Abstract
BACKGROUND: Staff wellbeing is a growing concerns in healthcare settings, where increased workload, emotional demand, and organisational pressures contribute to stress, burnout, and reduced psychological safety. Mental Health First Aid (MHFA) training is an evidence-based programme designed to support early recognition of mental distress, provide initial reassurance, and facilitate signposting to appropriate help. Its specific contribution to staff wellbeing within hospital and associated healthcare settings, however, remains underexplored. This paper presents a protocol for a realist review that will examine how, why, and in what contexts an MHFA programme may support staff wellbeing within hospital and associated healthcare settings. [Table: see text]. METHODS: This protocol for a realist review will follow RAMESES standards to examine the contribution of MHFA training to staff health and wellbeing. The review will proceed through five stages: (1) clarifying the scope of the review; (2) developing initial programme theories; (3) searching for evidence; (4) extracting and synthesising data using realist logic; and (5) refining the programme theories. An expert panel will be convened to support the development and refinement of the programme theories as the review progresses. Conclusions This realist review protocol will guide the development of context-mechanism-outcome (CMO) configurations to explain how MHFA training may operate within different hospital contexts. The resulting programme theories may contribute to organisational strategy, leadership practice, and policy decisions aimed at improving staff wellbeing in acute hospital settings.