IDEAS home Printed from https://ideas.repec.org/a/bla/ijhplm/v40y2025i3p655-671.html

The Role of Contextual Determinants in Implementation of Complex Suicide Prevention Interventions: An Application of the Exploration, Preparation, Implementation and Sustainment (EPIS) Framework

Author

Listed:
  • Sadhvi Krishnamoorthy
  • Gregory Armstrong
  • Victoria Ross
  • Sharna Mathieu
  • Kairi Kõlves

Abstract

Introduction Prevention of suicidal behaviour is complex, and a host of effective interventions have now been recognised in addressing this concern. However, adoption, delivery, and sustainment of these interventions within real‐life settings is challenging; and the translation process, often overlooked. Examining the impact of context is necessary to explain how implementation outcomes are achieved and aid generalisability of findings. This study aims to explore factors influencing implementation outcomes (contextual determinants) across the implementation lifecycle of complex suicide prevention interventions. Methods A qualitative design was adopted. Semi structured interviews were conducted with 16 stakeholders (leaders, project managers/implementors, lived experience advocates) involved in implementation of complex suicide prevention interventions across the world. A purposive and snowball sampling approach was used to identify participants with requisite experiences. An understanding of determinants was deduced from participant narratives. These were mapped using the Exploration, Preparation, Implementation and Sustainment (EPIS) framework. Results Across different phases of implementation, outer context barriers were predominantly reported and pertained to service environmental factors, pre‐existing dynamics, and engaging leadership. Several inner context barriers including individual characteristics, staffing and resources, and challenges in maintaining fidelity were reported during the implementation phase. Bridging factors (such as interrelationships and partnerships) were identified as important facilitators throughout different phases of implementation and levels of context. Implementation strategies related to stakeholder relationship building were prioritised across different phases of implementation. Conclusion This study helps expand the notion of an evidence‐base for complex suicide prevention interventions. Determinants salient across different levels of the social‐ecology and phases of implementation address questions related to what works and under what circumstances.

Suggested Citation

  • Sadhvi Krishnamoorthy & Gregory Armstrong & Victoria Ross & Sharna Mathieu & Kairi Kõlves, 2025. "The Role of Contextual Determinants in Implementation of Complex Suicide Prevention Interventions: An Application of the Exploration, Preparation, Implementation and Sustainment (EPIS) Framework," International Journal of Health Planning and Management, Wiley Blackwell, vol. 40(3), pages 655-671, May.
    • Handle: RePEc:bla:ijhplm:v:40:y:2025:i:3:p:655-671
    DOI: 10.1002/hpm.3911
    as

    Download full text from publisher

    File URL: https://doi.org/10.1002/hpm.3911
    Download Restriction: no
    File URL: https://libkey.io/10.1002/hpm.3911?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Merzel, C. & D'Afflitti, J., 2003. "Reconsidering community-based health promotion: Promise, performance, and potential," American Journal of Public Health, American Public Health Association, vol. 93(4), pages 557-574.
    2. Knox, K.L. & Pflanz, S. & Talcott, G.W. & Campise, R.L. & Lavigne, J.E. & Bajorska, A. & Tu, X. & Caine, E.D., 2010. "The US air force suicide prevention program: Implications for public health policy," American Journal of Public Health, American Public Health Association, vol. 100(12), pages 2457-2463.
    3. Zbukvic, Isabel C. & Mok, Katherine & McGillivray, Lauren & Chen, Nicola A. & Shand, Fiona L. & Torok, Michelle H., 2020. "Short report: Understanding the process of multilevel suicide prevention research trials," Evaluation and Program Planning, Elsevier, vol. 82(C).
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Richard, Lucie & Lehoux, Pascale & Breton, Eric & Denis, Jean-Louis & Labrie, Louise & Leonard, Claudine, 2004. "Implementing the ecological approach in tobacco control programs: results of a case study," Evaluation and Program Planning, Elsevier, vol. 27(4), pages 409-421, November.
    2. Maria Felice Arezzo & Cristina Giudici, 2017. "Social Capital and Self Perceived Health Among European Older Adults," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 130(2), pages 665-685, January.
    3. Selma Metintas & Cemalettin Kalyoncu & İnci Arıkan, 2009. "Two Distinct Training Methods for a Doctrine of Life with Healthy Heart in a Low Socioeconomic Society Model," IJERPH, MDPI, vol. 6(11), pages 1-15, November.
    4. de Leeuw, Evelyne & Skovgaard, Thomas, 2005. "Utility-driven evidence for healthy cities: Problems with evidence generation and application," Social Science & Medicine, Elsevier, vol. 61(6), pages 1331-1341, September.
    5. Kristie L. Ebi, 2011. "Resilience to the Health Risks of Extreme Weather Events in a Changing Climate in the United States," IJERPH, MDPI, vol. 8(12), pages 1-14, December.
    6. Ella Arensman & Claire Coffey & Eve Griffin & Chantal Van Audenhove & Gert Scheerder & Ricardo Gusmao & Susana Costa & Celine Larkin & Nicole Koburger & Margaret Maxwell & Fiona Harris & Vita Postuvan, 2016. "Effectiveness of Depression–Suicidal Behaviour Gatekeeper Training among police officers in three European regions: Outcomes of the Optimising Suicide Prevention Programmes and Their Implementation in Europe (OSPI-Europe) study," International Journal of Social Psychiatry, , vol. 62(7), pages 651-660, November.
    7. Katz, Jason & Wandersman, Abraham & Goodman, Robert M. & Griffin, Sarah & Wilson, Dawn K. & Schillaci, Michael, 2013. "Updating the FORECAST formative evaluation approach and some implications for ameliorating theory failure, implementation failure, and evaluation failure," Evaluation and Program Planning, Elsevier, vol. 39(C), pages 42-50.
    8. Mertens, Frédéric & Saint-Charles, Johanne & Mergler, Donna, 2012. "Social communication network analysis of the role of participatory research in the adoption of new fish consumption behaviors," Social Science & Medicine, Elsevier, vol. 75(4), pages 643-650.
    9. Jones, Andrew D. & Cruz Agudo, Yesmina & Galway, Lindsay & Bentley, Jeffery & Pinstrup-Andersen, Per, 2012. "Heavy agricultural workloads and low crop diversity are strong barriers to improving child feeding practices in the Bolivian Andes," Social Science & Medicine, Elsevier, vol. 75(9), pages 1673-1684.
    10. Colleen M. Fisher & Michael G. Lee & Mary E. Boudreau, 2014. "Using Mixed-Method Assessment to Advance Adolescent HIV Prevention," Clinical Nursing Research, , vol. 23(5), pages 490-513, October.
    11. Tilman Brand & Claudia R. Pischke & Berit Steenbock & Johanna Schoenbach & Saskia Poettgen & Florence Samkange-Zeeb & Hajo Zeeb, 2014. "What Works in Community-Based Interventions Promoting Physical Activity and Healthy Eating? A Review of Reviews," IJERPH, MDPI, vol. 11(6), pages 1-23, May.
    12. Maria Felice Arezzo & Cristina Giudici, 2017. "The Effect of Social Capital on Health Among European Older Adults: An Instrumental Variable Approach," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 134(1), pages 153-166, October.
    13. Stephen Linder & Dritana Marko & Ye Tian & Tami Wisniewski, 2018. "A Population-Based Approach to Mapping Vulnerability to Diabetes," IJERPH, MDPI, vol. 15(10), pages 1-13, October.
    14. Roshini Balasooriya Lekamge & Ria Jain & Jenny Sheen & Pravik Solanki & Yida Zhou & Lorena Romero & Margaret M. Barry & Leo Chen & Md Nazmul Karim & Dragan Ilic, 2025. "Evidence and Gap Map of Whole‐School Interventions Promoting Mental Health and Preventing Risk Behaviours in Adolescence: Programme Component Mapping Within the Health‐Promoting Schools Framework: An evidence and gap map," Campbell Systematic Reviews, John Wiley & Sons, vol. 21(1), March.
    15. Mariano Kanamori & Mario De La Rosa & Cho-Hee Shrader & Cesar Munayco & Susanne Doblecki-Lewis & Guillermo Prado & Steven Safren & Mary Jo Trepka & Kayo Fujimoto, 2019. "Progreso en Salud: Findings from Two Adapted Social Network HIV Risk Reduction Interventions for Latina Seasonal Workers," IJERPH, MDPI, vol. 16(22), pages 1-13, November.
    16. Vermeulen, Lisa & Schäfer, Willemijn & Pavlic, Danica Rotar & Groenewegen, Peter, 2018. "Community orientation of general practitioners in 34 countries," Health Policy, Elsevier, vol. 122(10), pages 1070-1077.
    17. Boelens, Mirte & Jonkman, Harrie & Hosman, Clemens M.H. & Raat, Hein & Jansen, Wilma, 2026. "Process-evaluation of the implementation of a collaborative community programme for health, safety and talent development in youth," Children and Youth Services Review, Elsevier, vol. 182(C).
    18. Navarez, Joel C. & Dela Cruz, Charles Kelvin F., 2024. "Life Skills Integration and Flourishing Education (LIFE): A Suicide Prevention Program," International Journal of Research and Innovation in Social Science, International Journal of Research and Innovation in Social Science (IJRISS), vol. 8(5), pages 701-707, May.
    19. Yiwei Qian & Yi Ming Zheng & Sarah-Eve Dill & Scott Rozelle, 2020. "Correlates of participation in community-based interventions: Evidence from a parenting program in rural China," PLOS ONE, Public Library of Science, vol. 15(9), pages 1-19, September.
    20. Andrej Belak & Zuzana Dankulincova Veselska & Andrea Madarasova Geckova & Jitse P. van Dijk & Sijmen A. Reijneveld, 2017. "How Well Do Health-Mediation Programs Address the Determinants of the Poor Health Status of Roma? A Longitudinal Case Study," IJERPH, MDPI, vol. 14(12), pages 1-18, December.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:bla:ijhplm:v:40:y:2025:i:3:p:655-671. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Wiley Content Delivery (email available below). General contact details of provider: http://www.blackwellpublishing.com/journal.asp?ref=0749-6753 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.