On January 25, 2020, the first case of COVID-19 was detected in Malaysia. As of December 8, 2021, there were 2,673,019 COVID-19 cases, including 30,746 deaths and 2,581,395 cases recovered reported by the Ministry of Health (MOH) in Malaysia.
A number of researches showed that the impact of COVID-19, including movement control orders, huge financial losses, conflicting messages from authorities, and other psychosocial concerns, could contribute to emotional distress and increased risk for psychiatric disease associated with COVID-19. It includes health-care providers who have a higher risk expose to the virus, constant worry about infecting their loved ones, longer work hours, shortages of resources, and burnout.
Majority of the survivors appeared to be resilient after disaster / pandemic and did not fall into the category of psychopathology. It is supported by the research of Saha, Torous, Caine, and Choudhury (2020), stating that mental health symptomatic and support expressions have significantly increased during the COVID-19 period, but the effect gradually lessened over time, indicating that people are adapting to the “new normal.” However, prevention, early identification of vulnerable population, and provide initial support remain crucial.
Various journals/guidelines recommended education and training be provided to health-care professionals, first responders, and community to address psychosocial concerns. MOH has developed standard operating procedure in providing mental health and psychosocial support services for COVID-19 response in quarantine stations. To empower local community, Mercy Malaysia has collaborated with various nonprofit organization and universities to empower them with skills of psychological first aid (PFA).
PFA is an evidence-informed and consensus-driven approach to assisting survivors following disasters/during pandemics. The objective of PFA is to provide humane, supportive, and practical help to the survivors after crisis events. The PFA module was designed for Ebola outbreaks and could be extended to respond to COVID pandemic. With proper training, not only mental health professionals but also first responders or lay community people are able to provide PFA.
Few researches support that face-to-face PFA training could improve PFA knowledge, perceived competence in PFA skill and perceived preparedness and confidence to provide PFA. However, during the period of movement control order, it is near impossible to conduct the training face to face and there is a lack of evidence in providing virtual PFA, thus leading the researchers to conduct and review the effectiveness of virtual PFA training in Malaysia.
The objective of the study is to examine the training effects of virtual PFA program in increasing participants’ knowledge, and confident level and perceived skills in conducting PFA in Malaysia.
MATERIALS AND METHODS
Participants and procedures
One group pretest–posttest was used to evaluate the training effect of virtual PFA. Seven virtual PFA training to adult practitioners and three virtual PFA training to child practitioners were conducted between June and December 2020. In total, 102 participants completed virtual PFA training to adult practitioners and 42 participants completed virtual PFA training for child practitioners.
Each session consists of 2-days virtual training using Zoom apps. The training content was adopted by the World Health Organization PFA training the trainers manual. The trainings were conducted by licensed mental health professionals, including clinical psychologists, health psychologists, and counselors. Participants’ consent was obtained before the program, and questionnaires were distributed before and after the training.
Pre- and posttest of PFA training were adopted from PFA: facilitator’s manual for orienting field workers to assess participants’ knowledge and confident level and perceived skills in conducting PFA. The measures were assessed by five mental health professionals to ensure that it is valid in Malaysia cultural context and to adopt it into the context of PFA for child practitioners.
Nine items on a 5-point Likert scale (1 = very low, 2 = low, 3 = medium, 4 = high, 5 = very high) were used to assess confident level and perceived skills in conducting PFA. The questions included “Ability to support people who have experienced disasters or other extremely stressful events), “Ability to listen in a supportive way, according to someone’s cultural context,” and “Ability to link people affected by crisis events to needed services, information, and loved ones.” The internal consistency coefficient for this construct is 0.907 for pretest and 0.927 for posttest.
As for PFA knowledge, 15 dichotomous (Yes/No) questionnaires were used to test the understanding of the participants in PFA. The sum of the correct answers will determine to what extent the participants learned from the program.
Based on the P-P plots and Shapiro–Wilk test, the data are not a normal distribution, and thus, the Wilcoxon signed-rank test was used for PFA knowledge and perceived competence in PFA skill, using IBM SPSS version 23 (New York, US).
As shown in Table 1, 70.6% (n = 72) of the participants were female and 29.4% (n = 30) were male in virtual PFA for adult practitioners, whereas 88.1% (n = 37) of the participants were female and 11.9% (n = 5) were male in virtual PFA for child practitioners.
