This project is designed to respond to the urgent and critical need for accessible mental health services and supports for front-line healthcare workers. Innovative solutions are needed to ensure the psychological health and safety of frontline workers and to ensure quality care for the millions of Canadians who rely on their services. This project will provide an opportunity to study the implementation and impact of Beyond Silence, a new e-mental health approach to early intervention and peer support that is customized for healthcare workers.~The objectives of this study are to answer both implementation and impact questions:~Implementation~What are the patterns of app use among healthcare workers over a 3 month period?~What factors influence how the app is utilized among workers in diverse healthcare organizations?~Impact:~Does use of the app increase mental health literacy among healthcare workers?~Does the app increase outreach to peer support?~Does outreach to peer support in the app reduce level of distress?~This will be a prospective cohort implementation study, studying implementation and impact of the app over a 3-month period in participating healthcare organizations. The Consolidated Framework for Implementation Research (CFIR) will inform exploration of how the app is adopted and the individual and organizational forces that shape adoption. Pre/post impact data will be collected over a 3-month implementation period to assess whether the app leads to improved mental health knowledge among workers who use the app (primary outcome), and to increased access to peer support (secondary outcome).~Recruitment for this study will occur on three levels: (1) organization (2) peer support providers (3) frontline healthcare workers. Eight to ten healthcare organizations across Canada will be recruited into the study, with at least one organizational champion who will liaise with the research team. Champions will be interviewed to understand the workplace context and create a communication plan. Each organization will also nominate at least 4-5 peer support providers who will be trained to provide service through the app. Frontline workers will be invited to complete a baseline survey, then invited to download the app using an organizational code. Implementation will take place over a 3-month period; utilization patterns will be tracked over time (aggregate data only). At the end of the trial, champions will be interviewed again to gather their feedback, and peer support providers will be invited to a focus group discussion to reflect on the implementation process. All employees will be invited to complete a follow-up survey to gather their input and to track change in mental health knowledge, mental distress and help outreach. Implementation and impact data will be analyzed to identify trends within and across organizations.~The investigators will utilize a multi-pronged approach to data collection via the following:~App utilization data including adoption rates across each organization, as well as aggregate data on how often the app was used, average duration of use, the number of times different features were accessed, and how often users accessed links to the different types of peer support~App user impact - impact on app users will be tracked through baseline and 3-month surveys to see if there are any statistically significant changes in mental health literacy, symptoms of mental distress (anxiety, depression, PTSD), burn-out, help outreach behaviors, and perceived psychological safety.~Peer support provider focus group interviews conducted after the three-month implementation period to explore providers' experiences facilitating peer support via the app~Organizational champion interviews conducted after the three-month implementation period to explore organizational contextual factors~Analysis of the collected survey data will examine change scores across the dataset as well as trends, with results disaggregated by gender, caregiver status, work role, organization, job tenure. Linear mixed models will be used to track changes over time in mental health knowledge (primary outcome), distress levels, self-report of help-seeking/outreach. The model will include fixed effect for time and random effects for organization types and participants. Age, gender and caregiver status will be included in the models as covariates. The investigators will also explore potential predictors of outcomes using linear regression models (e.g., app usage age, gender, education, role in organization - clinical/non-clinical). Additionally, qualitative content analysis will be used to examine focus group and interview data. All focus group and interview data will be transcribed with the transcripts then reviewed and used for thematic analysis. Lastly, a cost-benefit analysis will be conducted to examine app implementation costs.
The purpose of this project is to scale implementation and evaluation of an m-health app designed to promote early intervention and mental health support for frontline healthcare workers to reduce their risk of post-traumatic stress disorder (PTSD) and/or the mental health impact of the COVID-19 pandemic.