Researching implementation processes is important to determine whether the integrated intervention is sustainable while being implemented on a wider scale, and eventually, spread to other contexts. Within the scale-up study component, researchers aim to explore and assess the translation and public health impact of the integrated intervention program by studying the following elements: A) Reach of the different sub-elements of the complex suicide prevention intervention in the target population in a district in rural Gujarat (adolescents & adults) B) Effectiveness of the integrated intervention in reducing suicide rates and suicidal behaviors in the target populations in a district in rural Gujarat C) Adoption of the complex suicide prevention program by villages, schools and primary health care system in a district in rural Gujarat D) Consistency and cost effectiveness of the delivery of complex suicide prevention program in a district in rural Gujarat To achieve these aims, the said intervention will be implemented in Gujarat?s Mehsana district which has 74% rural population. Of its 9 sub-districts (talukas/blocks) and 618 villages, 60 villages will be selected and randomized to the intervention, and 60 villages will be randomized to the control condition. The intervention group will receive the integrated suicide prevention intervention (implementation in schools in selected villages, community storage facilities in selected villages, and community health worker gatekeeper training in selected villages). We will compare outcomes (suicide rates, suicide attempts and suicide ideation) in villages that receive an intensive, integrated suicide prevention program to comparable control villages, stratified for demographic variables in order to keep the villages in both conditions comparable within the same district who are only exposed to ?usual care? as delivered by the existing primary and secondary health care system.
Scale-up Component Narrative: The scale up study plans to study the implementation of an integrated integrated suicide prevention intervention in Gujarat (India) to better understand the factors associated with sustainable adoption and implementation of effective, generalizable, evidence based interventions for suicide prevention in India and South Asia. This study will therefore contribute to increasing our knowledge and understanding of of key components for scaling up suicide prevention intervention in Gujarat, India and thus help to narrow the implementation gap in Gujarat and South Asia.
