The 12-hour, two-day MHFA training program was advertised widely through community channels in the Vietnamese community in Melbourne, emphasising that all community members were welcome to participate in the program, which was delivered free of charge. Participants in the training programs were general members of the community who registered for the training. There was no specific selection process. An interest in learning about mental health was sufficient. Participants in three training groups were invited by the trainers to participate in the evaluation of the program by anonymously completing the evaluation questionnaire prior to the commencement of the training (pre-test) and at its completion (post-test).
The training was delivered by two qualified MHFA instructors, both mental health professionals (psychology and social work), and both born in Vietnam, who were involved in the cultural adaptation of the MHFA training course and manual. The adapted MHFA manual was translated into Vietnamese by a Vietnamese psychiatrist. The training program was conducted in Vietnamese.
The evaluation questionnaire consisted of the following components:
1) A section seeking brief socio-demographic information.
2) Presentation of four brief vignettes about each of which the following questions were asked:
a) What would you say, if anything, is wrong with John?
b) Imagine John is someone you have known for a long time and care about. You want to help him. What would you do?
c) Has anyone in your family or close circle of friends ever had problems similar to John's?
d) Have they received any professional help or treatment for these problems?'
e) Have you ever had a job that involved providing treatment or services to a person with a problem like John's?
The vignettes were taken from a paper by Griffiths et al.  reporting a study of stigma associated with mental disorders. The vignettes described a person with: depression; depression with suicidal ideation; early schizophrenia; and chronic schizophrenia. Each of the disorders depicted in the vignettes satisfied both DSM-IV and ICD-10 diagnostic criteria for either major depressive disorder or schizophrenia.
3) Following the open-ended responses to the questions above, respondents were asked to indicate level of agreement with a number of statements in relation to each vignette on a 5-point scale (1 = Strongly agree, 2 = Agree, 3 = Neither agree nor disagree, 4 = Disagree, 5 = Strongly disagree). The first group of statements asked respondents to "indicate how strongly you agree or disagree with each of the following statements by ticking the appropriate box". This was intended as a measure of personal stigma . The second groups of statements, identical in content to the first, asked respondents to "indicate what you think most other people believe". This was intended as a measure of perceived stigma . The statements concerning which participants were asked to indicate level of agreement were:
a) People with a problem like John's could snap out of it if they wanted
b) A problem like John's is a sign of personal weakness
c) A problem like John's is not a real medical illness
d) People with a problem like John's are dangerous
e) It is best to avoid people with a problem like John's so you don't develop the problem yourself
f) People with a problem like John's are unpredictable
g) If I had a problem like John's I would not tell anyone
h) I would not employ someone if I knew they had a problem like John's
i) I would not vote for a politician if I knew they had a problem like John's
The post-test questionnaire was identical except that the socio-demographic information was excluded. The questionnaires were presented in English, but participants were invited to write their responses to the open-ended questions in either English or Vietnamese. Vietnamese responses were translated into English by a bilingual mental health professional.
The data collected were analysed in two ways. First, data collected at pre-test were analysed to examine participants' recognition of disorders, their mental health first aid responses and the level of personal and perceived stigma. The data collected at post-test were compared with data collected at pre-test to measure change in recognition of disorders, first aid responses and stigma towards people with mental disorders. Only participants who completed both the pre- and post-test questionnaires were included for analysis. From a total of 138 training participants, 114 returned completed pre- and post-test questionnaires (82.6% response rate). Twenty-four questionnaires were excluded because of incomplete data or because the code that was necessary to link pre- and post-test questionnaires was not entered.
For each vignette there were two open-ended questions. (1. What would you say, if anything, is wrong with John? 2. Imagine John is someone you have known for a long time and care about. You want to help him. What would you do?) The first was to assess participants' recognition of the mental disorder described in the vignette and the second inquired about mental health first aid responses. The four diagnoses that were considered correct were: depression (for vignette 1), psychosis or schizophrenia (vignettes 2 and 4) and depression and/or a reference to suicidality (vignette 3). Responses were coded 0 (incorrect diagnosis) or 1 (correct).
In the MHFA training program a structured response, consisting of five actions, is taught. The actions are:
1) A ssess risk of suicide or harm
2) L isten non-judgmentally
3) G ive reassurance and information
4) E ncourage the person to get appropriate professional help
5) E ncourage self-help strategies
The initial letters of these actions constitute the mnemonic ALGEE.
The free responses to the second question (What would you do?) were coded on a 0-2 scale according to the quality of the response for each of the ALGEE actions: 0 = no mention or inadequate response, 1 = superficial response, 2 = specific details. The ratings were then summed to give a total score out of 10. Detailed scoring criteria were drawn up for this purpose. A research assistant was trained in the use of the scoring criteria and she rated the responses after their order had been randomized. Randomization of the order ensured that the rater was not told what vignette the response was to, nor whether it was a pre-test or post-test response. In order to assess the reliability of her ratings, the research assistant was also asked to score 40 responses from another data set that had been previously scored using the consensus of four experts in MHFA. Her ratings correlated highly with the expert consensus ratings. Pearson correlations were: A 1.00, L 0.90, G 0.78, E (Professional) 0.81, E (Self-help) 0.87, Total 0.95.
To evaluate the effect of the training, answers to the structured questions and to the coded open-ended questions given at pre- and post-test were compared using McNemar tests for dichotomous values and Wilcoxon tests for other scores. These non-parametric tests were used because the scores did not meet the distributional assumptions of parametric tests. The analysis was carried out using SPSS 16.0. The p < 0.05 significance level was used. Mean scores, standard deviations and p-values are reported in the tables below.