Community mobilization for rural suicide prevention: Process, learning and behavioral outcomes from Promoting Community Conversations About Research to End Suicide (PC CARES) in Northwest Alaska

Abstract

Rationale This study evaluates the process and preliminary outcomes of Promoting Community Conversations About Research to End Suicide (PC CARES), an intervention that brings key stakeholders together so they can discuss suicide prevention research and find ways to put it into practice. Originally piloted in remote and rural Alaskan communities, the approach shows promise. Method Using a multi-method design, the study describes a series of locally-facilitated “learning circles” over 15 months and their preliminary results. Sign-in sheets documented participation. Transcriptions of audio-recorded sessions captured facilitator fidelity, accuracy, and the dominant themes of community discussions. Linked participant surveys (n=83) compared attendees’ perceived knowledge, skills, attitudes, and their ‘community of practice’ at baseline and follow-up. A cross-sectional design compared 112 participants’ with 335 non-participants’ scores on knowledge and prevention behaviors, and considered the social impact with social network analyses. Results Demonstrating feasibility in small rural communities, local PC CARES facilitators hosted 59 two to three hour learning circles with 535 participants (376 unique). Local facilitators achieved acceptable fidelity to the model (80%), and interpreted the research accurately 81% of the time. Discussions reflected participants’ understanding of the research content and its use in their lives. Participants showed positive changes in perceived knowledge, skills, and attitudes and strengthened their ‘community of practice’ from baseline to follow-up. Social network analyses indicate PC CARES had social impact, sustaining and enhancing prevention activities of non-participants who were ‘close to’ participants. These close associates were more likely take preventive actions than other non-participants after the intervention. Conclusion PC CARES offers a practical, scalable method for community-based translation of research evidence into selfdetermined, culturally-responsive suicide prevention practice.

Exploring the potential roles of community-university partnerships in northern suicide prevention implementation research

“…There seemed to be a strong desire to share northern-based knowledge on the subject rather than adapting southern programmes. As mentioned by our partners, suicide prevention programmes were being developed across Inuit Nunangat and in other northern regions, including Alaska [30,35].…”

“…CoPs must offer a safe environment to help foster a feeling of belonging and equality within the community. CoPs are recognized as a promising approach in health, education and social services and, more specifically, in mental health promotion and suicide prevention [30,35].…”

A call for expansion and innovation in research on protective factors and suicide prevention among American Indian and Alaska Native populations.

“…Research done in partnership with AIAN communities has moved towards innovation of alternative methods that are equally rigorous, yet ethically and culturally responsive. For example, to address small sample size and community desire to reduce burden on participants Wexler et al (2019) take an innovative multimethod approach to evaluate preliminary outcomes of the Promoting Community Conversations About Research to End Suicide using focus group data, individual data, and social network analysis. Another example of innovation to RCT design in AIAN communities can be found in the Thiwáhe Gluwáš'akapi (Sacred Home in Which Family is Made Strong) project.…”

Protective Factors as a Unifying Framework for Strength-Based Intervention and Culturally Responsive American Indian and Alaska Native Suicide Prevention

“…PC-CARES has demonstrated feasibility and fidelity when implemented by local facilitators in remote, rural Alaska Native communities. Participants strengthened their 'community of practice' and showed positive changes in perceived knowledge, skills, and attitudes, and prevention behaviors from baseline to follow-up (Wexler, et. al, 2019).…”

“…Recent research with American Indian and Alaska Native (AIAN) youth, a group identified at vastly heightened suicide risk (DHHS, 2012b), offers promising fresh insights and potential solutions. AIAN suicide research provides numerous innovations in prevention science including examples of successful intervention implementation and outcomes (Allen et al, 2018;Cwik et al, 2014;Wexler et al, 2019). Notably, much of this work expands the aims of suicide prevention beyond tertiary prevention at the individual level (Wexler et al, 2015) and emphasizes the distinctive contribution of culture in effective intervention (Manson, 2020).…”