INTRODUCTION

Psychological First Aid (PFA) is a world-wide implemented approach to help people affected by an emergency, disaster, or other adverse events. It is an approach to assist people in the immediate crisis to reduce the initial stress as well as their short-term and long-term impacts.¹ Psychological First Aid (PFA) is usually described as human support as well as practical response provided to others in stressful events and to population who is suffering from threatening situations.² These PFA services involve in different ways such as medical treatments, psychological interventions, and environmental distress. ³ Despite worldwide consensus that PFA should be the first-line approach in the immediate aftermath of disaster and humanitarian crisis. Psychological First Aid (PFA) usually provided to staff including; health workers, medical and paramedical staff, professionals, psychological support services providers, teachers, volunteers, and other responsible community members.  Most of the training department preferred that the trained staff of PFA must improve their capacity to manage the disaster’s victim and enhance their confidence as service provider. However, it is the main role of PFA trainer to facilitate the community by following the principle and standards. Psychological and mental distress can happen anywhere; in school, home, workplace, public places, learning centers and hospital as well. The trained PFA trainers can help the victims to overcome their stressful situations.¹

In school settings, PFA plays and inevitable role to manage the stress of teachers and other staff members that will use to motivate them towards their work at workplace as well as to improve the interpersonal relationships among staff and students.⁴ In medical and paramedical staff, PFA plays an important role to deal with patients and their families that will help to overcome their any kind of trauma related to their children, family and themselves. The trauma may include their personal, familial, financial and other issues. Nurses are trained to manage their patients while using PFA to overcome their stress. Another study was conducted on nurses who have had attended PFA trainings and implemented it to their other staff and patients with their families. For this purpose, total 56 nurses staff were included to evaluate their efficacy and to evaluate the training for healthcare assistance by using pre and post assessment that will show the effect of first aid on patients and their families.⁵

Psychological First Aid (PFA) is playing a vital role in recovery of people affected by any kind of disaster, it works as a group of skills applied that shows its impacts on mental health of people from traumatic experiences. As COVID-19 and smart lockdown has caused a significant level of anxiousness, anger, uncertainty and fear among people that further caused other mental health issues all over the world. Another research was conducted on caregivers that used to manage children in institutions, school and home sittings. In the pandemic, PFA works as a crucial psychological intervention tool for mitigating the influence of such traumatic events that have influence on physical, behavioral, emotional as well as spiritual reactions in the result of disasters.⁶

Literature from 1990-2010 indicate that even though PFA is widely suggested by expert opinion, there is a lack of scientific evidence supporting PFA as an effective disaster intervention.⁷

Very few studies look at the effectiveness of PFA training of frontline workers in post emergency situation. A study looking at impact of receiving one day PFA training (in physical) during Ebola outbreak in Sierre Leone not only found improved understanding and knowledge of professionals about psychological support strategies but also better understanding of application of these strategies after the patient was affected by acute crises. However, there was no significant difference found in quality of life, confidence and professional attitude in this study.⁸

The Current Study

COVID-19 pandemic is still on the rise and continuously affecting not only the physiological health but mental health of people as well. Considering the need of the time, PAHCHAAN in collaboration with UNICEF arranged two days training workshop for frontline workers during COVID-19 to provide information on the provision of psychological first aid (PFA) to minimize the outcomes of disaster situations. The current study was designed to find out the effectiveness of providing PFA training to frontline workers during COVID-19 pandemic on their knowledge, skills and attitude to work in disaster and stressful situations. Based on the current objective, study attempted to answer the following questions:

●      Is there any effect of the PFA training on overall perceived competence of frontline workers during COVID-19 pandemic?

●      Is there any effect of the PFA training on knowledge, skills, attitude and ability to prevent burnout of frontline workers in COVID-19 pandemic?

METHODS

Research Design

The design of the current study was descriptive in and a quantitative survey was conducted to assess the effectiveness of the training on psychological first aid on the perceived competence of the frontline workers in disaster situations.

Participants

Sample of 67 participants was purposively selected from the total number of 97 participants who attended the complete two days in-person training and were willing to take part in the study.

Instrumentation and Validation

The Perceived Competence Scale for Disasters Mental Health Workforce⁹ was administered on the participants first at the start and then on completion of the training. This scale is comprised of 27-items to calculate individual perceived competence on disaster situations, including dimensions of knowledge, skills, attitudes and prevention of burnout. Reliability of this scale for the current data was calculated through Cronbach’s Alpha and its value was α=.89 for the overall scale.

