CRITICAL APPRAISAL

Effectiveness of the Mental Health First Aid programme for general nursing
students in Hong Kong: A randomised controlled trial

Disusun dalam rangka memenuhi tugas ujian tengah semester (UTS)

mata kuliah Evidence Based Practice of Nursing

OLEH:
Patricia Mega Sri Y.T
132024153003

PROGRAM STUDI MAGISTER KEPERAWATAN

FAKULTAS KEPERAWATAN
UNIVERSITAS AIRLANGGA
SURABAYA
2021
 LEMBAR PERNYATAAN

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Surabaya, 04 April 2021

Nama : Patricia Mega Sri Y.T

NIM. 132024153003

1
 LEMBAR PENILAIAN
CRITICAL APPRAISAL

Nama Mata Ajaran : Evidence Based in Nursing

Nama Tugas : Critical Appraisal

Nama Mahasiswa : Patricia Mega Sri Yulianty Tae

NIM : 132024153003

Jumlah Kata : 1500 kata ( Daftar Isi – Bab 3)

2.300 kata ( Dari halaman judul - daftar pustaka)
No Aspek Yang Bobot Kriteria penilaian
Dinilai
1 Pendahuluan 10 % Menjelaskan topik, tujuan, dan alat yang
digunakan untuk mengkritisi jurnal.
Memberikan deskripsi singkat makalah dan
deskripsi singkat jurnal yang ditelaah secara
spesifik da relevan.
2 Kritik Artikel 80 % Deskripsi dan kritik jurnal/artikel
menggunakan alat kritik (tool yang tepat):
Analisa tidak logis Sangat
Koheren
Pemilihan tool dan logis
Yang tidak sesuai Tool tepat
Ide susah dipahami Ide Lugas
Dan jelas
3 Kesimpulan 10 % Menyimpulkan makalah dan menuliskan
refleksi atas kritik jurnal
4 Pengurangan 5% Nilai akan mendapatkan pengurangan jika
nilai kriteria berikut tidak terpenuhi:
Jumlah kata kurang atau lebih dari batas
toleransi 5% dari 1500 Tidak mengikuti
aturan penulisan referensi dengan benar
Penulisan bahasa Indonesia yang tidak baik
dan benar, termasuk tanda baca.
Catatan: Makalah tidak akan dinilai jika terbukti bukan karya sendiri
Nilai Total :
Komentar dosen
....................................................................................................................................
....................................................................................................................................

2
 DAFTAR ISI

Lembar Pernyataan 1
Lembar Penilaian 2
Daftar Isi 3
Bab 1 Pendahuluan 4
Bab 2 Pembahasan 6
2.1 Apakah penelitian tersebut menunjukkan fokus masalah yang jelas ?
6
2.2 Apakah metode penelitian telah menjawab pertanyaan penelitian?
6
2.3 Apakah responden pada penelitian sudah cukup sehingga hasil yang
didapatkan bukan hal yang kebetulan? 6
2.4 Apakah subjek dialokasikan secara acak ke kelompok eksperimen dan
kontrol? Jika tidak, dapatkah ini menimbulkan bias? 7
2.5 Apakah kriteria inklusi / eksklusi yang digunakan? 7
2.6 Apakah kedua kelompok sebanding pada awal studi ? 7
2.7 Apakah terdapat kriteria hasil yang digunakan untuk menentukan hasil
yang objektif dan tidak bias ? 8
2.8 Apakah penelitian telah menggunakan alat yang sudah divalidasi untuk
mengukur hasil ? 8
2.9 Apakah efek yang dihasilkan secara praktik relevan ? 8
2.10 Seberapa tepat perkiraan efek yang dihasilkan ? apakah terdapat nilai
interval yang dapat dipercaya ? 8
2.11 Apakah terdapat faktor perancu yang tidak dijelaskan ? 9
2.12 Apakah hasil yang dihasilkan bisa diaplikasikan ? 9
Bab 3 Kesimpulan 10
Daftar Pustaka 11

3
 BAB 1
PENDAHULUAN

Kesehatan mental atau kesehatan jiwa merupakan aspek penting dalam

mewujudkan kesehatan secara menyeluruh. Kesehatan mental juga penting
diperhatikan selayaknya kesehatan fisik. There is no health without mental health,
sebagaimana definisi sehat yang dikemukakan oleh World Health Organization
(WHO) bahwa “health as a state of complete physical, mental and social well-
being and not merely the absence of disease or infirmity.” Kesehatan mental
merupakan komponen mendasar dari definisi kesehatan. Kesehatan mental yang
baik memungkinkan orang untuk menyadari potensi mereka, mengatasi tekanan
kehidupan yang normal, bekerja secara produktif, dan berkontribusi pada
komunitas mereka.

Menurut Organisasi Kesehatan Dunia (Organisasi Kesehatan Dunia,2017),

kira-kira satu dari empat orang di seluruh dunia terkena penyakit mental selama
hidup mereka. WHO merekomendasikan upaya kolaboratif global untuk
mempromosikan kesehatan mental dan penyakit pencegahan. Masalah kesehatan
yang paling umum pertama kali muncul selama masa remaja dan sangat lazim di
kalangan mahasiswa, terutama mereka di bidang perawatan kesehatan ( Eisenberg,
2011 ). Studi akademis yang lama, beban kerja yang berat dan praktikum klinis
dengan tekanan tinggi, mungkin memiliki efek buruk pada kesejahteraan mental
dan fisik para siswa ini (Sun dkk., 2016 ). Cheung (2016) mengatakan
perntingnya untuk memberikan dukungan dan bantuan ekstensif untuk masalah ini
( Cheung dkk., 2016).

Pelatihan Pertolongan Pertama Kesehatan Mental (MHFA) dikembangkan

di Australia untuk meningkatkan literasi kesehatan mental di kalangan masyarakat
umum dan juga untuk memberikan keterampilan dalam memberikan bantuan awal
kepada orang-orang dalam situasi krisis kesehatan mental dan bagi mereka yang

4
memiliki masalah kesehatan mental yang sedang berlangsung ( Kitchener & Jorm,
2002 ). Dalam dekade terakhir, beberapa evaluasi populasi sasaran yang beragam
di berbagai negara, termasuk mahasiswa keperawatan, telah menunjukkan efek
dari pelatihan MHFA ( Bond,dkk 2008). Penelitian tersebut merupakan sumber
pendukung terkait dengan penelitian yang bertujuan meningkatkan literasi
kesehatnan jiwa melalui proses critical appraisal untuk mengetahui validitas,
makna, dan relevansi untuk diterapkan. Instrumen yang digunakan untuk
mengkritisi penelitian ini adalah Center for Evidence-Based Management yang
terdiri dari 12 pertanyaan.

