Tailoring Psychological First Aid for frontline healthcare workers to manage trauma and stress beyond emergency response to routine healthcare settings--- a qualitative multi-stakeholder consultation study in China

Healthcare workers (HCWs) are frequently exposed to trauma, either by witnessing patients' suffering or directly experiencing workplace violence and responding to public health emergencies yet a historical lack of mental health preparedness existed for them. Although Psychological First Aid (PFA) has been widely advocated as a training approach to support HCWs, limited evidence on its’ cultural adaptation and implementation in healthcare settings hinders its’ uptake. Guided by cultural adaptation and implementation science frameworks, this qualitative study employed a multi-step stakeholder consultation approach to adapt the PFA model and develop an implementation strategy tailored for Chinese HCWs. Diverse stakeholders, including mental health experts, key informants, medical education experts, scholars, and HCWs, participated in three phased activities: 1) In-depth individual expert consultations, 2) Focus group discussions, and 3) Expert workshops. Ethical approval was obtained in both the UK and China. Data was analysed using framework analysis. The original PFA model was adapted to make cultural, contextual, structural, delivery format, and implementation strategy changes. Through adapting PFA model, modifying the training format and developing implementation strategy, resulted in the development of the READ-Y PFA model: R-Rapport, E-Evaluation, A-Aid, D-Disposition, and Yourself-Self-Care for others. The model includes a flexible training protocol and implementation strategies, integrated into a logical framework, to enable its use in frontline routine healthcare settings in China. This study presents a culturally adapted a READ-Y PFA model and training protocol extending PFA use beyond emergency response to routine healthcare. The stakeholder-informed approach offers a replicable framework for potentially scaling up PFA to better equip HCWs to manage trauma and stress.