Developing a tailored implementation action plan for a suicide prevention clinical intervention in an Australian mental health service: A qualitative study using the EPIS framework

Background: Tailoring implementation strategies to local contexts is a promising approach to supporting implementation and sustainment of evidence-based practices in health settings. While there is increasing research on tailored implementation of mental health interventions, implementation research on suicide prevention interventions is limited. This study aimed to evaluate implementation and subsequently develop a tailored action plan to support sustainment of an evidence-based suicide prevention intervention; Collaborative Assessment and Management of Suicidality (CAMS) in an Australian public mental health service. Methods: Approximately 150 mental health staff working within a regional and remote Local Health District in Australia were trained in CAMS. Semi-structured interviews and focus groups with frontline staff and clinical leaders were conducted to examine barriers and facilitators to using CAMS. Data were analysed using a reflexive thematic analysis approach and mapped to the Exploration, Preparation, Implementation and Sustainment (EPIS) framework and followed by stakeholder engagement to design a tailored implementation action plan based on a ‘tailored blueprint’ methodology. Results: A total of 22 barriers to implementing CAMS were identified. Based on the perceived impact on implementation fidelity and the feasibility of addressing identified barriers, six barriers were prioritised for addressing through an implementation action plan. These barriers were mapped to evidence-based implementation strategies and, in collaboration with local health district staff, goals and actionable steps for each strategy were generated. This information was combined into a tailored implementation plan to support the sustainable use of CAMS as part of routine care within this mental health service. Conclusions: This study provides an example of a collaborative approach to tailoring strategies for implementation on a large scale. Novel insights were obtained into the challenges of evaluating the implementation process and barriers to implementing an evidence-based suicide prevention treatment approach within a geographically large and varied mental health service in Australia. Plain language abstract: This study outlines the process of using a collaborative stakeholder engagement approach to develop tailored implementation plans. Using the Exploration Preparation Implementation Sustainment Framework, findings identify the barriers to and strategies for implementing a clinical suicide prevention intervention in an Australian community mental health setting. This is the first known study to use an implementation science framework to investigate the implementation of the clinical suicide prevention intervention (Collaborative Assessment and Management of Suicidality) within a community mental health setting. This work highlights the challenges of conducting implementation research in a dynamic public health service.

Economic Models of Community-Based Falls Prevention: A Systematic Review With Subsequent Commissioning And Methodological Recommendations

Background: Falls impose significant health and economic burdens among older populations, making their prevention a priority. Health economic decision models can inform whether the falls prevention intervention represents a cost-effective use of resources and/or meet additional decisional objectives such as reducing social inequities of health. This study aims to conduct a systematic review (SR) of community-based falls prevention models to: (i) systematically identify such models; (ii) synthesise and critically appraise the modelling methods/results; and (iii) formulate methodological and commissioning recommendations.Methods: The SR followed the PRISMA guideline, covering the period 2003-2020, 12 academic databases and grey literature. A study was included if it: targeted community-dwelling persons aged 60 and over and/or aged 50-59 at high falls risk; evaluated intervention(s) designed to reduce falls or fall-related injuries; against any comparator(s); reported outcomes of economic evaluation; used decision modelling; and had English full text. Extracted data fields were grouped under higher categories: (A) model and evaluation overview; (B) falls epidemiology features; (C) falls prevention intervention features; and (D) evaluation methods and outcomes. A checklist for falls prevention economic evaluations assessed reporting/methodological quality. Extracted fields were narratively synthesised and critically appraised to inform methodological and commissioning recommendations. The SR protocol is registered in the Prospective Register of Systematic Reviews (CRD42021232147).Results: 46 models were identified. The most prevalent issue according to the checklist was non-incorporation of all-cause care costs. Based on general population, lifetime models conducting cost-utility analyses, seven interventions produced favourable ICERs relative to no intervention under the cost-effectiveness threshold of £30,000 per QALY gained; of these, results for (1) combined multifactorial and environmental intervention, (2) physical activity promotion for women, and (3) targeted vitamin D supplementation were from validated models. Decision-makers should explore the transferability and feasible reaches of these interventions in their local settings. There was some evidence that exercise and home modification exacerbate existing social inequities of health. Sixteen methodological recommendations were formulated from critical appraisal.Conclusion: There is significant methodological heterogeneity across falls prevention models. This SR’s appraisals of modelling methods should facilitate the conceptualisation of future falls prevention models. Its synthesis of evaluation outcomes could inform commissioning.

Development and Preliminary Feasibility of iByte4Health: A Mobile Health (mHealth) Pediatric Obesity Prevention Intervention to Engage Parents with Low-Income of Children 2–9 Years

This research describes the development and preliminary feasibility of iByte4Health, a mobile health (mHealth) obesity prevention intervention designed for parents with a low-income of children 2–9 years of age. Study 1 (n = 36) presents findings from formative work used to develop the program. Study 2 (n = 23) presents a 2-week proof-of-concept feasibility testing of iByte4Health, including participant acceptability, utilization, and engagement. Based on Study 1, iByte4Health was designed as a text-messaging program, targeting barriers and challenges identified by parents of young children for six key obesity prevention behaviors: (1) snacking; (2) physical activity; (3) sleep; (4) sugary drinks; (5) fruit and vegetable intake; and (6) healthy cooking at home. In Study 2, participants demonstrated high program retention (95.7% at follow-up) and acceptability (90.9% reported liking or loving the program). Users were engaged with the program; 87.0% responded to at least one self-monitoring text message; 90.9% found the videos and linked content to be helpful or extremely helpful; 86.4% found text messages helpful or extremely helpful. iByte4Health is a community-informed, evidenced-based program that holds promise for obesity prevention efforts, especially for those families at the increased risk of obesity and related disparities. Future work is warranted to test the efficacy of the program.

Adaptation of an Evidence-Based Online Depression Prevention Intervention for College Students: Intervention Development and Pilot Study Results

College and university students across the United States are experiencing increases in depressive symptoms and risk for clinical depression. As college counseling centers strive to address the problem through wellness outreach and psychoeducation, limited resources make it difficult to reach students who would most benefit. Technology-based prevention programs have the potential to increase reach and address barriers to access encountered by students in need of mental health support. Part 1 of this manuscript describes the development of the Willow intervention, an adaptation of the technology-based CATCH-IT depression prevention intervention using a community participatory approach, for use by students at a women’s liberal arts college. Part 2 presents data from a pilot study of Willow with N = 34 (mean age = 19.82, SD = 1.19) students. Twenty-nine participants (85%) logged onto Willow at least once, and eight (24%) completed the full intervention. Participants positively rated the acceptability, appropriateness, and feasibility of Willow. After eight weeks of use, results suggested decreases in depressive symptoms (95% CI (0.46–3.59)), anxiety symptoms (95% CI (0.41–3.04)), and rumination (95% CI (0.45–8.18)). This internet-based prevention intervention was found to be acceptable, feasible to implement, and may be associated with decreased internalizing symptoms.