4. Discussion
schizophrenia, a mental disorder
DISORDERS
This study is the first RCT in Switzerland to evaluate the impact of an MHFA/ensa training course on undergraduate students attending two different universities. Face-to-face MHFA/ensa program training was found to be both effective, sustainable, and feasible among Swiss undergraduate students.The study revealed the significant short-term and long-term effectiveness of the MHFA training program. We found significant time*group interaction effects for the intervention group, increased basic knowledge about mental health and their confidence to help someone experiencing a mental health problem while decreasing the stigma towards mental illness compared to the control group. Interestingly, for reducing social distance toward those with a mental disorder, we found a marginal interaction effect at T1 but a very strong interaction effect at T2, with the difference between intervention and control groups being more pronounced at T2. For ‘intention to help’, we did not find significant time*group interaction effects but significant time effects, with both the intervention group and the control group increasing their scores of intention to help someone with a mental disorder at both T1 and T2. This can be partially explained by the study sample, with 74% of the students studying at the School of Nursing; the control group was also motivated to help patients without the MHFA course. Unfortunately, the sample size from the other school was too small to examine the difference between schools.Although most of these effects decreased slightly over the time period between 3 months and 12 months after the intervention, these decreases were statistically non-significant and medium-to-large effect sizes were evident for most improvements at both T1 and T2.These findings are consistent with those of other studies, especially regarding the significant increase in knowledge mean scores after the 12-h training [In the present study, recognition of schizophrenia was greater in the control group versus the intervention group, both at baseline (T0) and at follow-up (T2). However, the proportion of participants who recognized schizophrenia correctly did not significantly differ between control and intervention groups at any of the three data-collection times (T0, T1, T2). In the intervention group, the proportion of students correctly recognizing schizophrenia remained at 47.2% after the intervention and only increased to 48.5% at the 12-month follow-up. Relative to other studies among nursing students [The results of this study demonstrated a significant positive impact of MHFA/ensa training in decreasing personal stigma and social distance of participants towards persons with mental health disorders. These findings are consistent with those of other studies that demonstrated improvements over time [Our study had limitations. First, females were highly overrepresented among the nursing students (86%). This, however, reflects the current demographic reality of the nursing workforce. We tried to include more males by enlisting subjects from another university to minimize gender bias. Unfortunately, the participation rate was low, mainly because many students already felt over-extended due to their class schedule and were unable to find time to participate. A few dropouts also occurred in the intervention group after the baseline assessment because of their inability to attend the 12-h course. However, few dropped out between T1 and T2, even though the last data collection happened during the COVID-19 shutdown.This study also lacked a post-intervention assessment right after the course (less than 3 months after the baseline), but it did collect data 12 months afterwards to measure the long-term effects of the training, which prior studies had generally not done. For future research, embedding the MHFA/ensa course into students’ schedule as an optional course, or during semester breaks, could overcome the low participation rate we observed. The study population could also be extended to other universities and to first- year students to avoid potential biases in knowledge that might occur from prior courses within nursing, medical, social work, and other healthcare programs, wherein students would be expected to become more aware of mental health subjects over the course of their studies.