5
 BAB 2
PEMBAHASAN

2.1 Apakah penelitian tersebut menunjukkan fokus masalah yang jelas ?

Penelitian ini telah menunjukkan fokus masalah yang dapat diketahui pada
bagian abstrak penelitian. Analisis PICO. Population (P): responden yang
akan dilakukan Mental Health First Aid (MHFA), Intervention (I): Pelatihan
Mental Health First Aid Programme (MHFA) (C) Memberikan kegiatan
belajar mengajar interaktif kelompok, Outcome (O) Peningkatan literasi pada
mahasiswa dan peningkatan niat pertolongan pertama pada gangguan jiwa.
2.2 Apakah metode penelitian telah menjawab pertanyaan penelitian ?
Tujuan dari penelitian adalah untuk mengetahui pengaruh pemberian
pelatihan MHFA dalam meningkatkan literasi kesehatan mental, mengurangi
jarak social, meningkatkan niat pertolongan pertama pada gangguan jiwa, dan
meningkatkan kepercayaan diri mereka. Penelitan telah menggunakan metode
yang tepat yaitu randomized controlled trial.
2.3 Apakah responden pada penelitian sudah cukup sehingga hasil yang
didapatkan bukan hal yang kebetulan ?
Penelitian ini menggunakan 358 responden. Penelitian ini terdiri dari
kelompok experiment sejumlah 182 responden dan kelompok control
sejumlah 176 responden.
Peneliti menyebutkan bahwa populasi penelitian terbatas, dan tidak
menyebutkan jumlah populasi,dengan harapannya dapat mewakili keadaan
populasi. Hal tersebut sesuai dengan Sugoyono (2016) sampel merupakan
bagian dari jumlah dan karakteristik yang dimiliki oleh populasi tersebut dan
diperoleh sampel yang benar dapat menggambarkan keadaan populasi yang
sebenarnya atau representatif.

6
2.4 Apakah subjek dialokasikan secara acak ke kelompok eksperimen dan
kontrol? Jika tidak, dapatkah ini menimbulkan bias?
Desain penelitian yang digunakan ialah randomized controlled trial, yaitu
penelitian untuk mengetahui pengaruh pengaruh pemberian pelatihan MHFA
dalam meningkatkan literasi kesehatan mental, mengurangi jarak social dari
orang dengan gangguan jiwa, meningkatkan pertolongan pertama, dan
meningkatkan kepercayaan diri. Penelitan mengungkapkan hubungan sebab–
akibat dengan cara melibatkan kelompok kontrol di samping kelompok
intervensi. Selain itu, pengambilan subjek pada penelitian ini secara acak,
sehingga dapat meminimalkan bias. Pengacakan tersebut terkomputerisasi
(menggunakan situs pengacak) digunakan untuk menetapkan pasien ke dalam
kelompok. 
2.5 Apakah kriteria inklusi / eksklusi yang digunakan?
Pasien yang memenuhi kriteria berikut dimasukkan dalam penelitian: (a)
berusia minimal 18 tahun, (b) terdaftar dalam program sarjana keperawatan
umum (3) memahami materi Bahasa mandarin dan inggris. Peneliti tidak
menyebutkan kriteria eksklusi penelitian. Namun, peneliti menyebutkan bila
responden bisa manarik diri dari penelitian kapan saja tanpa konsekuensi
negative
2.6 Apakah kedua kelompok sebanding pada awal studi?
Kelompok kontrol dan kelopok intervensi diambil berdasarkan kriteria inklusi
dan eksklusi, sehingga tidak ada perbedaan terkait dengan karakteristik
responden. Perbedaan yang dilakukan kelompok kontrol tidak diberikan
intervensi, dan kelompok intervensi tetap menjadi satu dan diberikan
intervensi berupa pelatihan MHFA.
2.7 Apakah terdapat kriteria hasil yang digunakan untuk menentukan hasil
yang objektif dan tidak bias ?
Salah satu cara yang dilakukan untuk menghindari bias ialah dengan
menentukan kriteria inklusi dari responden. Kemudian memasuki proses
penelitian, yaitu pemberian intervensi pelatihan MHFA pada kelompok
interversi yang diberikan selama 1 bulan serta tetap melakukan pengukuran
pada kelompok kontrol. Pengukuran yang dilakukan ialah pengukuran

7
 literasi kesehatan mental dan kesehatan mental. Pengukuran tersebut
dilakukan sebelum dan setelah tindakan MHFA. Hasil tersebut dilakukan
analisis supaya tidak memperoleh hasil yang bias.
2.8 Apakah penelitian menggunakan alat yang sudah divalidasi untuk
mengukur hasil?
Alat yang digunakan dalam penelitian adalah Mental health literacy dan
Chinese Health Questionnaire (CHQ). CHQ digunakan untuk mengukur
kesehatan mental. Instrument ini, terdiri dari 12 item. Sedangkan Mental
health literacy digunakan untuk menilai pengenalan peserta terhadap
gangguan kesehatan mental, kesadaran akan masalah kesehatan mental, dan
pengetahuan tentang perawatan untuk penyakit mental.
2.9 Apakah efek yang dihasilkan secara praktik relevan?
Efek yang dihasilkan secara praktik ialah perbedaan hasil dari kelompok
kontrol dan kelompok intervensi. Pada kelompok intervensi didapatkan hasil
yang significant yaitu adanya perubahan pada mental dan niat yang
meningkatkan pada pertolongan pertama kesehatan mental, namun pada
kelompok kontrol mendapatkan hasil niat mahasiswa untuk memberikan
pertolongan pertama lebih menuru dari pada kelompok intervensi. Sehingga
secara praktik dapat dikatakan efek atau hasil yang dihasilkan relevan.
2.10 Seberapa tepat perkiraan efek yang dihasilkan ? apakah terdapat
nilai interval yang dapat dipercaya ?
Efek dari MHFA menunjukan pemahaman literasi kesehatan jiwa semakin
meningkat hal ini dibuktikan dengan Hasil tersebut di dapatkan dari hasil
pengukuran menggunakan uji Chi-square dan Green House Geiser. Selain itu
juga niat dan kepercayaan diri siswa dalam menawarkan bantuan pada
pertolongan pertama kesehatan mental lebih tinggi dibandingkan dengan
kelompok control. Hasil tersebut didapatkan dengan adanya perubahan
significant pada 6 bulan yaitu pada kelompok intervensi yang lebih banyak
melakukan kontak dengan orang dengan masalah mental dan menawarkan
bantuan/dukungan untuk individual.

8
2.11 Apakah terdapat faktor perancu yang tidak dijelaskan ?
Penelitian ini terdapat beberapa faktor perancu yang dapat mempengaruhi
hasil penelitian. Salah satunya ialah faktor psikologis dari setiap responden.
Sehingga peneliti mengatakan bahwa kelompok intervensi mungkin telah
dipengaruhi secara psikologis karena mereka berfikir bahwa mereka akan
mendapat manfaat dari intervensi yang telah dilakukan. 
2.12 Apakah hasil yang dihasilkan bisa diaplikasikan ?
Intervensi MHFA memiliki dampak dalam meningkatkan literasi kesehatan
jiwa serta kesehateraan jiwa perawat. Bukti dari penelitian ini menunjukkan
bahwa pelatihan MHFA harus dipromosikan dan diintegrasikan sebagai
pelatihan wajib dan sebagai bagian dari kegiatan ekstrakurikuler untuk
kesehatan dan mahasiswa/perguruan tinggi umum secara lokal dan global.

9
 BAB 3
KESIMPULAN

Penulisan makalah ini digunakan untuk telaah kritis pada suatu artikel
untuk menilai validitas, makna dan reliabilitas penelitian sehingga hasil dari telaah
kritis ini dapat digunakan sebagai evidence based nursing. Artikel ini dapat
dipertimbangkan sebagai dasar penelitian lebih lanjut tentang intervensi non-
farmakologis untuk menimgkatkan literasi kesehatan jiwa..

