Cultural adaptation of Mental Health First Aid Training for China

© 2021 Shurong LuThe Mental Health First Aid (MHFA) training program is an evidence-based health intervention, which focuses on teaching members of the public how to provide mental health first aid, i.e., the help offered to a person developing a mental health problem, experiencing a worsening of an existing mental health problem or in a mental health crisis, until appropriate professional help is received or until the crisis resolves. Evidence is still limited regarding the adaptation of this and other similar health interventions in resource-constrained settings. The research described in this thesis aims to inform the cultural adaptation of MHFA training for China, a country with a very different culture, language and mental health system from English-speaking countries where MHFA was established. To achieve this aim, four interrelated studies were undertaken, guided by a systematic program adaptation process. Study 1 presents a systematic scoping review of population-based surveys and interventions for mental health literacy in China during 1997-2018. This study provided a comprehensive understanding of relevant interventions in this context and identified a need for evidence-based mental health interventions to improve mental health literacy targeted to the general public. Study 2 and Study 3 involved the cultural adaptation for China of the mental health first aid guidelines for depression and suicide, respectively. These studies drew on the guidelines developed for English-speaking countries and were re-developed using the Delphi expert consensus method with Chinese mental health professionals and people with lived experience. Findings from these two studies reveal wide similarities and some important differences between mental health first aid guidelines for English-speaking countries and China. Study 4, through in-depth interviews with key stakeholders guided by implementation science frameworks, investigated implementation issues and contextual factors relevant to the scale-up and implementation of MHFA in China in a culturally appropriate way. This study identified several significant contextual adaptations of the program for future efforts, particularly in terms of course content, delivery formats and financing models. This research, while having broader implications for cultural adaptation internationally, presents a compelling case for cultural adaptation of MHFA for countries with less well-resourced health systems. The two mental health first aid guidelines developed from this research can be openly accessed by the Chinese public, which creates opportunities for the public to learn basic mental health first aid actions, and to apply them when needed. This is a step towards more effective early detection of mental disorders, increased access to mental health care, prevention of suicide deaths and better health outcomes for the Chinese population. This research is also central to the development of culturally appropriate MHFA training for China, which will be evaluated in future research