Abstract
BackgroundAs part of a national co-ordinated and multifaceted response to the excess suicide rate, the Choose Life initiative, the Highland Choose Life Group launched an ambitious programme of training for National Health Service (NHS), Council and voluntary organisation staff. In this study of the dissemination and implementation of STORM (Skills-based Training On Risk Management), we set out to explore not only the outcomes of training, but key factors involved in the processes of diffusion, dissemination and implementation of the educational intervention.MethodsParticipants attending STORM training in Highland Region provided by 12 trained facilitators during the period March 2004 to February 2005 were recruited. Quantitative data collection from participants took place at three time points; immediately before training, immediately post-training and six months after training. Semi-structured telephone interviews were carried out with the training facilitators and with a sample of course participants 6 months after they had been trained. We have utilized the conceptual model described by Greenhalgh and colleagues in a Framework analysis of the data, for considering the determinants of diffusion, dissemination and implementation of interventions in health service delivery and organization.ResultsSome 203 individuals completed a series of questionnaire measures immediately pre (time 1) and immediately post (time 2) training and there were significant improvements in attitudes and confidence of participants. Key factors in the diffusion, dissemination and implementation process were the presence of a champion or local opinion leader who supported and directed the intervention, local adaptation of the materials, commissioning of a group of facilitators who were provided with financial and administrative support, dedicated time to provide the training and regular peer-support.ConclusionFeatures that contributed to the success of STORM were related to both the context (the multi-dimensional support provided from the host organisation and the favourable policy environment) and the intervention (openness to local adaptation, clinical relevance and utility), and the dynamic interaction between context and the intervention.
Highlights
As part of a national co-ordinated and multifaceted response to the excess suicide rate, the Choose Life initiative [11], the Highland Choose Life Group launched an ambitious programme of training for National Health Service (NHS), Council and voluntary organisation staff
The mean age was 43, 73% were female, 60% were born in Scotland (27% in England) and 98% specified 'White' as their ethnic group. 64% had received no previous training on suicide risk assessment or prevention and for the majority of those who had received previous training (68%) the duration had been of eight hours or less
Utilizing primarily the model described by Greenhalgh and her colleagues [29] we have described in detail the key stages of diffusion, dissemination and implementation of a training intervention for suicide prevention, the STORM programme, as part of the multifaceted Choose Life initiative [11] in the Highland Region of Scotland
Summary
As part of a national co-ordinated and multifaceted response to the excess suicide rate, the Choose Life initiative, the Highland Choose Life Group launched an ambitious programme of training for National Health Service (NHS), Council and voluntary organisation staff. Across Scotland during the period 1989–2004 male suicide rates increased by 22 percent and female suicide rates by 6 percent [1] Over this period, Scotland has experienced a greater number of deaths from suicide than other countries in the UK [2] and the increase in deaths in men has led to a change in its rank from 12th to 11th highest rate within Europe [3]. Highland Region has one of the highest rates of suicide in Scotland [4,5]. Firearms and by others gases and vapours (mainly due to car exhausts) are overrepresented in the Highlands in comparison with the rest of Scotland. The reasons for these higher rates in the Highlands are unknown, but a number of factors could be involved. Farmers have access to lethal means including firearms [9] and may differ in their help-seeking behaviour, with more presentation of physical symptoms of emotional distress [10]
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