Design, Development, and Validation of a Chatbot to Support Health Care Professionals Experiencing Workplace Aggression: Protocol for a Mixed Methods Study
Clinical Snapshot
PICO Framework
| P — Population | Healthcare professionals working in emergency and critical care settings in Almería, Spain, who experience workplace aggression |
| I — Intervention | Sanidad Segura — a purpose-built chatbot providing confidential reporting, psychological support, medical and legal guidance, and institutional resource navigation for workplace aggression |
| C — Comparator | No active comparator specified; this is a development and feasibility protocol without a control arm |
| O — Outcomes | Primary: usability (System Usability Scale), readability (Inflesz scale), acceptability, and feasibility. Exploratory: perceived usefulness, perceived support, barriers and facilitators to use (qualitative thematic analysis) |
Bottom Line
This paper presents a protocol — not completed research — for the design, development, and feasibility testing of a chatbot (Sanidad Segura) intended to support healthcare professionals experiencing workplace aggression. The mixed methods approach, grounded in the MRC Framework for Complex Interventions, is methodologically appropriate for this early development phase. Use of validated instruments (SUS, Inflesz) and triangulation of quantitative and qualitative data are genuine strengths. However, clinicians should note that no results exist yet, and the protocol has significant gaps: no sample size justification, no pre-specified success thresholds, no formal harm assessment, and no independent evaluation of the tool by parties external to the development team. The intervention addresses a clinically important and globally prevalent problem — underreporting and inadequate support following workplace violence — but evidence of effectiveness on meaningful clinical outcomes (psychological distress, reporting rates, help-seeking) remains entirely absent at this stage. For Australian practitioners and health service managers, the concept is highly relevant given documented underreporting of aggression across emergency, primary care, and paramedic settings. Any local adaptation would require regulatory review, content localisation, and independent validation before implementation. This protocol represents a necessary first step, but clinicians should await peer-reviewed outcome data before drawing practice conclusions.
Key Findings
P Value: Not applicable at protocol stage
Effect Size: Not applicable — protocol stage; no effect size reported or pre-specified
Primary Outcome: No results available — this is a study protocol. Planned primary outcomes are System Usability Scale (SUS) scores and Inflesz readability scores for the Sanidad Segura chatbot
Nnt Or Sensitivity: Not applicable — feasibility and usability study; no NNT, sensitivity, or hazard ratio relevant at this phase
Confidence Interval: Not reported — protocol does not specify whether CIs will be calculated for feasibility outcomes
Clinical Application
Feasibility in the Spanish context is the explicit focus of Phase 2. Broader implementation would require: content adaptation to local legal and institutional frameworks; translation and linguistic validation for non-Spanish-speaking populations; integration with existing occupational health and employee assistance programme infrastructure; and regulatory clearance as a digital health tool. The MRC framework approach supports iterative scale-up if feasibility is demonstrated. Workplace violence against healthcare workers is a recognised occupational health priority in Australia, addressed by Safe Work Australia guidelines, state-based Work Health and Safety legislation, and RACGP frameworks for general practice safety. The Sanidad Segura chatbot concept is directly relevant to Australian emergency departments, primary care, and paramedic services where underreporting of aggression is well-documented. However, direct application would require: (1) content adaptation to Australian legal frameworks (e.g., state WHS Acts, Fair Work Act provisions); (2) alignment with existing reporting systems such as the Victorian Health Incident Management System (VHIMS) or equivalent; (3) TGA assessment if the tool makes health claims or provides clinical decision support; (4) integration with EAP services and Beyond Blue's healthcare worker mental health resources; and (5) consideration of RACGP standards for digital health tools in primary care. PBS listing is not relevant to this intervention type. The concept aligns with the National Safety and Quality Health Service (NSQHS) Standards for workforce safety. Healthcare professionals in emergency and critical care settings who have experienced or are at risk of workplace aggression. Potentially applicable to nursing, medical, allied health, and paramedic workforces in high-acuity environments globally, pending validation in respective contexts
Abstract
BACKGROUND: Workplace violence against health care professionals has increased worldwide, leading to negative psychological, professional, and organizational outcomes. Despite existing prevention and reporting programs, underreporting and lack of accessible, confidential support persist. Digital health tools, including chatbots, may offer scalable support, guidance, and follow-up for affected professionals. OBJECTIVE: This study aims to design, develop, and validate a chatbot (Sanidad Segura) to assist health care professionals who experience workplace aggression and evaluate its usability, readability, and exploratory indicators of perceived usefulness and support in a pilot study. METHODS: This study will follow a mixed methods design conducted in two main phases: (1) design, development, and content validation of the chatbot based on literature review, institutional protocols, and expert consensus; and (2) pilot-testing, including usability and readability assessment using standardized instruments, as well as feasibility and acceptability evaluation among health care professionals working in emergency and critical care settings in Almería (Spain). The study is aligned with the Medical Research Council framework for complex interventions, incorporating development and feasibility stages. Quantitative data will be collected using the System Usability Scale and Inflesz readability scale. Qualitative data will be collected through semistructured interviews and analyzed using thematic analysis to explore user experience and identify barriers to and facilitators of use. RESULTS: The study has been funded for a 2-year period starting on December 18, 2024. Quantitative outcomes will include usability scores (System Usability Scale), readability scores (Inflesz), and participants' sociodemographic characteristics. Qualitative findings will identify themes related to usability, user experience, and suggestions for improvement. Integration of quantitative and qualitative findings will be conducted through triangulation to provide a comprehensive understanding of the usability, acceptability, and readability of the chatbot. CONCLUSIONS: This study addresses the increasing incidence of workplace violence against health care professionals through the development of a new chatbot (Sanidad Segura). This intervention seeks to facilitate the identification, support, and follow-up of affected individuals while minimizing the adverse effects of such events on their physical and psychological well-being, social interaction, and professional performance. Sanidad Segura will enable confidential case reporting and provide access to tailored medical, psychological, and legal resources, as well as information about institutional support services. This project represents a crucial step toward implementing an integrated digital framework for the detection, management, and prevention of workplace violence in health care settings. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/92511.
References
- 1.García-Viola, A., Márquez-Hernández, V. V., Garrido-Molina, J. M., Alcayde-García, A., & Rodríguez-García, M. C. (2026). Design, development, and validation of a chatbot to support health care professionals experiencing workplace aggression: Protocol for a mixed methods study. JMIR Research Protocols. https://doi.org/10.2196/92511
This content is for educational purposes for healthcare professionals only and does not constitute clinical advice. Clinical decisions should be based on individual patient assessment, current guidelines, and appropriate specialist consultation. Editorial Standards · Privacy Policy · Terms of Service