Penelitian ini melibatkan 358 responden yang akan dilakukaN MHFA,

sebelum dilakukan MHFA dilakukan pengukuran dengan menggunakan pre-test
Mental health literacy dan Chinese Health Questionnaire (CHQ). Penelitian
sebelumnya ada yang mendukung penelitian ini, yaitu sebuah penelitian
menggunakan MHFA untuk perawat untuk meningkatkan literasi kesehatan
mental dan mengurangi stigmatisasi dan jarak sosial dari orang-orang gangguan
mental. Kesimpulan ini sejalan dengan penelitian yang peneliti lakukan. 

Kekurangan penelitian ini yaitu kemungkinan ditemukan faktor perancu

karena mahasiswa direkrut dari tahun yang berbeda program keperawatan. Oleh
karena itu sedapat mungkin peneliti dapat menggunakan mahasiswa tahun
pertama tanpa pelatihan sebelumnya. Selain itu perlunya penelitian kualitatif lebih
lanjut harus dilakukan untuk menentukan secara lebih rinci bagaimana
pengalaman dan penerapan MHFA memberikan pemahaman mendalam tentang
cara terbaik untuk membantu orang dengan masalah kesehatan mental. Selain itu,
lokakarya pelatihan MHFA disarankan bagi para profesional kesehatan yang
belum menerima pelatihan terkait kesehatan mental.

10
 DAFTAR PUSTAKA

Bingham, H., & O’Brien, A. J. (2018). Educational intervention to

decreasestigmatizing attitudes of undergraduate nurses towards people
with mentalillness. International Journal of Mental Health Nursing, 27(1),
311–319.

Eisenberg, D., Hunt, J., & Speer, N. (2012). Help seeking for mental health on
collegecampuses: Review of evidence and next steps for research and
practice.Harvard Review of Psychiatry, 20(4), 222–232.

Fokuo, J. K., Goldrick, V., Rossetti, J., Wahlstrom, C., Kocurek, C., Larson, J.,
&Corrigan, P. (2017). Decreasing the stigma of mental illness through
astudent-nurse mentoring program: A qualitative study. Community
MentalHealth Journal, 53(3), 257–265.

Farner, J. et al. (2019) ‘Aromatherapy hand massage for test anxiety and self-ef fi
cacy in nursing students : A pilot study’, Teaching and Learning in
Nursing. Organization for Associate Degree Nursing., 14(4), pp. 225–230.
doi: 10.1016/j.teln.2019.04.008.

Heidari, F. et al. (2017) ‘European Journal of Integrative Medicine Clinical trial E

ff ect of short-term hand re fl exology on anxiety in patients before
coronary angiography : A randomized placebo controlled trial’, 16(July),
pp. 1–7. doi: 10.1016/j.eujim.2017.09.010.

Kala, P. et al. (2016) ‘Depression and Anxiety after Acute Myocardial Infarction
Treated by Primary PCI’, pp. 1–9. doi: 10.1371/journal.pone.0152367.

Kemenkes RI (2018) ‘HASIL UTAMA RISKESDAS 2018’. Jakarta: Badan

Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan RI.

Kitchener, B. A., & Jorm, A. F. (2002). Mental health first aid training for the
public:Evaluation of effects on knowledge, attitudes and helping behavior.
BMCPsychiatry, 2(1), 10.

11
Nursalam. (2015). Manajemen Keperawatan: Aplikasi Dalam Praktik
Keperawatan Profesional. Jakarta: Salemba Medika

Ramezanibadr, F. et al. (2018) ‘The impacts of foot reflexology on anxiety among

male candidates for coronary angiography : A three-group single-blind
randomized clinical trial Complementary Therapies in Clinical Practice
The impacts of foot re fl exology on anxiety among male candidates for
coronary angiography : A three-group single-blind randomized clinical
trial’, Complementary Therapies in Clinical Practice. Elsevier, 32(July),
pp. 200–204. doi: 10.1016/j.ctcp.2018.07.005.

Smeltzer, S.C. & Bare, B.G. (2013). Buku Ajar Keperawatan Medikal Bedah Brunner
& Suddarth, edisi 8. Jakarta : EGC.

Stuart, W. (2013). Prinsip dan Praktik Keperawatan Kesehatan Jiwa. Edisi

Indonesia. Jakarta : Fakultas Keperawatan Indonesia.

Sugiyono. (2016). Metode Penelitian Kuantitatif, Kualitatif dan R&D. Bandung:

PT Alfabet

Sun, F. K., Long, A., Tseng, Y. S., Huang, H. M., You, J. H., & Chiang, C. Y.
(2016).Undergraduate student nurses’ lived experiences of anxiety during
their firstclinical practicum: A phenomenological study. Nurse Education
Today, 37,21–26.

Svensson, B., & Hansson, L. (2014). Effectiveness of mental health first aid
trainingin Sweden. A randomized controlled trial with a six-month and
two-yearfollow-up. PLoS One, 9(6), Article e100911.WHO (2012)
‘Prevention and Control of Noncommunicable Diseases: Guidelines for
primary health care in low-resource settings’.

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World Health Organization.

Wong, N. D. (2014) ‘Epidemiological studies of CHD and the evolution of

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 Collegian 28 (2021) 106–113

Contents lists available at ScienceDirect

Collegian

Effectiveness of the Mental Health First Aid programme for general nursing
students in Hong Kong: A randomised controlled trial
∗
Maria S.Y. Hunga, , Meyrick C.M. Chowa, Wai Tong Chienb, Prudence Y.K. Wongc

a
Tung Wah College, Hong Kong Special Administrative Region, China

b
Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China

c
The Mental Health Association of Hong Kong, Hong Kong Special Administrative Region, China

A R T I C L E I N F O A B S T R A C T

Article history:
Background: Insufficient mental health related knowledge among healthcare professionals and students may
lead to higher levels of stigma towards and increased social distance from mentally unwell patients.
Received 6 July 2019 Moreover, university students enrolled in healthcare programmes are particularly susceptible to stress,
Received in revised form depression, anxiety and other mental health problems.
10 December 2019

Objective: This study evaluated the effectiveness of the Mental Health First Aid (MHFA) Programme for
Accepted 15 April 2020
undergraduate general nursing students in improving their mental health literacy, decreasing their social distance
from persons with mental health issues, increasing their mental health first-aid intention, and enhancing their
confidence in assisting others. The programme was also extended the effectiveness to help students to
Keywords:
maintain their own mental wellbeing.

Nursing students Methods: A randomised controlled trial study with a pre-test, post-test, and follow-up research design was
Undergraduate students
conducted. Three hundred and fifty-eight students were recruited. The experimental group comprised 182
Mental wellbeing Mental
students, of whom 168 completed MHFA training and a post-test questionnaire in mid-2017, and 167
Health First Aid
students completed a follow-up questionnaire early in 2018. Meanwhile, 175 and 165 of the 176 students in
the control group completed the post-test and follow-up questionnaires, respectively.

Results: The effectiveness of the MHFA programme was supported by the results of repeated measures
analysis of variance with Greenhouse-Geisser correction. Significant interaction effects were found in mental
health knowledge in recognition of depression ( p2 = 0.17; 95% CI: 0.24, 0.42), recognition of schizophrenia ( p2
= 0.16; 95% CI: 0.33, 0.47), depression social distance ( p2 = 0.20; 95% CI: −0.41.

−0.22), schizophrenia social distance ( p2 = 0.31; 95% CI: −0.58, −0.37), confidence in helping ( p2 = 0.04;
2

95% CI: 0.11. 0.14), mental first-aid actions ( p = 0.08; 95% CI: 1.75, 2.90), and mental wellbeing

( p2 = 0.15; 95% CI: −0.53, −0.19).

