title: Mental Health First Aid in Rural Communities: Appropriateness and Outcomes.
abstract: Mental Health First Aid (MHFA), an early intervention training program for general audiences, has been promoted as a means for improving population-level behavioral health (BH) in rural communities by encouraging treatment-seeking. This study examined MHFA's appropriateness and impacts in rural contexts.
  
  
  
  We used a mixed-methods approach to study MHFA trainings conducted from November 2012 through September 2013 in rural communities across the country.
  
  
  
  (a) posttraining questionnaires completed by 44,273 MHFA participants at 2,651 rural and urban trainings in 50 US states; (b) administrative data on these trainings; and (c) interviews with 16 key informants who had taught, sponsored, or participated in rural MHFA. Measure of Rurality: Rural-Urban Commuting Area Codes.
  
  
  
  Chi-square tests were conducted on questionnaire data. Structural, descriptive, and pattern coding techniques were used to analyze interview data.
  
  
  
  MHFA appears aligned with some key rural needs. MHFA may help to reduce unmet need for BH treatment in rural communities by raising awareness of BH issues and mitigating stigma, thereby promoting appropriate treatment-seeking. However, rural infrastructure deficits may limit some communities' ability to meet new demand generated by MHFA. MHFA may help motivate rural communities to develop initiatives for strengthening infrastructure, but additional tools and consultation may be needed.
  
  
  
  This study provides preliminary evidence that MHFA holds promise for improving rural BH. MHFA alone cannot compensate for weaknesses in rural BH infrastructure.
authors.affiliation: Maine Rural Health Research Center, Muskie School of Public Service, Cutler Institute for Health and Social Policy, University of Southern Maine, Portland, Maine.
authors.forename: Jean A
authors.initials: JA
authors.lastname: Talbot
authors.affiliation: Maine Rural Health Research Center, Muskie School of Public Service, Cutler Institute for Health and Social Policy, University of Southern Maine, Portland, Maine.
authors.forename: Erika C
authors.initials: EC
authors.lastname: Ziller
authors.affiliation: Maine Rural Health Research Center, Muskie School of Public Service, Cutler Institute for Health and Social Policy, University of Southern Maine, Portland, Maine.
authors.forename: Donald A
authors.initials: DA
authors.lastname: Szlosek
mesh_terms: D001291:Attitude of Health Personnel; D024201:Bystander Effect; D016009:Chi-Square Distribution; D006282:Health Personnel / Q000523:psychology*; D006297:Health Services Accessibility / Q000592:standards; D006801:Humans; D008605:Mental Health Services / Q000639:trends*; D063868:Patient Outcome Assessment; D015397:Program Evaluation / Q000379:methods; D036301:Qualitative Research; D012424:Rural Population; D057545:Social Stigma; D011795:Surveys and Questionnaires; D013663:Teaching / Q000592:standards* / Q000639:trends
keywords: Mental Health First Aid; health promotion; mental health; rural; stigma