Cultural adaptation of the mental health first aid guidelines for depression used in English-speaking countries for China: a Delphi expert consensus study

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Background Suicide is a significant public health concern in China and there is a need for evidence-based suicide prevention programs to assist people in the community who may be in a position to support those in their social networks who are at risk of suicide. English-language mental health first aid guidelines for this purpose have been developed. However, due to differences in culture, language and health systems, guidelines for English-speaking countries require cultural adaptation for use in China. Methods A Delphi expert consensus study was conducted among mainland Chinese panellists with a diverse range of expertise in suicide crisis intervention (n = 56). Using the mental health first aid guidelines used in English-speaking countries as a basis, a questionnaire containing 141 statements on how to help a person at risk of suicide was developed and translated. Panellists were asked to rate the importance of each item for inclusion in the Chinese guidelines. They were also encouraged to suggest any additional statements that were not included in the original questionnaire. Statements were accepted for inclusion in the adapted guidelines if they were endorsed by at least 80% of panellists as essential or important. Results Consensus was achieved after two survey rounds on 152 statements for inclusion in the adapted guidelines for China, with 141 adopted from the guidelines for English-speaking countries and 11 generated from the comments of panellists. Conclusions While the adapted guidelines were similar to the guidelines for English-speaking countries, they also incorporated actions specific to the Chinese context, including Chinese attitudes towards suicide, the role of families and friends and removal of the means of suicide. Further research is needed to investigate the use of the guidelines by the Chinese public and the implementation of Mental Health First Aid training in appropriate settings in China.

Section: Discussionmentioning

confidence: 99%

Cultural adaptation of the mental health first aid guidelines for assisting a person at risk of suicide to China: a Delphi expert consensus study

Oldenburg

et al. 2020

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“…This Delphi study was conducted according to the following steps as outlined by author AFJ in his article "Using the Delphi expert consensus method in mental health research" [37]: questionnaire development, recruitment of expert panel members, data collection and analyses, and guidelines development. The Delphi method was chosen because it has been demonstrated to be feasible for use in developing mental health first aid guidelines for a range of mental disorders in many countries, including Chinese-language depression, suicide and psychosis first aid guidelines [34][35][36], and the Englishlanguage problem drinking first aid guidelines [38].…”

Section: Methodsmentioning

confidence: 99%

“…Previous research, which focused on developing depression, suicide and psychosis first aid guidelines for Asian countries [29][30][31][32][33][34][35][36], has indeed found differences across cultures. For example, compared with the guidelines developed for English speaking high-income countries, first aid actions that involve a person's family are further emphasized in the Chinese-language depression, suicide and psychosis first aid guidelines [34][35][36]. Therefore, the current study aimed to use the Delphi method to develop culturally appropriate mental health first aid guidelines for members of the public providing help to people with problem drinking in mainland China.…”

Section: Introductionmentioning

confidence: 99%

Development of Chinese mental health first aid guidelines for problem drinking: a Delphi expert consensus study

Jorm

Wang

et al. 2021

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Background Alcohol use disorders have become the second leading cause of death for mental and substance use disorders in China. However, with early diagnosis and timely treatment, the burden can be mitigated. Family and friends of a person with alcohol use problems are well placed to recognize the signs, encourage professional help-seeking and help the person until treatment is received. We aimed to use the Delphi consensus methodology to develop guidelines about how members of the public can provide this “mental health first aid” to someone with problem drinking in China. Methods A Chinese-language questionnaire was developed, comprising statements that were endorsed for inclusion in the English-language problem drinking first aid guidelines for high-income countries. Participants were also encouraged to suggest new statements. These statements were evaluated by two Chinese expert panels – a professional panel and a lived experience panel – on how important they believed each statement was for members of the public providing mental health first aid to a person with problem drinking in China. Three survey rounds were conducted. To be included in the final guidelines, statements had to receive a “very important” or “important” rating from at least 80% of participants from each of the panels. Results The majority of statements were rated in the first survey round by 30 mental health professionals and 25 lived experience panel members. One hundred and eighty-one statements met the inclusion criteria and were used to form the guidelines. Compared to the English-language guidelines, the importance of family involvement and mutual support were highlighted by both Chinese expert panels, while a number of statements relating to low-risk drinking were rejected by the lived experience panel. Conclusions The Chinese-language problem drinking first aid guidelines cover a variety of first aid strategies that members of the public can use when providing initial help to a person with problem drinking, such as how to communicate with the person and what to do if the person is intoxicated. These guidelines will be used as a stand-alone document will also inform the content of Mental Health First Aid training in China.

“…However, as the training course and the guidelines have been mainly developed for high-income countries, they may not be applicable for low-and middle-income countries with different health care systems and cultures, including mainland China. Previous Delphi studies, which focused on developing suicide first aid guidelines for Asian countries, namely Japan (high-income country), Philippines (lower middle-income country), India (lower middle-income country), Sri Lanka (upper middle-income country) and mainland China (upper middle-income country), have indeed identified some differences across cultures [46][47][48][49][50][51]. For example, considering a suicidal person's religious and spiritual beliefs appeared to be more important when providing mental health first aid for Filipinos than for Japanese, Indian, Sri Lankan and Chinese.…”

Section: Introductionmentioning

confidence: 99%

“…For example, considering a suicidal person's religious and spiritual beliefs appeared to be more important when providing mental health first aid for Filipinos than for Japanese, Indian, Sri Lankan and Chinese. Additionally, compared with mental health professionals from the other countries, Japanese professionals were less likely to endorse the actions relating to dissuading the person from suicide, while the importance of family and friends was highlighted by Chinese panelists [46,47,50,51]. Therefore, this study aimed to use the Delphi methodology to develop guidelines for members of the public providing first aid to people with psychosis in mainland China [51].…”

Section: Introductionmentioning

confidence: 99%

Development of Chinese mental health first aid guidelines for psychosis: a Delphi expert consensus study

Jorm

Wang

et al. 2020

Self Cite

Background Family and friends of a person developing a mental illness or in a mental health crisis can help the person until treatment is received or the crisis resolves. Guidelines for providing this ‘mental health first aid’ have been developed and disseminated in high-income countries. However, they may not be appropriate for use in China due to cultural and health care system differences. The aim of this study was to use the Delphi expert consensus method to develop culturally appropriate guidelines for a member of the public providing mental health first aid to someone with psychosis in mainland China. Methods A Chinese-language survey, comprising statements about how to provide mental health first aid to a person with psychosis, was developed. This was based on the endorsed items from the first round of the English-language questionnaire for high-income countries. These statements were rated by two expert panels from mainland China – a mental health professional panel (N = 31) and a lived experience panel (N = 41) – on how important they believed each statement was for a member of the public providing first aid to a person with psychosis in China. There were three Delphi rounds, with experts able to suggest additional items in Round 1. Items had to have at least 80% endorsement from both panels for inclusion. Results Out of 208 statements, 207 were endorsed for inclusion in the Chinese-language guidelines. Eight new statements were also included. Compared to the English-language guidelines, the importance of family involvement was emphasized in the development of the Chinese-language guidelines. Conclusions While many of the actions in the English-language guidelines were endorsed by Chinese participants, a number of additional items point to the importance of developing culturally appropriate mental health first aid guidelines. These guidelines will form the basis for the development of Chinese Mental Health First Aid course aiming at training members of the public on how to provide first aid to someone with a mental health problem.