Interventions aimed at improving Japanese healthcare professionals’ mental health literacy in the workplace: a scoping review protocol

Abstract

Objectives: Mental health literacy (MHL) is a crucial determinant of mental wellbeing and encompasses knowledge, understanding, and attitudes related to mental health and mental disorders. Presently, no systematic reviews or meta-analyses, or even literature reviews exist regarding MHL interventions targeting healthcare professionals in Japan. Therefore, this protocol for scoping review aims to provide strategies to report interventions intended at improving MHL among Japanese healthcare professionals in the workplace. Methods: The review will adhere to the methodological framework proposed by Arksey and O’Malley and enhanced by the Joanna Briggs Institute, which consists of five stages: identifying the research question; identifying relevant studies; selecting eligible studies; charting the data; and collating, summarizing, and reporting the results. This review will be reported in accordance with the Preferred Reporting Items for Systematic Reviews Extension for Scoping Reviews. The participants, concept, and context framework will be employed to identify the key elements of the research question, with the participants being Japanese healthcare professionals (doctors or nurses), the concept being the content and effectiveness of MHL intervention programs, and the context being the workplace setting in Japan. The search strategy will involve searching electronic databases, hand-searching the reference lists of the included studies, and consulting experts in the field. Strengths and limitations: Given the lack of research and reviews on this topic in Japan, this review will provide valuable insights into the current state of MHL interventions for Japanese healthcare professionals and inform future research and practice in this area.

Introduction

Mental Health Literacy (MHL) is a crucial determinant of mental wellbeing. It refers to knowledge, understanding, and attitudes related to mental health, including mental disorders^1,2). MHL is a concept aimed at enhancing accurate knowledge and understanding of mental health and, as a result, reducing stigma, promoting the prevention of mental disorders, and encouraging early diagnosis and treatment^3,4). MHL comprises the following six attributes^3,5): i) ability to perceive various psychological stress reactions or specific mental disorders; ii) knowledge of risk factors and causes of mental disorders; iii) knowledge of self-help strategies; iv) knowledge of available professional assistance; v) knowledge, understanding, and attitudes about contacting others who have mental disorders; and vi) knowledge of how to seek information about mental health. Stigma toward mental health is a pressing issue worldwide⁶⁾, and various efforts are being made to reduce it^7,8). MHL is associated with reduced stigma of mental health, including mental disorders^3,4). People with higher MHL have lower prejudice against mental health⁹⁾, higher willingness to seek professional assistance¹⁰⁾, and tend to be more positive and proactive in their interactions with those with mental disorders⁹⁾. Therefore, spreading MHL throughout society to reduce the stigma surrounding mental health and create a positive and warm environment for seeking treatment and help is important.

While spreading MHL throughout the community is desirable, MHL in healthcare professionals is particularly important for the following reasons. First, healthcare professionals, such as doctors and nurses, experience particularly high levels of occupational stress, which can lead to depression and other mental disorders^11,12). While the impacts of these are significant, many healthcare professionals tend to keep their mental health problems to themselves and do not seek help, even if the problems become more severe^13,14,15). It is reported that stigma related to mental health was a factor in this trend, and many healthcare professionals lacked awareness of their own psychological stress reactions and the need for early intervention for mental health problems¹⁶⁾. Increasing MHL among healthcare professionals will help them recognize their own mental health problems and take appropriate help-seeking actions when necessary, resulting in improved mental wellbeing. Second, healthcare professionals have many opportunities to interact with patients with mental disorders. The number of patients with both physical and mental disorders is increasing¹⁷⁾, accounting for approximately 20–40% of the patients in general hospitals^18,19). For patients with mental disorders combined with physical illness, healthcare professionals can become uncertain about their skills and abilities to care for the patients and can perceive patient behavior as unpredictable, thereby affecting the quality of treatment and care provided to the patients^16,20). The quality of treatment and care for patients with both physical and mental disorders is expected to be improved by increasing healthcare professionals’ MHL; that is, by acquiring accurate knowledge, understanding, and attitudes regarding mental disorders¹⁶⁾. Thus, it is important for healthcare professionals to improve their MHL to ensure the quality of healthcare they provide as well as their own mental health in the workplace.

