{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:55:17Z","timestamp":1785412517951,"version":"3.56.0"},"reference-count":35,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010052","name":"Northumbria University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100010052","id-type":"DOI","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/049e6bc10","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Care home staff are routinely exposed to stressful and traumatic events, increasing risks of psychological distress, burnout, and reduced workforce resilience. Psychological First Aid (PFA), recommended by the World Health Organization, provides an evidence-based framework for delivering immediate emotional and practical support; however, its adaptation for care home contexts is limited. This study aimed to co-produce and adapt an existing PFA training resource for care home staff using a person-based approach (PBA) to enhance contextual relevance, acceptability, and feasibility. A two-phase qualitative design guided by PBA principles was used. Phase 1 integrated stakeholder workshops, semi-structured interviews, and literature review to generate guiding principles, a logic model, and preliminary training content. We adapted the WHO PFA \u201cLook\u2013Listen\u2013Link\u201d framework alongside existing open-access materials. Phase 2 used think aloud interviews to optimize usability and contextual fit. Thematic and sentiment analysis identified key needs: high exposure to traumatic events, inconsistent organisational support, desire for measurable skill development, the importance of transferable competencies, and motivational factors. Participants emphasized the need for flexibility, inclusivity, and realistic care-home-specific examples. Adaptations included bite-sized interactive modules, blended delivery options, and reflective exercises. The final co-produced intervention aligns with trauma-informed principles and organisational realities. Further work is needed to access feasibility, acceptability, and fidelity in real-world settings, offering a transferable model for adapting psychological interventions in other high-stress care environments internationally.<\/jats:p>","DOI":"10.3390\/ijerph23040431","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T13:41:53Z","timestamp":1774878113000},"page":"431","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Adapting and Co-Producing a Psychological First Aid Intervention for Care Home Staff: A Person-Based Approach to Enhance Workforce Resilience"],"prefix":"10.3390","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3780-8110","authenticated-orcid":false,"given":"Mariyana","family":"Schoultz","sequence":"first","affiliation":[{"name":"Department of Nursing, Midwifery & Health, Northumbria University, Coach Lane Campus, 15 Coach Lane, Newcastle upon Tyne NE7 7TR, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9197-5721","authenticated-orcid":false,"given":"Alexandra","family":"Kirton","sequence":"additional","affiliation":[{"name":"Department of Nursing, Midwifery & Health, Northumbria University, Coach Lane Campus, 15 Coach Lane, Newcastle upon Tyne NE7 7TR, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Scott","sequence":"additional","affiliation":[{"name":"Department of Nursing, Midwifery & Health, Northumbria University, Coach Lane Campus, 15 Coach Lane, Newcastle upon Tyne NE7 7TR, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7390-632X","authenticated-orcid":false,"given":"Darren","family":"Flynn","sequence":"additional","affiliation":[{"name":"Department of Nursing, Midwifery & Health, Northumbria University, Coach Lane Campus, 15 Coach Lane, Newcastle upon Tyne NE7 7TR, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Beattie","sequence":"additional","affiliation":[{"name":"Centre for Rural Health Sciences, University of the Highlands and Islands, Old Perth Rd, Inverness IV2 3JH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Denford","sequence":"additional","affiliation":[{"name":"Health Protection Research Unit, University of Bristol, Beacon House, Queens Rd, Bristol BS8 1QU, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8862-1527","authenticated-orcid":false,"given":"Geoffrey L.","family":"Dickens","sequence":"additional","affiliation":[{"name":"Department of Nursing, Midwifery & Health, Northumbria University, Coach Lane Campus, 15 Coach Lane, Newcastle upon Tyne NE7 7TR, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e000621","DOI":"10.1136\/bmjoq-2018-000621","article-title":"Monitoring Work Well-Being, Job Confidence and Care Provided by Care Home Staff Using a Self-Report Survey","volume":"8","author":"Benson","year":"2019","journal-title":"BMJ Open Qual."