Self-reflection resilience-recovery activity promotion training for emergency medical service clinicians: A randomized controlled pilot trial of a novel digital intervention.

Abstract

Objectives: The emergency medical service profession needs resilience interventions that address clinicians’ mental health risk. This study performed a randomized controlled pilot trial examining 1) feasibility, acceptability, and adoptability of a novel digital intervention: Self-Reflection Resilience-Recovery Activity Promotion Training; 2) the intervention’s effect on hypothesized mechanisms of action (HMAs: meaning made from stressors, adaptive self-reflection, recovery activities, recovery experiences); and 3) the intervention’s impact on mental health outcomes (MHOs: PTSD, anxiety, depression symptoms).Methods: Eligible participants were ≥18 years with ≥1 EMS shift scheduled in the next 8 days. Recruitment took 6 months; 83/126 workers were eligible and randomized to intervention (n = 37) or control groups (n = 46). Most were White (89%) and male (51%). Both groups completed 8 daily assessments on mobile devices/computers that monitored the HMAs/MHOs. Intervention respondents received 10 additional open-ended questions prompting reflection about stressors encountered, lessons learned, and recovery strategies. We used Welch’s t-tests and Fisher’s exact tests for the feasibility analyses, summary measures for the acceptability and adoptability analyses, and multilevel models for the HMA/MHO analyses. Results: We recruited over 80% of respondents within the first 3 weeks; 70/83 respondents submitted ≥1 complete daily assessment (M = 6.07, SD = 2.20); the intervention was rated helpful, useful, not burdensome, and likely to be used in the future. The intervention group reported more meaning made relative to the control group across all assessments (b = 1.46, 95%CI = 0.17, 2.75, p = .027) and higher levels of meaning made on each subsequent assessment (b = 0.35, 95%CI = 0.16, 0.53, p < .001). These effects varied by intervention fidelity. Respondents demonstrating greater adherence reported more meaning made across all assessments (b = 1.53, 95%CI = 0.03, 1.02, p = .039), and higher levels on each subsequent assessment (b = 0.13, 95%CI = 0.06, 0.20, p < .001). No statistically significant differences were detected on the other HMAs and MHOsConclusion: While results support the intervention’s feasibility, acceptability, and adoptability, some refinement to the intervention’s content and procedures is necessary to detect expected differences on all HMAs and MHOs before conducting a definitive trial.