RAND Corporation, Boston, MA, USA.
RAND Corporation, Santa Monica, CA, USA.
BMC Health Serv Res. 2024 Nov 26;24(1):1475. doi: 10.1186/s12913-024-11812-4.
The COVID-19 pandemic has taken a toll on frontline health care workers (HCWs), leading to poor mental and physical well-being. We conducted a large, cluster randomized controlled trial to implement an adapted Stress First Aid (SFA) intervention to support HCW well-being using a train-the-trainer (TTT) approach for rapid deployment in the United States and collected qualitative data through interviews to understand implementation. The goal of this study is to understand barriers and facilitators to deploying SFA using a TTT model, with particular emphasis on the acceptability, uptake, and barriers from the implementation.
We conducted seven individual and seven group semi-structured qualitative interviews with 28 trainers (i.e., site champions) who delivered SFA training to their local HCWs from Spring 2021 to Winter 2022 in hospitals and health care centers within the United States. We utilized both inductive and deductive approaches to coding transcripts. All transcripts were coded in Dedoose. We used the Consolidated Framework for Implementation Research (CFIR) to rigorously assess implementation experiences.
Site champions highlighted leadership buy-in, protected time and incentives, and teams as implementation facilitators, while implementation barriers included unhelpful training materials and content, time constraints and scheduling difficulties, and pandemic-related factors, such as COVID-19 surges. SFA implementation processes varied: some champions had virtual SFA presentations, while others held informal discussions about SFA material in person. Champions also differed on their perceptions of SFA sustainability: some indicated it would be difficult to sustain SFA in their organization due to limited structure and time, while others stated they would continue to utilize it.
Limited research has examined the implementation of HCW well-being interventions using a TTT approach in a changing environment. Site champions were able to implement SFA during a period of rapid and frequent change and shared several implementation facilitators and barriers related to the SFA intervention. In the future, addressing the implementation barriers proactively and prioritizing the implementation facilitators may prove to be useful for large-scale interventions implemented during disease outbreaks and pandemics.
COVID-19 大流行给一线医护人员（HCWs）造成了严重影响，导致他们身心健康状况不佳。我们开展了一项大规模的群组随机对照试验，采用培训师培训（TTT）方法实施改良后的应激第一反应（SFA）干预，以支持美国 HCW 的健康，并通过访谈收集定性数据，以了解实施情况。本研究的目的是了解采用 TTT 模型实施 SFA 的障碍和促进因素，特别强调实施过程中的可接受性、采用情况和障碍。
我们对 28 名培训师（即现场冠军）进行了七次个人和七次小组半结构化定性访谈，这些培训师于 2021 年春季至 2022 年冬季在美国的医院和医疗保健中心向当地 HCWs 提供 SFA 培训。我们采用归纳和演绎方法对转录本进行编码。所有转录本均在 Dedoose 中进行编码。我们使用整合实施研究框架（CFIR）严格评估实施经验。
现场冠军强调领导力认同、受保护的时间和激励措施以及团队是实施的促进因素，而实施障碍包括培训材料和内容无益、时间限制和调度困难以及与大流行相关的因素，如 COVID-19 激增。SFA 的实施过程各不相同：一些冠军进行了虚拟 SFA 演示，而另一些则亲自进行了关于 SFA 材料的非正式讨论。冠军们对 SFA 的可持续性也有不同的看法：一些人表示，由于结构和时间有限，他们很难在组织中维持 SFA，而另一些人则表示他们将继续使用它。
在不断变化的环境中，采用 TTT 方法实施 HCW 健康干预的研究有限。现场冠军能够在快速且频繁变化的时期实施 SFA，并分享了与 SFA 干预相关的一些实施促进因素和障碍。在未来，积极应对实施障碍并优先考虑实施促进因素可能有助于在疾病爆发和大流行期间实施大规模干预。
