When Helpers Need Help: Encouraging Mental Health Care Use Among Health Workers

Last registered on August 20, 2026
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Pre-Trial

Trial Information

General Information

Title
When Helpers Need Help: Encouraging Mental Health Care Use Among Health Workers
RCT ID
AEARCTR-0019171
Initial registration date
August 11, 2026

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
August 20, 2026, 8:34 AM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Locations

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Primary Investigator

Name
Michelle Escobar
Affiliation
University of Melbourne
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Other Primary Investigator(s)

PI Name
Carlos Schmidt-Padilla
PI Affiliation
University of California, Berkeley
Contact Investigator

Additional Trial Information

Status
In development
Start date
2026-07-26
End date
2027-07-31
Keywords
Behavior, Crime, Violence, & Conflict, Education, Health
Additional Keywords
mental health, health workers, burnout, help-seeking, service take-up, information provision, psychoeducation
JEL code(s)
C93, I12, I18, D83
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
Health workers face elevated rates of anxiety, burnout, and low emotional wellbeing, yet few seek support, and specialized mental health services in El Salvador are scarce. This study evaluates strategies to increase voluntary demand for a free emotional accompaniment service, which consists of up to four brief individual psychoeducation sessions on stress, anxiety, trauma, and grief, delivered by trained lay counselors through calls or messages.

The study population is public hospital workers in El Salvador who have previously completed general trauma-informed care training between 2022 and 2025. Respondents (N = 1,057) will be individually randomized, with equal allocation across three arms. All arms offer the same underlying service and differ only in the outreach they receive: a control group receives general information about the service and may contact it on their own initiative, while the two treatment arms vary the informational content of the outreach and who initiates the first contact.

The primary outcome is demand for the accompaniment service, measured from program administrative records as take-up of at least one session and the number of sessions used. Secondary outcomes are mental health and wellbeing indicators (GAD-7, WHO-5, PHQ-2, sleep-related impairment, and burnout, among others) measured in a follow-up survey six months after the intervention. All effects are estimated by intention to treat.
External Link(s)

Registration Citation

Citation
Escobar, Michelle and Carlos Schmidt-Padilla. 2026. "When Helpers Need Help: Encouraging Mental Health Care Use Among Health Workers." AEA RCT Registry. August 20. https://doi.org/10.1257/rct.19171-1.0
Sponsors & Partners

Partner

Name
Glasswing International
Type
ngo
URL
https://glasswing.org/
Experimental Details

Interventions

Intervention(s)
The intervention consists of follow-up outreach to public hospital workers who have previously completed general trauma-informed care training. All study participants are offered the same underlying service: up to four individual wellbeing sessions of 10 to 15 minutes with a trained lay counselor, covering psychoeducation on stress, anxiety, trauma, and grief, together with practical emotion regulation exercises. Sessions are delivered by WhatsApp call or WhatsApp message, and each participant chooses the format at the start (calls or messages). Participation is voluntary at every step.

The study arms differ only in the outreach participants receive, specifically in the informational content of the initial invitation message and in who initiates the first contact. The purpose is to identify which outreach strategies reduce the barriers to taking the first step toward using emotional support services.
Intervention Start Date
2026-07-31
Intervention End Date
2026-09-30

Primary Outcomes

Primary Outcomes (end points)
Demand for and voluntary use of the emotional accompaniment service: (1) take-up, an indicator for the participant completing at least one session with a lay counselor; (2) intensity, the number of sessions used (0 to 4). A complementary earlier-stage indicator is any affirmative response to the outreach message (expressing interest or scheduling a session).
Primary Outcomes (explanation)
Primary outcomes are constructed from administrative and monitoring records of the intervention, which log outreach messages sent, participant responses, scheduled contacts, and completed sessions for every participant. Records are matched to the randomized sample through each participant's unique program code. Outcomes are defined for all 1,057 randomized participants regardless of response, so estimates are intention to treat.

Secondary Outcomes

Secondary Outcomes (end points)
Mental health, wellbeing, and professional functioning measured at the endline survey six months after the intervention: subjective wellbeing (WHO-5); anxiety symptoms (GAD-7); depressive symptoms (PHQ-2); sleep-related daytime impairment (PROMIS); occupational burnout (Copenhagen Burnout Inventory, short version); difficulties in emotion regulation (DERS-SF); coping strategies (Mini-COPE); patient-centered self-efficacy (SEPCQ-27); closeness to colleagues (Inclusion of Other in the Self scale); disposition to seek emotional support and reported use of mental health services outside the program.
Secondary Outcomes (explanation)
The endline survey repeats the baseline instruments, so each secondary outcome is scored following the standard scoring rules of the corresponding validated scale, as continuous scores and as binary indicators at conventional cutoffs (for example GAD-7 of five or above for at least mild anxiety symptoms, WHO-5 below 50 for low wellbeing). Effects are estimated by intention to treat. As a complementary descriptive analysis, indicators will be compared by the delivery format each participant chose (calls versus WhatsApp messages). Because format is chosen rather than randomized, this comparison is exploratory and descriptive only.

Experimental Design

Experimental Design
The study is an individual-level randomized controlled trial with three arms of equal size: a control group and two treatment groups that vary the outreach participants receive. Eligible participants completed the baseline survey, consented to the experimental phase, still work in a public hospital, and had not previously received follow-up activities delivered by the NGO. The 1,057 eligible participants were assigned to arms within eight blocks defined by sex crossed with age band (29 and under, 30 to 39, 40 to 49, 50 and over), with equal 1:1:1 allocation within blocks. Outcomes are measured in program administrative records and in an endline survey six months after the intervention.
Experimental Design Details
Not available
Randomization Method
Randomization done in office by computer, using a self-contained R script with a fixed seed.
Randomization Unit
Individual
Was the treatment clustered?
No

Experiment Characteristics

Sample size: planned number of clusters
Not applicable, randomization is at the individual level. 1,057 individuals
Sample size: planned number of observations
1,057 public hospital health workers
Sample size (or number of clusters) by treatment arms
351 individuals in control, 354 individuals in Treatment 1 (information), 352 individuals in Treatment 2 (proactive contact).
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Supporting Documents and Materials
IRB

Institutional Review Boards (IRBs)

IRB Name
Universidad Francisco Gavidia
IRB Approval Date
2026-07-15
IRB Approval Number
002-2026
Analysis Plan