Discussion: Mental illnesses present substantial challenges to healthcare professionals worldwide. MHFA
training should be promoted locally and integrated within compulsory training and extracurricular activ- ities in
curricula developed for healthcare and general university students.

Conclusion: This study confirms the benefits of MHFA for general nursing students in developing their
professional understanding of and willingness to assist people with mental health problems, and in
developing, maintaining, and improving their understanding of their own mental health.

106
© 2020
Australian
College of
Nursing Ltd.
Published by
Elsevier Ltd.

107
 M.S.Y. Hung et al. / Collegian 28 (2021) 106–113
10

with mentally unwell patients (Bingham &

Summary of relevance O’Brien, 2018; Chernomas & Shapiro, 2013;
Problem or Issue
Fokuo et al., 2017; Giandinoto, Stephenson, &
Little is known about the effect of the Edward, 2018; Knaak et al., 2017; Mak et al.,
Mental Health First Aid (MHFA) programme 2015). In particu- lar, nurses often spend
in improving the mental health knowl- edge, considerably more time providing patient care than
behaviour, attitudes, and wellbeing of other healthcare professionals. These obstacles
general nursing students. likely hin- der nurses’ motivation and ability to
What is Already Known
provide quality holistic care. Accordingly, relevant
The MHFA programme is a psycho- pre-registration education for nursing stu- dents
educational training pro- gramme that has that establishes a holistic and positive view of
been shown to enhance mental health people with mental disorders may better facilitate
knowledge in diverse populations in various the needs of these patients. The MHFA programme
countries. is an effective standardised psycho- educational
What this Paper Adds
training programme that was established in
Australia in 2000. It aims to enhance attendees’
knowledge of general mental health and common
1. Introduction and background mental problems such as anxiety, depres- sion, and
psychosis, and the self-harming behaviours that
According to the World Health Organization
can be triggered by these problems, with the aim
(World Health Organization, 2017), approximately
of supporting people with mental health problems
one in four people worldwide are affected by
(Kitchener & Jorm, 2002). In the last decade,
mental illness during their lifetimes. The WHO rec-
several evaluations of diverse target populations in
ommends global collaborative efforts to promote
vari- ous countries, including nursing students, have
mental health and prevent mental illness. Most
demonstrated the effects of MHFA training (Bond,
mental health problems first arise during
Jorm, Kitchener, & Reavley, 2015; Burns et al.,
adolescence and are highly prevalent among
2017; Davies, Beever, & Glazebrook, 2018; Hung,
college and university students, particularly those
Lam,
in the field of healthcare (Eisenberg, Hunt, &
Speer, 2012; Kelly et al., 2011). Prolonged aca-
demic study, together with a heavy workload and
high-pressure clinical practicum, may have
adverse effects on the mental and physical well-
being of these students (He, Turnbull, Kirshbaum,
Phillips, & Klainin-Yobas, 2018; IsHak et al.,
2013; Lee, Lee, & Lee, 2018; Sun et al., 2016), and
indicates the need to provide extensive support for
this population (Cheung et al., 2016; He et al.,
2018; Mospan, Hess, Blackwelder, Grover, &
Dula, 2017; Rotenstein et al., 2016). Moreover,
healthcare students and nurses who face men- tal
health problems have expressed concerns about
disclosure and lack of acceptance from their
colleagues (Fokuo et al., 2017; Knaak, Mantler, &
Szeto, 2017).
In addition, it has been reported in several
studies that
insufficient mental health related knowledge
among healthcare professionals and students might
lead to higher levels of stigma, prejudice, and
social distance when these individuals are faced
107
 M.S.Y. Hung et al. / Collegian 28 (2021) 106–113
& Chow, 2019; Kelly & Birks, 2017; Svensson &
Hansson, 2014; Wong, Lau, Kwok, Wong, & Tori,
2017). A recent systematic review and meta-
analysis of 18 studies of MHFA training with
5936 par- ticipants demonstrated that the training
significantly improved the participants’
knowledge and identification of mental illnesses,
increased their awareness of effective treatments
for these ill- nesses, and improved their confidence
when assisting individuals with mental health
problems (Morgan, Ross, & Reavley, 2018). In
addition, in a recent qualitative study of nursing
students’ experi- ence of MHFA training
conducted by the first two authors of this paper,
the participants reported gaining a greater
awareness of the importance of their own mental
wellbeing from the programme (Hung et al.,
2019).
The Mental Health Review Report (Food &
Health Bureau,
HKSAR, 2017) published by the Hong Kong
government noted that some forms of psychosis,
such as schizophrenia, are typically more evident
in late adolescence and early adulthood. Tertiary
insti- tutions are thus optimally positioned to
organise peer support training to promote and
improve adolescents’ mental wellbeing. For
nurses, knowledge regarding the early
identification of men- tal health problems and
effective interventions, together with a positive
attitude and willingness to offer help and support
for indi- viduals with mental health disorders,
should be a fundamental attribute of patient care.
This waitlist-based randomised controlled trial
aimed to evalu- ate the effectiveness of MHFA
training for undergraduate nursing students. The
objectives were as follows: 1) to increase the par-
ticipants’ mental health literacy; 2) to decrease the
social distance between the participants and
people with mental health problems;
3) to increase the participants’ confidence in
helping others; 4) to enhance participants’ mental
health first-aid intentions; and 5) to improve the
participants’ mental wellbeing as a secondary
effect of the MHFA programme.
2. Methods
2.1. Participants and procedures
The eligible participants were all students who
(a) were at least 18 years of age, (b) were enrolled
108
in an undergraduate general nursing programme,
10
and (c) could understand both Chinese and English
language materials. The study setting was one of
the largest tertiary institutions in Hong Kong,
which provides several under- graduate general
nursing programmes for more than 1600 nursing
students. The estimated minimum sample size was
128 per group in a two-group statistical analysis,
assuming an effect size of 0.5, a desired power of
0.8 and an α level of 0.05 (Cunningham &
McCrum- Gardner, 2007).
2.2. Ethical considerations
After receiving ethical approval for the study
from the Research Ethics Sub-Committee of the
participating institution, general nurs- ing
undergraduate students were invited to join the
study through class announcements and emails in
April 2017. Three hundred and fifty-eight eligible
students were enrolled within one week dur- ing
May 2017. The participants were supplied with an
information sheet that clearly described the
purpose, procedure, risks, and ben- efits of the
study, and the voluntary nature of participation.
They were also informed of their ability to
withdraw from the study at any time without any
negative consequences. Informed consent was then
obtained from all of the participants.
2.3. Data collection and intervention
The first author (HSYM) generated a random
allocation sequence table. Two research assistants
were responsible for then
 M.S.Y. Hung et al. / Collegian 28 (2021) 106–113
10
suffering from these problems. In the experimental
group, 168 of the 182 students completed MHFA
training and the post- test questionnaire during mid-
2017, and 167 students completed the follow-up
questionnaire early in 2018. Meanwhile, 175 and 165
of the 176 students in the control group completed the
post-test and follow-up questionnaires, respectively.
After completing the follow-up questionnaire, the
participants in the control group also underwent
MHFA training, as this was expected to benefit all the
participants. Overall, 20 12-hour MHFA training
classes comprising approximately 15–20 students
were provided for the experimental and waitlisted
groups in this study.

