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Appears in Collections:Faculty of Health Sciences and Sport Journal Articles
Peer Review Status: Refereed
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
Author(s): Harris, Fiona Margaret
Maxwell, Margaret
O'Connor, Rory
Coyne, James
Arensman, Ella
Szekely, Andras
Gusmao, Ricardo
Coffey, Claire
Costa, Susana
Cserháti, Zoltan
Koburger, Nicole
Audenhove, Chantal van
McDaid, David
Maloney, Julia
Värnik, Peeter
Hegerl, Ulrich
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Keywords: Complex interventions
process evaluation
suicide prevention
realist evaluation
social capital
Issue Date: Feb-2013
Citation: Harris FM, Maxwell M, O'Connor R, Coyne J, Arensman E, Szekely A, Gusmao R, Coffey C, Costa S, Cserháti Z, Koburger N, Audenhove Cv, McDaid D, Maloney J, Värnik P & Hegerl U (2013) Developing social capital in implementing a complex intervention: A process evaluation of the early implementation of a suicide prevention intervention in four European countries, BMC Public Health, 13 (Article 158).
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 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 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 particular actors 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.
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Rights: © 2013 Harris et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The electronic version of this article is the complete one and can be found online at:

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