| Study characteristics |
| Methods |
Design: mixed methods, including cluster‐randomised trial and qualitative interviews
Country: Sierra Leone and Liberia
Study aim: to systematically evaluate PFA
Study recruitment details:
for the qualitative study ‐ purposive sampling of people involved in PFA during the EVD outbreak in Sierra Leone and Liberia for the randomised trial ‐ staff members from 143 'Peripheral Health Units' across 6 districts of Sierra Leone who had not previously had any PFA training
Setting: community
Epidemic/pandemic disease: EVD virus disease
Phase of disease outbreak: after the pandemic |
| Participants |
Total study population: for the qualitative study ‐ 73 participants (23 trainers, 36 providers and 14 key informants). For the randomised trial ‐ 408 participants
Inclusion criteria:
for the qualitative study ‐ either: received training in PFA between 1 April 2014 and 31 March 2016 in Liberia; provided PFA training to other stakeholders during this time; or a formally recognised PFA trainer for the randomised trial ‐ primary HCWs (age > 18 years), with adequate oral and written command of the English or Krio language, and who had not previously received any PFA training or a training with overlapping content (i.e. they were PFA naive).
Exclusion criteria: not reported
Type (profession) of staff:
for the qualitative study ‐ people trained to use PFA included HCWs, community leaders, teachers and social workers; participants included healthcare professionals (nurses, midwives, mental health clinicians, social workers) and people in other roles (e.g. volunteers, burial teams, administrators, technicians, teachers, caregivers) for the randomised trial (intervention and control group) ‐ nurses (35.4% and 44.1%), community health workers (9.7% and 5.9%) midwives (7.3% and 7.9%), maternal health assistants (38.8% and 36.1%) and other (vaccinator, lab assistant etc; 8.7% & 5.9%).
Length of time in the profession:
Previous experience of working in the frontline during an epidemic/pandemic:
Details of who the frontline staff were providing care for: people directly affected by EVD |
| Interventions |
1. Training in delivery of psychological first aid: (n = 206)
Type of intervention: workplace intervention (training) Materials: PFA facilitators' manual: WHO. Psychological first aid: Facilitator’s Manual for Orienting Field Workers; WHO: Geneva, Switzerland, 2013 Procedure: PFA training was "based on a PFA ToT manual adapted by the WHO Mental Health focal person for Sierra Leone (Dr. Florence Baingana), which included elements of mental health awareness along with PFA training based on the PFA Facilitators’ Manual for Orienting Field Workers". "In this training, the following topics were covered: (1) explaining important terms (mental health, mental disorder, psychosocial support and psychosocial disorder); (2) understanding reactions to traumatic and stressful events; (3) understanding PFA; (4) understanding sources and signs of stress; (5) self‐care; (6) providing PFA‐prepare for your role, look, listen and link; (7) ending your assistance; (8) practicing PFA with role‐play." Provided by: mental health nurses who had participated in a 1‐day Training of Trainers (ToT) delivered by the WHO 2 months earlier Delivery: 1‐day, face‐to‐face PFA group training Regimen: 1 day of training Tailoring: no Modification: no Adherence: "Of the 206 participants who were allocated to PFA training, 135 (65.5%) received PFA, whereas 71 (34.5%) did not receive PFA due to factors including heavy rainfall during the days of the trainings." "Of the 198 participants who were allocated to control, 4 participants (1.9%) received the training." Details of any adverse events/unintended consequences: no
2. Control group (no intervention): (n = 202) |
| Outcomes |
Qualitative study
Semi‐structured interviews "explored how PFA training was delivered during the EVD crisis, whether fidelity to the original model was maintained, and the trainers’ reflections on the process of rolling out the training"
Randomised trial
Outcomes: self‐report questionnaires for
knowledge about psychosocial support for individuals who are exposed to adversities understanding of how to apply appropriate skills and response strategies for individuals who are exposed to adversities professional attitude confidence in taking care of people who have experienced a crisis or difficult event professional quality of life ‐ 10 items from the ProQOL‐5, which were 6 items from the "6 items from the Compassion Fatigue scale (items 3, 12, 20, 22, 24, and 30) and 4 items from the Burnout Scale (items 2, 3, 5, and 7)
Data collection: baseline, "3 months post‐assessment" (timed to follow shortly after the PFA training for the PFA group), 6 months post‐assessment |
| Funding |
Elrha’s Research for Health in Humanitarian Crises (R2HC) Programme (Grant number 21163). (The R2HC programme is funded by the UK Government (DFID), the Wellcome Trust, and the UK National Institute for Health Research (NHIR).)
"Additional funding was obtained at the United States Agency for International Development (USAID) through the Advancing Partners & Communities project, implemented by JSI Research &Training Institute, Inc., in collaboration with FHI 360 under Cooperative Agreement No. AID‐OAA‐A‐12‐00047." |
| Notes |
Included in the review of quantitative evidence ‐ randomised trial
Included in the review of qualitative evidence synthesis ‐ classified as a 'qualitative study', as data were extracted from the qualitative component of this mixed‐method study.
Methodological assessment
Overall assessment: no or few limitations. For details of assessment see Table 9, and for support for judgements see Appendix 13. |
