Promoting Community Conversations About Research to End Suicide: learning and behavioural outcomes of a training-of-trainers model to facilitate grassroots community health education to address Indigenous youth suicide prevention

Figures & data

Figure 1. Conceptual model: Promoting Community Conversations About Research to End Suicide.

Box 1. PC CARES content, sharing method and learning circle format content and sharing method.

(LC 1)Film re: Historical trauma, culture suicide (LC 2)Chart: Adults roles in youth suicide prevention (LC 3)Figure: Seasonality and Alaska Native youth suicide (LC 4)Charts: community protective factors (LC 5)Film: Supportive counseling as prevention (LC 6)Image: Restricting lethal means (LC 7)Case study: Follow up after a suicide attempt (LC 8)Chart: Postvention: What to do /not to do to (LC 9)Posters: Review all and plan moving forward Format of the 3-Hour Monthly Learning Circle Format: Create a hospitable space (safe, private) where traditional practices are respected (e.g. Elders, circle seating, food) 1. Start with prayer led by an Elder from the community 2. Establish agreements for how to work together & remind participants about safely talking about suicide (posters) 3. Reflections about last meeting – reporting of actions taken (“small wins”) 4. Go over the purpose of PC CARES and of particular session • WHAT DO WE KNOW? “Bite-size” information from research (5–10 min) • WHAT DO WE THINK? Storytelling to consider the research (45–60 min) • WHAT DO WE WANT TO DO? Apply the research (20–30 minutes) 5. Check-out – Circle so that everyone gets a chance to speak 6. End with a prayer led by an Elder from the community

Figure 2. Readiness of facilitators to support suicide prevention in their communities before (pre) and after (post) attending the week-long facilitator training.

Figure 3. Facilitator satisfaction with PC CARES (after participating in LC1 compared with after participating in all 9 LCs over the course of the week-long training).

Table 1. Number of villages hosting each learning circle & participants.

	Number of villageshosting each LC	Number of attendees combined
LC1	10	160
LC2	10	83
LC3	9	76
LC4	7	54
LC5	5	39
LC6	4	21
LC7	4	13
LC8	3	9
LC9	2	10
Totals	54 LCs done in Villages	465 (not unique)

Table 2. Data collection and analysis.

Measure description	When given	Examination of findings
Facilitator readiness: 19-item, 5-point Likert scale of agreement	Before and after week-long TOF	Paired pre-post means compared using Wilcoxon signed rank test with STATA 14 (n=23)
Facilitator satisfaction: 25-item, 5-point Likert scale of agreement	After facilitators participated in LC1, and after attending all LCs in the TOF	All surveys for each time point (after LC1 and after doing 9 LCs in the TOF) are combined to find means for each item and compared using Wilcoxon signed rank test with STATA 14
Demonstration of facilitation	During the TOF, each facilitation team hosted 1 LC	Trainers participated in the LC facilitated by trainees, and offered feedback about their session: what went well and could be improved
Group Quiz about LC research content with individuals answering T/F questions about the research content of LCs	End of TOF	All responses recorded by team, and correct answers are discussed with rationale. Areas of confusion are clarified in a group setting
Implementation or process tracking in villages
Accuracy in interpreting research evidence presented in LCs	Audio recording of LCs taking place in villages	3-point scale used to assess the degree of accuracy: 1=accurate, aligned with intent, to 3=inaccurate
Fidelity checking: documenting the extent to which local facilitators adhered to Facilitator Guide	Audio recording of LCs taking place in villages	Transcribed and coded by 2 independent reviewers: 1–0 for following the procedures on 6 LC elements, averaged for each session and across all sessions
Facilitator feedback in group discussions	Facilitator meetings midway and after doing PC CARES in their villages	Notes taken during the 2 in-person meetings in April 2016 and January 2017 were analysed for basic themes and shared back with facilitators for their approval