Results Summary

What was the research about?

The COVID-19 pandemic increased distress for healthcare workers. Ongoing distress can cause mental health problems, such as posttraumatic stress disorder, or PTSD. PTSD causes people to relive traumatic events and have bad dreams and scary thoughts.

In this study, the research team tested whether a peer support program called Stress First Aid, or SFA, protected healthcare workers’ mental well-being during the pandemic. SFA encourages healthcare workers to spot distress in coworkers, support self-care, and get mental health care when needed. The team compared the well-being of healthcare workers at sites that did and didn’t receive SFA.

What were the results?

After four months, healthcare workers at sites that did and didn’t receive SFA had similar mental well-being, including:

  • Mental distress
  • Sleep problems
  • Workplace stress
  • Burnout
  • Moral distress, or feeling helpless in their work
  • Resilience, or the ability to recover from stressful situations

Healthcare workers in hospitals who received SFA were more likely to have PTSD than those in hospitals that didn’t receive it.

In additional analyses, researchers found that, compared with their peers who didn’t receive SFA, healthcare workers younger than 30 who received SFA at health centers had:

  • Less mental distress
  • Lower PTSD symptom severity
  • Higher resilience

Other well-being outcomes didn’t differ across age groups.

Who was in the study?

The study included 2,077 healthcare workers employed at one of 16 hospitals or 12 health centers. The hospitals and health centers employed more than 7,000 healthcare workers.

Of healthcare workers, 46 percent were White, 20 percent were Hispanic or Latino/a, 13 percent were Black, and 21 percent were another race or ethnicity. Also, 24 percent were younger than 31, 57 percent were 31–50, and 19 percent were 51 and older; 79 percent were women.

What did the research team do?

The research team matched pairs of hospitals and health centers that were similar in size, number of COVID-19 cases, and teaching site status. The team assigned one site in each pair by chance to provide SFA. The other site offered staff support already in place, such as wellness coaches and support groups. SFA was designed for military personnel. The team adapted it for healthcare workers.

In SFA, the research team taught one champion at each site for every 50 healthcare workers. The champions held five hours of training with their peers over four months.

At the start of the study and four months later, healthcare workers completed surveys about mental well-being.

Healthcare workers, patients, health insurers, and health system representatives provided input during the study.

What were the limits of the study?

Only 32 percent of healthcare workers at hospitals attended SFA training, making it hard to know if SFA worked at hospitals. Surges in the number of COVID-19 cases happened at different times and places during the study, which may have affected the results.

Future studies could focus on SFA for workers younger than 30.

How can people use the results?

Hospitals and health centers can use the results when considering ways to support healthcare workers’ mental well-being.

Final Research Report

This project's final research report is expected to be available by Sept. 2024.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:

  • The reviewers noted that the COVID-19 pandemic had surges of infection as well as low periods for infection and asked how the researchers accounted for these waves in administering rounds of surveys. The researchers admitted that they did not foresee the ebb and flow of infection rates and so could not account for them, but the researchers pointed out that they paired clinical sites based partly on COVID-19 case rates and adjusted for pairs in the analyses. This would reduce the risk of bias between groups, but the effect of the intervention might still be over- or under-estimated because of survey timing.
  • The reviewers expressed concern about the preponderance of administrative and technical personnel instead of clinical staff in the health center cohorts. They asked whether non-clinical staff had significant interactions with patients. The researchers explained that healthcare workers could include any clinic staff with direct contact with patients as any such staff could be exposed to infections. They also stated that staff not providing direct clinical care might be even more vulnerable because they would be less likely to have experience with infection control and protective measures. The researchers also added more information that the people counted as healthcare workers in the study included administrative and technical staff.
  • The reviewers asked the researchers to consider the potential harm created by the intervention, which may also have blunted the effect of any benefits. The reviewers noted that the intervention’s short duration and inherent risks in using non-mental health clinicians to deliver what was a mental health-focused training could have led to attendees feeling that they would not benefit from additional treatment. The researchers explained that the training they used was focused on healthcare workers reaching out to their peers for support rather than trying to cope on their own. The researchers also explained that the training approach they used had been delivered by non-mental health clinicians in the past. The researchers did acknowledge that intervention participants did have to make time to attend sessions when they were already overwhelmed with work, and they revised the report to point out this potential harm.
  • The reviewers asked the researchers to provide codes and frequencies in their qualitative analyses. The researchers explained that their thematic analysis did not lend itself to analyzing frequencies, but they did add information on the number of each type of resources used by the healthcare organization.
  • The reviewers noted that the report overemphasized the one significant subgroup analysis. The researchers revised the report to deemphasize this finding throughout and characterize the finding as exploratory.

Conflict of Interest Disclosures

Project Information

Lisa S. Meredith, PhD
Courtney Gidengil
RAND Corporation
Protecting the Mental and Physical Well-Being of Frontline Healthcare Workers During COVID-19

Key Dates

November 2023


Has Results
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Last updated: February 29, 2024