2.4. Outcome measures

The outcomes were measured in terms of local

relevance and application, according to the
participants’ self-completed responses to two well-
Fig. 1. The stages of the study. validated questionnaires: the Mental Health

enrolling and assigning the participants to either the

experimental group or a waitlisted control group.
Self-administrated question- naires were used to
collect data immediately after randomisation (pre-
test), after participation in the 12-hour MHFA
programme (post-test), and six months after
completion (follow-up). Fig. 1 shows a flow
diagram of different stages of the study.
During the face-to-face MHFA training sessions
(Hong Kong version) con- ducted by certified
MHFA instructors in Cantonese with English
supplementation, the participants were given an
overview of the main classifications of mental
health disorders, such as anxiety, depression,
psychosis, and related manifestations, such as sub-
stance abuse.
The Chinese rd version of MHFA manual
(Hong Kong 3 Edi-
tion) (The Mental Health Association of Hong
Kong, 2015) and an information booklet about
local mental health resources were distributed to
each participant. Each three-hour training session
comprised small-group interactive teaching and
learning activi- ties, and four sessions were
administered over a one-month period. During
these sessions, the participating students learned
not only the signs and symptoms, possible risk
factors, and crises associ- ated with these mental
health problems, but also strategies to help those
109
Literacy Scale (Chinese version) and
M.S.Y. Hung et al. / Collegian 28 (2021) 106–113
the anyone else they knew, and if so, what kinds of
11
Chinese Health Question- naire (CHQ). assistance or MHFA actions they had been able
to offer. One mark was given to each action that
2.5. Mental Health Literacy Scale (Chinese version)
was based on the ‘ALGEE’ action plan (Kitchener,
Jorm, & Kelly, 2017), comprising assessment of
Mental health literacy was evaluated using the
the risk of harm or suicidal plan, listening non-
Mental Health Literacy Scale (Chinese version),
judgementally to the person’s problems and
which comprises two scenarios of major
encouraging the person to talk with fam- ily
depression and schizophrenia that fulfil the
members or others. A higher score indicated that
indicative stan- dards in the Diagnostic and
more MHFA actions had been performed.
Statistical Manual of Mental Disorders (Fourth
Edition) (Wong, Lam, & Poon, 2010). The scale 2.6. Chinese Health Questionnaire (CHQ)
assessed the participants’ recognition of mental
health disorders, awareness of mental health The CHQ was selected to measure the students’
problems, and knowledge of treatments for mental health. This tool was developed to screen
men- tal illness. Their knowledge and beliefs of for minor mental health problems (e.g., symptoms
students regarding the ‘helpfulness’ of different of general psychological distress or minor psychi-
professionals, such as general physicians, atric disorders) in the general population,
clinical psychologists, and counsellors, who can including adolescents in community settings
offer assistance to people with mental health (Cheng, Wu, Chong, & Williams, 1990). It assesses
problems (i.e., professional consensus) and the participant’s mental health status at the time of
appropriate treatment decisions (i.e., beliefs the interview relative to his or her usual state. The
about treatment) were also assessed. Each CHQ comprises 12 items, such as ‘Have you been
correct answer received one mark, and a higher suffering from a headache or pres- sure in your
score indicated better mental health knowledge. head?’ Each item is scored on a 4-point Likert scale
For the social distance scale, five types of ranging from 1 (never) to 4 (more than usual), and
interpersonal relation- summed to cal- culate a mean score. A lower score
ship were used to describe the participant’s
indicates better mental health, and a higher score
willingness to have a relationship with a person
represents more psychological distress. The reli-
who has mental health problems, such as living
ability coefficients for the CHQ ranged from 0.83
in a neighbourhood or marrying into a family
to 0.86, displaying satisfactory internal consistency.
with a person who has mental health problems.
These items were scored on a 4- point Likert 2.7. Data analysis
scale ranging from 1 (definitely would) to 4
(definitely would not). A higher mean score IBM SPSS-Statistics 23 was used for the data
indicated greater social distance. The reliability analysis, which was conducted on an intention-to-
coefficients for the social distance scale ranged treat basis. The missing data for every
from
0.86 to 0.93, which demonstrated good internal
consistency.
In addition, nursing students were asked about
their confidence in their ability to provide
assistance to individuals with mental health
disorders. They were required to respond to
this item on a 5-point Likert scale ranging from
1 (not confident at all) to 5 (extremely
confident).
For the assessment of mental health first-aid
intentions, the par- ticipants were asked
whether they had observed mental health
problems themselves during the past six
months, in their family members or friends or

110
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11
Table 1

Descriptive statistics for the experimental and control group

Experimental group Control group

Mean ± SD Frequency Percentage Mean ± SD Frequency Percentage

N 182 176
Gender
Male 36 19.9% 27 15.3%
Female 146 80.1% 149 84.7%
Age 20.80 ± 1.91 20.76 ± 1.91
Previous training on mental health training 25 13.9 14 8.0%
Mental health issues in self 59 32.8 68 36.8

