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Jackson P, Monroe-Lord L, Maiden J, Revelle V. Fostering mental health first aid competence among older African Americans adults: a feasibility study. HPHR. 2023;62. DOI: 10.54111/0001/JJJ13
The manuscript presents a mixed-method pilot study evaluating the implementation of Mental Health First Aid (MHFA) for Older Adults, aiming to enhance mental health literacy among older African American adults. The research methodology combined quantitative assessments via pre and post-intervention quizzes and qualitative analysis from focus group discussions. This study examined the intervention’s impact on participants’ knowledge enhancement and experiences post-training.
Seventeen older African American adults participated in an MHFA program in Washington, DC, involving two half-day sessions. The pilot study employed a purposeful sampling strategy through the Senior Companions Retired and Senior Volunteer Program (SCRAP). Data analysis included paired-sample t-tests for quantitative data and thematic analysis for qualitative insights.
Results indicated a substantial increase in mental health knowledge among participants, illustrated by a significant mean difference in quiz scores post-intervention (P = 0.0036). Additionally, qualitative analysis from focus group discussions unveiled essential themes, such as skill acquisition, sharing experiences, barriers, and strategies for encouraging MHFA participation.
This research underscores the intervention’s success in enhancing mental health knowledge and sharing experiences among older African American adults. The findings highlight the efficacy of MHFA, emphasizing its potential for broader dissemination. The pilot study’s quantitative outcomes demonstrated a remarkable increase in participants’ mental health knowledge, while qualitative insights provided in-depth perspectives and barriers concerning MHFA participation.
The study underscores the effectiveness of MHFA in enhancing mental health literacy among older adults, indicating its potential for widespread adoption. The results emphasize the significance of MHFA in addressing mental health disparities and empowering older African American adults to advocate for mental health within their communities. Overall, this manuscript provides valuable insights into the benefits and challenges of MHFA, advocating for the integration of tailored mental health interventions for older populations.
Mental health is paramount in well-being, transcending age, ethnicity, and cultural background. However, the experiences and challenges associated with mental health among older African American adults constitute a complex and understudied domain. The United States’s aging population is steadily growing, and older African Americans constitute a substantial segment. According to the U.S. Census Bureau, by 2060, the African American population aged 65 and over is expected to reach 20 million, nearly tripling from the 7.5 million in 2017.1 This demographic shift underscores the importance of understanding the unique mental health needs and challenges faced by older African American adults.
Mental health disparities among older African American adults have long been a subject of concern and a health equity issue. This population encounters numerous stressors and adversities, such as discrimination, socioeconomic inequalities, and historical trauma. These stressors intersect with the natural aging process, potentially exacerbating the risk of mental health issues.
Literature on mental health among older African American adults offers valuable insights but is limited in scope. While studies examined depression (Cao et al., 2016). 2, anxiety (Kogan et al., 2000). 3, and cognitive health (Kumar et al., 2018). 4 in this population, few investigated feasibility and effectiveness of programs like Mental Health First Aid (MHFA). MHFA is a groundbreaking approach aimed at equipping individuals with the skills to identify, understand, and respond to mental health challenges in others and themselves. Its potential impact on older African American adults, who may serve as pillars of wisdom within their communities, merits exploration.
MHFA is an intervention-training program created by Kitchener and Jorm. 2 MHFA is designed to equip adults with essential skills and knowledge about mental health while seeking to combat stigma, empower participants to recognize mental health crises, and guide individuals towards appropriate resources that may help to bring about health equity. The training is typically conducted by a certified instructor during an 8-hour interactive course. Post training, participants undergo an examination. Those who pass are certified as Mental Health First Aiders for a three-year period. Empowering older African American adults with MHFA training holds the potential to enhance their mental health literacy and self-efficacy. This can empower them to advocate for and promote mental health within their community.
MHFA has been implemented globally. It has also been used as a method to create social justice. Several systematic reviews, including studies, have indicated that MHFA training significantly improves mental health knowledge, recognition of mental health issues, and reduces mental health stigma. 5,6,7,8 Furthermore, Lee and Tokmic implemented MHFA in a U.S. community that experienced an increase in the Latinx and Asian immigrant population and reported enhanced mental health knowledge and reduced negative attitudes towards individuals with mental health issues. 9
This manuscript seeks to bridge the existing gap in the literature by presenting the results of a pilot feasibility study focused on training older African American adults in MHFA. By examining the practicality, acceptability, and initial outcomes of such a program, we aim to shed light on the potential benefits of MHFA in improving the mental well-being of this demographic.