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Frias, C.E., Samarasinghe, N., Cuzco, C., Koorankot, J., de Juan, A., Ali Rudwan, H.M., Rahim, H., Zabalegui, A., Tulley, I., and Al-Harahsheh, S. (2025). Strategies to Support the Mental Health and Well-Being of Health and Care Workforce: A Rapid Review of Reviews. Front. Med., 12.","DOI":"10.3389\/fmed.2025.1530287"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1002\/nop2.1335","article-title":"Care Home Workers\u2019 Experiences of Stress and Coping during COVID-19 Pandemic: A Mixed-Methods Study","volume":"10","author":"Beattie","year":"2023","journal-title":"Nurs. Open"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"230","DOI":"10.31389\/jltc.66","article-title":"Practice-Based Approaches to Supporting the Work-Related Well-Being of Frontline Care Workers in Care Homes: A Scoping Review","volume":"2021","author":"Johnston","year":"2021","journal-title":"J. Long-Term Care"},{"key":"ref_5","unstructured":"Carers UK (2026, March 15). State of Caring 2025. Available online: https:\/\/www.carersuk.org\/media\/mtvkquhy\/cuk-state-of-caring-2025-cost-of-caring-report-web.pdf."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.jad.2020.06.022","article-title":"Impact of Coronavirus Syndromes on Physical and Mental Health of Health Care Workers: Systematic Review and Meta-Analysis","volume":"275","author":"Catalan","year":"2020","journal-title":"J. Affect. Disord."},{"key":"ref_7","unstructured":"World Health Organization (WHO) (2013). Psychological First Aid: Facilitator\u2019s Manual for Orienting Field Workers, WHO. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789241548618."},{"key":"ref_8","unstructured":"Department of Health (2020). COVID-19: Psychological First Aid (Training Course), FutureLearn. Available online: https:\/\/www.futurelearn.com\/courses\/psychological-first-aid-covid-19."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"m1642","DOI":"10.1136\/bmj.m1642","article-title":"Occurrence, Prevention, and Management of the Psychological Effects of Emerging Virus Outbreaks on Healthcare Workers: Rapid Review and Meta-Analysis","volume":"369","author":"Kisely","year":"2020","journal-title":"BMJ"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2857","DOI":"10.1080\/09585192.2023.2229100","article-title":"Human Resource Management in Times of Crisis: What Have We Learnt from the Recent Pandemic?","volume":"34","author":"Newman","year":"2023","journal-title":"Int. J. Hum. Resour. Manag."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Blake, H., Bermingham, F., Johnson, G., and Tabner, A. (2020). Mitigating the Psychological Impact of COVID-19 on Healthcare Workers: A Digital Learning Package. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17092997"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Schoultz, M., McGrogan, C., Beattie, M., Macaden, L., Carolan, C., and Dickens, G.L. (2022). Uptake and Effects of Psychological First Aid Training for Healthcare Workers\u2019 Well-Being in Nursing Homes: A UK National Survey. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0277062"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Ramirez, M., Harland, K., Frederick, M., Shepard, R., Wong, M., and Cavanaugh, J. (2013). Listen Protect Connect for Traumatized Schoolchildren: A Pilot Study of Psychological First Aid. BMC Psychol., 1.","DOI":"10.1186\/2050-7283-1-26"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1097\/NMD.0000000000001029","article-title":"A Randomized Controlled Trial Assessing the Efficacy of Group Psychological First Aid","volume":"207","author":"Despeaux","year":"2019","journal-title":"J. Nerv. Ment. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1111\/inm.12767","article-title":"Supporting Mental Health Staff Following Exposure to Occupational Violence: Staff Perceptions of \u2018Peer\u2019 Support","volume":"30","author":"Mansfield","year":"2021","journal-title":"Int. J. Ment. Health Nurs."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1080\/07317110902895317","article-title":"A Pilot Study Evaluating the Feasibility of Psychological First Aid for Nursing Home Residents","volume":"32","author":"Brown","year":"2009","journal-title":"Clin. Gerontol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"afac014","DOI":"10.1093\/ageing\/afac014","article-title":"Contextual Factors Influencing Complex Intervention Research Processes in Care Homes: A Systematic Review and Framework Synthesis","volume":"51","author":"Peryer","year":"2022","journal-title":"Age Ageing"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2758","DOI":"10.1111\/jocn.15297","article-title":"Nursing Homes and COVID-19: We Can and Should Do Better","volume":"29","author":"Davidson","year":"2020","journal-title":"J. Clin. Nurs."