A health community assessment found suicide is a public health priority in Malekan County, East Azarbaijan Province, Iran 2014 (incidence rate of 12 per 100 000 persons). Then a regional community-based SPP was developed in Primary Health Care (PHC) of Malekan County during 2014–2017.
Malkan County is located in northwestern Iran with a population of 111,319 people (female: 53,653; male: 57,666) according to the 2015 national census. The native language of all the people of this County is Turkish (Azerbiajan) and all of them are Muslims. Almost, 70% of the county population lives in rural areas. Their main occupations are farming or farming-related. For developing a local (Malekan County) suicide prevention program, a mixed-method study was conducted to determine and prioritize the best practice and strategies of multilevel elements of suicide prevention.
We used two methods for selecting effective programs and interventions for suicide prevention: 1) A review of systematic reviews and 2) Field expert opinions and priority through the Hanlon technique. The identified programs and strategies from electronic search (research evidence) were combined with expert comments to select and prioritize the best and effective interventions for community-based suicide prevention in Malekan society.
1) Review Of Systematic Reviews
Search strategy
A review of systematic reviews has been performed by Christina et al [9] in 2011 related to the best practice and interventions or programs for suicide prevention. Accordingly, we systematically searched for all English language published systematic review studies through Medline, Cochrane Library, PsycINFO, and grey literature from January 1, 2011, and December 30, 2014.
Our search focused on effective community-based interventions and programs that were used for suicide prevention overall, and in particular among the general population and young people. Grey literature and relevant sites, such as WHO and CDC, were explicitly explored. The initial search used the relevant MeSH terms (i.e., Medical Subject Headings) in conjunction with “suicide” “prevention” and “review” in the title and/or abstract. Then the primary search was combined with “programs, strategies, methods, control, intervention, depression, suicidal behavior/behavior, suicide attempted, primary health care, family physicians, mass media, schools, adolescents, and health promotion”. Boolean operators including AND, OR, NOT was used to combine the terms.
We selected community-based strategies or interventions in the review of systematic reviews that were effective in reduction of suicide and SB. The target group was also the general population, especially with an emphasis on adolescents and young people.
All primary researches, narrative and scoping reviews, critical and literature reviews, pharmacological interventions, reviews which assessed single intervention or special groups of people or patients, records with poor information, and reviews that not identified an effective SPP reduce suicide rates were excluded.
Two experts independently reviewed the included papers and extracted and summarized the required data (authors, year, name and type of SPP, and target group) in MS Excel 2010 software. For discrepancies, a third expert made the final decision. At the end of this stage first draft of list of interventions or programs was prepared by the two experts.
2) Expert Panel Opinion
The effective strategies and programs identified from the review of systematic reviews (evidence-based) were assessed and prioritized by an expert panel in Tabriz University of Medical Sciences including academics from the Department of Psychiatry and executives from the Department of Mental Health (the provincial Deputy of Health), and the County Health Network experts. The panel used the Hanlon method to prioritize the best strategies for developing an SPP for Malekan County. Interventions from published evidence (review studies) were discussed in accordance with the local level by experts including health managers, psychiatrists, psychologists, mental health experts, adolescent health experts, epidemiologists, health system researchers, family physicians, community health workers, and nurses of the hospital emergency ward.
In the Hanlon method, a list of suicide prevention strategies and programs has been identified from the review of systematic reviews, then the strategies were ranked by the panel members using a five-point scale. Then, strategies have been rated by expert panel members based on following 5 criteria: feasibility: the degree of being simply or conveniently done), effect/importance: is the program suitable for the health problem?, cost-effectiveness: compares the relative costs and outcomes of different courses of programs and actions based on field expert views in the present study, timeliness: the time/speed of the steps, from obtaining information up to the action in a surveillance system, and acceptability: will the community accept the program? Is it wanted? Based on the five criteria rankings assigned to each strategy or program from the previous step, and then the priority scores were calculated for each particular strategy/program.