At the start of the COVID-19 pandemic, we gathered the most important questions from a range of stakeholders, including clinicians, patients and researchers. These led to a string of new reviews during 2020 and one of these, published in November 2020, looks at interventions to support the resilience and mental health of frontline workers. Here’s Alex Pollock from Glasgow Caledonian University in Scotland to tell us about the review.
Monaz: Hello, I'm Monaz Mehta, editor in the Cochrane Editorial and Methods department. At the start of the COVID-19 pandemic, we gathered the most important questions from a range of stakeholders, including clinicians, patients and researchers. These led to a string of new reviews during 2020 and one of these, published in November 2020, looks at interventions to support the resilience and mental health of frontline workers. Here's Alex Pollock from Glasgow Caledonian University in Scotland to tell us about the review.
Alex: Our review is what's called a mixed methods Cochrane review, which had two main objectives. Firstly, we wanted to find out if any interventions were successful at supporting the resilience or mental wellbeing of healthcare professionals; and, secondly, we wanted to know about any barriers or facilitators to delivering these interventions.
We searched for studies – both qualitative and quantitative – that investigated interventions which were designed to support the resilience or mental wellbeing of healthcare professionals working at the frontline during any epidemic or pandemic infectious disease. We found 16 eligible studies, which came from different disease outbreaks. Two were from SARS (severe acute respiratory syndrome); nine from Ebola; one from MERS (Middle East respiratory syndrome); and four from COVID-19. The studies mainly looked at workplace interventions that involved either psychological support, such as counselling or seeing a psychologist; or work-based interventions, such as providing training or changing routines.
Only one study investigated how well an intervention worked. This was a cluster randomised trial among 408 staff members from Sierra Leone and Liberia, which was done in March 2017, immediately after the Ebola outbreak. The study investigated whether staff who were trained to give other people (such as patients and their family members) 'psychological first aid' felt less 'burnt out'. Unfortunately, though, our confidence in this evidence is very low, due to concerns about the study methods, so we cannot say whether the intervention helped or not.
Turning to the qualitative evidence, all 16 studies provided some evidence about barriers and facilitators to the implementation of interventions, and our qualitative synthesis identified 17 main findings. For example, we are moderately confident that if frontline workers, or the organisations in which they work, are not fully aware of what they need to support mental well-being; or if there is a lack of equipment, staff time or skills needed for an intervention; then these will be barriers to implementation of an intervention. We are also moderately confident that if interventions can be adapted for a local area, if there is effective communication, and if there is a positive, safe, supportive learning environment for frontline healthcare professionals, then these factors will support implementation of an intervention. And, finally, we are moderately confident that the knowledge and beliefs of frontline healthcare professionals have about an intervention can have an impact, either positive or negative, on its implementation.
In summary, we didn't find any evidence that tells us how well different strategies work at supporting the resilience and mental well-being of frontline workers, but we did find some limited evidence about things that might help successful delivery of interventions. This highlights a clear and urgent need for properly planned research studies in this field.
Monaz: Pending the availability of those new studies, if you would like to read about the current evidence and watch for updates of the review as new evidence becomes available, it's available free in full at Cochrane Library dot com. Just go to the website and search 'resilience during pandemics' to find it.