Abstract
Background: Psychological First Aid (PFA) is a widely recognized early intervention of choice to reduce acute stress and foster adaptation in the aftermath of trauma exposure. So far, empirical exploration of PFA has primarily taken place in mass trauma conditions, and how it is delivered by non-specialists, such as disaster workers. The understanding of PFA beyond these limited settings, is scarce, particularly among healthcare workers, who are vital roles in managing trauma and stress at the frontline, responding to public health emergencies as well as providing direct care to patients.Overarching aim: This Ph.D. research aims to prepare healthcare workers through culturally adapting PFA for use amongst Chinese healthcare workers and evaluating its preliminary effectiveness on their ability to manage trauma and stress at the frontline.
Methods: The research project consisted of three phases, interlinked mixed-method studies guided by the ADAPT guidance, combined cultural adaptation frameworks, and the Medical Research Council Framework.
Results: Phase One: Evidence Reviews. Two literature reviews were conducted. 1) An integrative review of PFA as a therapeutic intervention following trauma exposure to synthesise the effectiveness and implementation, which informed a model delineating common process inherent in PFA intervention mechanism of action; 2) A scoping review of PFA training application, outcomes, and implementation, yet highlighted further efforts to adapt and evaluate appropriate training for non-specialist workers, which informed the PFA model selected for training and implementation strategy for the study population.
Phase Two: Adaptation. Adapting PFA to a frontline Clinical Care Setting (FCCS) was achieved through three sub-studies, that included: 1) A qualitative study involving interviews with mental health experts, key informants, and frontline healthcare workers was conducted, which obtained the Chinese cultural context of trauma interpretation, early trauma response and preferred needs; 2) A multiple-stakeholder consultant study involving experts consultant and focus group with frontline workers was conducted, which decided the adaptation needs resulting in an adapted READ-Y PFA model, and training protocol with an implementation strategy; 3) A study to manualise READ-Y PFA training programme with an expert group consisting of mental health experts and clinical education experts was conducted, and then field tested it among healthcare workers, which made the adapted training intervention ready to be tested.
Phase Three: Feasibility Testing. The feasibility study involved a feasibility trial and embedded process evaluation. 1) A small-scale randomized controlled feasibility trial was conducted in a Chinese tertiary hospital with 96 frontline healthcare workers. The quantitative results demonstrated the feasibility and acceptability of this culturally adapted PFA training among Chinese frontline healthcare workers. During a 3-month follow-up, preliminary positive changes were observed in knowledge acquisition, resilience, and a reduction in symptoms of depression and burnout compared to psycho-education. 2) An embedded process evaluation was also completed, including observation of training delivery and interviews with trainees, clinical ward managers, and training providers, which indicated a positive perception of the adapted PFA training, PFA relevance to clinical care, and benefits for workplace well-being, with no harm indicated to implement at FCCS.
Conclusion: This research contributes a novel exploration of how PFA and training can be adapted to prepare healthcare workers in managing trauma exposure at Chinese FCCS. Through a well-planned adaptation of PFA, it extends a theory-driven and evidence- informed PFA and PFA training prototype tailored to frontline clinical care beyond disaster setting in the international context. This can be used as a starting point to enable the practice of trauma-informed care, as well as prioritize workplace well-being in healthcare settings.
| Date of Award | 1 May 2024 |
|---|---|
| Original language | English |
| Awarding Institution |
|
| Supervisor | Mary Leamy (Supervisor) & Ian Norman (Supervisor) |