Developing social capital in implementing a complex intervention: a process evaluation of the early implementation of a suicide prevention intervention in four European countries (original) (raw)
Related papers
Background: The Medical Research Council (MRC) Framework for complex interventions highlights the need to explore interactions between components of complex interventions, but this has not yet been fully explored within complex, non-pharmacological interventions. This paper draws on the process evaluation data of a suicide prevention programme implemented in four European countries to illustrate the synergistic interactions between intervention levels in a complex programme, and to present our method for exploring these. Methods: A realist evaluation approach informed the process evaluation, which drew on mixed methods, longitudinal case studies. Data collection consisted of 47 semi-structured interviews, 12 focus groups, one workshop, fieldnoted observations of six programme meetings and 20 questionnaires (delivered at six month intervals to each of the four intervention sites). Analysis drew on the framework approach, facilitated by the use of QSR NVivo (v10). Our qualitative approach to exploring synergistic interactions (QuaSIC) also developed a matrix of hypothesised synergies that were explored within one workshop and two waves of data collection. Results: All four implementation countries provided examples of synergistic interactions that added value beyond the sum of individual intervention levels or components in isolation. For instance, the launch ceremony of the public health campaign (a level 3 intervention) in Ireland had an impact on the community-based professional training, increasing uptake and visibility of training for journalists in particular. In turn, this led to increased media reporting of OSPI activities (monitored as part of the public health campaign) and also led to wider dissemination of editorial guidelines for responsible reporting of suicidal acts. Analysis of the total process evaluation dataset also revealed the new phenomenon of the OSPI programme acting as a catalyst for externally generated (and funded) activity that shared the goals of suicide prevention.
2018
Connecting for Life, Ireland's national strategy for suicide prevention (2015-2020), is managed and implemented by the National Office for Suicide Prevention (NOSP). NOSP is based within the Mental Health Division of the Health Service Executive (HSE) and collaborates with strategic partners and government departments, including education and justice among others in implementing the actions associated with the strategy. It is the body tasked with coordinating suicide prevention strategy in Ireland and holds an operating budget of €11.87 million (2015). The cross-sectoral engagement, consultation and relationships in the process of reviewing, agenda setting and planning suicide prevention policy is the consideration of this study. The stated aim, for the review of Ireland's national suicide prevention strategy was to have an evidence informed action plan for suicide prevention in Ireland and Connecting for Life was launched in 2015 as a whole of government approach to achieving the outcomes associated with the plan. The Department of Health and NOSP, as the statutory, or public health agency tasked with preventing suicide, can provide, fund, commission and purchase services from across statutory, non-governmental and voluntary sectors. As with many public sector departments, it can also be tasked with and involved in regulation, research and training among its range of functions. In providing services, the statutory sector can be a competitor, a partner of private sector and community or voluntary sectors and nongovernmental groups. It can be complex if the statutory or public sector also holds a regulatory or standards and quality assurance responsibility. In completing such commissioning of services and regulatory actions, the statutory sector may rely on knowledge and information, outputs and outcomes of practice from the sectors it is overseeing and indeed funding. In addition, health issues such as suicide, the focus of this study, are often emotive and high profile and there can be a demand from the public for responses and actions. Resourcing Suicide Prevention in Ireland This research is focused on cross-sectoral relationships and the impact on suicide prevention policy process. It is useful to examine funding protocols and decision making procedures in the assessment, management and awarding of resources in the National Office for Suicide Prevention (NOSP) as funding is an important feature in
2021
Purpose: Emerging evidence indicates that systems-based suicide prevention programs can help optimise suicide prevention activities, with the National Suicide Prevention Trial using these approaches in regional and community contexts throughout Australia. The Tasmanian arm of the Trial adopted the LifeSpan systems framework to deliver suicide prevention activities across three distinct geographical areas, focusing on high-risk populations of men aged 40-64 and people 65 and over. The University of Tasmania’s Centre for Rural Health undertook a local-level evaluation of the Trial in Tasmania.Aims: To explore key stakeholder perceptions of the implementation of a systems-based suicide prevention program in regional and rural communities in Tasmania, Australia.Method: Focus groups and interviews with 46 participants, comprising Working Group members (n=25), Tasmania’s Primary Health Network employees (n=7), and other key stakeholders (n=14), with the majority (53.3%) reporting a lived ...
Facilitators and barriers to implementation of suicide prevention interventions: Scoping review
Cambridge Prisms: Global Mental Health
We know that suicide is preventable, yet hundreds of thousands of people still die due to suicide every year. Many interventions were proven to be effective, and dozens of others showed promising results. However, translating these interventions into new settings brings several challenges. One of the crucial obstacles to success is not anticipating possible barriers to implementation nor enhancing possible benefits of factors facilitating the implementation. While we witnessed great support for suicide prevention activities globally in the past years, implementation barriers and facilitating factors are yet to be comprehensively mapped to help implementation activities worldwide. This scoping review maps current knowledge on facilitators and barriers to the implementation of suicide prevention interventions while using the Consolidated Framework for Implementation Research (CFIR) for classification. We included 64 studies. Barriers and facilitators were most commonly identified in t...
