title: Developing social capital in implementing a complex intervention: a process evaluation of the early implementation of a suicide prevention intervention in four European countries.
abstract: BACKGROUND
  Variation in the implementation of complex multilevel interventions can impact on their delivery and outcomes. Few suicide prevention interventions, especially multilevel interventions, have included evaluation of both the process of implementation as well as outcomes. Such evaluation is essential for the replication of interventions, for interpreting and understanding outcomes, and for improving implementation science. This paper reports on a process evaluation of the early implementation stage of an optimised suicide prevention programme (OSPI-Europe) implemented in four European countries.
  
  
  METHODS
  The process analysis was conducted within the framework of a realist evaluation methodology, and involved case studies of the process of implementation in four European countries. Datasets include: repeated questionnaires to track progress of implementation including delivery of individual activities and their intensity; serial interviews and focus groups with stakeholder groups; and detailed observations at OSPI implementation team meetings.
  
  
  RESULTS
  Analysis of local contexts in each of the four countries revealed that the advisory group was a key mechanism that had a substantial impact on the ease of implementation of OSPI interventions, particularly on their ability to recruit to training interventions. However, simply recruiting representatives of key organisations into an advisory group is not sufficient to achieve impact on the delivery of interventions. In order to maximise the potential of high level 'gatekeepers', it is necessary to first transform them into OSPI stakeholders. Motivations for OSPI participation as a stakeholder included: personal affinity with the shared goals and target groups within OSPI; the complementary and participatory nature of OSPI that adds value to pre-existing suicide prevention initiatives; and reciprocal reward for participants through access to the extended network capacity that organisations could accrue for themselves and their organisations from participation in OSPI.
  
  
  CONCLUSIONS
  Exploring the role of advisory groups and the meaning of participation for these participants revealed some key areas for best practice in implementation: careful planning of the composition of the advisory group to access target groups; the importance of establishing common goals; the importance of acknowledging and complementing existing experience and activity; and facilitating an equivalence of benefit from network participation.
authors: Nursing, Midwifery and Allied Health Professions Research Unit, Iris Murdoch Building, University of Stirling, Stirling FK9 4LA, UK. fiona.harris@stir.ac.uk
authors: Fiona M
authors: FM
authors: Harris
authors: Margaret
authors: M
authors: Maxwell
authors: Rory C
authors: RC
authors: O'Connor
authors: James
authors: J
authors: Coyne
authors: Ella
authors: E
authors: Arensman
authors: András
authors: A
authors: Székely
authors: Ricardo
authors: R
authors: Gusmão
authors: Claire
authors: C
authors: Coffey
authors: Susana
authors: S
authors: Costa
authors: Zoltan
authors: Z
authors: Cserháti
authors: Nicole
authors: N
authors: Koburger
authors: Chantal
authors: C
authors: van Audenhove
authors: David
authors: D
authors: McDaid
authors: Julia
authors: J
authors: Maloney
authors: Peeter
authors: P
authors: Värnik
authors: Ulrich
authors: U
authors: Hegerl
mesh_terms: D061345:Early Medical Intervention / Q000458:organization & administration*; D005060:Europe; D017144:Focus Groups; D006801:Humans; D019982:Organizational Case Studies; D015397:Program Evaluation; D036301:Qualitative Research; D012944:Social Support; D000092864:Suicide Prevention