Hollenberg Elisa, Shin Hwayeon Danielle, Reid Nadine, Stergiopoulos Vicky, Lestage Laurent, Nicoll Gina, Walji Alyna, Zaheer Juveria
Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON M6J 1H4, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON M5T 3M6, Canada.
J Clin Med. 2025 Jun 7;14(12):4047. doi: 10.3390/jcm14124047.
: This research aimed to identify and investigate how context facilitates or hinders safety planning interventions (SPIs) intended to manage suicidal ideation (SI) and behaviour (SB) from the perspective of service users, friends, family members, service providers and other key informants. Additionally, this research aimed to identify underlying mechanisms influencing the effective and acceptable management of SI and SB across these groups. : A realist evaluation framework (i.e., Context + Mechanism = Outcome; CMO) was used to inform the qualitative study design, which explores whether SPIs are perceived as effective (i.e., outcome) and examines the underlying mechanism(s) and specific contexts involved. A total of 28 service users, 11 family members or friends and 15 key informants, including service providers and other stakeholders, participated in semi-structured interviews. A total of 18 frontline service providers also participated in three focus groups. These interviews and focus groups were analyzed to develop a shared model capturing the mechanisms and contexts influencing effective SPI implementation. Data was collected between September 2019 and December 2021. : The model consists of three pillars: (1) understanding the importance of context, timing and relationships in safety planning, (2) identifying perceived barriers and facilitators to safety planning as described by service users, family members and service providers, (3) bridging the gap between evidence and experience in implementing safety planning interventions. : While SPIs are evidence-based interventions, contextual factors and perceived barriers and facilitators can impact implementation and outcomes in mental health care settings. Understanding these factors can help to explain differences in outcomes within and across patient populations and care settings, and addressing perceived challenges can improve implementation and experiences for service users, family members and service providers.
本研究旨在从服务使用者、朋友、家庭成员、服务提供者及其他关键信息提供者的角度，识别并调查情境如何促进或阻碍旨在管理自杀意念（SI）和自杀行为（SB）的安全计划干预措施（SPI）。此外，本研究旨在确定影响这些群体有效且可接受地管理SI和SB的潜在机制。
采用了一种现实主义评估框架（即情境+机制=结果；CMO）来指导定性研究设计，该设计探讨SPI是否被视为有效（即结果），并检查其中涉及的潜在机制和特定情境。共有28名服务使用者、11名家庭成员或朋友以及15名关键信息提供者（包括服务提供者和其他利益相关者）参与了半结构化访谈。共有18名一线服务提供者也参与了三个焦点小组。对这些访谈和焦点小组进行了分析，以建立一个共享模型，捕捉影响SPI有效实施的机制和情境。数据收集时间为2019年9月至2021年12月。
（1）理解情境、时机和关系在安全计划中的重要性，（2）识别服务使用者、家庭成员和服务提供者所描述的安全计划的感知障碍和促进因素，（3）弥合实施安全计划干预措施时证据与经验之间的差距。
虽然SPI是基于证据的干预措施，但情境因素以及感知到的障碍和促进因素可能会影响精神卫生保健环境中的实施和结果。了解这些因素有助于解释不同患者群体和护理环境中结果的差异，应对感知到的挑战可以改善服务使用者、家庭成员和服务提供者的实施情况和体验。
