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

Abstract

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 the outer setting CFIR domain, namely in the sub-domain of patient needs and resources, which refers to the way in which these needs and resources are reflected by the reviewed interventions. The second most saturated CFIR domain for facilitators was intervention characteristics, where relative advantage, adaptability and cost of intervention sub-domains were equally represented. These sub-domains refer mostly to how the intervention is perceived by key stakeholders, to what extent it can be tailored to the implementation context and how much it costs. While intervention characteristics domain was the second most common also for barriers, the complexity sub-domain referring to high perceived difficulty of implementation was the most frequently represented. With reference to the results, we recommend adapting interventions to the needs of the target groups. Furthermore, carefully selecting the intervention to suit the target context concerning their adaptability, costs and complexity is vital for a successful implementation. Further implications for practice and research are discussed.

Implementation strategies in suicide prevention: a scoping review

“…Funding agencies may wish to encourage the incorporation of Type I hybrid study procedures (e.g., qualitative inquiry on barriers and facilitators post-implementation of interventions) to ensure research studies collect sufficient information regarding implementation processes to increase future adoption and uptake of findings. Additionally, past literature has highlighted tailoring to patient needs as a key facilitator in the implementation of suicide prevention interventions [ 8 ]. However, outcomes involving feedback from patients were the least common in our sample.…”

“…However, there remains limited adoption of these interventions as well as significant variability in effectiveness, which may be secondary to implementation challenges. A recent review identifies several implementation barriers that impact suicide prevention programming, including but not limited to high levels of complexity and cost as well as insufficient tailoring to patient needs [ 8 ]. It is, however, unknown which implementation strategies may be most helpful for addressing these needs to enhance the reach and effectiveness of promising suicide prevention programming.…”

Addressing help-seeking, stigma and risk factors for suicidality in secondary schools: short-term and mid-term effects of the HEYLiFE suicide prevention program in a randomized controlled trial

“…Although adverse effects have been reported [ 25 ], evaluation studies rarely explicitly assess unwanted side effects (USE) and serious adverse events (SAE) [ 11 ] raising doubts about the safety of prevention programs. Ultimately, the implementation of evidence-based programs is hindered by significant practical barriers, such as low acceptability and high costs [ 12 , 26 ]. Accessible and acceptable interventions with a solid empiric foundation are urgently needed and should be evaluated in high-quality trials with adequate outcomes considering both positive and negative effects [ 11 , 22 ].…”

Addressing Help-seeking, Stigma and Risk Factors for Suicidality in Secondary Schools: Short-term and Mid-term Effects of the HEYLiFE Suicide Prevention Program in a Randomized Controlled Trial

“…Although adverse effects have been reported [23], evaluation studies rarely explicitly assess unwanted side effects (USE) and serious adverse events (SAE) [10] raising doubts about the safety of prevention programs. Ultimately, the implementation of evidence-based programs is hindered by signi cant practical barriers, such as low acceptability and high costs [11,24]. Accessible and acceptable interventions with a solid empiric foundation are urgently needed and should be evaluated in high-quality trials with adequate outcomes considering both positive and negative effects [10,20].…”