Abstract
BackgroundSuicide constitutes a cause of death which could be prevented by e-health programs accessible to the general population. Effective promotion has the potential to maximize the uptake of such programs. However, few e-health programs have been combined with promotion campaigns. The primary objective of this trial is to assess the effectiveness of a tailored promotion, at a local level, of a mobile application and website offering evidence-based content for suicide prevention (the StopBlues program), and to compare the effectiveness of two types of local promotion in terms of their impact on suicidal acts. Secondary objectives focus on the effectiveness of the promotion in terms of the intensity of utilization of the StopBlues program, help-seeking behaviors and the level of psychological impairment of program users.Methods/designThis is a three-arm, parallel-group, cluster-randomized controlled trial, with before-and-after observation. Thirty-four clusters, corresponding to geographical areas sharing a common local authority in France, will be included. They will be randomly assigned to one of the following arms with a ratio of 1:1:1: a control group; a basic promotion group in which promotion of the StopBlues program will be done by local authorities; and an intensified promotion group in which basic promotion will be supplemented by an additional one in a general practitioner’s waiting room. The primary outcome measure will be the number of suicidal acts within each cluster over a 12-month period following the launch of the intervention. Baseline data will be collected for each cluster over the 12-month period prior to the trial. Secondary outcomes will include length of use of the StopBlues program, measures of help-seeking behaviors and level of psychological distress among users of the program, as well as the cost-effectiveness and budgetary impact of its promotion. A more sustained promotion by local authorities will also be implemented after 12 months in the control group and assessed using the same outcome measures.DiscussionThis research should contribute to the sparse evidence base regarding the promotion of e-health programs and will support the wider delivery of the intervention evaluated if proven effective.Trial registrationClinicalTrials.gov, ID: NCT03565562. Registered on 11 June 2018
Highlights
Suicide constitutes a cause of death which could be prevented by e-health programs accessible to the general population
This research should contribute to the sparse evidence base regarding the promotion of e-health programs and will support the wider delivery of the intervention evaluated if proven effective
Previous research has shown that awareness campaigns in the community can be effective for suicide prevention, by decreasing the stigma associated with mental disorders and help-seeking, in particular when such campaigns are associated with other interventions [22, 65]
Summary
Suicide constitutes a cause of death which could be prevented by e-health programs accessible to the general population. Suicide represents a cause of avoidable death which could be significantly reduced by effective prevention programs in the general population targeting the main challenges in the field of suicide prevention. These challenges include impaired upstream identification and care for people at risk, whereas early detection and management of mental disorders and suicide ideation has been identified as one of the current key priorities for efficient suicide prevention by the World Health Organization (WHO) [10]. It has been shown that healthinformation-seeking on the Internet is higher among those with stigmatized health conditions, including depression and anxiety, and that users with these conditions increase their utilization of healthcare after accessing such information [17, 18]
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