Implementation of a First Responder Operational Stress Injury Clinic Using the TDF-II and CFIR Frameworks: A Paramedic Perspective

Abstract

Background: First responders (firefighters, paramedics, and police officers) are often exposed to potentially psychologically traumatic events. When combined with insufficient social support and reduced help-seeking behaviours, such exposures may increase the risk of mental health challenges, particularly among paramedics who report the highest rates of mental disorders. Objective: The current study used the Theoretical Domains Framework (TDF) and the Consolidated Framework for Implementation Research (CFIR) to identify critical barriers and facilitators to help-seeking and accessing mental health care, and the feasibility and sustainability of a first responder clinic. Methods: Semi-structured qualitative interviews included 11 paramedics (frontline, mid-and-senior management, and union), recruited using purposive and snowball sampling. Interviews were analyzed using content and thematic analyses. The TDF and CFIR guided study design, interview content, data collection, and analysis. Results: Barriers included the complexities of stigma, confidentiality, cultural competency, and trust. Conclusions: The findings will be instrumental in developing evidence-based approaches to mental health care for paramedics.