outcome measure were imputed by using the last-
observation- carried-forward method.
3. Results
The participants comprised 358 nursing students
(63 (17.6%) male and 295 (82.4%) female). Table
1 shows the descriptive statis- tics for the
experimental and control groups, respectively.
The 358 students were randomised
− into either the
experimental group (n = 182) or the control group (n
= 176). Twenty-five (13.9%) par- ticipants in the
experimental group − and 14 (8%) in the control
group had previously undergone mental health
training, and 59 (32.8%) and 68 (38.6%)
participants in the experimental and con- trol
groups, respectively, had experienced problems
with their own mental health. A chi-square test and
independent samples t-test found no significant
differences between the experimental and control
groups in terms of sex [y 2 (1) = 1.27, p = 0.26],
age [t (354) = 0.27, p = 0.82], or previous training
in mental health [y2 (1) = 3.32, p = 0.07].
A repeated-measures analysis of variance
with Greenhouse-
Geisser correction was used to investigate the
effectiveness of MHFA training. Table 2 provides
the means, standard deviations, within-subject
variances, and effect sizes of the outcome mea-
sures. Significant interaction effects were observed
across the pre-test, post-test, and follow-up
assessments of the depression scenario, including
recognition of depression [F (2,355) = 36.56, p <
0.01, p2 = 0.17], professional consensus [F (2,355) =
3.82, p < 0.05, p2 = 0.02], beliefs about treatment
[F (2,355) 4.28, p < 0.05, p = 0.02], and
social distance [F (2,355) = 47.01, p < 0.01,
p2 = 0.20]; the schizophrenia scenario, including
recognition of
schizophrenia [F (2,355) = 33.94, p < 0.01, p2 = 0.16],
professional consensus [F (2,355) = 6.28, p < 0.01, p2
111
= 0.03], beliefs about treat- ment [F (2,355) = 7.50, p <
0.01, p2 = 0.04], and social distance [F (2,355) =
81.35, p < 0.01, p2 = 0.31]; confidence in the ability
to help [F (2,355) = 7.53, p < 0.01, p2 = 0.04]; mental
health first-aid action [F (2,355) = 5.92, p < 0.01, p2
= 0.08]; and mental health status in the CHQ [F
(2,355) = 31.69, p < 0.01, p2 = 0.15].
Furthermore, a post hoc Bonferroni correction
revealed that the MHFA training improved the
participants’ scores between the pre-test and post-
test for the depression scenario, including recog-
nition of depression (Cohen’s d = 1.10, p < 0.01)
and social distance (Cohen’s d = 0.88, p < 0.01), and
the schizophrenia scenario, includ- ing recognition
of schizophrenia (Cohen’s d = 1.44, p < 0.01), social
distance (Cohen’s d = 1.15, p < 0.01), confidence in
the ability to pro- vide help (Cohen’s d = 0.34, p <
0.01), and the CHQ score (Cohen’s d = 0.76, p <
0.01). This effectiveness was sustained at the six-
month follow-up assessment for all of the measures
except the CHQ score. Although no significant
differences were observed between the pre-test and
post-test in beliefs about treatment for the
depression scenario, professional consensus for the
schizophrenia scenario, or mental health first aid
action, these measures showed significant
improvement at the six-month follow-up
assessment.
In terms of mental health first-aid action, 125
participants (86
[68.8%] in the experimental group and 39 [31.2%] in
the control
group) reported having had contact with
M.S.Y. Hung et al. / Collegian 28 (2021) 106–113
individuals with mental health problems within six
months of receiving the MHFA training. Of these
students, only ten (four and six students in the
exper- imental and control groups, respectively)
revealed that they had not offered any help or
support to these individuals. The ALGEE skills
commonly used by the study participants included
listening to the individual’s problems in a non-
judgemental manner (80 in the experimental
group; 36 in the control group), encouraging the
individual to discuss their concerns (80 in the
experimental group; 35 in the control group),
encouraging the individual to seek support from
their relatives (56 in the experimental group; 21 in
the control group) and professionals (51 in the
experimental group; 17 in the control group), and
accompanying the individual to seek help and
advice (30 in the experimental group; 5 in the
control group).
evidenced by the increased recognition of mental
11
ill- ness (depression and schizophrenia) and
improved understanding of the roles of relevant
professionals, medication, and treatment available
to assist people with mental health problems. The
great- est gain was observed in the recognition of
mental illness. The improvement was expected
because the MHFA programme had been
specifically developed to enhance the recipients’
recognition of mental illness.
These results are consistent with those of local
and foreign studies conducted with healthcare
students (Bond et al., 2015; Burns et al., 2017;
Davies et al., 2018; Hung et al., 2019; Kelly &
Birks, 2017, with the Hong Kong public (Wong et
al., 2017) and in Chinese-speaking communities in
Australia (Lam et al., 2010). The programme also
emphasised the importance of early treatment and
clearly delineated the roles of various healthcare
professionals in

4. Discussion
The results of this study indicate the
effectiveness of MHFA training for undergraduate
nursing students in terms of enhancing their
mental health literacy, confidence in helping
others, mental health first-aid action and mental
wellbeing, and reducing their social distance from
people with mental disorders. This face-to-face
MHFA training course, which comprised small-
group interactive teaching and learning activities,
aroused the participants’ learn- ing interest and
active involvement and enhanced their knowledge
and practical skills, which echoed the findings of
previous studies (Hung et al., 2019; Kelly &
Birks, 2017). The feedback from a pilot
randomised controlled e-learning MHFA study of
UK medical stu- dents expressed difficulties in
practising new skills via eLearning (Davies et al.,
2018); however, another study recommended that
a blended strategy that combined face-to-face
training with online learning might be more
favourable and effective than an approach based
only on face-to-face or e-learning (Bond et al.,
2015; Liu et al., 2016).

4.1. Mental health literacy

Notably, this study demonstrated the ability of

MHFA training to increase the mental health
knowledge of the participating nursing students, as
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 M.S.Y. Hung et al. / Collegian 28 (2021) 106–113
11
treating people with mental disorders (Wong et al.,
Pre–follow- up 2017). How- ever, in line with other studies (Burns
Cohen’s d

−1.46**

−1.28**

−1.32**
−0.28**
et al., 2017; Jorm, Kitchener, Sawyer, Scales, &

−0.03*
0.05**

0.92**
−0.10

−0.09

0.48
Cvetkovski, 2010), a slight decrease in knowledge
of treatments for mental illness and helpfulness
from different pro- fessionals was observed in the
Cohen’s d
Pre– Post

−1.10**

−1.44**

−0.34*
0.88**

1.15**
−0.26
−0.17

−0.25
−0.21
post-test compared to the six-month follow-up

0.06
assessment. This attenuation reflects the need for
regu- lar refreshment or further professional
development to reinforce the learned knowledge.
Mental illnesses present substantial challenges to
healthcare professionals worldwide, especially in
general hospital settings in which patients often
present with mental and physical comorbidi- ties
Partial Eta Sq.

(Vasiliadis, Lamoureux-Lamarche, & Guerra,

0.03**

0.31**
0.17**

0.16**

0.04**
0.02*

2017). Although MHFA training is not intended to

replace mental health nursing education in the
curriculum (Kelly & Birks, 2017; Kitchener &
Jorm, 2017), the general nursing students in this
F (time*group

study were expected to use mental health first-aid

effect)

81.35
36.56

33.94

skills after their training to provide assis- tance and

3.82

6.28

7.50

to refer people efficiently and effectively to mental

health professionals and local resources. The
valuable and relevant infor- mation provided in the
MHFA programme not only enhanced the mental
health knowledge and practical skills of the general
nurs- ing students but also helped to consolidate
what they had learned during their general nursing
training (Hung et al., 2019).

4.2. Social distance

Mean (SD)

2.29 (0.57)
4.75 (1.68)

2.34 (0.58)
4.25 (1.93)

5.31 (2.37)

2.88 (0.63)

Several studies have reported that insufficient

Control

mental health related knowledge among healthcare

professionals and students might lead to higher
levels of stigma, prejudice and social distance when
Experimental

Mean (SD)

2.82 (0.41)
5.08 (1.75)

2.87 (0.33)
4.89 (1.82)

6.08 (2.33)

2.21 (0.56)
Follow-up

these individuals face mentally unwell patients

(Bingham & O’Brien, 2018; Chernomas & Shapiro,
reenhouse-Geisser and post hoc Bonferroni correction were performed.

2013; Fokuo et al., 2017; Henderson et al., 2014;

Giandinoto et al., 2018; Knaak et al., 2017; Mak et
Mean (SD)

2.25 (0.55)
5.04 (1.13)

2.32 (0.46)
4.69 (1.50)

5.49 (1.87)

2.85 (0.59)

al., 2015). An Australian survey that compared the

Control

atti- tudes of healthcare professionals, such as

psychiatrists, clinical psychologists, and general
practitioners, with those of the gen- eral
Experimental

Mean (SD)

2.71 (0.48)
5.30 (1.65)

2.91 (0.28)
5.23 (1.69)

6.33 (2.25)

2.07 (0.59)

community, found that women and general

Post-test

practitioners were prone to have more personal

stigmatising attitudes about men- tally ill patients,
and maintain greater social distance from these
st, post-test and follow-up

Mean (SD)

2.15 (0.45)
5.12 (1.04)

2.24 (0.46)
4.89 (1.23)

5.93 (1.52)