Data Analysis

Data were analyzed by using SPSS version 21. Descriptive statistics were calculated in the form of mean, frequency, percentage and standard deviation. Paired sample t-test was applied to find out the difference in the pre and post training mean scores of overall individual perceived competence, knowledge, skills, attitude and ability to prevent burnout of the participants. Independent sample t-test was applied to find out the difference in the perceived competence scores of the participants who attended any prior training on PFA and those who did not.

Procedure

PAHCHAAN in collaboration with UNICEF conducted a two-day training on Psychological First Aid for frontline workers so that they can manage the mental health and psychological issues in the masses that come along the COVID-19 pandemic. The current study was designed to find out the effectiveness of psychological first aid training on the perceived competence of frontline workers during COVID-19 pandemic. On the first day of training, participants were explained the purpose of his study and asked if they were willing to participate. After taking consent, questionnaires were administered on the participants. On second day at the completion of the training, same questionnaire was administered on the same participants. Data were entered, cleaned and analyzed using SPSS version 21 and descriptive and inferential statistics were calculated.

RESULTS

Results show a statistically significant difference in the pre and post training scores of psychological first aid knowledge, skills, attitude and overall perceived competence. Results indicate that knowledge, skills, attitude and overall perceived competence scores are higher after psychological first aid training than before training. Scores for ability to prevent burnout were also higher after training than before but there was no statistically significant difference in the pre and post training mean scores of the ability to prevent burnout.

Table 1: Demographic Information of the Participants (N=67)

Table 2: Comparison of Pre and Post Training Perceived Competence Scores (N=67).

**p<.001, *p<.05

 Table 3: Mean and Standard Deviation of perceived competence scores to compare groups based on the prior training on PFA (N=67)

Mean scores of the perceived competence were higher for those participants who have attended prior training on psychological first aid, however, there was no statistically significant difference among two groups.

DISCUSSION

PFA is a widely used mental health approach to help children, adults and families post disaster or traumatic events to reduce the initial distress along with short term and long-term psychological issues. It has been used in a variety of settings including hospitals, schools, shelter houses and care institutions along with the general public, adapting to socio-cultural contexts in developing and developing countries.¹⁰ The current study was an effort to understand the effectiveness of the psychological first aid training on the perceived competence of mental health professionals, working as frontline workers during the COVID-19 pandemic by examining their knowledge, skills, attitude and the ability to prevent from burnout in the stressful and disastrous situations.

Kılıç & Şimşek ⁵ conducted a research to examine the impact of psychological first aid training on the self-efficacy and perceived preparedness of nursing staff in the disaster situations. They reported that mean scores were significantly increased after the PFA training in all the dimensions of self-concept and disaster preparedness. Findings of the current study also show a statistically significant difference in the pre and post training scores of psychological first aid regarding knowledge, skills, attitude and overall perceived competence of the frontline workers. Results indicate that knowledge, skills, attitude and overall perceived competence scores are higher after psychological first aid training than before training. McCabe et al.¹¹emphasized that skills gained through the trainings on psychological first aid helps the professionals to understand disaster mental health principles, moreover perceived self-efficacy in response to disaster and trauma was also high after PFA training. In a study looking at comparison of PFA education program through simulation based learning (experimental group), PFA lecture only (comparison group) and self-learning PFA material (control group), it was seen that relief workers who had received simulation based PFA education showed better self-efficacy along with improved PFA competence and knowledge.¹²

Current study indicates that mean scores of the perceived competence were higher for those participants who have attended prior training on psychological first aid, however, there was no statistically significant difference among two groups.

Empowering the frontline workers by providing psychological first aid training is crucial in response to disaster management so that these workers can be prepared to help public in dealing with trauma and stress ¹³ because in emergency situations availability of skilled personnel becomes even more challenging. ¹⁴ Training programs to enhance the competence of frontline workers have been proved effective during SARS outbreak ¹⁵ and their significance and contribution cannot be overlooked in the COVID-19 pandemic considering the rising statistics of affected population and the rising need of mental health interventions.¹⁶

Little research is done on the effectiveness of PFA training especially in context to the COVOD19 pandemic. For disaster or emergency preparedness and sustainability of PFA trainings, policies need to address on engagement of health-related response agencies.¹⁷ PFA education module should be a part of undergraduate programs of frontline workers.⁵

There is a dire need to educate health care professionals and other relevant staff in providing psychological first aid and prepare a workforce to provide PFA to masses, to minimize associated psychological and mental distress in the individuals as well as families dealing with COVID-19.⁶

CONCLUSION AND RECOMMENDATIONS

The current study identified the effectiveness of psychological first aid training on the perception of frontline workers about their individual competence in stressful and disaster situations. Findings of the current study indicate an increase in the perceived competence and its sub-dimension; knowledge, skills and attitudes. Findings highlight the importance of providing psychological first aid trainings to frontline workers and how it can contribute in strengthening perception about competence in managing disasters. PFA trainings ensure the availability of skilled frontline workers in any disaster such as current COVID-19 pandemic. Public and private sectors should collaborate to prepare skilled professionals and frontline workers in COVID-19 pandemic so that these workers can further protect the masses from mental health issues associated with the pandemic.  There is a dire need to educate health care professionals and other relevant staff in providing psychological first aid and prepare a workforce to provide PFA to masses.

