Journal Article

Mental health first aid training to improve depression literacy among health ambassadors in Iran: study protocol for a cluster-randomized controlled trial

Ghadirian, Laleh, Hallajian, Fatemeh, Jamshidi, Ensiyeh, Ahmadi, Ayat, Sayarifard, Azadeh

2025

Overview

Background and objective One of the strategies for enhancing the mental health literacy of the community could be capacity building in the field of mental health first aid (MHFA) training among health ambassadors, who serve as volunteers between health service providers and families. The present study aims to investigate the effectiveness of MHFA training packages for depression prevention using critical thinking methods on the depression literacy (as a key component of mental health literacy) of health ambassadors to assist in the early identification and timely referral of individuals with depressive disorders. Depressive disorders are among the most prevalent mental health conditions, yet many individuals delay or avoid seeking treatment due to stigma and limited awareness. Improving mental health literacy is therefore essential to promote early recognition and timely help-seeking. Health ambassadors, as community volunteers linking families to health services, are uniquely positioned to support this goal. This study applies a culturally adapted MHFA training package for depression, delivered through critical thinking and role playing, in improving the depression literacy (as a key component of mental health literacy) of health ambassadors. The trial seeks to determine whether this approach enhances their ability to recognize symptoms, provide initial support, and facilitate referral to professional care. Methodology This is a study protocol for a cluster-randomized controlled trial conducted in 10 comprehensive health service centers (CHSCs) in Islamshahr, Iran. A computer-generated random sequence will assign five centers to the intervention group and five to the control group. The allocation sequence will be prepared and concealed by an independent epidemiologist not involved in recruitment or intervention delivery. From each center, 25 eligible health ambassadors (women aged 25–45 years with ≥ 2 years of experience) will be randomly selected, yielding a total sample of 250 participants. The intervention group will receive an eight-session, culturally adapted MHFA training package delivered using problem-based learning and role-playing methods. Depression literacy (as a key component of mental health literacy) will be assessed at baseline and 2 months post-intervention using the questionnaire developed by Reavley et al. (2014). For statistical inference, analysis of covariance (ANCOVA) will be employed to examine group differences, and multivariate linear regression will be applied to adjust for potential confounders, using SPSS software version 24. A p -value of < 0.05 will be considered statistically significant. Discussion This protocol describes a trial designed to evaluate whether mental health first aid (MHFA) training with a critical thinking approach can improve depression literacy (as a key component of mental health literacy) among health ambassadors. Findings from this study may provide evidence to guide future mental health promotion strategies, particularly for the early identification and referral of individuals with depression and the prevention of suicide. Trial registration Iran Randomized Clinical Trial Center IRCT20231225060521N1. Registered on 21 January 2024 (current status: ongoing).

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Advertising campaigns / Analysis / Biomedicine / Clinical trials / Cognitive behavioral therapy / Community / Community Health Workers - education / Community Health Workers - psychology / Critical thinking / Depression / Depression - diagnosis / Depression - prevention & control / Depression - psychology / Depression - therapy / Depression literacy / Depression, Mental / Developing countries / Experiential learning / First aid / First Aid - methods / First aid in illness and injury / Health ambassador / Health education / Health Knowledge, Attitudes, Practice - ethnology / Health Literacy / Health Sciences / Help seeking behavior / Humans / Intervention / Iran / LDCs / Literacy / Medical personnel / Medicine / Medicine & Public Health / Mental depression / Mental disorders / Mental Health / Mental health first aid / Mental health literacy / Multicenter Studies as Topic / Psychiatrists / Randomized Controlled Trials as Topic / Statistics for Life Sciences / Stigma / Study Protocol / Training