Particularly, the MHL among Japanese healthcare professionals may be somewhat limited. One literature review has shown that stigma toward mental health and mental disorders is stronger in Japan compared with other countries⁷⁾. Some Japanese healthcare professionals believe that having mental health problems or mental disorders renders individuals unqualified to serve as healthcare professionals²¹⁾. This perception may stem from limited MHL and stronger societal stigma surrounding mental health issues in Japan. Limited MHL can lead to a strong stigma toward mental health and mental disorders^3,4); therefore, improving MHL for Japanese healthcare professionals is necessary.

Regarding intervention studies aimed at improving MHL among healthcare professionals, a systematic review of eight randomized controlled trials (RCTs) reported various content and format programs developed and tested for effectiveness²²⁾. All intervention programs included educational lectures, ranging from lectures on specific psychiatric symptoms, such as delirium, to lectures on mental health in general, including broader mental disorders. In addition to educational lectures, some programs included lectures in which the participants interacted with people with mental disorders. Lecture formats varied from in-person sessions to web-based sessions using e-mail, Facebook, or a hybrid format combining both. Through the programs, the healthcare professionals acquired knowledge related to mental health, including dealing with mentally ill patients, and developed an understanding of and positive attitudes toward mental disorders, suggesting the possibility of improving MHL. However, this systematic review did not include articles on Japanese healthcare professionals, and the results did not consider the Japanese situation. Due to significant cultural differences, particularly regarding stigma toward mental health and mental disorders, this systematic review’s results may not be directly applicable to Japan. To increase the effectiveness of MHL intervention programs targeting Japanese healthcare professionals, measures, such as increasing the number of modules and improving participant involvement in the program, may be necessary. Therefore, MHL programs appropriate to the Japanese cultural context should be developed with appropriate verification of effectiveness.

Given these limitations and the growing requirement for evidence-based interventions, there is an urgent need to comprehensively and systematically examine existing studies related to the content and effectiveness of MHL interventions specifically targeting Japanese healthcare professionals. However, currently, no systematic reviews, meta-analyses, or literature reviews of MHL interventions targeting healthcare professionals in Japan have been conducted. Nonetheless, individual intervention studies aimed at improving MHL among Japanese healthcare professionals have been reported, for example, those conducted by Matsuzaka et al.²³⁾ and Otsu²⁴⁾. In a study by Matsuzaka et al., a half-day intervention program based on interviews with patients with mental disorders was conducted for university hospital interns in the outpatient psychiatry department of a local general hospital and examined the effects of the program on improving their perception and understanding of mental disorders²³⁾. After the half-day intervention program, the program showed significant improvement in several items related to perception and understanding of mental disorders compared to the pre-implementation period. Otsu developed an educational program for nurses to manage patients with physical and mental complications and examined the effectiveness of the program²⁴⁾. The evaluation items related to program effectiveness measured the understanding of how to assess psychiatric symptoms and deal with patients with psychiatric symptoms but did not measure MHL. In the study, no baseline survey was conducted, only immediately following the end of the intervention. Therefore, conducting a comprehensive search of intervention studies aimed at improving MHL among healthcare professionals in Japan and accumulating those individual findings to establish a higher level of evidence is required. This protocol for scoping review aims to provide strategies to report interventions intended at improving MHL among Japanese healthcare professionals’ in the workplace.

Methods

Study design

This scoping review will adhere to the methodological framework proposed by Arksey and O’Malley²⁵⁾, which was later enhanced by the Joanna Briggs Institute (JBI)²⁶⁾. This framework comprises five fundamental successive stages: (1) identifying the research question; (2) identifying relevant studies; (3) selecting eligible studies; (4) charting the data; and (5) collating, summarizing, and reporting the results. This scoping review will be reported in accordance with the Preferred Reporting Items for Systematic Reviews Extension for Scoping Reviews (PRISMA-ScR)²⁷⁾. PRISMA-ScR presents a comprehensive reporting guideline comprising 20 fundamental elements and two supplementary components that should be incorporated into scoping reviews, which promote methodological clarity and validity of research outcomes within the scholarly community²⁷⁾.

