JMIR Publications

ABSTRACT

Background:

Many Intensive Care Unit (ICU) staff experience intrusive memories following work-related traumatic events, which can lead to long-term mental health outcomes and impact work functioning. There is a need for interventions that target intrusive memories in this population, however, factors such as mental health stigma and difficulty fitting interventions into busy schedules can pose barriers. The GAINS study tested a brief, digital imagery-competing task gameplay intervention with the aim to reduce and prevent the recurrence of intrusive memories which holds particular promise for overcoming some of these barriers. This paper presents a sub-study exploring the acceptability of the intervention.

Objective:

To explore barriers and facilitators to the uptake and practical usage of the intervention in ICU staff, alongside its acceptability; To iteratively explore the impact of intervention optimisations to further refine the intervention.

Methods:

The GAINS Study is a randomised controlled trial (RCT) of access to a brief digital imagery-competing task intervention for 4 weeks versus usual care (followed by delayed access to the intervention). Participants were ICU staff who worked through the COVID-19 pandemic and experienced intrusive memories. All participants were sent a bespoke questionnaire 4-weeks after the first intervention session to gather data about intervention acceptability. Nested within the RCT, a subset of 16 participants were interviewed and data analysed using thematic analysis drawing from a framework approach.

Results:

Quantitative and qualitative data both point towards high acceptability of the intervention. Intervention usage data shows that, on average, staff were able to target around 73% of their intrusive memories and used the intervention for the full 20 minutes per session. Overall, on the acceptability questionnaire, the staff found the intervention easy-to-use, helpful and highly acceptable. Four themes were generated from the interviews: Approach to Intervention, Positives of Intervention, Negatives of Intervention, Improvements and Optimisations. The findings highlighted barriers that ICU staff experienced when approaching the intervention: stigma, feeling weak for seeking help, not wanting colleagues to know they were struggling, scepticism. However, they provided suggestions for how these barriers could be overcome and discussed advantages of the intervention when compared to other existing treatments. Whilst participants described many positives of the intervention, such as it being easy-to-use, enjoyable and leading to a reduction in frequency or intensity of intrusive memories, they also raised practical issues to be considered for implementation.

Conclusions:

The intervention has the potential to overcome stigma and reduce the frequency of intrusive memories after traumatic events in ICU staff. There is scope for further refinement to improve adoption and reach of this intervention for ICU staff. A limitation is that we could not interview NHS staff who were unable or unwilling to take part in the trial. Clinical Trial: The trial is registered at ClinicalTrials.gov (NCT04992390).