Insights into barriers and enablers when implementing complex suicide prevention interventions
Limited research exists examining the gap between evidence to implementation in practice. The researchers systematically mapped and summarised barriers, facilitators, and lessons learned for implementation of complex suicide prevention interventions.
What’s the issue?
Limited research exists examining the gap between effective suicide prevention interventions and applying or implementing into policy and practice. This gap can mean that we may continue to implement complex prevention strategies that may not be reaching the target audiences or settings.
To help bridge this gap, understanding what the barriers, enablers and key learnings are, can help inform future approaches. Formal or informal reflections of intervention phases of complex suicide prevention strategies may provide valuable insight and reduce potential of implementing ineffective prevention approaches.
What was done?
Using the updated PRIMSA guidelines, researchers conducted a secondary analysis of a systematic review of complex suicide prevention interventions. The researchers systematically mapped and summarised barriers, facilitators and lessons learned from reports of suicide prevention interventions implemented across the world that were included in the previous research.
Suicide prevention interventions were classified as complex if they were multicomponent interventions, meaning they combined three of more distinct intervention components that were implemented across multiple levels.
The researchers then identified barriers and facilitators to implementation and ranked these on level of importance.
What was found?
19 complex suicide prevention interventions were examined and included in the research. Most of the complex interventions were implemented in high-income countries.
Examples of frequently reported barriers and facilitators to implementation of complex suicide prevention interventions include:
Barriers
- Differences between researcher agendas and community needs and expectations.
- Difficulty in generating community ownership
- Inappropriate intervention to suit cultural and social needs and identities
- Unexpected challenges from external factors such as economic changes and disasters
- Changes in governance or management
- Changes in health or prevention priorities
Facilitators
- Motivation
- Capability
- Understanding content and need
- Stakeholder investment and engagement with both the delivery and value of the intervention
- Stakeholder relationship and alignment of goals
- Communities’ willingness to support and participate in the approach, particularly to support sustainability of the initiative.
- Prevention approaches that reflected the cultural and social diversity, and community needs
- Prevention approaches that utilised existing resources and settings including funding
Lessons learned
Researchers identified a number of lessons present across studies. The lessons were categorised into three themes. Some examples of lessons under each theme are listed below:
Design and evaluation
- Combining interventions created synergistic and catalytic effects.
- Advisory groups key in ensuring reciprocity, capacity building and sustainability.
- Regular evaluation can help to inform any required changes to support successful implementation and continued presence of the intervention.
- Sustained implementation of a multilevel, community based and overlapping approach can reduce suicide rates.
- If lessons learned are not shared, it is difficult to apply suicide prevention approaches in different settings and contexts.
Stakeholder engagement
- Participation based engagement with the prevention approach can fade and change over time.
- Communities are more likely to support a prevention approach if they believe they need it, believe it is the right fit for their community and take a level of ownership of the intervention.
- Community buy-ins support implementation and sustainability.
Intervention delivery/context
- Training supported facilitation.
- Interventions are more successful if delivered by known person or group.
- Regular check ins support implementation.
- Clear procedures help with implementation.
- The prevention approach must be suitable for the context in which it is applied.
- Adaptation of intervention activities to the local context supports effectiveness of implementation.
- The intervention must consider financial, structural, cultural and demographic factors that may impact effective implementation.
Why are the findings important?
Although the interventions included in this review were mostly implemented in high-income countries, the research highlights that suicide prevention evidence to practice must consider the barriers and facilitators for implementation of effective suicide prevention approaches.
Deeper understanding of barriers and facilitators can ensure that we are utilising the resources available, and that the intervention is what the community or target group needs and believes in, for them to engage with the approach taken.
Some of the barriers and facilitators are overlapping, such as cultural appropriateness. The research highlights the need to develop a complete picture of what is happening and why a complex strategy is or isn’t meeting its intended outcomes and ensure that this wisdom is collectively shared to support effective implementation in future.
Notes
- 1
Krishnamoorthy, S., Mathieu, S., Armstrong, G., Ross, V., Francis, J., Reifels, L., & Kõlves, K. (2023). Utilisation and application of implementation science in complex suicide prevention interventions: A systematic review. Journal of Affective Disorders, 330, 57–73. https://doi.org/10.1016/j.jad....