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1186\/s13643-020-01344-3","article-title":"The Influence of Contextual Factors on Healthcare Quality Improvement Initiatives: A Realist Review","volume":"9","author":"Coles","year":"2020","journal-title":"Syst. Rev."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/s40814-015-0033-z","article-title":"The Person-Based Approach to Enhancing the Acceptability and Feasibility of Interventions","volume":"1","author":"Yardley","year":"2015","journal-title":"Pilot Feasibility Stud."},{"key":"ref_21","unstructured":"Medical Research Council (MRC) (2021). Developing and Evaluating Complex Interventions: New Guidance."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1002\/jts.22888","article-title":"We Need to Build the Evidence: A Systematic Review of Psychological First Aid on Mental Health and Well-Being","volume":"36","author":"Hermosilla","year":"2023","journal-title":"J. Trauma Stress"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1080\/2159676X.2017.1331501","article-title":"The Think-Aloud Method: What It Is and How to Use It","volume":"9","author":"Eccles","year":"2017","journal-title":"Qual. Res. Sport Exerc. Health"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using Thematic Analysis in Psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual. Res. Psychol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e0196868","DOI":"10.1371\/journal.pone.0196868","article-title":"Using the Person-Based Approach to Optimise a Digital Intervention for the Management of Hypertension","volume":"13","author":"Bradbury","year":"2018","journal-title":"PLoS ONE"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1017\/S1041610218001606","article-title":"A Systematic Review and Meta-Analysis of the Prevalence and Associations of Stress and Burnout among Staff in Long-Term Care Facilities for People with Dementia","volume":"31","author":"Costello","year":"2019","journal-title":"Int. Psychogeriatr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1111\/bjet.12235","article-title":"Promoting Engagement in Online Courses: What Strategies Can We Learn from Three Highly Rated MOOCs?","volume":"47","author":"Hew","year":"2016","journal-title":"Br. J. Educ. Technol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1108\/13665620810860477","article-title":"Engaging Workers in Simulation-Based E-Learning","volume":"20","author":"Slotte","year":"2008","journal-title":"J. Workplace Learn."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e001153","DOI":"10.1136\/bmjoq-2020-001153","article-title":"Care Homes Education: What Can We Learn?","volume":"10","author":"Armstrong","year":"2021","journal-title":"BMJ Open Qual."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1093\/occmed\/kqaa098","article-title":"Supporting Hospital Staff during COVID-19: Early Interventions","volume":"70","author":"Billings","year":"2020","journal-title":"Occup. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2638","DOI":"10.1177\/15248380231221492","article-title":"The Effectiveness and Implementation of Psychological First Aid as a Therapeutic Intervention after Trauma: An Integrative Review","volume":"25","author":"Wang","year":"2024","journal-title":"Trauma Violence Abus."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Berring, L.L., Holm, T., Hansen, J.P., Lie Delcomyn, C., S\u00f8ndergaard, R., and Hvidhjelm, J. (2024). Implementing Trauma-Informed Care\u2014Settings, Definitions, Interventions, Measures, and Implementation across Settings: A Scoping Review. Healthcare, 12.","DOI":"10.3390\/healthcare12090908"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"ooae136","DOI":"10.1093\/jamiaopen\/ooae136","article-title":"Development of an Evidence- and Consensus-Based Digital Healthcare Equity Framework","volume":"7","author":"Hatef","year":"2024","journal-title":"JAMIA Open"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2087","DOI":"10.1002\/jclp.23395","article-title":"Adapting Narrative Exposure Therapy with a Tribal Community: A Community-Based Approach","volume":"78","author":"Kaysen","year":"2022","journal-title":"J. Clin. Psychol."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Han, H.R., Miller, H.N., Nkimbeng, M., Budhathoki, C., Mikhael, T., Rivers, E., Gray, J., Trimble, K., Chow, S., and Wilson, P. (2021). Trauma-Informed Interventions: A Systematic Review. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0252747"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/4\/431\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T04:36:09Z","timestamp":1775190969000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/4\/431"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,30]]},"references-count":35,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["ijerph23040431"],"URL":"https:\/\/doi.org\/10.3390\/ijerph23040431","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,30]]}}}