Krishnamoorthy Sadhvi, Armstrong Gregory, Mathieu Sharna, Ross Victoria, Kõlves Kairi
Australian Institute for Suicide Research and Prevention, World Health Organization Collaborating Centre for Research and Training in Suicide Prevention, School of Applied Psychology, Griffith University, Brisbane, QLD, Australia.
Centre for Mental Health and Community Wellbeing, The University of Melbourne, Carlton, VIC, Australia.
Front Health Serv. 2025 Aug 7;5:1473682. doi: 10.3389/frhs.2025.1473682. eCollection 2025.
Although there has been some investigation into what works in suicide prevention, exploration into the mechanisms by which implementation strategies impact outcomes or how and why strategies work remains largely under-studied. Consequently, implementation efforts often lack a clear strategy, and may contribute little toward the desired outcomes. This study aims to explore and examine the role of context and mechanisms involved in the implementation of complex suicide prevention interventions.
In-depth qualitative interviews were used to explore relevant stakeholder experiences of implementing complex suicide prevention interventions. Stakeholders (nine intervention leaders, five implementors and two lived experience advocates) from six interventions were purposively recruited for their experiences involved in implementing complex interventions in real-world settings. The Normalisation Process Theory translational coding manual was used to map data related to the primary and secondary constructs defined in the theory and its extensions.
Three domains pertaining to implementation context, mechanisms, and outcomes (CMO) were explored. Participants expressed their agency by: using contextual influences to modify the design and plan for delivery; making adaptations to the form and function of interventions and characteristics of the implementation environment to suit intervention needs; and, leveraging the intervention environment to integrate the intervention into existing systems and practices. Activities and strategies served multiple mechanisms involved in: understanding what the work entails; who does the work; developing the capacity to implement the work; and, understanding the work. An interdependent and interacting relationship between mechanisms emerged. Outcomes related to: change in existing practices; the ways in which people are organised; changes in existing norms; and, incorporation of the intervention into daily practice were observed.
This study is notable in its exploration of mechanisms underlying implementation of complex suicide prevention interventions. Data from this study can help inform the development, refinement and use of specific implementation strategies and understand the applicability of strategies across varied contexts. The study also demonstrates the use of an implementation theory to inform practice and potentially contributes to an understanding of what works, why, for whom and in what context. There is a need for a paradigm shift towards the use of more theory based and informed approaches to understand causal links between implementation strategies, context, mechanisms, and outcomes.
尽管对于自杀预防的有效措施已有一些研究，但对于实施策略影响结果的机制，或者这些策略如何以及为何起作用的探索，在很大程度上仍未得到充分研究。因此，实施工作往往缺乏明确的策略，可能对预期结果贡献甚微。本研究旨在探索和检验复杂自杀预防干预措施实施过程中背景和机制所起的作用。
采用深入的定性访谈来探索实施复杂自杀预防干预措施的相关利益相关者的经历。从六项干预措施中，有目的地招募了利益相关者（九名干预领导者、五名实施者和两名有实际经历的倡导者），因为他们在现实环境中实施复杂干预措施方面有相关经历。使用常态化过程理论转化编码手册来梳理与该理论及其扩展中定义的主要和次要结构相关的数据。
探讨了与实施背景、机制和结果（CMO）相关的三个领域。参与者通过以下方式发挥其能动性：利用背景影响来修改实施设计和计划；对干预措施的形式和功能以及实施环境的特征进行调整，以适应干预需求；以及利用干预环境将干预措施融入现有系统和实践。活动和策略服务于多个机制，这些机制涉及：了解工作内容；谁来做这项工作；培养实施工作的能力；以及理解这项工作。机制之间呈现出相互依存和相互作用的关系。观察到的结果包括：现有实践的改变；人员组织方式的改变；现有规范的改变；以及将干预措施纳入日常实践。
本研究在探索复杂自杀预防干预措施实施背后的机制方面具有重要意义。本研究的数据有助于为特定实施策略的制定、完善和使用提供信息，并理解这些策略在不同背景下的适用性。该研究还展示了运用实施理论为实践提供指导，并有可能有助于理解什么有效、为何有效、对谁有效以及在何种背景下有效。有必要向使用更多基于理论且信息充分的方法转变，以理解实施策略、背景、机制和结果之间的因果联系。
