# Theoretical evaluation of mental health first aid using the behavioural change wheel (BCW)

## TL;DR

This paper analyzes mental health first aid training using a theoretical framework to identify its key components and how they influence behavior.

## Contribution

The study maps mental health first aid to the Behavioral Change Wheel, identifying specific techniques and mechanisms of action.

## Key findings

- Twelve behavioral change techniques and four intervention functions were identified in the MHFA intervention.
- Social support, enablement, and persuasion were consistently present across data sources.
- Reflective motivation and social opportunity were the main mechanisms of action for promoting help-seeking behavior.

## Abstract

Mental health first aid (MHFA) has gained popularity over the years. This study retrospectively maps the MHFA intervention to characterise its content using the Behavioural Change Wheel to identify the active ingredients and mechanisms of action.

Three data sources formed the data for the current study. Namely, the MHFA training manual, a roleplay video demonstrating how to implement the intervention, and interviews with six participants of whom five were MHFAers and five were MHFA recipients, on their experiences of the MHFA intervention. The interview data source formed part of the EMPOWER trial. The study presented here utilised a two-step approach: a) The MHFA intervention was described using the Template for Intervention Description and Replication (TIDieR) framework, and b) the content was analysed to identify the behavioural change techniques (BCTs) using the behavioural change techniques taxonomy version 1 and intervention functions using the behavioural change wheel. The mechanisms of action were specified using the capability, opportunity, motivation model of behaviour and theoretical domains framework.

Twelve BCTs and four intervention functions were identified across the three data sources. Only social support BCTs and the intervention functions of enablement and persuasion were consistently identified across the three data sources in the MHFA. The most frequent mechanisms of action were reflective motivation (particularly ‘beliefs about capabilities’ and ‘goals’) and social opportunity (particularly ‘social influences’).

The MHFA intervention incorporates BCTs to increase reflective motivation and social opportunity to seek help for mental health concerns. However, psychological capability and physical opportunity need to be addressed to enhance help-seeking behaviours in those experiencing mental health difficulties. Future research should evaluate the impact of integrating additional BCTs and intervention functions into the MHFA programme to determine the most effective combination for promoting help-seeking behaviour and improving mental health outcomes.