The significance of this research lies in its potential to enhance mental health outcomes of older African American adults, address disparities in mental health care, and contribute to a comprehensive understanding of the challenges and strengths of this demographic. By fostering empowerment and promoting mental health literacy among older African American adults, we aim to pave the way for culturally tailored mental health interventions that can positively impact their well-being and the broader fabric of American society. This manuscript will detail the methodology, results, and implications of our pilot feasibility study, thereby providing a valuable contribution to the field of mental health research and practice.
We created a mixed method pilot study design to assess the feasibility of implementing the MHFA for Older Adults Intervention. We hypothesized that quantitative data collected from the participants’ MHFA knowledge would indicate an increase from pre- to postintervention. We conducted a focus group with a subsample of participants six months after the MHFA training. We anticipate the qualitative data gathered from the focus group will provide us with an opportunity to obtain rich in-depth information participant perspectives specifically, related to what they learned in the training, whether they shared this knowledge with others in their community, and what impact it had on their MH self-efficacy skills.
Seventeen older African American adults who reside in Washington, DC participated in two half days of MHFA training for older adults. All participants reported being in the age range from 60 – 100 years of age. Four identified as male (25%) and 12 (75%) identified as female. The educational background of participants was diverse: Fifty percent reported being a high school graduates, twenty-five percent reported having earned some college credits, 12.5% percent had attended college for at least one or more years; and twelve percent reported earning a bachelor’s degree.
Participants of the Senior Companions Senior Respite Aide Program SCRAP, a program that enables older adults in Washington, District of Columbia (DC) to support their peers through volunteer work, preserving the independence of low-income and disabled individuals aged 55 and above. The SCRAP volunteers participants who were recruited to attend a MHFA for Older Adults training were adults 60 years of age and older and reside in DC. Although often viewed as bias, this non-probability method of purposeful sampling is appropriate for this feasibility study. As explained by Etikan,10 it proves beneficial when the researcher faces constraints in terms of resources, time, and manpower. The director SCRAP distributed flyers developed by the Primary Investigator (PI) of the Healthy Cities Healthy People Prevention Intervention Laboratory (HCHPPIL) and made announcements about the training during SCRAP’s in-person and virtual meetings. Flyers provided potential participants with information about the study, a phone number and email to contact the study’s PI to learn more and register for the study.
The research team employed the evidence based MHFA for Older Adults intervention in December 2022 at the University of the District of Columbia’s Van Ness Campus (UDCVN). Immediately before the training, participants completed a consent form, a short twenty question quiz that assessed MHFA knowledge. Straightaway after the training the participants completed the same short twenty question quiz. The participants were given lunch each day and a first aid kit after attending the second and final MHFA sessions. Seventeen unique participants attended the training. Sixteen participants attended the first day of training, and Sixteen participants attended the second day of training (including one participant who did not attend on Day 1 and on Day 2 a different participant did not attend the training). Eight months later in August 2023, 13 trainees participated in a focus group that lasted approximately two hours and was held at UDCVN. The focus group participants were provided with continental breakfast and $10 for their time and effort. During the focus group, participants openly discussed the experience since the MHFA training. This rich dialogue provided insight and measures of the participants opinions, perceptions, and beliefs relating to MHFA knowledge gain and dissemination, self-efficacy, access, and barriers.
The participants who completed both preintervention and postintervention quizzes were included in the quantitative data analysis (N = 13). Four participants had between one and up to five missing data points at the postintervention quiz. These were determined to be missing at random.