Identifying the research question

This study will employ the participants, concept, and context (PCC) framework, as suggested by the JBI guidelines²⁶⁾, to identify the key elements of the research question. The PCC of this scoping review is defined as follows: (P: Participants) Japanese healthcare professionals (doctors or nurses); (C: Concept) the content, delivery mode, and effectiveness of MHL intervention programs; and (C: Context) the workplace setting such as hospitals.

The healthcare professionals in this study will include doctors and nurses because they spend most of their time in direct contact with patients, including those with both physical and mental disorders, in healthcare institutions¹⁶⁾. Additionally, they are known to have particularly high occupational stress compared to other healthcare professionals^11,12). While we acknowledge that other healthcare workers, such as pharmacists, practical nurses, or nursing aides may also experience uncertainty when supporting patients with mental health conditions, limiting the scope to these doctors and nurses helps ensure consistency in the analysis and allows us to better examine the specific design and effects of MHL interventions tailored to their clinical roles. There are no exclusion criteria regarding the participants’ employment status, their rank, years of work experience, or healthcare settings in which they are employed.

Interventions in this study are broadly defined as attempts to focus on any or all six attributes of MHL^3,5). All components of the interventions aimed at improving MHL among Japanese healthcare professionals will be included in this review. The delivery mode of interventions can be in any format, such as face-to-face interactions, web-based interventions, or a hybrid of both. The outcomes will be MHL or knowledge, understanding, and attitudes toward mental health, including mental disorders. All intervention study designs (RCTs, cluster RCTs, quasi-experimental studies, and before-and-after studies [pre-/post-test]) will be included. Studies that did not conduct statistical analyses to examine the intervention effects will be excluded.

This scoping review will include studies that aimed to improve the MHL of Japanese healthcare professionals (doctors and/or nurses), used any interventional study design, and published as original articles written in Japanese or English. The exclusion criteria will be: (1) no statistical analysis; and (2) written in a language other than Japanese or English.

We construct the following primary research question: What has been reported in the literature regarding the content and effectiveness of interventions aimed at improving Japanese healthcare professionals’ MHL in the workplace?

Consequently, the research sub-questions include:

1. What are the delivery modes of those intervention programs?

2. What scales are used to measure outcomes?

3. What is the duration of follow-up in the studies?

To support the feasibility of this scoping review, we conducted a pilot search using the Ichushi-Web database. This search identified only two relevant intervention studies targeting Japanese healthcare professionals, conducted by Matsuzaka et al.²³⁾ and Otsu²⁴⁾. These studies differed in terms of the intervention conducted, target populations, and outcome measures, suggesting that current intervention designs are not yet standardized. These findings further support the need for a systematic and comprehensive mapping of current evidence.

Identifying relevant studies

Systematic searches of published studies will be performed using multiple electronic databases, such as the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed (MEDLINE), CINAHL, APA PsycINFO, APA PsycARTICLES, and the Ichushi-Web (Japan Medical Abstracts Society). The search focuses on terms relevant to PCC. The specific search terms and strategies are outlined in eMaterial 1.

We will exclude Web of Science in our database selection because the databases used in this review — CENTRAL, PubMed, CINAHL, APA PsycINFO, APA PsycArticles, and Ichushi-Web — already cover the major medical, psychological, and nursing literature relevant to MHL interventions. Furthermore, a preliminary search indicated that most relevant studies indexed in Web of Science also appear in these other selected databases.

This systematic review will include original research articles and grey literature, such as conference proceedings, opinion papers, editorials, and letters, to ensure comprehensive coverage.

In addition to searching existing studies using the aforementioned electronic databases, we will screen study protocols registered in the University Hospital Medical Information Network Clinical Trials Registry. If necessary, we will contact the corresponding authors to inquire about the availability of unpublished study results.

All the identified studies will be managed using Microsoft Excel (Microsoft Corp., Redmond, WA, USA). Prior to the study selection process, duplicate citations in the Excel files will be removed by KK, the first author. All decisions related to the study will be meticulously documented.

