Stifter Meredith, Goklish Novalene, Watchman Charity, Mitchell Kristin, Duncan Jennifer, Miller Michelle, HorseChief Mary, Kemp Christopher G, Cwik Mary, Haroz Emily E
Johns Hopkins Center for Indigenous Health, 415 N. Washington St., Baltimore, MD 21231, USA.
White Mountain Apache Center for Indigenous Health, Whiteriver, AZ 85941, USA.
Int J Environ Res Public Health. 2024 Dec 3;21(12):1616. doi: 10.3390/ijerph21121616.
Suicide is the second leading cause of death for American Indian youth, far surpassing the rates of suicide experienced by other races. The White Mountain Apache Tribe has made significant impacts on suicide risk by implementing a robust suicide prevention program which includes a community-led database and case management follow-ups. Due to the success of the program in preventing suicides, the White Mountain Apache team has worked with other tribal communities to adapt the program. We wanted to understand the factors that are most important to implementing and sustaining this model and how these factors compare with existing implementation science frameworks. We employed an adapted nominal group technique to compile facilitators and barriers to implementation of the suicide prevention model across settings with five partner teams. Two researchers independently coded the resulting list of facilitators and barriers using the Consolidated Framework for Implementation Research (version 1.0) codebook. The final list of cross-site prioritized facilitators and barriers included 41 factors. Some factors did not match easily with the framework's constructs. The White Mountain Apache suicide prevention team noted that seven of the top prioritized factors are considerations they most try to emphasize to new communities working in suicide prevention. The factors fall into two key themes: staffing and tribal engagement. This finding affirms their focus when they conduct suicide prevention trainings with new communities and provides an opportunity for more structure and in-depth training in those two areas. Several factors could not be easily coded to the framework, especially around the sociocultural characteristics of suicide prevention work in Native communities. This contributes to the larger discussion in implementation science concerning the ways in which Indigenous approaches to public health differ from Western models.
自杀是美国印第安青年的第二大死因，远远超过其他种族的自杀率。白山阿帕奇部落通过实施一项强有力的自杀预防计划，对自杀风险产生了重大影响，该计划包括一个由社区主导的数据库和病例管理随访。由于该计划在预防自杀方面取得了成功，白山阿帕奇团队已与其他部落社区合作调整该计划。我们想了解对实施和维持该模式最重要的因素，以及这些因素与现有的实施科学框架相比如何。我们采用了一种改编的名义小组技术，与五个合作团队一起编制了跨环境实施自杀预防模式的促进因素和障碍。两名研究人员使用实施研究综合框架（1.0版）编码手册对由此产生的促进因素和障碍清单进行了独立编码。跨站点优先排序的促进因素和障碍的最终清单包括41个因素。一些因素不容易与该框架的结构相匹配。白山阿帕奇自杀预防团队指出，排名最靠前的七个因素是他们最想向从事自杀预防工作的新社区强调的考虑因素。这些因素分为两个关键主题：人员配备和部落参与。这一发现证实了他们在与新社区进行自杀预防培训时的重点，并为在这两个领域进行更有条理和深入的培训提供了机会。有几个因素不容易编码到该框架中，特别是围绕原住民社区自杀预防工作的社会文化特征。这有助于在实施科学中进行更广泛的讨论，即本土公共卫生方法与西方模式的不同之处。