Training of mental health professionals and other professionals in relevant fields is crucial as we have seen in the findings that these trainings enhance the ability to perform in crisis situations. Public and private sectors should collaborate to enhance learning opportunities of professionals such as “train the trainer programs” and other capacity building activities.

REFERENCES

1. Ruzek JI, Brymer MJ, Jacobs AK, Layne CM, Vernberg EM, Watson PJ. Psychological first aid. Journal of Mental Health Counseling. 2007 Jan 1;29(1):17-49.
2. Schafer A, Snider L, Sammour R. A reflective learning report about the implementation and impacts of Psychological First Aid (PFA) in Gaza. Disaster Health. 2016 Jan 2;3(1):1-0.
3. Shultz JM, Forbes D. Psychological first aid: rapid proliferation and the search for evidence. Disaster Health. 2014 Jan 1;2(1):3-12.
4. Lee JS, You S, Choi YK, Youn HY, Shin HS. A preliminary evaluation of the training effects of a didactic and simulation-based psychological first aid program in students and school counselors in South Korea. PloS one. 2017 Jul 17;12(7):e0181271.doi:10.1371/journal.pone.0181271
5. Kılıç N, Şimşek N. The effects of psychological first aid training on disaster preparedness perception and self-efficacy. Nurse education today. 2019 Dec 1;83:104203.
6. Shah K, Bedi S, Onyeaka H, Singh R, Chaudhari G. The role of psychological first aid to support public mental health in the COVID-19 pandemic. Cureus. 2020 Jun;12(6).
7. Fox JH, Burkle FM, Bass J, Pia FA, Epstein JL, Markenson D. The effectiveness of psychological first aid as a disaster intervention tool: research analysis of peer-reviewed literature from 1990-2010. Disaster medicine and public health preparedness. 2012 Oct;6(3):247-52.
8. Sijbrandij M, Horn R, Esliker R, O’may F, Reiffers R, Ruttenberg L, Stam K, de Jong J, Ager A. The effect of psychological first aid training on knowledge and understanding about psychosocial support principles: a cluster-randomized controlled trial. International journal of environmental research and public health. 2020 Jan;17(2):484.
9. Yoon HY, Choi YK. The development and validation of the perceived competence scale for disaster mental health workforce. Psychiatry investigation. 2019 Nov;16(11):816.
10. Vernberg EM, Steinberg AM, Jacobs AK, Brymer MJ, Watson PJ, Osofsky JD, Layne CM, Pynoos RS, Ruzek JI. Innovations in disaster mental health: Psychological first aid. Professional Psychology: Research and Practice. 2008 Aug;39(4):381.
11. McCabe OL, Perry C, Azur M, Taylor HG, Bailey M, Links JM. Psychological first-aid training for paraprofessionals: a systems-based model for enhancing capacity of rural emergency responses. Prehospital and disaster medicine. 2011 Aug;26(4):251-8.
12. Kang JY, Choi YJ. Effects of a psychological first aid simulated training for pregnant flood victims on disaster relief worker's knowledge, competence, and self-efficacy. Applied nursing research. 2021 Feb 1;57:151348.
13. Nusbaum, K. E., Wenzel, J. G., & Everly Jr, G. S. (2007). Psychologic first aid and veterinarians in rural communities undergoing livestock depopulation. Journal of the American Veterinary Medical Association, 231(5), 692-694.
14. Brown LM, Bruce ML, Hyer K, Mills WL, Vongxaiburana E, Polivka-West L. A pilot study evaluating the feasibility of psychological first aid for nursing home residents. Clinical gerontologist. 2009 May 27;32(3):293-308.
15. Allen B, Brymer MJ, Steinberg AM, Vernberg EM, Jacobs A, Speier AH, Pynoos RS. Perceptions of psychological first aid among providers responding to Hurricanes Gustav and Ike. Journal of Traumatic Stress. 2010 Aug;23(4):509-13.
16. Dong L, Bouey J. Public mental health crisis during COVID-19 pandemic, China. Emerging infectious diseases. 2020 Jul;26(7):1616.
17. Birkhead GS, Vermeulen K. Sustainability of psychological first aid training for the disaster response workforce. doi:10.2105/ajph.2018.304643