibir psicoeducación (el brazo de control). Se recopilaron indicadores de viabilidad y resultados seleccionados.

Resultados: Se evaluó la elegibilidad de 215 trabajadores que expresaron interés en participar en el ensayo, lo que dio como resultado que 96 participantes elegibles fueran asignados aleatoriamente al brazo de intervención (n = 48) y al brazo de control (n = 48). Hubo una tasa de retención más alta para la sesión de capacitación presencial de PFA que para cuatro sesiones grupales de PFA en línea. Los participantes calificaron la capacitación de PFA como muy útil (86%), con una tasa de satisfacción del 74,25%, y el 47% de ellos informaron que podían aplicar sus habilidades de PFA para responder a emergencias de salud pública o brindar atención clínica de primera línea. Se observaron cambios positivos en sus conocimientos, habilidades, actitudes, resiliencia, autoeficacia, satisfacción por compasión y crecimiento postraumático de la PFA. Sus puntuaciones en las medidas de depresión, ansiedad, estrés y agotamiento disminuyeron. Es alentador que la mayoría de estos cambios se mantuvieran durante tres meses (p < ,05). El análisis ANOVA de medidas repetidas encontró un efecto de interacción estadística sobre la depresión (F_2,232 = 2,874, p = ,046, $\eta p^2$ = ,031) y burnout (F_2,211 = 3,729, p = ,018, $\eta p^2$ = ,037), indicando una mayor reducción de los síntomas de depresión y burnout en la PFA en comparación con la formación en psicoeducación.

Conclusión: Esta intervención de capacitación en PFA adaptada culturalmente fue muy aceptable entre los trabajadores de la salud chinos y fue factible en un entorno de atención de primera línea. Los hallazgos preliminares indicaron cambios positivos para la intervención de capacitación de PFA en conocimientos, habilidades, actitudes, resiliencia, autoeficacia, satisfacción por compasión y crecimiento postraumático, especialmente una reducción de la depresión y el agotamiento. Se recomiendan modificaciones adicionales y se justifica una evaluación completa de la capacitación de PFA.

KEYWORDS:

• Psychological first aid training
• front-line healthcare workers
• mental health and well-being
• feasibility randomized controlled trial

PALABRAS CLAVE:

• Capacitación en primeros auxilios psicológicos
• trabajadores sanitarios de primera línea
• salud mental y bienestar
• ensayo controlado aleatorizado de viabilidad

Open Scholarship

This article has earned the Center for Open Science badges for Open Data, Open Materials and Preregistered. The data and materials are openly accessible at 1) Chinese clinical trial registration website: www.medresman.org; 2) trial protocol: doi.org/10.3389/fpsyt.2021.809679 and 3) trial protocol: doi.org/10.3389/fpsyt.2021.809679.

Acknowledgements

The authors would like to express their gratitude to all healthcare professionals and their clinical ward managers on the front-line who took part in this study and generously shared their valuable experiences. The authors also appreciate the invaluable administrative support of the Nursing Department, Medical Department, Academic Affairs Department, Clinical Skill Training Center, Medical Simulation Center, and Department of Psychiatry at the Second Xiangya Hospital.

Disclosure statement

No potential conflict of interest was reported by the authors.

Trial registration

This trial has been approved by the Institution Review Board from Central South University (XTXL20200610) and by the Psychiatry, Nursing and Midwifery Research Ethics Committee at King’s College London, UK (LRS/DP-21/22-23161). It has also been processed for registration at the Chinese Clinical Trial Registry (ChiCTR2300071402).

Author contributions

I. N., M. L., and L. W. were responsible for the research concept development, methodology, and trial registration. L. W. drafted the manuscript. I. N. and M. L. contributed to the text and critically revised the manuscript. Y. L and T. X. obtained part of the funding and support from the local authorities, and undertook hospital population engagement. X. L., C. J., and Z. Z. contributed to recruitment, data collection, and research facilitation. T. L., J. W., and L. Z. contributed to training development, delivery, and supervision. All authors approved the final version of the manuscript.

Data availability statement

All materials (data, code, and supporting information) are available from ResMan (www.medresman.org), archived at the time of submission on ResMan (DOI: 10.5281/zenodo.3968301).

Notes

1 For example, during the COVID-19 pandemic response, more than 10 teams with 600 front-line workers from different disciplines were called out and dispatched by the national and provincial health commission to rescue Wuhan and other provinces.

Additional information

Funding

This study is supported by the Health Research Project from Health Commission of Hunan Province [20190365] and the innovative education project of Central South University [2018CXKZ06].