2.72 (0.56)

individuals, than men and psychologists,

Control

respectively (Reavley, Mackinnon, Morgan, &

113
 M.S.Y. Hung et al. / Collegian 28 (2021) 106–113
Jorm, 2014). A local study of healthcare
11
professionals and students in Hong Kong found that
doctors main- tained the greatest social distance
and social workers maintained the smallest social
distance from individuals with mental illness,
whereas nursing students maintained less social
distance from individuals with bipolar disorder or
schizophrenia than social work students (Mak et
al., 2015). Despite the differences in the
magnitudes of these attitudes, all likely hinder the
professional’s motivation and ability to provide
quality holistic care. It is there- fore the
development and implementation of relevant
strategies to reduce stigma and social distance in
the healthcare system are significant (Knaak et al.,
2017).
In line with other results, this study demonstrated
that MHFA
Experimental
Mean (SD)

training could decrease the perceived social

2.21 (0.42)
4.93 (1.13)

2.35 (0.47)
4.84 (1.30)

5.89 (1.79)

2.71 (0.52)

distance among nurs- ing student participants

(Bond et al., 2015; Burns et al., 2017; Hung et al.,
2019). In a recent qualitative study that explored
nursing students’ experiences three months after
Professional consensus Beliefs

Chinese Health Questionnaire

Recognition of schizophrenia

Mental health first aid action

Confidence in ability to help

MHFA training, the par- ticipants reported that the

Recognition of depression

Beliefs about treatment

Schizophrenia scenario
Professional consensus

about treatment Social

MHFA programme had improved their beliefs and

Depression scenario

values (Hung et al., 2019). Specifically, they had

Social distance

acquired the belief that nurses should present a

distance

neutral, therapeutic atti- tude towards and become

more accepting of people with mental illness. This
demonstrates that improvements in mental health
lit- eracy can help these students to normalise
mental health problems and dispel the myths that
surround these problems, thus decreas- ing
stigmatisation and social distancing from people
with mental illness.
However, the stigma of mental illness, including self-stigma
as well as family and public stigma, is deeply rooted in Chinese

114
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11
communities, and those with mental disorders are and interact helpfully with individuals in society or
perceived as dangerous, impulsive and patients in their future workplace suffering from
uncontrollable (Lam et al., 2010). Given this mental health problems.
cultural background, the individuals and their Furthermore, it was notable that an enhanced
sense of achieve-
families are often criticised and blamed because
ment and satisfaction was reported by the nursing
they are believed to be responsible for the illness.
students after practising their skills and providing
This moralising view further frustrates the individ-
help for their peers or relatives (Hung et al., 2019).
uals and their families, who often already
They found that performing MHFA for family
experience feelings of shame or guilt when seeking
members and friends was a positive and valuable
help and treatment, leading to greater social
experience. The members of other helping
distancing from others (Lam et al., 2010). Thus,
professions, such as teachers, have also reported
local gov- ernment and healthcare organiszations
gaining confidence in their ability to assist students
are optimally positioned to support these families
and colleagues after completing the MHFA course
and to promote compassionate and altruis- tic
(Jorm et al., 2010).
attitudes and behaviours towards those in society
suffering from mental illness. 4.4. Students’ mental health

4.3. Confidence in the ability to help and mental health first aid
action
Evidence suggests that healthcare students both
locally and globally often experience high levels of
Consistent with the findings of previous studies, mental distress (Cheung et al., 2016; He et al.,
the MHFA inter- vention was effective in 2018; Sun et al., 2016) and may have sui- cidal
increasing medical and nursing students’ ideation due to the high academic and social
confidence in providing help and support to people demands of their professional training (Mospan et
with mental problems (Bond et al., 2015; Burns et al., 2017; Rotenstein et al., 2016). In Hong Kong,
al., 2017; Kitchener & Jorm, 2002; Hadlaczky, 20.0%, 24.3%, and 39.9% of nursing students
Hökby, Mkrtchian, Carli, & Wasserman, 2014). reported modest to exceptionally severe levels of
The student participants acquired a greater stress, depres- sion, and anxiety, respectively
understanding of men- tal disorders, including of (Cheung et al., 2016), and the most common stressor
the associated signs, symptoms, and crises, which was a lack of professional knowledge and skills
may have reduced the stigma and social distance (Chan, So, & Fong, 2009). Similarly, more than
and increased their confidence in communicating one-third of partic- ipants in this study (127; 35.5%)
and assisting individ- uals with mental disorders. had experienced problems with their own mental
health.
It was clear that the participants in the
experimental group were more willing than those in
the control group to identify and offer help to
those in need, which is in agreement with the
find- ing of another study that the participants
became more competent in identifying ways to help
(Hung et al., 2019). The participants learned basic
ALGEE engagement skills during training via
interac- tive teaching and learning activities, such
as role-playing. A possible explanation for this
observation may be that the participants were
future ‘helping professionals’ and were therefore
more inclined to feel compassion and care for
others. In addition, nearly half of the study’s
participants (173; 48.3%) reported that a friend or
rela- tive had encountered mental health problems.
The skills they had learned from these experiences
had likely bolstered their readi- ness to encounter
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 M.S.Y. Hung et al. / Collegian 28 (2021) 106–113
The initial evidence from this study, gleaned
from repeated use of the CHQ, demonstrated
that the MHFA training improved the student
participants’ mental health as a secondary effect
that was maintained for six months. These results
are consistent with international evaluations of
MHFA training, which have reported its positive
effects on the mental health of teenagers and
medi- cal and nursing students (Bond et al.,
2015; Davies et al., 2018) and its potential to
intensify nursing students’ self-awareness of their
personal mental health (Hung et al., 2019). The
student participants mentioned that they
encountered various kinds of stressors each day,
including study workload and peer relation- ships.
After the MHFA training, they were more
conscious of and attentive to their own mental
status when handling such life chal- lenges.
In Hong Kong, general nursing and
psychiatric nursing are
the two predominant registration streams in the
field. This study mainly targeted general nursing
students, who receive limited the- oretical mental
health education (a minimum of 40 hours) and
clinical practicum (a minimum of 60 hours) during
their nursing training (The Nursing Council of
Hong Kong, 2017). Although recent studies have
aroused concerns and discussion regarding the role
of MHFA training in Australian undergraduate
mental health nursing education (Happell &
McAllister, 2015; Kitchener & Jorm, 2017), the
advantages of MHFA for local general nursing
students can- not be underestimated. MHFA
training is not intended to replace mental health
education in the pre-registration nursing
curriculum (Happell & McAllister, 2015;
Kitchener & Jorm, 2017), but it clearly can enrich
the mental-health knowledge of future general
nurses, and thereby help them provide holistic care
for patients with physi- cal and mental
comorbidities in Hong Kong. In addition, we
suggest that MHFA could be promoted as a
compulsory subject for junior healthcare students,
who lack sophistication in caring for people with
mental health issues.
In recent years, the WHO has globally
promoted the impor-
tance of mental health in response to an increase
in the prevalence of mental disorders, especially
in youngsters. Local governments and non-
governmental organisations have organ- ised
various health promotion and disease prevention
116
programmes that target mental health awareness,
11
stigma, suicide preven- tion, and school-based
mental health promotion (World Health
Organization, 2017). Thus, MHFA training could
be introduced as an elective subject or
extracurricular activity for all students at local
colleges/universities, to improve their mental
wellbeing and abil- ity to cope with the stressors of
academic life. Furthermore, tertiary institutions
should review their existing curricula and provide
ade- quate rest and leisure time with social and
extracurricular activities for students, to further
enhance their students’ physical and mental health
(Legislative Council, HKSAR, 2017).
According to a local government report,
adolescents with poor
mental health may achieve a low level of academic
success, leading to poor employment and social
adaptation (Food & Health Bureau, HKSAR,
2017). It is therefore in the interests of educational
insti- tutions to organise informative and beneficial
activities, including mental health
seminars/workshops and counselling sessions, to
nurture an encouraging atmosphere and emphasise
the signifi- cance of an environment that supports
mental health, and enhances their students’
academic achievement (Legislative Council,
HKSAR, 2017).
5. Conclusions
In this study, we aimed to determine the
effectiveness of MHFA training and explore the
mental wellbeing of university-level gen- eral
nursing students. Similar to other recent studies,
this study confirmed the benefits of the MHFA
programme for healthcare stu-
 M.S.Y. Hung et al. / Collegian 28 (2021) 106–113
11
dents in Hong Kong and other countries. The health, no significant differences were found between
students’ awareness of their own mental wellbeing the experimental and control groups. All the nursing
was also enhanced after training. students were recruited from a single tertiary
We therefore suggest that the local promotion of institution, so study contamination may have occurred,
MHFA training will empower adolescents to although the students were also instructed to avoid
develop good mental health status and mental disclosing any study information to their peers.
wellbeing, to optimise their potential and Since 2005, the Mental Health Association of
Hong Kong was
strengthen their ability to overcome later hardships authorised to develop the local version of MHFA
in life. Manual and to translate the manual based on the
Australia MHFA training pro- gramme (The Mental
Health Association of Hong Kong, 2015). However, a
6. Implications minor limitation is that the validity and reliability of
the translated training manual had not been
The evidence from this study shows that conducted.
MHFA training should be promoted and
integrated as compulsory training and as part of
extracurricular activities for healthcare and general Funding
college/university students locally and globally. It
would also be interesting and important to evaluate
the effects of MHFA training on the mental The study was fully supported by the Competitive
wellbeing of general university/college students. Research Funding Schemes for Local Self-financing
Degree Sector, Research Grants Council of the Hong
Further qualitative research should be conducted
Kong Special Administrative Region, China
to determine in greater detail how the experience
(<GN1>UGC/FDS17/H01/16<GN1>).
and application of MHFA pro- vide an in-depth
understanding of the best ways to assist people with
mental health problems. In addition, MHFA
training work- shops are suggested for existing
Ethical statement
healthcare professionals who have not received
mental health related training. The study involved human research and obtained
ethical approval from the Tung Wah College’s
Research Ethics Sub- Committee.
7. Limitations
Finally, several important limitations must be
considered. First, the study population is not
representative of the general popula- tion, as
general nursing students usually possess better
healthcare knowledge than other students at
university do. Second, some may have had prior
theoretical and practical mental health nursing
inputs, because the students were recruited from
different years of undergraduate general nursing
programmes. It may thus be wise to invite junior
year students without prior training to take part in a
future study. Third, the study had a higher sex ratio
(63 [17.6%] male, 295 [82.4%] female) than the
active registered nurses practis- ing locally (1505
[12.2%] male, 10,812 [87.8%] female) (Department
of Health, HKSAR, 2015). However, in terms of
the effects of sex and previous training on mental
117
 M.S.Y. Hung et al. / Collegian 28 (2021) 106–113
11
Conflict of interest
Chan, C. K., So, W. K., & Fong, D. Y. (2009). Hong Kong baccalaureate
nursing students’ stress and their coping strategies in clinical practice.
Journal of Professional Nursing, 25(5), 307–313.

