Effectiveness of Psychological
First Aid and Communication Skills in Enhancing Self-Efficacy: A Randomized
Controlled Trial
Alfiatur Rahmi1, Marlina1 , Marthoenis1*
1Faculty of Nursing, Universtas Syiah Kuala,
*Corresponding
author: marthoenis@usk.ac.id
Background: Supporting students' psychological
well-being is crucial for teachers, especially during crises. However,
communication barriers and a lack of confidence in administering Psychological
First Aid (PFA) often hinder effective support. This study examines the impact
of PFA training and interpersonal communication skills on educators'
self-efficacy.
Methods: A randomized controlled trial with cluster sampling was
conducted among 88 educators from four schools in Aceh (September–October
2024). Participants were randomly assigned to intervention and control groups,
and data were collected using a pre-test and post-test design. The intervention
consisted of PFA and interpersonal communication training, delivered in 2-hour
sessions over four weeks. Self-efficacy was measured using the General
Self-Efficacy Scale, and data were analyzed using normality tests, the Wilcoxon
Signed-Rank Test, and the Mann-Whitney U Test.
Results: Educators who received PFA training showed significantly
higher self-efficacy than the control group (U=537.500, Z=-5.785, p<0.001).
Similarly, interpersonal communication training significantly improved
self-efficacy (U=306.500, Z=-5.783, p<0.001).
Conclusion: PFA and interpersonal communication
training enhance teachers' self-efficacy in providing psychological support.
Wider implementation of these interventions is recommended to improve students'
psychological well-being in Aceh.
Keywords: Psychological First Aid, Communication
Skills, Self-Efficacy, Mental Health Training
Introduction
Teachers play a crucial role in education,
particularly in supporting students' mental health and helping them cope with
trauma. In times of crisis or distress, teachers are often the first to provide
psychological support to students. However, students may experience anxiety,
depression, or stress due to academic pressure, social media influences, or
family-related issues. These psychological challenges not only impact students’
well-being but also affect their academic performance and social development (Lestari
and Rista, 2023).
To effectively address these issues, teachers must possess high levels of
self-efficacy. Self-efficacy, defined as a person’s belief in their ability to
overcome difficulties, is critical for teachers in managing classrooms and
providing psychological support (Bandura,
1977; Rahayu, 2023).
In
Indonesia, mental health issues among students are increasingly concerning. A
2023 survey by the Ministry of Health of the Republic of Indonesia found that
6.1% of adolescents aged 15 and older were diagnosed with mental disorders.
Additionally, more than 3,200 students from elementary to high school levels
exhibited mild to severe symptoms of depression (Kompas.com,
2022).
Teachers' lack of training in providing psychological support exacerbates the
problem, making it difficult for students to receive timely and appropriate
help.
Aceh,
a disaster-prone region, faces even greater challenges regarding student mental
health. In 2023, Aceh experienced 418 recorded disasters (Badan
Penanggulangan Bencana Aceh, 2024), many of which had significant psychological
consequences. Post-disaster trauma often leads to mental health conditions such
as PTSD (World
Risk Report, 2023).
Given this context, equipping teachers with the skills to provide psychological
support is essential.
However,
the lack of teacher training in Indonesia makes it difficult to address
students' mental health challenges effectively. A study found that 65.6% of
high school students exhibited symptoms of poor mental health. One potential
intervention to address this issue is Psychological First Aid (PFA) training
(Suswati,
Yuhbaba and Budiman, 2023).
PFA is an internationally recognized, empathy-based approach designed to help
individuals experiencing psychological distress due to trauma or disaster.
Organizations such as the National Institute for Mental Health and the World
Health Organization endorse PFA as a first-line intervention for trauma
management.
Beyond
PFA, interpersonal communication skills are also critical in providing
psychological support. Strong communication enables teachers to build rapport
with students, fostering a supportive environment where students feel
comfortable discussing their concerns (UNICEF,
2015).
Research indicates that self-efficacy significantly influences interpersonal
communication, shaping an individual's ability to engage effectively with
others (Rubin
and Martin, 1994).
By enhancing their communication skills, teachers can better understand
students' emotional needs and provide more effective support.