Outcome of PFA training for adult practitioners and child practitioners
For the effectiveness of virtual PFA training for adult practitioners, Table 2 shows a statistically increase (z = −8.198, P < 0.05) in the confident level and perceived skills in conducting PFA between pretest (median = 31.5) and posttest (median = 37), with a large effect size (r = 0.81) using the Cohen’s criteria (1988) of r = 0.1 to 0.3 = small effect, 0.3 to 0.5 = medium effect, and >0.5 = large effect (Cohen, 1988). There is a significant increase (z = −6.537, P < 0.5) for PFA knowledge before (median = 73.3) and after (median = 86.7) measurement of the PFA training as well, with large effect size of r = 0.65. It shows that virtual PFA training for adult practitioners has significantly increased both PFA knowledge, and confident level and perceived skills in conducting PFA.
As for virtual PFA training for child practitioners, Table 3 showed that there is a significant increase (z = −5.059, P < 0.5) on confident level and perceived skills in conducting PFA, with a large effect size of 0.78. The median score on this variable increased from 30 preintervention to 37 postintervention. Similar result appeared in PFA knowledge, showing a significant increase (z = −4.573, P < 0.5) from 80 preintervention to 93.3 postintervention, with a large effect size of 0.70. Thus, we can reject the null hypothesis and assume that virtual PFA training for child practitioners has significantly increased both PFA knowledge, and confident level and perceived skills in conducting PFA.
The main findings showed that 2-day virtual PFA training for both adult and child practitioners has significantly increased PFA knowledge and confident level and perceived skills in conducting PFA, with a large effect size ranging from 0.65 to 0.81.
The findings above are compatible and comparable with the literature related to face-to-face PFA training. In the study of Lee et al., a 1-day didactic and simulation-based PFA program has statistically improved school counselors’ PFA knowledge, perceived competence in PFA skills, and perceived preparedness and confidence to provide support in future disaster but did not change perceived willingness to provide support. As for the research conducted by Kilic and Simsek (2019), PFA education was found to have a positive effect on disaster preparedness perception and self-efficacy.
In the study of Lalani (2020), PFA training has significantly improved participants’ PFA knowledge and perceived competence in PFA skills and has enhanced their confidence, disaster preparedness, and self-care strategies. In the cluster randomized trial conducted by Sijbrandij et al., PFA training significantly improved the acquisition and retention of knowledge and understanding of appropriate psychosocial responses and skills in supporting affected individuals but no significant differences for professional attitude, confidence, and professional quality of life.
Despite the impact of training as stated above, based on the qualitative data, some participants still prefer to have face-to-face PFA training, as they felt that they could learn better on the field, easier to practice the skills face-to-face mock simulations, lack of motivations to join virtual class, have more interaction with other participants, and minimize internet connection issues. The challenges were similar to the past literature; for example, Zalat et al. have identified the highest barriers to e-learning were insufficient/unstable Internet connectivity, inadequate computer laboratories, lack of computers/laptops, and technical problems. It also posted challenges for the trainers/academic staff as it required higher levels of technological competency and proficiency on top of their current workload.
There are several limitations to be noted. First, the study used one-group pretest-posttest research design, and thus, it did not include random allocation of participants to control group, which limit the ability to determine the genuine effect of the online PFA program. Second, despite the measures were recommended by the WHO, reviewed by mental health professionals and studied on their internal consistency coefficients, the measures warrant further psychometric examinations. Third, for practical issues, we were not able to compare the impacts between face-to-face PFA training and virtual PFA training.
Despite the limitations above, the present study provides empirical supports on the training impact of virtual PFA in the Malaysian cultural context. The findings are able to guide the mental health professionals, universities, nonprofit organization, and policymakers to support affected individuals and planning for ongoing and future pandemic responses, disaster, and humanitarian crisis.
This study provides preliminary evidence on the impact of virtual PFA training for adult and child practitioners in enhancing PFA knowledge and confident level and perceived skills in conducting PFA. However, future study on a larger sample and comparison with face-to-face PFA training, with randomized control trials and longitudinal study, remains imperative.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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