Cheng, T. A., Wu, J. T., Chong, M. Y., & Williams, P. (1990). Internal consistency and
This manuscript is the authors’ original work. factor structure of the Chinese Health questionnaire. Acta Psychiatrica Scandinavica,
82(4) http://dx.doi.org/10.1111/j.1600-0447.1990.tb01389.x
It has not been published and is not under
consideration for publication elsewhere. The Chernomas, W. M., & Shapiro, C. (2013). Stress, depression, and anxiety among
undergraduate nursing students. International Journal of Nursing Education
authors have accepted the copyright terms and Scholarship, 10(1), 255–266.

conditions of Elsevier and the Australian Cheung, T., Wong, S., Wong, K., Law, L., Ng, K., Tong, M., . . . & Yip, P. (2016).

College of Nursing. We had no initial contacts

Depression, anxiety and symptoms of stress among baccalaureate nursing
with Collegian regarding the manuscript. We students in Hong Kong: A cross-sectional study. International Journal of
Environmental Research and Public Health, 13(8), 779.
have no con- flicts of interest to disclose. We
have no particular preferences regarding the Cunningham, J. B., & McCrum-Gardner, E. (2007). Power, effect and sample size
using GPower: Practical issues for researchers and members of research ethics
selection of academic editors and reviewers to committees. Evidence-Based Midwifery, 5(4), 132–137.

handle this manuscript. Davies, E. B., Beever, E., & Glazebrook, C. (2018). A pilot randomised controlled
study of the mental health first aid eLearning course with UK medical students.
BMC Medical Education, 18(1), 45.
CRediT authorship contribution Department of Health, HKSAR. (2015). 2013 health manpower survey. Summary of the
characteristics of registered nurse enumerated 27 January. https://www.dh.
statement gov.hk/english/statistics/statistics hms/sumrn13.html

Eisenberg, D., Hunt, J., & Speer, N. (2012). Help seeking for mental health on college
campuses: Review of evidence and next steps for research and practice.
Conceptualisation and design of the study,
Harvard Review of Psychiatry, 20(4), 222–232.
M.S.Y.H., M.C.M.C., W.T.C., P.Y.K.W.; data
curation, M.S.Y.H.; literature review and Fokuo, J. K., Goldrick, V., Rossetti, J., Wahlstrom, C., Kocurek, C., Larson, J., &
Corrigan, P. (2017). Decreasing the stigma of mental illness through a
manuscript draft writing, M.S.Y.H.; manuscript student-nurse mentoring program: A qualitative study. Community Mental
Health Journal, 53(3), 257–265.
review and editing, M.C.M.C., W.T.C.,
P.Y.K.W.; funding acquisition, M.S.Y.H., Food and Health Bureau, HKSAR. (2017). Mental health review report. https://www.
fhb.gov.hk/download/press and publications/otherinfo/180500 mhr/e mhr full
M.C.M.C., report.pdf

W.T.C., P.Y.K.W. All authors have read and Giandinoto, J. A., Stephenson, J., & Edward, K. L. (2018). General hospital health
professionals’ attitudes and perceived dangerousness towards patients with
agreed to the published version of the comorbid mental and physical health conditions: Systematic review and meta-
analysis. International Journal of Mental Health Nursing, 27(3), 942–955.
manuscript.

Acknowledgements

The authors would like to thank 1) all of the

nursing students who participated in this study;
2) the Mental Health Association of Hong Kong
for approving the use of the Mental Health
Literacy Scale (Chinese version); and 3) Dr
Cheng, Andrew Tai Ann for approving the use
of the CHQ.

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Maria S.Y. Hung, RN, DHSc, is an associate professor in the School of Nursing at Tung
Wah College, Kowloon, Hong Kong.
Meyrick C.M. Chow, RN, PhD, is a professor in the School of Nursing at Tung Wah
College, Kowloon, Hong Kong.
Wai Tong Chien, RN(Psy), PhD, is a professor in the Nethersole School of Nursing at
The Chinese University of Hong Kong.
Prudence Y.K. Wong, RSW, BSW, is the co-ordinator of Mental Health First Aid
programme of the Mental Health Association of Hong Kong.