Previous
studies have demonstrated that both PFA training and interpersonal
communication skills can enhance teachers' ability to support students. PFA
training has been shown to improve teachers' confidence in responding to
students’ psychological needs (Rahmatulloh,
Pratiwi and Rahimmatussalisa, 2021).
Similarly, research suggests that improved interpersonal communication skills
contribute to greater self-efficacy among teachers (Yulikhah,
Bukhori and Murtadho, 2019).
These findings underscore the need for comprehensive training programs that
integrate both PFA and interpersonal communication skills to strengthen
teachers' self-efficacy in providing psychological support to students. This
study aims to evaluate the effectiveness of PFA training and interpersonal
communication skills in enhancing teachers' self-efficacy. By increasing
self-efficacy, teachers are expected to provide better psychological support to
students experiencing mental health challenges, particularly in disaster-prone
areas such as Aceh.
Methods
This research follows the CONSORT criteria
and employs a randomized controlled trial (RCT) design with a cluster sampling
technique using a pretest-posttest approach in both the intervention and
control groups. The study aims to evaluate the effectiveness of Psychological
First Aid (PFA) training and interpersonal communication skills in enhancing
teacher self-efficacy in Aceh. Data were collected using a validated
questionnaire administered before and after the intervention. The intervention
group received PFA training and interpersonal communication training using the
GATHER method, whereas the control group did not receive any training and was
only assessed through questionnaires.
This
study was conducted in Aceh, a province in Indonesia with a high disaster risk
and psychological impact on its population. Teachers working in schools within
the region were selected as study participants. The inclusion criteria required
that teachers be willing to participate in the training, have at least one year
of work experience, and have not previously attended similar training. The
sample size was determined based on Cohen’s table, ensuring an adequate number
of participants to achieve statistical power. Given a 95% confidence level and
an alpha value of 0.05 in a population of 100 people, a minimum sample of 88
teachers was required, with 44 assigned to the intervention group and 44 to the
control group.
The
RCT process began with an enrollment phase, during which 106 teachers were
assessed for eligibility. While no participants refused to participate, 18
individuals were excluded as they did not meet the inclusion criteria. The
remaining 88 participants were randomly allocated into two groups: one
receiving the intervention and the other serving as a control. Notably, there
was no attrition throughout the study, as all participants completed the
intervention and post-intervention assessments. This exceptionally high
retention rate ensured that the final analysis included the entire randomized
population, allowing for robust conclusions about the intervention’s effects.
The study flow is illustrated in Figure 1.
To
measure self-efficacy, the study utilized the General Self-Efficacy (GSE)
questionnaire, a well-established instrument designed to assess an individual’s
confidence in achieving goals and overcoming obstacles. The questionnaire,
which consists of multiple Likert-scale items, was administered both before and
after the intervention. Additionally, observation sheets were used during the
training to assess participants’ behavioral and skill-based changes, including
active listening, communication effectiveness, and support provision.
The
intervention involved PFA training and interpersonal communication training for
the intervention group, conducted over a period of four weeks, with weekly
sessions lasting two hours. The PFA training was structured around the “Look,
Listen, Link” approach, which emphasizes observing needs, actively listening,
and facilitating access to necessary resources for students experiencing
psychological distress due to disasters, crises, or trauma. The interpersonal
communication component of the training focused on enhancing teachers’
communication skills using the GATHER method, which includes: Greeting
individuals warmly, Assessing and Asking about their situation, Telling
relevant and calming information, Helping in developing an action plan or
seeking support, Explaining next steps clearly to reduce uncertainty, and
Reassuring the individual that they are not alone.
Table 1 Frequency Distribution of Respondent
Characteristics
The
training content was divided into two key components. The PFA module introduced
participants to the concept of PFA, its core principles, and the “Look, Listen,
Link” strategy, which included practical exercises in identifying psychological
needs, active listening, and providing appropriate support. Meanwhile, the
interpersonal communication module focused on an empathetic communication
approach and the GATHER framework, equipping teachers with practical strategies
to support students experiencing psychological distress.