MHFA knowledge before and after the intervention was calculated using paired-sample t tests. Statistical analysis was performed using Graph Pad by Dotmatics, a data analyses tool specifically to run analysis of quantitative and categorical data. Our focus group qualitative data analyses are a replication of the plan created by Corona et. al., 11 in their pilot feasibility trial of Training Spanish-speaking Latinx adults in MHFA. We coded using a thematic analysis approach. Initially, two coders became familiar with the data by listening to the recording, reading, and rereading the transcript, and jotting observations and personal reflections. The coders initially formulated general primary codes through open-coding, enabling the generation of new codes and the adjustment of existing ones while reviewing the transcript. Following this, they inspected the initial codes, pinpointed, and explored emerging themes. Subsequently, they ensured the alignment of these themes with the data and initial codes before refining the themes and creating a thematic map. The conclusion of this process involved documenting the findings. Two team members, the first and third authors, engaged in this coding procedure, both possessing qualitative research and coding experience. Trustworthiness in the qualitative analysis was fortified through triangulation between team members, comprehensive documentation of thoughts and notes, the implementation of a coding framework, and team consensus Nowell.12
A 20 question pre and postintervention quiz collected quantitative data providing a bench and ending score of the participants’ knowledge about mental health. Except for one participant, all participants demonstrated an increase in knowledge from pre to postintervention quiz. The results of the paired t-test revealed a two-tailed P value of 0.0036, indicating an extremely significant difference by conventional standards. The mean difference between the preintervention quiz and the postintervention quiz was calculated to be -3.62, with a 95% confidence interval spanning from -5.80 to -1.43. The statistical values utilized in the computations included a t-score of 3.6030, degrees of freedom (df) at 12, and a standard error of the difference at 1.003. The data of the preintervention quiz and the postintervention quiz displayed distinct characteristics: The pre quiz data had a mean of 10.15 with a standard deviation (SD) of 4.10, a standard error of the mean (SEM) at 1.14, and a sample size (N) of 13. On the other hand, the post quiz data exhibited a mean of 13.77, an SD of 3.49, an SEM of 0.97, and a sample size (N) of 13. The statistical analysis strongly supports a noteworthy and meaningful difference in scores from the pre to post quizzes, signifying statistical significance in the comparison.
A focus group consisting of a subset of the original cohort who participated in the MHFA training for older adults engaged the attendees in a dialog around four questions. What did you learn during? How have you used the information that you learned? Who have you shared the information with? What are barriers for others to get this training and how can they be overcome? The qualitative analysis of the focus group data unveiled several prevalent themes reflective of the participants’ experiences in MHFA training for Older Adults. Theme 1, “Learning and Knowledge Acquisition,” encompassed the acquisition of various critical skills. Participants gained insights into suicide awareness and prevention, emphasizing the importance of recognizing signs and offering support to individuals at risk. Additionally, they highlighted the development of patience, effective listening skills, communication techniques when interacting with those facing mental health challenges, and the need for self-control and self-understanding in managing personal mental health issues. The step in the MH action plan, which require the MH first aider to conduct an assessment, focusing on self-harm awareness and ensuring safety, emerged as a significant learning aspect. Theme 2, “Sharing Knowledge and Experiences,” detailed how participants disseminated their newfound knowledge, imparting it to family members, church communities, healthcare professionals, and individuals coping with mental health issues. The diverse ways of showcasing their MHFA certification, from framing it to preserving it at home, underscored their commitment to sharing their expertise. Theme 3, “Barriers to Participation in MHFA,” brought attention to various deterrents hindering engagement in MHFA training, including lack of interest, reluctance to acknowledge personal issues, limited information, time constraints, and an aversion to engaging with others. Theme 4, “Encouraging Participation and Support,” emphasized strategies to boost involvement, ranging from seminars and word-of-mouth dissemination to advocating for mental health education in schools and fostering a better understanding of mental health within families. Lastly, Theme 5, “Final Comments and Reflections,” illuminated the participants’ expressions of gratitude for the course, their increased confidence in assisting individuals with mental health concerns, and their stress on the significance of care, love, and understanding in managing such issues. These themes collectively provide a rich tapestry of experiences and perspectives gained from the MHFA program. These themes encompass a wide array of learnings, sharing experiences, barriers, and strategies to encourage more participation in Mental Health First Aid training.
The intervention for mental health training in older adults produced significant quantitative and qualitative outcomes. Quantitatively, the pre and post-intervention quizzes showcased a substantial improvement in participants’ knowledge about mental health, with nearly all attendees demonstrating an increase in their scores. Statistical analyses through a paired t-test revealed a highly significant difference (P value = 0.0036) between pre and post-intervention scores, solidified by a calculated mean difference of -3.62 and a confident interval ranging from -5.80 to -1.43. These statistics, including a t-score of 3.6030 and specific characteristics of the data, emphasized the substantial shift in knowledge from pre to post-intervention quizzes. The qualitative aspect, involving a focused group discussion on the MHFA training for older adults, revealed key themes. These encompassed a wide spectrum of learnings and experiences, showcasing the acquisition of critical skills, including suicide awareness, communication techniques, and the importance of recognizing and responding to mental health issues. Moreover, the qualitative analysis highlighted how participants shared their newfound knowledge, the barriers hindering participation in mental health training, and strategies to encourage more involvement. These outcomes collectively underline the success of the program in enhancing knowledge and sharing experiences related to mental health for older adults, suggesting its potential for wider dissemination.
