Dataset Information

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.

SUBMITTER: Wexler L

PROVIDER: S-EPMC6925945 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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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.

Wexler Lisa L Rataj Suzanne S Ivanich Jerreed J Plavin Jya J Mullany Anna A Moto Roberta R Kirk Tanya T Goldwater Eva E Johnson Rhonda R Dombrowski Kirk K

Social science & medicine (1982) 20190523

<h4>Rationale</h4>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.<h4>Method</h4>Using a multi-method design, the study describes a series of locally-facilitated "learning circles" ov ...[more]

PMID: 31151026

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Project description:Alaska Native (AN) youth suicide remains a substantial and recalcitrant health disparity, especially in rural/remote communities. Promoting Community Conversations About Research to End Suicide (PC CARES) is a community health intervention that responds to the need for culturally responsive and evidence-supported prevention practice, using a grassroots approach to spark multilevel and community-based efforts for suicide prevention. This paper describes theoretical and practical considerations of the approach, and assesses the feasibility and preliminary learning and behavioural outcomes of the training-of-trainers model. It details the training of a first cohort of intervention facilitators in Northwest Alaska (NWA). Thirty-two people from 11 NWA village communities completed the PC CARES facilitator training, preparing them to implement the intervention in their home communities. Facilitator pre-post surveys focused on readiness to facilitate, a group quiz assessed participants' understanding of relevant research evidence, and practice facilitation exercises demonstrated competency. Curriculum fidelity and accuracy scores were calculated using audio recordings from learning circles conducted by facilitators in their home communities. Facilitator reflections describe the successes of the model and identify several areas for improvement. As of March 2017, 20 of the 32 trained facilitators in 10 of the 11 participating villages have hosted 54 LCs, with a total of 309 unique community members. Coding of these LCs by 2 independent raters indicate acceptable levels of fidelity and accurate dissemination of research evidence by facilitators. Facilitator reflections were positive overall, suggesting PC CARES is feasible, acceptable and potentially impactful as a way to translate research to practice in under-resourced, rural AN communities. PC CARES represents a practical community education and mobilisation approach to Indigenous youth suicide prevention that displays preliminary success in learning and behavioural outcomes of local facilitators.

Project description:Importance: Goals of care discussions at the end of life give opportunity to affirm the autonomy and humanity of dying patients. Best practices exist for communication around goals of care, but there is no research on differences in approach taken by different specialties engaging these conversations. Objective: To describe the communication practices of internal medicine (IM), emergency medicine (EM), and critical care (CC) physicians in a high-fidelity simulation of a terminally ill patient with stable and defined end-of-life preferences. Design, Setting, and Participants: Mixed-methods secondary analysis of transcripts obtained from a multicenter study simulating high stakes, time-limited end-of-life decision making in a cohort of 88 volunteer physicians (27 IM, 22 EM, and 39 CC) who were called to evaluate a standardized patient in extremis. The patient had clear comfort-oriented goals of care that the physician needed to elicit and use to inform treatment decisions. Discussions were coded at the level of the sentence for semantic content. Exposures: Data were analyzed by physician specialty. Main Outcome Measure: Occurrence of content codes indicative of prudent (right outcome by the right means) goals of care conversations. Data were analyzed both for number of occurrences of the code in a simulated conversation and for presence or absence of the code within a conversation. Results: There was no difference between physician types in intubation rates or intensive care unit admissions. Codes for "comfort as a goal of care," "noncurative goals of care," and "oblique references to death" emerged as significantly different between physician types. Conclusions and Relevance: This experiment shows demonstrable differences in practice patterns between physician specialties when addressing end-of-life decision making. Some of the variation likely arose from differences in setting, but these data suggest that training in goals of care conversations may benefit if it is adapted to the distinct needs and culture of each specialty.

Dataset Information

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.

Publications

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.

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