Adaptation and Implementation of Safety Planning for Suicide Prevention Among Youth in Botswana

PROJECT SUMMARY Reducing the high burden of death by suicide in low- and middle-income countries requires the effective implementation of evidence-based practices for suicide prevention. In Botswana, suicide disproportionately affects youth. Specifically, high school and university-age students experience elevated rates of suicide-related thoughts and behaviors. The Safety Planning Intervention (SPI) is an established practice for suicide prevention. To maximize successful implementation of SPI among youth in Botswana, there is a need to adapt SPI for use in the target setting and to use participatory methods to co-design implementation strategies. Schools offer an ideal setting to implement SPI to increase reach to individuals in greatest need. This research will focus on youth aged 15-24 years in the public educational sector. Through a partnership with the University of Botswana and local public schools, we will employ rigorous participatory methods to culturally adapt SPI and inform implementation of SPI. Specifically, over the three-year period, we will adapt SPI through linguistic and content modifications, task-shift delivery of SPI to guidance and counselling (G&C) teachers, co-create strategies to implement the adapted SPI into schools, and pilot implementation strategies. First, we will apply the World Health Organization guidelines to employ a three-step process of forward translation, back translation, and focus group discussions to complete linguistic and content adaptations. Second, we will develop implementation strategies for SPI. We will elicit perspectives on determinants of implementation (e.g., barriers and facilitators) of SPI through semi-structured interviews with a multi-partner group of implementers (e.g., teachers) and leadership (e.g., Ministry of Education and Skills Development (MoESD) officials). A group of experts (e.g., implementation scientists, Ministry of Health and Wellness leadership, MoESD leadership, G&C teachers, mental health clinicians, youth, and educational leadership) will operationalize the input gleaned from the interviews through the systematic process of implementation mapping that integrates theory, participatory input, and context. This work will yield a menu of contextually and partner-informed implementation strategies for the adapted SPI among youth in schools in Botswana. Third, we will conduct a pilot hybrid type III effectiveness-implementation trial to test the implementation strategies among six public schools in the South East region of Botswana, during which we will measure the impact on feasibility, acceptability, appropriateness, fidelity, and preliminary effectiveness (suicidal ideation and behavior). This work will yield generalizable insights for other regions and community engagement engendered through the research process. Leveraging the new partnerships formed for this proposal, future efforts can systematically evaluate the impact of the strategies on reducing death by suicide and increasing the uptake of SPI across Botswana.