For
data analysis, statistical software was used to assess the effectiveness of the
intervention. The normality of the data distribution was first evaluated
through a normality test, which indicated that the data were not normally
distributed. Consequently, the Wilcoxon Signed-Rank Test was employed to
analyze within-group differences, with a significant threshold of p<0.05. To
compare differences between the intervention and control groups, the
Mann-Whitney U test was applied, where a p-value of less than 0.05 was
considered statistically significant.
Ethical
approval for this study was granted by the Ethics Committee of the Faculty of
Nursing, Universitas Syiah Kuala. Before participation, all teachers received
comprehensive information about the study’s objectives, potential benefits, and
risks. Informed written consent was obtained from each participant before
enrollment. To maintain confidentiality, no personal identifiers were included
in the research reports. Participation was entirely voluntary, and teachers
were informed that they could withdraw from the study at any time without any
negative consequences.
Results
Pre-Test Comparisons
Pre-test results revealed no significant
difference in interpersonal communication self-efficacy between the
intervention and control groups (U=475.000, p=0.798). This indicates that both
groups had similar self-efficacy levels before the intervention.
Table
2 Comparison of Psychological First Aid Self-Efficacy in the Intervention and
Control Groups
Post-Test Comparisons
Following the intervention, the median
self-efficacy score in the intervention group increased to 41.00 (IQR = 10),
while the control group had a median score of 31.00 (IQR=6). The Mann-Whitney U
test revealed a significant difference between the groups (U=306.500,
p<0.001), demonstrating the intervention's positive effect on interpersonal
communication self-efficacy (Table 2).
Within-Group Analysis
A
within-group analysis using the Wilcoxon test showed that the intervention
group experienced a significant improvement in self-efficacy scores from
pre-test to post-test (Z =-4.402, p<0.001). In contrast, the control group
did not exhibit a statistically significant change (Z= -1.783, p=0.075) (Table
3). These findings suggest that the intervention was effective in enhancing
interpersonal communication self-efficacy, whereas the control group did not
show notable improvement.
Table 3. Comparison of Interpersonal Communication
Self-Efficacy In the Intervention and Control Groups
Discussion
Strengthening teachers' self-efficacy
is particularly beneficial in Aceh, where students may face mental health
difficulties due to trauma, academic pressures, or external stressors. Improved
self-efficacy enables teachers to create a supportive learning environment and
respond effectively to students' needs (Ramin Mojtabai and Mark Olfson,
2020; Lestari and Rista, 2023). Previous studies have also
confirmed that PFA and communication skills training equip educators with the
ability to identify and address students' mental health concerns (Ohrt et al., 2020; Zaza and Yeung,
2023).
Additional
research suggests that different subgroups of teachers may experience varying
impacts from PFA and communication training. The increase in self-efficacy was
higher for teachers who had many years of teaching experience and received
training compared to teachers with less experience and never received training.
Teachers' experiences with PFA and communication training differ according on
their years of teaching and past expertise. Experienced teachers benefited more
from additional training, according to previous research, and they also showed
a greater rise in self-efficacy following training. But in order to make
comparable improvement, less experienced teachers might require longer or more
frequent sessions.
The
observation showed that experienced teachers gained self-assurance,
participated in conversations, and gave well-organized criticism. Increased
empathetic communication and increased understanding of students' emotional
needs were seen after the intervention. The good effect of the training on
teachers' capacity to provide psychological support is corroborated by these
findings. The possibility of informal exposure to PFA in the control group
cannot be eliminated, but there is no indication that they received similar
training or information during the study. In addition, significant improvements
only occurred in the intervention group, reinforcing the effectiveness of the
training. If external factors play a role, their impact is estimated to be
minimal. For further research, stricter control over potential external
exposure can be considered.