BMC Public Health
Purpose With emerging evidence indicating that systems-based approaches help optimise suicide prevention efforts, the National Suicide Prevention Trial sought to gather evidence on the appropriateness of these approaches to prevent suicide among at-risk populations, in regional and rural communities throughout Australia. The Tasmanian component of the Trial implemented the LifeSpan systems framework across three distinct rural areas with priority populations of men aged 40–64 and people 65 and over. The University of Tasmania’s Centre for Rural Health undertook a local-level evaluation of the Trial. Aims To explore key stakeholder perceptions of implementing a systems-based suicide prevention program in regional and rural communities in Tasmania, Australia. Method This study utilised qualitative methods to explore in depth, stakeholder perspectives. Focus groups and interviews were conducted with 46 participants, comprising Trial Site Working Group members (n = 25), Tasmania’s Prima...
Implementation Science in Suicide Prevention
Crisis
Although the effectiveness of interventions remains variable and is hard to compare across the spectrum of universal, selective, and indicated interventions and settings (Mann et al., 2021), real-world decisions to implement suicide prevention programs and services are rarely driven only by the evidence base. Decisions are frequently informed by population needs, equity considerations, or available resources or they are motivated by policy priorities, funding opportunities, innovation potential, or the prevailing ethos of care. As such, suicide prevention across countries may involve a range of programs, support services, and interventions, which exist side by side with varying quality and alignment to evidence-based practice. In this context, it therefore becomes important to carefully appraise evidence-practice and quality-of-care gaps
2013
STEP 3: Prevention, Education and Support Level The STEP model seeks to ensure that through good governance and effective management at a foundation and universal level that organisations are best placed to deliver coordinated practices and services of consistently high quality, with education a particular and important aspect to overall provision within the sphere of suicide Prevention, Intervention and Postvention practice. Coupled with this any information transmitted must also be delivered within a clear and concise framework and in a practical and understandable language and manner. The organisation is accountable to ensure effective governance around the responsible, considered practice and strategy in the development of effective services. In addition to the Foundation Level, Step 3 comprises core activities that organisations undertake. These activities involve Prevention, Education and Support and a number of distinct indicators, listed below will assist organisations to ensure required standards of practice. Step Four: Intervention, Targeted and Specialist Level The STEP model aims to ensure that through good governance and effective management at a foundation level that organisations are best placed to deliver coordinated practices and services of consistently high quality within the sphere of suicide Prevention, Intervention and Postvention practice. Coupled with this any information transmitted must also be delivered within a clear and concise framework and in a practical and understandable language and manner. In addition to the Foundation Level, Step 4 comprises core activities that organisations undertake. These activities involve intervention, targeted and specialist services and a number of distinct indicators will assist organisations to ensure required standards of practice. Conclusion: This research has found that the voluntary organisations working within the areas of deliberate self-harm, suicide Prevention, Intervention and Postvention in Ireland are a vibrant, committed, important and essential component of any national strategy to address this difficult, complex and painful issue for families and communities. This study used a mixed and creative approach to understanding and developing a model of accreditation. It was informed at all times by the work and experience of those local, regional and national organisations that engaged in and fully informed the research. This is the model realised from their vision and experience. In the incoming months the model, informed by this consultation, will be fully implemented within the suicide prevention, intervention and postvention sector in Ireland. Even this conclusion is not the final word on the work carried out as this model will be reviewed and developed over the next few years.
Research priorities in suicide prevention: A qualitative study of stakeholders' views
2009
The current study sought to inform priority setting in Australian suicide prevention research, by seeking stakeholders' views on where future priorities might lie. Three group interviews were conducted with a total of 28 participants. Group interview participants stressed that priority should be given to evaluating the efficacy of specific interventions and examining the response of the health and community service systems. They felt that the epidemiological profile of suicidal individuals had been explored, at least with respect to rates and individual-level risk factors, and that the above evaluative activities should focus on groups identified as having particularly high levels of risk. Most saw limited value in continuing to explore individual-level risk factors ad infinitum, and felt that the time had come to move on to considering wider societal influences on suicide and individual-level protective factors. Many felt that evaluation efforts should employ mixed methods, should be multidisciplinary and should be relevant to the Australian context. They also argued that there was scope for increasing the utility of research findings by communicating them in a manner that would enable them to be utilised by policy-makers, planners and practitioners. Several called for a more cohesive framework for suicide prevention that could guide suicide prevention research. The current study provides some guidance with respect to the direction Australia's suicide prevention research agenda should take. A prioritydriven approach to suicide prevention research will ensure that the research endeavour provides the most useful information for those whose day-to-day work involves trying to prevent suicide.
Objective: Tasmania is one of the 12 Australian sites chosen to participate in the National Suicide Prevention Trial. The Centre for Rural Health, University of Tasmania, was contracted to conduct a local-level, process evaluation of this initiative using a Participatory Action Research approach, with the objective of this article to summarise progress and key learnings from the local evaluation to date. Design: Empowerment and Utilisation-Focus Evaluation theoretical approaches informed the conduct of process evaluation activities, within an overarching participatory action research approach. Setting: Three participating regions in Tasmania were included as follows: