Publication: Piloting Implementation Design and Preliminary Readiness for Universal Suicide Risk Screening Program in Emergency Department of a Tertiary Care Centre, Nepal: A Mixed Method Study
| creativeworkseries.issn | JNMA Print ISSN: 0028-2715; Online ISSN: 1815-672X | |
| dc.contributor.author | Shrestha,Anmol Purna | |
| dc.contributor.author | Shrestha, Roshana | |
| dc.contributor.author | Shakya, Renu | |
| dc.contributor.author | Paudel, Pratiksha | |
| dc.contributor.author | Sorenson, Madeleine | |
| dc.contributor.author | Gurung, Amrita | |
| dc.contributor.author | Bajracharya, Riya | |
| dc.contributor.author | Risal, Ajay | |
| dc.contributor.author | Vijayakumar, Lakshmi | |
| dc.contributor.author | Hagaman, Ashley | |
| dc.date.accessioned | 2025-07-30T06:50:25Z | |
| dc.date.available | 2025-07-30T06:50:25Z | |
| dc.date.issued | 2024 | |
| dc.description | Anmol Purna Shrestha Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal Roshana Shrestha Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal Renu Shakya Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Kavre, Nepal Pratiksha Paudel Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Kavre, Nepal Madeleine Sorenson Department of Social and Behavioral Science Department, Yale School of Public Health, Connecticut, United States of America Amrita Gurung Department of Psychology, Padma Kanya Campus, Tribhuvan University, Kathmandu, Bagmati, Nepal Riya Bajracharya Department of Community Programs, Dhulikhel Hospital-Kathmandu University Hospital, Dhulikhel, Kavre, Nepal Ajay Risal Department of Psychiatry, Dhulikhel Hospital-Kathmandu University Hospital, Kavre, Dhulikhel, Kavre , Nepal Lakshmi Vijayakumar Department of Psychiatry, Volunteer Health Services Hospital, Chennai, India Ashley Hagaman Department of Social and Behavioral Science Department, Yale School of Public Health, Connecticut, United States of America | |
| dc.description.abstract | Abstract Introduction: Nearly three quarters of the suicides occur in developing world, however few evidenced-based health systems strategies exist to detect and prevent suicide in these contexts. This pilot study evaluates the feasibility of implementing a universal suicide risk screening program in a Nepalese emergency department. Methods: This study reports the preliminary training phases of a pilot implementation trial in the emergency department to evaluate the program. The approval was obtained from the Nepal Health Research Council (Approval no. 447/2021 P), and the Kathmandu University School of Medical Sciences Institutional Ethical Review Board (Approval no. 237/2021) and Yale University IRB (Protocol ID 2000029480). Implementation assessments included suicide screening acceptability, appropriateness, confidence, system priority, and myth knowledge of staff. Implementation strategies were selected, decolonized, and preliminarily trained followed by phased supportive coaching to initiate the screening package. We designed the implementation package through co-design staff focus groups and embedded ethnography. Results: Co-design focus groups (n=8) occurred with staff and leadership. We trained 26 (76.47%) the staff on the Nepali suicide screening tool followed by supported phased initial screening over two months. Implementation assessments demonstrated increased scores on appropriateness, confidence, system priority, and myth knowledge. The implementation package included key strategies to be deployed over six months. The embedded ethnographic observations revealed barriers to effective implementation, such as anticipated stigma, reluctance to engage families, and distrust in referral processes. Conclusions: The pilot study demonstrated that training improves staff appropriateness, confidence, system priority, and myth knowledge. Despite initial barriers, co-designed strategies and phased coaching facilitates screening uptake, highlighting the program's potential for sustainable implementation. | |
| dc.identifier | https://doi.org/10.31729/jnma.8832 | |
| dc.identifier.uri | https://hdl.handle.net/20.500.14572/956 | |
| dc.language.iso | en_US | |
| dc.publisher | Nepal Medical Association | |
| dc.title | Piloting Implementation Design and Preliminary Readiness for Universal Suicide Risk Screening Program in Emergency Department of a Tertiary Care Centre, Nepal: A Mixed Method Study | |
| dc.type | Article | |
| dspace.entity.type | Publication | |
| local.article.type | Original Article | |
| oaire.citation.endPage | 813 | |
| oaire.citation.startPage | 803 | |
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