Underreported Implementation Strategies in Studies of Suicide Prevention Interventions

While recent studies have shown the effectiveness of brief suicide prevention interventions delivered in health care settings, a new JAMA Psychiatry analysis shows that studies drastically underestimate the strategies needed for successful implementation of interventions.

The University of Illinois Chicago psychologist who led the study found that the researchers used about 26 strategies when implementing their interventions in clinical settings with patients during their studies. However, only four implementation strategies were described in the corresponding journal articles.

On average, about 85% of the strategies used for successful implementation, which could include things like staff training, making physical appointment space available, and updating billing processes, were missing from published reports.

Brittany Rudd, UIC clinical instructor in the department of psychiatry at the School of Medicine.

“Providers in clinical settings need to know what it takes to implement novel interventions in their settings. When the studies these providers review to inform their work don’t inform implementation processes, they limit their ability to successfully integrate cutting-edge scientific discoveries into clinical care,” said Brittany Rudd, UIC clinical instructor of psychiatry at the School of Medicine. “For interventions designed to reduce suicide attempts and increase treatment initiation, not sharing this information may create a missed opportunity to save lives.”

To conduct the study, the researchers used a standard implementation reporting tool that contains more than 70 different implementation strategies with standard names, definitions, and categories. They reviewed published studies to identify the strategies reported in the paper. The researchers also contacted the study authors and asked them to use the same reporting tool to indicate the strategies used during study implementation.

The two scores were compared, and the researchers not only observed a large statistically significant difference in the number of strategies reported compared to the number used (4 vs. 26), but also large differences for each implementation strategy category. Stakeholder training and education were the types of implementation strategies most frequently reported in the literature, but stakeholder relationship building was the most widely used, according to the authors’ reports.

“We need journals that require and allow space for researchers to describe their implementation processes so that health care systems, clinics, and individual providers can use those studies to make informed and realistic decisions about incorporating new interventions into care. of the patient,” Rudd said. “The implementation of innovation to improve public health is the goal of scientific discovery. Results from basic science and clinical science, no matter how promising, may not translate into better health for patients if implementation is not considered and shared at every translational step of science.

“I hope that all scientists become familiar with the importance of science and implementation practice so that we can improve public health,” Rudd said.

The JAMA Psychiatry article, “Implementation Strategies Used and Reported in Brief Suicide Prevention Intervention Studies,” is co-authored by Catalina Ordorica of UIC, Molly Davis and Stephanie Doupnik of Children’s Hospital of Philadelphia, and Steven Marcus and Rinad Beidas of the University of Pennsylvania .

The research was supported by grants from the US National Institute of Mental Health (T32MH109433, K23MH115162, and R01MH107452).

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