Cultural Adaptation of Guidelines for Providing Mental Health First Aid to a Person After a Potentially Traumatic Event: A Delphi Expert Consensus Study in Brazil | BMC Psychiatry

To our knowledge, this is the first cultural adaptation of the guidelines to help someone at risk of a potentially traumatic event for any country in Latin America. This is the first Brazilian study to culturally adapt the MHFA guidelines in English based on Delphi expert consensus to help people in crisis. There have been several studies in English-speaking countries, which have higher economic status and relatively well-resourced mental health systems, making it easier to conduct such studies. [16, 26, 27]. However, such research is less common in Latin American countries and other low- and middle-income countries (LMICs), which also have less well-developed lived experience advocacy movements.

Although Brazil is not characterized by the frequency of natural disasters such as cyclones, earthquakes, tsunamis or volcanoes, as in some other countries, the rates of urban violence such as muggings, kidnappings and murders are high [28]. Many victims also report fear, insecurity and lack of trust in authorities [5]. In many cases, effective public policies to address these issues either do not exist or are poorly implemented. This difference in context highlights the importance of cultural adaptation, which is reinforced by the finding that 25% of guideline items are newly suggested by the panels.

In Round 1, all items in the following sections were approved by both panels: Actions to be taken immediately; When to seek professional help; and Children during large-scale traumatic events. This shows the panel’s agreement with the rescuer’s preparation to act in potentially traumatic situations. Such situations are known to impact everyone involved, including professionals who also experience intense feelings of fear and helplessness. [29]. This reinforces the importance of also focusing on the care of healthcare professionals who are often the first responders in traumatic situations. [5, 6].

Both groups also endorsed strategies relating to the importance of first aiders working with and providing information to other professionals, perhaps reflecting a clear understanding that the role of the first aider is not to provide care. but rather to provide initial assistance, a concept that has been unknown in some contexts [30].

Differences between Brazilian and English guidelines

Most items (110; 83.9%) of the English guidelines were approved by both panels in the first round and 39 additional items suggested by the panel were approved in the second round, indicating the interest of the panelists for the field and the need for cultural adaptation of these guidelines. Many of the suggestions from Brazilian participants focused on addressing the emotional and psychological needs of the affected person, rather than the structural issues necessary for disaster response. This translated into items on the need to be welcoming, understanding and to listen carefully, without demanding or expecting answers. New items also addressed concern for the psychological aspects of the first aider, as well as the need to recognize and respect one’s own limits.

This is different from some existing guidelines for responding to potentially traumatic events which rely more on collective health assistance, with interventions on the physical aspects of disasters, responses for families and communities, and assistance planning. [17, 31]. This divergence can be understood by the socio-economic differences of Brazil, with public policies and more precarious assistance services, leading to a population with higher needs and less assistance. [5, 12, 32]. In emergency situations, such as the Mariana and Brumadinho accidents, authorities were unable to provide a fast enough response, and years after the disaster families are still living with the consequences. [12]. Thus, individuals must rely on each other rather than community/government resources. These guidelines may therefore help fill a gap in the design of interventions to help reduce these long-term psychological impacts.

Differences Between Health Professional and Lived Experience Panels

Although there were no strong thematic differences between the panels, the elements relating to the encouragement of the autonomy of the victims and the strengthening of their decisions were not recommended by the professionals, although these elements were somewhat more strongly endorsed by people with lived experience. In contrast, in the Delphi study, the elaboration of items in English about a person’s autonomy, the decision about their professional help and the need for the first aider to support their decisions were more strongly encouraged/approved. This has also been seen in other English guidelines (e.g. those for alcohol problems [33]). This may be due to the paternalistic culture in Brazil, in which individuals generally expect guidance from others instead of asserting their own independence. [34]. Although motivated by a legitimate intention to help, it can lead to a withdrawal of autonomy and a lack of recognition of another person’s needs. It can create an understanding that those who experience trauma and disaster are passive victims, unable to have done anything to prevent the disaster. Thus, the experience of trauma generates fear, helplessness and insecurity, which makes them even more vulnerable and passive. [15, 29]. Therefore, in these circumstances, people who have experienced potentially traumatic events are not expected to overcome and deal with their difficulties with their own resources. Instead, it is expected that external interventions and policies will be needed to help support them and provide them with better conditions. [5, 6].

Strengths and limitations

An important strength of the study is the fact that it is the first cultural adaptation of mental health first aid for someone going through a potentially traumatic event for a Latin American country and can play a role in increasing people’s ability to react to such situations. . This is important in Brazil, as a country with high urban violence, as well as other political and economic adversities, and a less well-resourced health system. In the current situation of the COVID-19 pandemic, it can also strengthen individuals’ ability to support each other to intervene early and encourage each other to seek professional help when needed. The many suggestions made by Brazilian panelists who have come into contact with traumatic situations are another strength, ensuring the inclusion of people with lived experience and understanding of Brazilian culture. In addition, the number of suggestions offered by the participants was high, which provided enough content to generate many additional elements.

The relatively low retention rate of round 2 participants is a limitation, especially for the lived experience panel. This is likely due to people with lived experience being more difficult to contact in the second round, possibly due to more limited access to the online questionnaire or deteriorating mental health or living circumstances. life.

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