Selecting eligible studies

The study selection process will involve two stages. In the first stage, authors KK and AI will independently screen the studies based on the inclusion criteria. They will review the titles and abstracts of the studies and assess their eligibility based on previously established criteria. In the second stage, the full texts of the eligible studies will be obtained and reviewed using a standard form to confirm their eligibility for inclusion in this review. Any disagreements in the assessment will be recorded, and if they cannot be resolved, they will be addressed through discussion among all authors. The reference lists of the studies will be thoroughly examined for any additional eligible studies, and the corresponding authors of the eligible studies will be contacted if the program’s contents or results of the publication are unclear or have possible multiple interpretations. A flowchart illustrating the review process is presented.

Charting the data

The two authors, KK and AI will independently extract data from the included studies using a standardized data extraction form (see eMaterial 2). Any disagreements or inconsistencies will be recorded and resolved through discussion among all the authors until a consensus is reached. The extracted data will include the following: source (database, journal, and year of publication), study design, number of participants included in the study, sampling framework, participants’ demographic characteristics (doctor and/or nurse, mean age, sex proportions, years of work experience, and employment status), intervention program content, intervention program delivery mode, control condition (no intervention, waiting-list control, or other), outcome variables and scales, number of participants excluded or lost to follow-up, length of follow-up, and main study findings regarding the effects of MHL interventions. This extraction format is experimental and may be modified as required. The relevant research teams of the studies will be contacted regarding the availability of unpublished or missing data.

Collating, summarizing, and reporting the results

We anticipate substantial variability between studies due to differences in intervention content, delivery modes, and follow-up periods. MHL interventions for healthcare professionals are still in their infancy in Japan, and further progress is expected in this field. As such, there may also be variability in the study design. Since scoping reviews aim to map the existing literature rather than evaluate the effectiveness of interventions through statistical synthesis, statistical pooling of data, as performed in meta-analyses, is neither feasible nor within the scope of this review. Consequently, we will conduct a narrative synthesis to summarize the findings, highlighting commonalities and differences in the intervention characteristics and outcomes. This will also show areas that have not yet been researched to inform future research directions.

Patient and public involvement statement

This study does not involve any human subjects or participants as the study protocol is for a scoping review.

Ethics and dissemination

Given that this scoping review is based on existing studies, it is exempt from ethical approval. The findings of this study will be disseminated through publications in peer-reviewed international journals and presentations at conferences, symposiums, and seminars related to the field.

Data availability statement

This study is a scoping review protocol and does not involve the generation or analysis of new data. All data sources will be publicly available literature. Therefore, no new data is associated with this article.

Strengths and limitations

The greatest strength of this review is that, to our knowledge, it will be the first scoping review to provide evidence on the current state of MHL interventions for Japanese healthcare professionals in the workplace. By providing an overview of programs and the effectiveness of interventions for improving MHL among Japanese healthcare professionals, this scoping review’s findings will be helpful in informing future research and practice in this area. Since the MHL of healthcare professionals is positively associated with individual and patient care outcomes^16,22), this review’s findings may further contribute to the mental health and well-being of Japanese healthcare professionals and lead to better health care for patients.

Additionally, while the main academic contributions of this study will be realized on completion of the full scoping review, publishing this protocol in advance offers academic value by promoting methodological transparency in a field with a relatively small evidence base. It will enable early peer feedback and help ensure consistency in the subsequent review. Moreover, given Japan’s unique cultural factors — particularly the strong stigma surrounding mental health compared to many Western contexts — this protocol may serve as a foundation for future research aiming to develop culturally appropriate MHL programs for healthcare professionals.

However, this scoping review may have the following limitation. The accuracy of this review may be affected by publication bias. Some high-quality studies that are not statistically significant tend to not be publicly available; therefore, to mitigate the impact of this bias, contacting relevant research teams and inquiring about the availability of unpublished or missing data is essential.

Acknowledgments

We would like to thank Editage (www.editage.jp) for the English language editing.

Conflicts of interest

KI is employed at the Department of Digital Mental Health, an endowment department supported with an unrestricted grant from 15 enterprises (https://dmh.m.u-tokyo.ac.jp/c) outside the submitted work. Other authors declare that there are no conflicts of interest.

Sources of funding

Not applicable.

Author contributions

The study was conceived and designed by KK. KI will supervise the study. The initial draft of the manuscript will be written by KK. All authors will be involved in critical revisions for important intellectual content and contribute to the final manuscript. The entire study process (ie, data collection, assessment, and synthesis) will be conducted by all the authors.

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