Information and communication technology-based interventions for suicide prevention implemented in clinical settings: a scoping review

Abstract

Background A large number of information and communication technology (ICT) based interventions exist for suicide prevention. However, not much is known about which of these ICTs are implemented in clinical settings and their implementation characteristics. In response, this scoping review aimed to systematically explore the breadth of evidence on ICT-based interventions for suicide prevention implemented in clinical settings and then to identify and characterize implementation barriers and facilitators, as well as evaluation outcomes, and measures. Methods We conducted this review following the Joanna Briggs Institute methodology for scoping reviews. A search strategy was applied to the following six databases between August 17–20, 2021: MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and Library, Information Science and Technology Abstracts. We also supplemented our search with Google searches and hand-searching reference lists of relevant reviews. To be included in this review, studies must include ICT-based interventions for any spectrum of suicide-related thoughts and behaviours including non-suicidal self-injury. Additionally, these ICTs must be implemented in clinical settings, such as emergency department and in-patient units. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist to prepare this full report. Results This review included a total of 75 citations, describing 70 studies and 66 ICT-based interventions for suicide prevention implemented in clinical settings. The majority of ICTs were computerized interventions and/or applications (n = 55). These ICTs were commonly used as indicated strategies (n = 49) targeting patients who were actively presenting with suicide risk. The three most common suicide prevention intervention categories identified were post-discharge follow-up (n = 27), screening and/or assessment (n = 22), and safety planning (n = 20). A paucity of reported information was identified related to implementation strategies, barriers and facilitators. The most reported implementation strategies included training, education, and collaborative initiatives. Barriers and facilitators of implementation included the need for resource supports, knowledge, skills, motivation as well as engagement with clinicians with research teams. Studies included outcomes at patient, clinician, and health system levels, and implementation outcomes included acceptability, feasibility, fidelity, and penetration. Conclusion This review presents several trends of the ICT-based interventions for suicide prevention implemented in clinical settings and identifies a need for future research to strengthen the evidence base for improving implementation. More effort is required to better understand and support the implementation and sustainability of ICTs in clinical settings. The findings can also serve as a future resource for researchers seeking to evaluate the impact and implementation of ICTs.

Designing Implementation Strategies for a Digital Suicide Safety Planning Intervention in a Psychiatric Emergency Department: Protocol for a Multimethod Research Project

“…Without a careful investigation of the context, implementation strategies have often been mismatched with existing barriers in a given context [58,59]. As a prior work for this study, Shin et al [52] conducted a scoping review of ICTs (eg, apps) for suicide prevention that have been implemented in clinical settings and identified that barriers and facilitators collectively influence clinicians' capability, opportunity, and motivation to implement innovations. Therefore, implementation strategies must be tailored and multifaceted to simultaneously target these determinants of behavior change to maximize implementation [60].…”

“…Therefore, implementation strategies must be tailored and multifaceted to simultaneously target these determinants of behavior change to maximize implementation [60]. However, most of the reported implementation strategies focus on improving knowledge and building skills (ie, capability) without addressing clinicians' motivation and opportunity [52]. The fact that implementation strategies are often developed nonsystematically and do not match contextual implementation determinants is a consistently reported gap in the literature [61].…”

“…The objectives of this research will address the following 3 steps of KTA: adapt the identified knowledge or research to the local context; assess barriers to using the knowledge; and select, tailor, and implement interventions to promote the use of knowledge. A previous study addressed steps 1 and 2 of KTA, in which we used a scoping review methodology to explore the breadth of existing evidence on ICT-based interventions for suicide prevention and collated identified implementation characteristics [52]. This step was necessary to make sense of all the relevant knowledge and identify gaps that require new research.…”

“…Implementation requires "organizational effort directed toward diffusing [ICTs] within a user community," with the end goal of routinization [51]. Implementation efforts may include training, making changes in the clinical settings and workflow, providing technical support, or clarifying professional responsibility related to an innovation, all of which are determinants of behavior change influencing one's knowledge, motivation, and opportunity [52]. The organizational decision to adopt the Hope app was based on existing evidence of SPI effectiveness and the organization's priority goal for suicide prevention.…”

Evaluation of the Effectiveness of Suicide.ca, Quebec’s Digital Suicide Prevention Strategy Platform: Cross-Sectional Descriptive Study

“…For example, the technical aspects of developing, maintaining, and operating digital interventions have rarely been discussed [ 21 , 22 ]. Furthermore, there is a dearth of comprehensive research that adequately examines the implementation characteristics of ICT-based interventions in real-world settings, encompassing both the obstacles and factors that aid their implementation [ 23 , 24 ]. Ultimately, to support well-informed decision-making regarding the development of DSPSs, it is vital to establish whether ICT-based suicide prevention strategies are effectively reaching various target audiences or whether they are reaching the same individuals through different means.…”