Evidence-Based Prevention

Practicing evidence-based prevention means using the best available research and data throughout the process of planning and implementing your suicide prevention efforts.

Evidence-based prevention includes:

• Engaging in evidence-based practice (sometimes called evidence-based public health)
• Selecting or developing evidence-based programs

Engaging in Evidence-Based Practice

Evidence-based practice has been defined as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of communities and populations in the domain of health protection, disease prevention, health maintenance and improvement (health promotion).”¹

Examples include:²

• Making decisions based on best available scientific evidence
• Using data and information systems systematically
• Applying program-planning frameworks
• Engaging the community in decision making
• Conducting sound evaluation 
• Disseminating what is learned

These processes and activities are a part of SPRC’s strategic planning approach to suicide prevention, which recognizes that suicide prevention efforts are more likely to succeed if they are guided by the best evidence available.

Using Evidence to Select or Develop Programs

One of the key steps in strategic planning is to make decisions about the programs and practices that will be a part of your comprehensive approach to suicide prevention.

Selecting Programs

Good sources of information regarding evidence-based programs are registries (lists of programs that have been evaluated) and literature reviews (articles that summarize findings from different studies).

See these pages of our website for information and resources:

• Best Practices Registry: SPRC’s library of suicide prevention programs and interventions that incorporate best practices, national frameworks and culturally relevant approaches.
• Finding Programs and Practices: Provides links to registries and other program listings, and tips on how to use them.

Things to Keep In Mind About Evidence-Based Programs

• For suicide prevention, relevant outcomes are reductions in suicidal thoughts and behaviors or changes in suicide-related risk and protective factors. Short-term outcomes, such as post-training increases in knowledge, suggest that a program might be effective, but are not conclusive.
• Make sure you look for programs that have evidence related to the desired outcomes and priority populations in your strategic plan.
• The program’s theory of change should also be clear: why would you expect the program to lead to your desired outcomes? (To learn more, see these resources on logic models, which are diagrams often used to answer this question.)
• Read the fine print! The criteria used to designate programs as “evidence-based” vary across registries and reviews.
• No registry or review includes a complete listing of all possible programs, so consult multiple sources.

Adapting or Developing a Program

Even if you can’t find an evidence-based program that meets your needs, your efforts can still be informed by evidence.

When adapting a suicide prevention program or developing a new one, make sure that it:

• Is grounded in a thorough understanding of local problems and assets
• Addresses research-based risk and protective factors for suicide
• Is guided by research-based theories (e.g., behavior change theories) and the voices of the community
• Has a clear theory of change documented in a logic model or conceptual model that shows how the program will achieve its intended results
• Draws from research on related programs and their effectiveness

Cultural Considerations

Using culturally competent approaches is another important key to success. One challenge is that many evidence-based programs for suicide prevention have not been assessed in diverse populations, so their effectiveness with these populations is not known. When implementing an evidence-based program that was evaluated with a population different from the one your program will be targeting, consider doing a small pilot test first.

Practice-based evidence (PBE) is a term sometimes used to refer to practices that are embedded in local cultures and are accepted as effective by the community. Practitioners of PBE models draw upon cultural knowledge to develop programs that are respectful of and responsive to local definitions of wellness. In some cases, PBE also refers to a participatory, “ground up” approach to designing programs, as opposed to a “top-down” process in which programs are developed by academic researchers and then disseminated to local communities. To the extent possible, PBE programs should be evaluated so that they can add to the evidence base for suicide prevention.

Our Settings section provides information and resources for conducting suicide prevention activities in various settings.

For information on practices that are culturally appropriate for American Indian/Alaska Native settings, see our Promising Prevention Practices page. Another excellent resource is Transforming Tribal Communities: Indigenous Perspectives on Suicide Prevention, which includes three brief videos and helpful tools for culturally relevant program development and adapting evidence-based practices for AI/AN communities.

References

1. Jenicek, M. (1997). Epidemiology, evidence-based medicine, and evidence-based public health. Journal of Epidemiology, 7, 187-197. Retrieved from: https://www.jstage.jst.go.jp/article/jea1991/7/4/7_4_187/_pdf
2. Brownson, R. C., Fielding, J. E., & Maylahn, C. M. (2009). Evidence-based public health: A fundamental concept for public health practice. Annual Review of Public Health, 30(1), 175–201.