The results of this intervention underscore the effectiveness of mental health training for older adults in both quantitative and qualitative terms. Quantitatively, the significant improvement observed from the pre to post-intervention quizzes indicates a substantial increase in knowledge among participants. Statistical analysis supported this finding, revealing a significant difference with strong confidence in the comparison. Qualitatively, the focus group discussions unveiled crucial themes encompassing a comprehensive range of learning experiences, knowledge sharing, barriers, and strategies to encourage greater participation in mental health first aid. These themes offer valuable insights into the multifaceted benefits and challenges faced by older adults engaging in mental health training. The success of this intervention suggests its potential for wider dissemination, promoting increased awareness, knowledge, and support for mental health among older populations.
Recognizing the limitations inherent in this study, it is important to underscore certain factors that could influence the generalizability of the results. To begin with, the study is constrained by a relatively modest sample size, a characteristic associated with its pilot nature, potentially restricting the statistical robustness and broader relevance of the findings. Moreover, the use of a purposeful sampling approach raises the prospect of inherent biases, given that participants are chosen based on specific characteristics or criteria. Readers are urged to interpret the study’s conclusions mindful of these constraints, acknowledging the exploratory nature of the research and the potential influence of both sample size and sampling method on the external validity of the study.
The present study introduced a mixed-method pilot initiative to evaluate the feasibility of implementing Mental Health First Aid (MHFA) for Older Adults intervention. Our objective was to investigate the impact of this program on participants’ knowledge enhancement concerning mental health. The research comprised both quantitative assessments through pre and post-intervention quizzes and a qualitative focus group session held eight months post-training. The combination of these approaches aimed to provide a comprehensive understanding of the intervention’s efficacy and participants’ experiences.
Seventeen older African American adults from Washington, DC, ranging between 60 and 100 years of age, participated in the MHFA training. The research team utilized a purposeful sampling method, facilitated through the Senior Companions Retired and Senior Volunteer Program (SCRAP), to recruit suitable participants. The MHFA intervention, conducted in December 2022 at the University of the District of Columbia’s Van Ness Campus, involved pre and post-intervention quizzes and culminated in a focus group discussion. Analysis of the data involved a quantitative assessment using paired-sample t-tests and a qualitative analysis following a thematic analysis approach, employing a team of coders to facilitate the initial stages of coding.
The results highlighted a significant increase in participants’ mental health knowledge, as demonstrated by a remarkable improvement in quiz scores post-intervention. The paired t-test revealed a highly significant difference, emphasizing a mean difference of -3.62 with a two-tailed P value of 0.0036. Furthermore, the qualitative data from the focus group discussions revealed pivotal themes. These included the acquisition of critical skills, such as suicide awareness and prevention, effective communication techniques, and strategies for recognizing and responding to mental health issues. Participants also shared experiences and perspectives, identifying barriers, and proposing strategies to foster greater participation in mental health first aid. The success of this intervention suggests its potential for broader dissemination, advocating for increased awareness, knowledge, and support for mental health among older populations. The study findings accentuate the effectiveness of the MHFA intervention, emphasizing its value in enhancing mental health literacy, and encouraging active participation among older adults, which empowers them to become agents of social change and justice.
The author(s) have no relevant financial disclosures or conflicts of interest.
Dr. Phronie Jackson is a professor in the Health Nursing, and Nutrition Department at the University of the District of Columbia. Her research areas include Dissemination and Implementation and Health Equity. She received her formal training at Walden University.
Dr. Lillie Monroe-Lord is the director of the Center of Dietetics and Nutrition and the Institute of Gerontology at the University of the District of Columbia. Her research area include the health and wellness of older adults and Nutrition
Dr. James Maiden is the Assistant Dean for Student Affairs and Associate Professor in the Graduate School of Nursing at Uniformed Services University of the Health Sciences. Dr. Maiden’s research is on factors promoting doctoral degree attainment in underrepresented groups, racial disparities in mental health, the inclusion of minorities in STEM, and confronting microaggressions.
Ms. Victoria Revelle is an independent public health practitioner. Her research areas include Public, Community as well as Maternal and Child Health. She received her MPH from Morehouse School of Medicine’s Master of Public Health Program and formal training at the Centers of Disease Control and Prevention (CDC).
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