Designing digital mental health interventions with paramedics: a reflexive thematic analysis of co-creation and acceptability

Background: Paramedics experience some of the highest levels of workplace trauma among frontline workers, placing them at significant risk of PTSD, anxiety, and depression. Their work involves unpredictable, high-pressure situations and frequent exposure to critical incidents, contributing to poor mental health outcomes. Despite available mental health support, barriers such as stigma, confidentiality concerns, and time constraints often prevent paramedics from seeking help. Digital mental health interventions offer a promising solution by providing accessible, flexible, and private support. However, to be effective, they must be tailored to the specific needs of paramedics while remaining relevant to other frontline workers.
Objective: This study aimed to explore paramedics’ mental health needs and assess their views on the acceptability of a co-created digital intervention designed to support their well-being. By identifying key user preferences, the research informs the development of a practical and impactful digital tool for paramedics and other frontline workers.
Methods: A qualitative study was conducted using in-depth, semi-structured interviews with 22 paramedics. The interviews explored their experiences with workplace trauma, existing mental health support, and perspectives on digital interventions. Reflexive thematic analysis, following Braun and Clarke’s framework, was used to identify key themes.
Results: Five key themes emerged. First, "It Has to Feel Easy to Use" – Navigating Acceptability and Usability, where paramedics stressed the need for a simple, intuitive design that does not add to their cognitive load after stressful shifts. Second, "Make It Fit My Needs" – The Importance of Customisation and Personalisation, which reflected their preference for a tool that adapts to their individual coping styles, schedules, and emotional states. Third, "We Need to Talk to Each Other" – Social Connection and Peer Support, highlighting the value of connecting with colleagues who understand the unique pressures of their role. Fourth, "I Need to Know It’s Safe" – Confidentiality, Privacy, and Safety, where participants voiced concerns about data security and the need for absolute privacy to overcome fears of stigma or professional consequences. Finally, "Support Needs to Feel Human" – Integration with Existing Services, emphasising that digital interventions should complement rather than replace human-led mental health support.
Conclusions: The findings suggest a digital mental health intervention could support paramedics if it is user-friendly, personalised, secure, and integrated with peer and professional networks. Given their high levels of workplace-related psychological distress, these insights are critical for shaping effective interventions. This research informs the development of Sentinel, a digital tool for paramedics and other frontline workers, including NHS staff and first responders, to prevent and manage acute and traumatic stress. By addressing the needs of high-pressure emergency environments, digital interventions can improve mental health outcomes through an accessible, evidence-based approach. Future research will co-create and evaluate Sentinel with frontline workers to ensure its effectiveness and adoption.