Development and Cultural Adaptation of Psychological First Aid for COVID-19 Frontline Workers in American Indian/Alaska Native Communities

Abstract

The coronavirus disease 19 (COVID-19) pandemic is broadly affecting the mental health and well-being of people around the world, and disproportionately affecting some groups with already pre-existing health inequities. Two groups at greater risk of physical and/or mental health detriments from COVID-19 and more profoundly impacted by the pandemic include frontline workers and American Indian/Alaska Native (AI/AN) communities. To provide support and prevent long-term mental health problems, we culturally adapted a psychological first aid guide specifically for COVID-19 frontline workers serving AI/AN communities. We engaged a diverse, collaborative work group to steer the adaptation content and process. We also held two focus group discussions with frontline workers in AI/AN communities to incorporate their perspectives into the adapted guide. Results from the group discussions and the collaborative work group were compiled, analyzed to extract themes and suggestions, and integrated into the adapted content of the guide. Main adaptations included updating language (i.e., to be more culturally appropriate, less prescriptive, and less text heavy), framing the guide from a harm-reduction lens, incorporating cultural activities, values, and teachings common across diverse AI/AN communities (e.g., importance of being a good relative), and validating feelings and experiences of frontline workers. The resulting adapted guide includes four modules and is available as a free online training. Our adaptation process may serve as a guiding framework for future adaptations of similar resources for specific groups. The adapted guide may stand as an enduring resource to support mental well-being, the prevention of mental health problems, and reduction of health inequities during the pandemic and beyond.

Content analysis of psychological first aid training manuals via topic modelling

“…This trend suggests that more emphasis is needed on these critical topics. On a positive note, newer manuals, such as the UNICEF Indian Alaska Native Communities manual (Grubin et al, 2022b ), are beginning to address the unique challenges communities might face in the aftermath of a crisis. This includes being mindful of the potential impact of discrimination, stigma, and marginalization on mental health and well-being.…”

“…The PFA manual for American Indian and Alaska Native communities by Grubin et al ( 2022b ) is an excellent example of integrating culture and PFA training richly and effectively. The article on developing this manual is a must-read for trainers (Grubin et al, 2022b ). Another practical implication concerns internet activities.…”

“…It has supported individuals and communities in coping with fear and anxiety during public health crises (e.g. SARS, Ebola, COVID-19) (Cénat et al, 2020 ; Grubin et al, 2022a ; WHO, 2014 ). The multiple settings of PFA include schools, workplaces, mass disaster venues, and circumscribed critical incidents such as armed conflict, floods, fires, accidents, and other traumatic events (Allen et al, 2010 ; Hechanova et al, 2015 ; Schafer et al, 2016 ).…”

Adapting Cognitive Remediation Group Therapy as an Online or Hybrid Intervention for People Aging With HIV and Cognitive Concerns: Focus Group Protocol

“…Each team member will carefully read and review the transcripts to extract and organize quotes into a spreadsheet; quotes reflecting similar concepts or themes will be grouped together. Independent coding of the data will permit individual conceptualizations of participants' preferences for an adapted CRGT and an efficacy RCT, while team meetings will subsequently take place to discuss convergence and divergence of identified themes, with the goal of achieving consensus regarding concepts and themes to include in an adapted intervention plan and RCT proposal (Grubin et al, 2022). All coding will be informed by the Consolidated Standards of Reporting Trials (CONSORT) checklist for reporting necessary components of an RCT, as we intend to define, develop, and deliver a clinical trial of the adapted CRGT intervention (Schulz et al, 2010).…”

Adapting Cognitive Remediation Group Therapy Online: Focus Groups with People Aging with HIV

“…Upon completion of the individual coding stage, team meetings were held to discuss convergence and divergence of identified themes; the goal of these meetings was to achieve consensus regarding concepts and themes to include in an adapted intervention plan and RCT proposal. 44 , 45 To mitigate issues of hierarchy or inequitable input within the analysis team, we ensured each team member had an opportunity to review an equal number of transcripts; prepare a written document; and voice feedback during discussion to reach consensus of themes. Prior to disseminating the results of the analyses, we utilized member-checking to discuss findings with focus group participants via email.…”