An E–Mental Health Solution to Prevent and Manage Posttraumatic Stress Injuries Among First Responders in Alberta: Protocol for the Implementation and Evaluation of Text Messaging Services (Text4PTSI and Text4Wellbeing)

Obuobi-Donkor, Gloria; Eboreime, Ejemai; Bond, Jennifer; Phung, Natalie; Eyben, Scarlett; Hayward, Jake; Zhang, Yanbo; MacMaster, Frank P.; Clelland, Steven R; Greiner, Russell; Jones, Chelsea; Cao, Bo; Brémault‐Phillips, Suzette; Wells, Kristopher; Li, Xinmin; Hilario, Carla; Greenshaw, Andrew J.; Agyapong, Vincent Israel Opoku

doi:10.2196/30680

Cited by 13 publications

(13 citation statements)

References 66 publications

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“…Data were collected through online self-administered questionnaires with the REDCap software program [41]. The procedure for data collection is fully described in the study protocol [2]. The targeted population was public safety personnel, including emergency department health workers, paramedics, firefighters, and police/law enforcement agents.…”

Section: Data Collectionmentioning

confidence: 99%

“…First responders comprise police, paramedics, firefighters, ambulance personnel, and emergency medical personnel who have acquired the skills and training and are the first contact to assist individuals during emergencies such as accidents and fire outbreaks [1,2]. Public safety personnel, on the other hand, ensure safety.…”

Section: Introductionmentioning

confidence: 99%

“…Supportive text message therapy has also been effective in mood disorders [40]. Text4PTSI is a supportive daily text messaging program based on CBT and trauma therapy principles and aims to provide mental health support for public safety personnel [2]. The program was initiated to prevent, manage, and reduce psychopathology in this cohort.…”

Section: Introductionmentioning

confidence: 99%

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Text4PTSI: A Promising Supportive Text Messaging Program to Mitigate Psychological Symptoms in Public Safety Personnel

Obuobi-Donkor

Shalaby

Eboreime

et al. 2023

IJERPH

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Background: Public safety personnel experience various mental health conditions due to their work’s complex and demanding nature. There are barriers to seeking support and treatment; hence, providing innovative and cost-effective interventions can help improve mental health symptoms in public safety personnel. Objective: The study aimed to evaluate the impact of Text4PTSI on depression, anxiety, trauma, and stress-related symptoms, and the resilience of public safety personnel after six months of providing supportive text message intervention. Methods: Public safety personnel subscribed to Text4PTSI and received daily supportive and psychoeducational SMS text messages for six months. Participants were invited to complete standardized self-rated web-based questionnaires to assess depression, anxiety, posttraumatic stress disorder (PTSD), and resilience symptoms measured on the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 scale (GAD-7), Posttraumatic Stress Disorder Checklist-Civilian Version (PCL-C), and the Brief Resilience Scale (BRS), respectively. The assessment of mental health conditions was conducted at baseline (enrolment) and six weeks, three months, and six months after enrollment. Results: One hundred and thirty-one subscribers participated in the Text4PTSI program, and eighteen completed both the baseline and any follow-up survey. A total of 31 participants completed the baseline survey and 107 total surveys were recorded at all follow-up time points. The baseline prevalence of psychological problems among public safety personnel were as follows: likely major depressive disorder (MDD) was 47.1%, likely generalized anxiety disorder (GAD) was 37.5%, low resilience was 22.2%, and likely PTSD was 13.3%. At six months post-intervention, the prevalence of likely MDD, likely GAD, and likely PTSD among respondents reduced; however, a statistically significant reduction was reported only for likely MDD (−35.3%, X2 (1) = 2.55, p = 0.03). There was no significant change in the prevalence of low resilience between baseline and post-intervention. There was a decrease in the mean scores on the PHQ-9, GAD-7, PCL-C, and the BRS from baseline to post-intervention by 25.8%, 24.7%, 9.5%, and 0.3%, respectively. However, the decrease was only statistically significant for the mean change in GAD-7 scores with a low effect size (t (15) = 2.73, p = 0.02). Conclusions: The results of this study suggest a significant reduction in the prevalence of likely MDD as well as the severity of anxiety symptoms from baseline to post-intervention for subscribers of the Text4PTSI program. Text4PTSI is a cost-effective, convenient, and easily scalable program that can augment other services for managing the mental health burdens of public safety personnel.

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Section: Data Collectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Text4PTSI: A Promising Supportive Text Messaging Program to Mitigate Psychological Symptoms in Public Safety Personnel

Obuobi-Donkor

Shalaby

Eboreime

et al. 2023

IJERPH

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“…In addition to being a promising tool for measuring physician well-being, SMS text message–based surveys can also serve as behavioral reinforcements and reminders of mindfulness. The implementation of SMS text messaging services acting as mental health interventions (daily supportive psychoeducational texts) has been shown to effectively reduce symptoms of stress [ 14 , 15 ]. Our study population included physician-trainees for this pilot phase and can be generalized to all physicians given that differences in burnout have been shown to be relatively minimal between physician-trainees and early career physicians [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluating the Mental Health of Physician-Trainees Using an SMS Text Message–Based Assessment Tool: Longitudinal Pilot Study

