Piloting Implementation Design and Preliminary Readiness for Universal Suicide Risk Screening Program in Emergency Department of a Tertiary Care Centre, Nepal: A Mixed Method Study
Introduction: Nearly three quarters of the suicides occur in developing world, however few evidenced-based health systems strategies exist to detect and prevent suicide in these contexts. This pilot study evaluates the feasibility of implementing a universal suicide risk screening program in a Nepa...
Saved in:
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Nepal Medical Association
2024-11-01
|
| Series: | Journal of Nepal Medical Association |
| Subjects: | |
| Online Access: | https://jnma.com.np/jnma/index.php/jnma/article/view/8832 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1846148293284855808 |
|---|---|
| author | Anmol Purna Shrestha Roshana Shrestha Renu Shakya Pratiksha Paudel Madeleine Sorenson Amrita Gurung Riya Bajracharya Ajay Risal Lakshmi Vijayakumar Ashley Hagaman |
| author_facet | Anmol Purna Shrestha Roshana Shrestha Renu Shakya Pratiksha Paudel Madeleine Sorenson Amrita Gurung Riya Bajracharya Ajay Risal Lakshmi Vijayakumar Ashley Hagaman |
| author_sort | Anmol Purna Shrestha |
| collection | DOAJ |
| description |
Introduction: Nearly three quarters of the suicides occur in developing world, however few evidenced-based health systems strategies exist to detect and prevent suicide in these contexts. This pilot study evaluates the feasibility of implementing a universal suicide risk screening program in a Nepalese emergency department.
Methods: This study reports the preliminary training phases of a pilot implementation trial in the emergency department to evaluate the program. The approval was obtained from the Nepal Health Research Council (Approval no. 447/2021 P), and the Kathmandu University School of Medical Sciences Institutional Ethical Review Board (Approval no. 237/2021) and Yale University IRB (Protocol ID 2000029480). Implementation assessments included suicide screening acceptability, appropriateness, confidence, system priority, and myth knowledge of staff. Implementation strategies were selected, decolonized, and preliminarily trained followed by phased supportive coaching to initiate the screening package. We designed the implementation package through co-design staff focus groups and embedded ethnography.
Results: Co-design focus groups (n=8) occurred with staff and leadership. We trained 26 (76.47%) the staff on the Nepali suicide screening tool followed by supported phased initial screening over two months. Implementation assessments demonstrated increased scores on appropriateness, confidence, system priority, and myth knowledge. The implementation package included key strategies to be deployed over six months. The embedded ethnographic observations revealed barriers to effective implementation, such as anticipated stigma, reluctance to engage families, and distrust in referral processes.
Conclusions: The pilot study demonstrated that training improves staff appropriateness, confidence, system priority, and myth knowledge. Despite initial barriers, co-designed strategies and phased coaching facilitates screening uptake, highlighting the program's potential for sustainable implementation.
|
| format | Article |
| id | doaj-art-09cde5f5aa824d61857f5c34bb8fcfe5 |
| institution | Kabale University |
| issn | 0028-2715 1815-672X |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Nepal Medical Association |
| record_format | Article |
| series | Journal of Nepal Medical Association |
| spelling | doaj-art-09cde5f5aa824d61857f5c34bb8fcfe52024-12-01T08:59:12ZengNepal Medical AssociationJournal of Nepal Medical Association0028-27151815-672X2024-11-016228010.31729/jnma.8832Piloting Implementation Design and Preliminary Readiness for Universal Suicide Risk Screening Program in Emergency Department of a Tertiary Care Centre, Nepal: A Mixed Method StudyAnmol Purna Shrestha0Roshana Shrestha1Renu Shakya2Pratiksha Paudel3Madeleine Sorenson4Amrita Gurung5Riya Bajracharya6Ajay Risal7Lakshmi Vijayakumar8Ashley Hagaman9Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Kavre, NepalDepartment of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Kavre, NepalDepartment of Social and Behavioral Science Department, Yale School of Public Health, Connecticut, United States of AmericaDepartment of Psychology, Padma Kanya Campus, Tribhuvan University, Kathmandu, Bagmati, NepalDepartment of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Kavre, NepalDepartment of Psychiatry, Dhulikhel Hospital-Kathmandu University Hospital, Kavre, Dhulikhel, Kavre , Nepal Department of Psychiatry, Volunteer Health Services Hospital, Chennai, IndiaDepartment of Social and Behavioral Science Department, Yale School of Public Health, Connecticut, United States of America Introduction: Nearly three quarters of the suicides occur in developing world, however few evidenced-based health systems strategies exist to detect and prevent suicide in these contexts. This pilot study evaluates the feasibility of implementing a universal suicide risk screening program in a Nepalese emergency department. Methods: This study reports the preliminary training phases of a pilot implementation trial in the emergency