The objective of this study is to identify the characteristics of effective messages that facilitate help seeking among Veterans at high risk for suicide. The following specific aims will be pursued to achieve this objective: (1) examine Veteran perceptions of existing public messages designed to motivate help seeking behaviors among those at high risk for suicide; (2) identify message features that influence the likelihood for help seeking behaviors by Veterans during periods of crisis; and (3) explore facilitators and barriers of message use to identify dissemination methods that reflect Veterans' preferences to effectively reach those at high risk for suicide. Individual interviews with Veteran patients (N=40) will be conducted using an interview guide, which reflects the study's conceptual framework (Elaboration Likelihood Model) focused on the mechanisms of persuasive communication. This guide will also be informed by insights gleaned from the Western NY Veteran Research Engagement Board, and will be pilot-tested and refined prior to data collection. Participants will be recruited nationwide. An iterative sampling approach will be employed in which, initially, purposive sampling with maximum variation will be used. Eligible participants will be identified based on the inclusion/exclusion criteria listed below and sample will then be selected to include heterogeneity by age and gender. As data analysis progresses, theoretical sampling will then be employed in which insights gleaned from analyses are used to guide the selection of additional participants. The VA Corporate Data Warehouse (CDW) will be used to identify eligible Veterans who are recruited through invitational mailing and subsequent telephone contact. Once phone contact is initiated with a potential participant, an eligibility screening will be conducted to examine criteria below. Individuals will be considered for participation based on: Inclusion criteria: 1) adult (18+) U.S. Veteran enrolled in VA health care; 2) evidence of a non-fatal suicide attempt in the past 3 to 6 months in VA medical records (ICD-10 code/s); 3) possess (self-reported) reliable internet access to complete study interview; and 4) capable of understanding the goals of the study; and 5) willing and able to provide consent. Exclusion criteria: 1) deemed cognitively impaired (i.e., psychosis, dementia, severe brain injury or other mental disorders that interfere with the ability to comprehend consent/participate); 2) currently institutionalized (i.e., incarcerated, hospitalized); 3) current suicide risk warranting crisis intervention. Additional inclusion criteria are further detailed in the proposal. Women and minorities will be included in the study. Interviews will be conducted using a web-based conferencing service at the convenience of the study participant. Enrolled participants will first review study procedures and provide verbal consent to the interviewer, including consent to be audio-recorded, prior to the interview. Next, participants are shown a convenience sample of three (3) public service announcements (PSAs) and then interviewed directed by the topic guide. Interviews will take approximately 60 minutes to complete, will be audio-recorded and then are transcribed verbatim. Limited demographics will also be collected. Constant comparison techniques will be used for analysis where two separate coders engage in an iterative process to identify and obtain consensus of themes in the data. A summary of findings will also be presented to the Upstate NY Veteran Research Engagement Board to garner additional insights on effective messaging strategies. Results from this proposed study have the potential to inform current VA suicide prevention practices, enhance the VA's mission to deliver Veteran-centric health services that meet the unique needs of the population, particularly vulnerable Veterans, and will guide next steps in this research trajectory that will include a future proposal testing outcomes associated with the resulting messages.
Veterans are at increased risk for suicide as compared to their civilian peers underscoring the need for effective strategies to facilitate help seeking among Veterans vulnerable to self-directed violence. Since 2010, VA has developed a number of public messaging campaigns as part of their suicide prevention strategy to increase help seeking in times of crisis. However, there is a paucity of research examining the effectiveness of these campaigns to increase help seeking among Veterans who need it most. Without careful study, unintentional (and potentially harmful) messages may be disseminated underscoring the importance of message testing with targeted audiences. Yet how these public messages are interpreted or resonate with Veterans at increased risk for suicide is not currently known. The main objective of this pilot study is to begin to address this gap and identify characteristics of effective messages that facilitate help seeking among Veterans at high risk for suicide.