These findings are consistent with
Bandura’s (1997) self-efficacy theory, which posits that self-efficacy is
influenced by four key sources: performance accomplishments, vicarious
learning, verbal encouragement, and emotional states. In this study, teachers'
self-efficacy improved due to direct training experiences, which provided
opportunities for skill development through role-playing and simulation
exercises. Vicarious learning occurred as teachers observed effective
psychological support techniques and applied them in practice. Verbal
encouragement, provided through feedback during training, reinforced teachers’
confidence in their abilities. Additionally, by helping teachers manage
emotional stress when supporting students, the interventions contributed to a
more stable emotional state, which further strengthened their self-efficacy. Bandura's
dimensions can be used to understand this increase in self-efficacy, strength
(those with high self-efficacy tend to persist in providing psychological
support), generality (teachers felt more capable of addressing mental health
issues) and magnitude (teachers felt more capable of addressing mental health issues)
(Sadovnikova
et al., 2018; Masa et al., 2022).
Teacher
self-efficacy in Aceh is crucial in facing the challenges of students' mental
health due to trauma and academic pressure (Ramin
Mojtabai and Mark Olfson, 2020; Lestari and Rista, 2023).
PFA training and communication help teachers identify and address this issue (Ohrt
et al., 2020; Zaza and Yeung, 2023).
The control group without training did not experience significant changes,
reinforcing the finding that PFA enhances educators' readiness (Ismail,
2023). PFA combines
practical approaches, simulations, and individual feedback to enhance
self-efficacy and mental resilience (Sijbrandij et al.,
2020; Gilbert et al., 2021;
Hermosilla et al., 2023; Deady et al., 2024). Higher self-efficacy contributes to a proactive
approach in mental health support (Villagonzalo
et al., 2018).
Supervision
and retraining are necessary to maintain the long-term benefits of PFA (Wang
et al., 2021; Park and Choi, 2022).
Additionally, good interpersonal communication strengthens the teacher-student
relationship, creating a safe environment for students to share their concerns (UNICEF,
2015; Attamimi, Lestari and Rinenggantyas, 2024).
Teachers skilled in communication provide better emotional support, build
relationships that encourage students to seek help, and recognize signs of
stress earlier (Rubin
and Martin, 1994; Ohrt et al., 2020;
de Sousa Mata et al., 2021; Linge et al., 2021; Xie and Derakhshan, 2021;
Byun and Kim, 2022).
Limitation
This
study has several limitations. The sample size was restricted to certain
regions in Aceh, limiting the generalizability of the findings. Additionally,
the short duration of the intervention may not fully capture its long-term
impact. Furthermore, relying solely on questionnaires and observation sheets
may not provide a comprehensive assessment of behavioral changes in real-life
situations. Future research should incorporate longitudinal designs and
qualitative methods to better understand the lasting effects of PFA and
communication skills training.
Conclusion
These interventions could be widely implemented in disaster-prone regions to
equip educators with the necessary skills to support students experiencing
mental health challenges. Sustained training and follow-up programs should be
considered to ensure long-term effectiveness in improving teachers’ ability to
offer psychological support. Future interventions should consider tailored
training models that accommodate teachers with differing degrees of prior
knowledge considering these differences in training efficacy across various
subgroups. Extended training modules or follow-up mentorship programs, for
instance, can be beneficial for new teachers, while advanced workshops on
crisis intervention techniques might be more appropriate for seasoned
educators. This strategy would guarantee that all teachers, regardless of
experience level, get the most out of communication and psychological first aid
training.
Acknowledgements
The
authors would like to thank the Faculty of Nursing, Universitas Syiah Kuala for
academic assistance, UNICEF Aceh Representative Office for providing training
resource persons and the Non-Governmental Organization Generasi Edukasi
Nanggroe Aceh (GEN-A) for logistical assistance. All teachers involved in this
study and providing contributions are also greatly appreciated.
Abbreviations
PFA: Psychological First Aid
GSE:
General Self-Efficacy
WHO:
World Health Organization
PTSD:
Post-Traumatic Stress Disorder
Funding
This
research was not funded.
Availability of Data and Materials
The
data used in this study are available to the primary author upon reasonable
request.
Declarations
Ethics
Approval and Consent to Participate
The
Ethics Committee of the Faculty of Nursing, Universitas Syiah Kuala has
approved this study. After receiving an explanation of the purpose of the
study, each participant gave written consent.
Consent
for Publication
Participants
provided written consent for anonymous data to be published as part of the
results of this study.
Competing
Interests
The
author declares that he has no conflict of interest related to this research.
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