Goldhaber¹,

Chea²,

Hekler³

et al. 2023

JMIR Form Res

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Background Physician burnout is a multibillion-dollar issue in the United States. Despite its prevalence, burnout is difficult to accurately measure. Institutions generally rely on periodic surveys that are subject to recall bias. SMS text message–based surveys or assessments have been used in health care and have the advantage of easy accessibility and high response rates. Objective In this pilot project, we evaluated the utility of and participant engagement with a simple, longitudinal, and SMS text message–based mental health assessment system for physician-trainees at the study institution. The goal of the SMS text message–based assessment system was to track stress, burnout, empathy, engagement, and work satisfaction levels faced by users in their normal working conditions. Methods Three SMS text message-based questions per week for 5 weeks were sent to each participant. All data received were deidentified. Additionally, each participant had a deidentified personal web page to follow their scores as well as the aggregated scores of all participants over time. A 13-question optional survey was sent at the conclusion of the study to evaluate the usability of the platform. Descriptive statistics were performed. Results In all, 81 participants were recruited and answered at least six (mean 14; median 14; range 6-16) questions for a total of 1113 responses. Overall, 10 (17%) out of 59 participants responded “Yes” to having experienced a traumatic experience during the study period. Only 3 participants ever answered being “Not at all satisfied” with their job. The highest number of responses indicating that participants were stressed or burnt out came on day 25 in the 34-day study period. There were mixed levels of concern for the privacy of responses. No substantial correlations were noted between responses and having experienced a traumatic experience during the study period. Furthermore, 12 participants responded to the optional feedback survey, and all either agreed or strongly agreed that the SMS text message–based assessment system was easy to use and the number of texts received was reasonable. None of the 12 respondents indicated that using the SMS text message–based assessment system caused stress. Conclusions Responses demonstrated that SMS text message–based mental health assessments are potentially useful for recording physician-trainee mental health levels in real time with minimal burden, but further study of SMS text message–based mental health assessments should address limitations such as improving response rates and clarifying participants’ sense of privacy when using the SMS text message–based assessment system. The findings of this pilot study can inform the development of institution-wide tools for assessing physician burnout and protecting physicians from occupational stress.

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“…SMS text messaging services such as Text4Support effectively reduced the risk of harm to self and other harm symptoms after 6 months of intervention in a randomized controlled trial [ 23 ] and improved distress, anxiety, and depression in clinical samples [ 24 ]. Similarly, the Text4PTSI program has achieved fidelity and significantly reduced psychological distress among public safety personnel post intervention [ 25 , 26 ]. SMS text message–based population-level messaging programs have reported user satisfaction rates of well over 80%, and most subscribers have reported feeling connected to support systems and improving their ability to manage anxiety, depression, and general life issues, suggesting an improvement in mental health literacy [ 15 , 27 - 29 ].…”

Section: Introductionmentioning

confidence: 99%

Cancer Care Supportive Text Messaging Program (Text4Hope) for People Living With Cancer and Their Caregivers During the COVID-19 Pandemic: Longitudinal Observational Study

Shalaby,

Vuong,

Agyapong

et al. 2024

JMIR Form Res

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Background Cancer is the leading cause of death in Canada, and living with cancer generates psychological demands, including depression and anxiety among cancer survivors and caregivers. Text4Hope-Cancer Care SMS text messaging–based service was provided to people with cancer and caregivers during the COVID-19 pandemic to support their mental health. Objective The aim of this study is to examine the clinical effectiveness of and satisfaction with Text4Hope-Cancer Care in addressing mental health conditions among people living with cancer and caregivers. Methods The study was conducted in Alberta, Canada. People who were diagnosed or receiving cancer treatment and caregivers self-subscribed to receive 3-months daily supportive cognitive behavioral therapy–based SMS text messages and a web-based survey was sent at designated time points to collect clinical and nonclinical data. The Hospital Anxiety and Depression scale (HADS) was used to examine changes in anxiety and depression symptoms after receiving the service. Satisfaction with the service was assessed using a survey with a Likert scale. Descriptive and inferential statistics were used, and test significance was considered with P≤.05. Results Overall, 107 individuals subscribed to the service, and 93 completed the program (completion rate 93/107, 86.9%). A significant improvement in the anxiety symptoms (HADS-Anxiety [HADS-A] subscale) was reported after 3 months of Text4Hope-Cancer Care (t11=2.62; P=.02), with medium effect size (Hedges g=0.7), but not depression symptoms (HADS-Depression [HADS-D] subscale). Subscribers expressed high satisfaction and agreed that the service has helped them to cope with mental health symptoms and improve their quality of life. Most subscribers read the SMS text messages more than once (30/30, 100%); took time to reflect or took a beneficial action after reading the messages (27/30, 90%); and highly agreed (27/30, >80%) with the value of the received supportive SMS text messages as being relevant, succinct, affirmative, and positive. All subscribers recommended SMS text messaging for stress, anxiety, and depression and for cancer care support (30/30, 100%). Conclusions Text4Hope-Cancer Care was well-perceived and effectively addressed anxiety symptoms among people living with cancer and caregivers during the peak of the COVID-19 pandemic. This study provides evidence-based support and insight for policy and stakeholders to implement similar convenient, economic, and accessible mental health services that support vulnerable populations during crises. International Registered Report Identifier (IRRID) RR2-10.2196/20240

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An E–Mental Health Solution to Prevent and Manage Posttraumatic Stress Injuries Among First Responders in Alberta: Protocol for the Implementation and Evaluation of Text Messaging Services (Text4PTSI and Text4Wellbeing)

Cited by 13 publications

References 66 publications

Text4PTSI: A Promising Supportive Text Messaging Program to Mitigate Psychological Symptoms in Public Safety Personnel

Text4PTSI: A Promising Supportive Text Messaging Program to Mitigate Psychological Symptoms in Public Safety Personnel

Evaluating the Mental Health of Physician-Trainees Using an SMS Text Message–Based Assessment Tool: Longitudinal Pilot Study

Cancer Care Supportive Text Messaging Program (Text4Hope) for People Living With Cancer and Their Caregivers During the COVID-19 Pandemic: Longitudinal Observational Study

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