Interventions to change clinicians’ behavior related to suicide prevention care in the emergency department: a scoping review

Abstract

The objective of this scoping review was to explore, characterize, and map the literature on interventions and intervention components implemented to change emergency department clinicians' behavior related to suicide prevention using the Behaviour Change Wheel as a guiding theoretical framework.Introduction: An emergency department is a critical place for suicide prevention, yet patients are often discharged without proper suicide risk assessments or referrals. In response, we must support emergency department clinicians' behavior change to follow evidence-based suicide prevention strategies. However, reviews to date have yet to systematically and theoretically examine the functional mechanisms of interventions and how these characteristics can influence emergency department clinicians' behaviors related to suicide prevention care. Inclusion criteria: This review considered interventions that targeted emergency department clinicians' behavior change related to suicide prevention. Behavior change referred to observable practice changes as well as proxy measures of behavior change, including changes in knowledge and attitude.Methods: This review followed JBI methodology for scoping reviews. Searches included PubMed, PsycINFO, CINAHL, Embase, and gray literature, including targeted Google searches for relevant organizations/websites, ProQuest Dissertations and Theses Global, and Scopus conference papers (using a specific filter). This review did not apply any date limits, but our search was limited to the English language. Data extraction was undertaken using a charting table developed specifically for the review objective. Narrative descriptions of interventions were coded using the Behaviour Change Wheel's intervention functions. Reported outcome measures were categorized. Findings were tabulated and synthesized narratively.Results: This review included a total of 70 sources, describing 66 different interventions. Forty-one studies were included from the database searches, representing a mixture of experimental (n ¼ 2), quasi-experimental (n ¼ 24), non-experimental (n ¼ 12), qualitative (n ¼ 1), and mixed methods (n ¼ 2) approaches. An additional 29 citations were included from gray literature searches. One was a pilot mixed methods study, and the rest were interventions. Identified interventions comprised a wide range of Behaviour Change Wheel intervention functions to change clinicians' behavior: education (n ¼ 48), training (n ¼ 40), enablement (n ¼ 36), persuasion (n ¼ 21), environmental restructuring (n ¼ 18), modeling (n ¼ 7), and incentivization (n ¼ 2). Based on the Behaviour Change Wheel analysis, many interventions targeted more than one determinant of behavior change, often employing education and training to improve clinicians' knowledge and skills simultaneously. Among the 42 studies that reported outcome measures, effectiveness was measured at clinician (n ¼ 38), patient (n ¼ 4), or organization levels (n ¼ 6). Few studies reported implementation outcomes, such as measures of reach (n ¼ 4), adoption...

Information and communication technology-based interventions for suicide prevention implemented in clinical settings: A scoping review

“…Of the reported studies, education and training were the most commonly reported implementation strategies for the ICTs. This is consistent with the current literature for implementation practice and knowledge translation [101,102]. Educational meetings and training workshops are often less costly and easier to implement compared to more complex strategies that require organizational change [103].…”

Multimodal region-based behavioral modeling for suicide risk screening

“…Given the prevalence of suicide rates, especially that the COVID-19 pandemic has heightened its causes, suicide has become the second leading cause of death in youth worldwide (Tanaka and Okamoto, 2021). With early identification, management, and follow-up of people at risk, suicide is preventable (Shin et al, 2022). To this end, we attempt to identify behavioral markers that are associated with different levels of suicide risks, which in turn could help reduce the gap and provide an objective measure for screening suicide risk.…”

“…However, suicide is preventable, and early identification, management, and follow-up with people at risk of suicide are a few preventable measures (Shin et al, 2022). For suicide preventative interventions, WHO suggests equipping non-specialized health workers with training in assessing suicide behaviors (WHO-Suicide, 2019).…”

“…have been developed for emergency departments (Shin et al, 2022) and school settings (Erbacher and Singer, 2018) for early detection and monitoring of such risks. However, these instruments rely on the sufferer's willingness to disclose (McGillivray et al, 2022), where building rapport and perceived care based on verbal and nonverbal cues from practitioners could be key for patient's disclosure (Boudreaux et al, 2016).…”

Barriers and Facilitators to Using an App-Based Tool for Suicide Safety Planning in a Psychiatric Emergency Department: A Qualitative Descriptive Study Using the Theoretical Domains Framework and COM-B Model

“…There are other barriers we identi ed that require more attention, such as motivation and opportunity, which are often not adequately addressed and lead to ineffective implementation in ED related to suicide prevention care. [37] To address concerns related to the busy ED and workload challenges, environmental restructuring may be necessary.…”