Facilitators and barriers to implementing suicide prevention interventions

Facilitators and barriers to implementation of suicide prevention interventions: Scoping review

by Alexandr Kasal, Roksana Táborská, Laura Juríková, Alexander Grabenhofer-Eggerth, Michaela Pichler, Beate Gruber, Hana Tomášková, and Thomas Niederkrotenthaler

Published 13 March 2023

What's the issue?

Suicide is a preventable public health issue. While many interventions are known to prevent suicide, applying these interventions in different settings can be challenging.

Understanding the challenges of implementing suicide prevention interventions may help to bridge the gap between research and implementation in policy and practice. This study aimed to identify what helps and hinders the implementation of different suicide prevention interventions.

What was done?

The authors conducted a scoping review to map current knowledge of barriers and facilitators to the Consolidated Framework for Implementation Research. This framework was created to support implementation and evaluate “what”, “where”, and “why” interventions work in different settings.

The framework has five domains, each with separate sub-domains, including:

• Intervention characteristics, including factors like cost and complexity
• Outer setting, referring to external factors like patient needs
• Inner setting, focusing on factors inside the organisation implementing the intervention
• Characteristics of individuals, considering the qualities of the people implementing the intervention
• Process, which relates to how the intervention is planned, executed, and evaluated.

What was found?

The authors identified 64 articles in the scoping review. The articles included 417 factors that facilitate or support implementation and 250 barriers to implementation. These facilitators and barriers were categorised into the five framework domains.

Barriers and facilitators were most commonly mapped to the ‘outer setting’ domain, particularly the extent to which patient needs are known and prioritised.

The authors found that implementation is facilitated when interventions meet patient needs, are affordable, adaptable and have a high relative advantage over other interventions.

On the other hand, barriers to implementation occurred when interventions did not reflect patient needs, were overly complex, expensive, and lacked relative advantage.

The authors also summarised the barriers and facilitators to implementing specific types of interventions, such as gatekeeper training, aftercare, surveillance, means restriction, media reporting, and awareness raising.

Why are findings important?

Reviewing factors that help or hinder implementation supports evidence-based interventions to be applied in different contexts.

Understanding and prioritising patient needs was the single most common factor. This emphasises how important involving people with lived or living experience of suicide is in suicide prevention.

It is also important to consider how an intervention's complexity, cost, adaptability and relative advantage could facilitate or act as a barrier to implementation.

The authors describe that barriers and facilitators vary across different intervention types. The review includes comprehensive supplementary materials where barriers and facilitators are described by the type of intervention and original study. These materials can inform the implementation of specific types of interventions and future research.