Implementation Strategies in Suicide Prevention

Implementation science is a field which studies the factors needed for ensuring an intervention is used and maintained when deployed in the real world. The goal of our review was to understand the current use of implementation strategies for supporting suicide prevention across diverse settings.
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BioMed Central
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Implementation strategies in suicide prevention: a scoping review - Implementation Science

Background Implementation strategies can be a vital leveraging point for enhancing the implementation and dissemination of evidence-based suicide prevention interventions and programming. However, much remains unknown about which implementation strategies are commonly used and effective for supporting suicide prevention efforts. Methods In light of the limited available literature, a scoping review was conducted to evaluate implementation strategies present in current suicide prevention studies. We identified studies that were published between 2013 and 2022 that focused on suicide prevention and incorporated at least one implementation strategy. Studies were coded by two independent coders who showed strong inter-rater reliability. Data were synthesized using descriptive statistics and a narrative synthesis of findings. Results Overall, we found that studies most commonly utilized strategies related to iterative evaluation, training, and education. The majority of studies did not include direct measurement of suicide behavior outcomes, and there were few studies that directly tested implementation strategy effectiveness. Conclusion Implementation science strategies remain an important component for improving suicide prevention and intervention implementation. Future research should consider the incorporation of more type 3 hybrid designs as well as increased systematic documentation of implementation strategies. Trial registration < de-identified >

Note: The views expressed in this blog poster are those of the author and do not necessarily reflect the position or policy of the U.S. Department of Veterans Affairs or the United States government.

We say often that the “how” of suicide prevention is just as important as the “what”. Many intervention and prevention programs have been developed that are promising for reducing suicide risk, but it can be difficult for them to spread due to a variety of challenges such as gaps in training and logistical support. The goal of our review was to understand how the broader field has utilized implementation strategies for supporting suicide prevention interventions and programs. I strongly believe that we heal in community and that we also learn in community. Understanding strategies used by the field allows us to all grow together to ensure our interventions and programs reach those in need.

You might be wondering what implementation science is exactly and what are implementation strategies. Implementation strategies are strategies used to support a system in using a given intervention or program. Implementation science can be jargony, so I will share an example using one of my favorite foods, pizza. Imagine a local pizzeria wanted to start making a new kind of pizza that required more time to bake and different ingredients. Things that could come up include how much the new kind of pizza would add to the current menu, the degree to which ingredients are available and cost-effective, and if they had enough staff to support the process. In addition, it may be unclear whether the community wants this new kind of pizza or would prefer something different. Implementation science works to address these questions so that the pizza or a suicide prevention program can reach the end user. My team and I worked to identify what types of implementation strategies are currently in use as well as gaps in the literature. Our original goal was to understand how use of specific strategies is associated with successfully deploying interventions. Unfortunately, the state of the literature was not yet there for us to do so, as many papers did not clearly document their implementation processes and outcomes. There remains a strong need for sharing detailed experiences of implementing suicide prevention programs so we can build upon this collective wisdom.

As we think about the “how” of things, the work for this review occurred over several years with initial challenges with making sure we were capturing all the literature we could. It was both exciting and work-intensive to see the literature grow rapidly, as we did several rounds of gathering articles for our review. Once we started documenting the implementation strategies being used, it became clear that we needed to find some way to organize them, as the coding systems from the broader literature had dozens and dozens of strategies. We found that training and education-based strategies as well as iterative refinement (e.g., evaluating and revising interventions based on field experience) were the most commonly used across the field. This makes sense as increasing suicide prevention skills and systematically evaluating and optimizing an intervention are important for making a given intervention successful in a given setting. However, fewer studies worked to support clinicians and engage those who would use the intervention. Active engagement is important for ensuring that the interventions we make can be used effectively and respond to the needs of our communities.

