Background
Impact of self-stigma and perceived-stigma
Suicide reporting
Help seeking
Social connection
Ongoing cycle of suicide risk
Reducing self-stigma and perceived-stigma
Identifying gaps in stigma reduction research
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There was a dearth of evidence about digital interventions as a stigma reduction strategy, despite suggestions that the potential for widespread dissemination through digital communication is likely to play a role in stigma reduction [39].
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There was a lack of programs targeting the needs of people aged 30–64 years, when compared with those for people under the age of 30 years (beyondblue, unpublished data, 2013).
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Digital engagement was identified as dropping off after the age of 64 years (beyondblue, unpublished data, 2013).
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Perceived-stigma was identified as being higher in men aged 30–64 years (beyondblue, unpublished data, 2013).
Methods/design
Study design
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At the pilot stage via an online survey and verbal feedback.
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At the post-intervention stage using a 7-point Likert scale, with additional opportunity for including comments.
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At follow-up via semi-structured qualitative interviews.
Study population
Intervention
Knowledge about suicide | Everyone’s experience is different | Talking about suicide | Recognising and maximising resources | Knowing what’s needed for keeping well |
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• Risk/protective factors • Warning signs • Precipitating events • Understanding suicide attempts/thoughts • Suicide stigma | • Cultural and linguistic diversity • Aboriginal and Torres Strait Islanders • Sexuality, sex and gender • Disability, illness and ageing | • Starting and managing conversations with people in distress • Crisis response • Avoiding judgement • Preparation and self-care • Talking in the community about suicide | • Positive and proactive support seeking • Knowing available resources • Overcoming barriers to support • Caring for and supporting others | • Maintaining physical, emotional, intellectual and spiritual health • Personal goal setting (evaluated us behaviourally anchored rating scale – BARS) |
Study tools
Quantitative
Qualitative
Evaluation
Ripple Effect Evaluation measures | Pre-intervention | During intervention | Post-intervention |
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Demographics | |||
• Age | ✓ | ||
• Gender | ✓ | ||
• Location (postal code) | ✓ | ||
• Farming type | ✓ | ||
Detail of suicide experience | ✓ | ||
Suicide stigma (SOSS) [42] | |||
• Self-stigma | ✓ | ✓ | |
• Perceived-stigma | ✓ | ✓ | |
Suicide literacy (LOSS) [44] | ✓ | ✓ | |
Personal goal achievement | ✓ | ✓ | |
Participant feedback | ✓ | ||
Qualitative interviews | ✓ |
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The initial stage of process evaluation will involve a pilot implementation of the Ripple Effect with members of the steering group. These members collectively provide extensive experience of the farming context and clinical mental health experience, and have knowledge about the aims of the Ripple Effect. Pilot participants will provide extensive online feedback via a qualitative survey as well as contribute to a group teleconference for further discussion of feedback that will be used to inform the refinement of the Ripple Effect.
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Following the completion of post-intervention quantitative tools (SOSS and LOSS), online feedback will be sought from the participants by way of a quantitative survey using a 7-point Likert scale, with opportunity for qualitative written comment.
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Follow-up semi-structured qualitative interviews with a small number of participants will investigate a) the further impact of the Ripple Effect on self-stigma and perceived-stigma, complementing and adding richness to the quantitative data in order to more clearly define what is helpful in reducing suicide stigma [12], and b) the experience of participating in the Ripple Effect.
Data collection
Sample size
Data analysis
Outcomes
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Learning and reporting about what works to reduce self-stigma and perceived-stigma associated with an experience of suicide within the farming community (as measured by the SOSS [42]).
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Learning and reporting about what works to increase literacy of suicide within the community of farming (as measured by the LOSS [44]).
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Strengthening participants’ self-perception to enable them to assist others who are suffering, thereby reducing the self-perception of shame and isolation often associated with an experience of suicide.
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Increasing the knowledge base of suicide and its experience, and the experience of associated stigma, in rural farming communities.
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Increasing the knowledge of appropriate and acceptable ways to deliver social and emotional wellbeing messaging to members of the farming community.