department to evaluate the program. The approval was obtained from the Nepal Health Research Council (Approval no. 447/2021 P), and the Kathmandu University School of Medical Sciences Institutional Ethical Review Board (Approval no. 237/2021) and Yale University IRB (Protocol ID 2000029480). Implementation assessments included suicide screening acceptability, appropriateness, confidence, system priority, and myth knowledge of staff. Implementation strategies were selected, decolonized, and preliminarily trained followed by phased supportive coaching to initiate the screening package. We designed the implementation package through co-design staff focus groups and embedded ethnography. Results: Co-design focus groups (n=8) occurred with staff and leadership. We trained 26 (76.47%) the staff on the Nepali suicide screening tool followed by supported phased initial screening over two months. Implementation assessments demonstrated increased scores on appropriateness, confidence, system priority, and myth knowledge. The implementation package included key strategies to be deployed over six months. The embedded ethnographic observations revealed barriers to effective implementation, such as anticipated stigma, reluctance to engage families, and distrust in referral processes. Conclusions: The pilot study demonstrated that training improves staff appropriateness, confidence, system priority, and myth knowledge. Despite initial barriers, co-designed strategies and phased coaching facilitates screening uptake, highlighting the program's potential for sustainable implementation. https://jnma.com.np/jnma/index.php/jnma/article/view/8832emergency medicineimplementation sciencedeveloping worldprevention |
| spellingShingle | Anmol Purna Shrestha Roshana Shrestha Renu Shakya Pratiksha Paudel Madeleine Sorenson Amrita Gurung Riya Bajracharya Ajay Risal Lakshmi Vijayakumar Ashley Hagaman Piloting Implementation Design and Preliminary Readiness for Universal Suicide Risk Screening Program in Emergency Department of a Tertiary Care Centre, Nepal: A Mixed Method Study Journal of Nepal Medical Association emergency medicine implementation science developing world prevention |
| title | Piloting Implementation Design and Preliminary Readiness for Universal Suicide Risk Screening Program in Emergency Department of a Tertiary Care Centre, Nepal: A Mixed Method Study |
| title_full | Piloting Implementation Design and Preliminary Readiness for Universal Suicide Risk Screening Program in Emergency Department of a Tertiary Care Centre, Nepal: A Mixed Method Study |
| title_fullStr | Piloting Implementation Design and Preliminary Readiness for Universal Suicide Risk Screening Program in Emergency Department of a Tertiary Care Centre, Nepal: A Mixed Method Study |
| title_full_unstemmed | Piloting Implementation Design and Preliminary Readiness for Universal Suicide Risk Screening Program in Emergency Department of a Tertiary Care Centre, Nepal: A Mixed Method Study |
| title_short | Piloting Implementation Design and Preliminary Readiness for Universal Suicide Risk Screening Program in Emergency Department of a Tertiary Care Centre, Nepal: A Mixed Method Study |
| title_sort | piloting implementation design and preliminary readiness for universal suicide risk screening program in emergency department of a tertiary care centre nepal a mixed method study |
| topic | emergency medicine implementation science developing world prevention |
| url | https://jnma.com.np/jnma/index.php/jnma/article/view/8832 |
| work_keys_str_mv | AT anmolpurnashrestha pilotingimplementationdesignandpreliminaryreadinessforuniversalsuicideriskscreeningprograminemergencydepartmentofatertiarycarecentrenepalamixedmethodstudy AT roshanashrestha pilotingimplementationdesignandpreliminaryreadinessforuniversalsuicideriskscreeningprograminemergencydepartmentofatertiarycarecentrenepalamixedmethodstudy AT renushakya pilotingimplementationdesignandpreliminaryreadinessforuniversalsuicideriskscreeningprograminemergencydepartmentofatertiarycarecentrenepalamixedmethodstudy AT pratikshapaudel pilotingimplementationdesignandpreliminaryreadinessforuniversalsuicideriskscreeningprograminemergencydepartmentofatertiarycarecentrenepalamixedmethodstudy AT madeleinesorenson pilotingimplementationdesignandpreliminaryreadinessforuniversalsuicideriskscreeningprograminemergencydepartmentofatertiarycarecentrenepalamixedmethodstudy AT amritagurung pilotingimplementationdesignandpreliminaryreadinessforuniversalsuicideriskscreeningprograminemergencydepartmentofatertiarycarecentrenepalamixedmethodstudy AT riyabajracharya pilotingimplementationdesignandpreliminaryreadinessforuniversalsuicideriskscreeningprograminemergencydepartmentofatertiarycarecentrenepalamixedmethodstudy AT ajayrisal pilotingimplementationdesignandpreliminaryreadinessforuniversalsuicideriskscreeningprograminemergencydepartmentofatertiarycarecentrenepalamixedmethodstudy AT lakshmivijayakumar pilotingimplementationdesignandpreliminaryreadinessforuniversalsuicideriskscreeningprograminemergencydepartmentofatertiarycarecentrenepalamixedmethodstudy AT ashleyhagaman pilotingimplementationdesignandpreliminaryreadinessforuniversalsuicideriskscreeningprograminemergencydepartmentofatertiarycarecentrenepalamixedmethodstudy |