Although we couldn’t clearly identify which implementation strategies work best, the hope is our review can encourage the field to share the work being done at a level where we can build upon our successes and challenges. For this year’s Suicide Prevention Month, I encourage you to take a moment for whatever you are doing to support suicide prevention and reflect on the “how”. That moment could help make sure that the next person in crisis is able to get to the support they need. In many ways, the multiple pieces needed for a positive experience happen long before the person even makes the call. Implementation science provides a way for those pieces to be assembled into a coherent puzzle to ensure all those at-risk for suicide get connected to care.

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Generalizing and Context in Implementation Research: Tensions and Opportunities

Implementation science both emphasizes the primacy of context but also seeks — as a scientific endeavor — generalizable or transferable insights and inferences that apply or inform across those settings. Implementing contexts are highly variable social, organizational, and community systems. Similarly, the nature of influence, power, and positionality varies across the relationships in these specific systems. Across such environments, singular insights about the effects of strategies, their barriers, facilitators, or even mechanisms cannot be expected to be invariant. Yet accepting the premise in implementation science that every context is unique seemingly precludes one of the central features of the discipline itself, which is to seek insights that apply widely and are useful for prediction. How does implementation science reconcile its pursuit of scientific legitimacy and generalizing while maintaining its commitment to understanding what works, for whom, and under what circumstances — when these circumstances vary?

In the growth of implementation science, scientific capacity and resources have been not equitably distributed, and we find a preponderance to generalize views that are particular, historical, and situated primarily in the Global North to the Global South. The same can be said for generalizing to marginalized settings within HIC. Although adaptation has been proposed to salvage such claims, there might also be a need to challenge existing routes of generalizing that reflect power more than science.

In order to address this tension, we seek a range of papers that address the question of generalizability in implementation science. We seek contributions that will contextualize the implications of this tension between generalizability and specificity to context and draw from other disciplines to explore methods and approaches to advance this area of inquiry. While context and generalizing are often discussed in implementation research, additional investment in this conversation can help untangle, flesh out, and even reconcile the perceived contradiction between context and generalizability. In this call, we seek to go beyond focusing on the importance of context and challenges in generalization in order to garner insights on how to address emergent issues and move key concepts and innovative frameworks in the field forward. Submissions that are responsive to this call will use various forms of evidence to address one or more of the following:

• Examine and interrogate the promises and pitfalls of key concepts in implementation science and their generalizability across settings, including HIC and LMIC settings.

• Discuss the implications for knowledge generation practices in implementation science; for example, contributors may consider how they ensure voices from the margins are included in this generative process.

• Produce both qualitative and quantitative insights that apply across contexts and accommodate heterogeneity. This may include an interrogation of the nature and notion of drawing inferences across settings.

• Utilize advanced qualitative methods to inform generalizability and transferability in implementation science, which may be inclusive of the use of non-traditional qualitative methods.

• Interrogate core elements of context and what needs to be known about them for generalizability.

• Consider the role of mechanisms and their use for bridging specificity to context and generalizability.

• Evaluate theoretical perspectives on context and generalizability, including the mobilization of critical theory, transportability, and/or realist approaches.

• Undertake a social epistemological analysis of generalizability in implementation science, accounting for situated and embodied knowledge, the social genesis, and positionality of ideas that constitute knowledge in a given context.

This Collection supports and amplifies research related to SDG 3, Good Health and Well-Being, SDG 4, Quality Education, SDG 10, Reduced Inequalities, and SDG 17, Partnerships for the Goals.

This collection is open for submissions from all authors on the condition that the manuscript falls within the scope of the collection and the journal it is submitted to.

All submissions in this collection undergo the relevant journal’s standard peer review process. Similarly, all manuscripts authored by a Guest Editor(s) will be handled by the Editor-in-Chief of the relevant journal. As an open access publication, participating journals levy an article processing fee (Implementation Science fees, and Implementation Science Communications fees). We recognize that many key stakeholders may not have access to such resources and are committed to supporting participation in this issue wherever resources are a barrier. For more information about what support may be available, please visit OA funding and support, or email OAfundingpolicy@springernature.com or the Editor-in-Chief of the journal where the article is being submitted.

Publishing Model: Open Access

Deadline: Mar 01, 2025