Community mobilization for rural suicide prevention: Process, learning and behavioral outcomes from Promoting Community Conversations About Research to End Suicide (PC CARES) in Northwest Alaska

Abstract

Rationale: This study evaluates the process and preliminary outcomes of Promoting Community Conversations About Research to End Suicide (PC CARES), an intervention that brings key stakeholders together so they can discuss suicide prevention research and find ways to put it into practice. Originally piloted in remote and rural Alaskan communities, the approach shows promise.

Method: Using a multi-method design, the study describes a series of locally-facilitated "learning circles" over 15 months and their preliminary results. Sign-in sheets documented participation. Transcriptions of audio-recorded sessions captured facilitator fidelity, accuracy, and the dominant themes of community discussions. Linked participant surveys (n=83) compared attendees' perceived knowledge, skills, attitudes, and their 'community of practice' at baseline and follow-up. A cross-sectional design compared 112 participants' with 335 non-participants' scores on knowledge and prevention behaviors, and considered the social impact with social network analyses.

Results: Demonstrating feasibility in small rural communities, local PC CARES facilitators hosted 59 two to three hour learning circles with 535 participants (376 unique). Local facilitators achieved acceptable fidelity to the model (80%), and interpreted the research accurately 81% of the time. Discussions reflected participants' understanding of the research content and its use in their lives. Participants showed positive changes in perceived knowledge, skills, and attitudes and strengthened their 'community of practice' from baseline to follow-up. Social network analyses indicate PC CARES had social impact, sustaining and enhancing prevention activities of non-participants who were 'close to' participants. These close associates were more likely take preventive actions than other non-participants after the intervention.

Conclusion: PC CARES offers a practical, scalable method for community-based translation of research evidence into selfdetermined, culturally-responsive suicide prevention practice.

Keywords: Alaska Native; Community Education; Community Mobilization; Community of Practice; Suicide Prevention; Train-the-Trainer; Upstream Prevention.

Copyright © 2019 Elsevier Ltd. All rights reserved.

Figures

Fig. 1.

Comparison of Mean Learning Outcome Scores by dose of intervention. Note: * represents a statistically significant finding between those who completed 2 + LCs and those who attended 0 LCs. All other pair-wise comparisons among groups were non-significant.

Fig. 2.

Social Network Results: Significance size and directionality of eight tests from PC CARES prevention program. Note. Pink circles signify statistically significant positive change, and blue triangles signify statistically significant negative change. The size of the symbol corresponds the magnitude of association between PC CARES and the item. Empty cells indicate that no significant relationship was found for a question given the respective measure. See online supplements for the measures related to Q1 - Q39 (Appendix C) and for a description of the tests used (Appendix D). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)