Evidence of co-creation practices in suicide prevention in government policy: a directed and summative content analysis.

BACKGROUND: In Australia, the collaborative involvement of stakeholders, especially those with lived experience in mental health and suicide prevention, has become important to government policy and practice at Federal and State levels. However, little is known about how governments translate this intention into frameworks of co-creation for policy, funding programs, service improvement, and research and evaluation. We investigated the extent to which publicly available government policies refer to collaborative practice using an established translation model. METHODS: An exploratory directed and summative content analysis approach was used to analyse the contents of Federal (also known as Commonwealth), State and Territories policy documents on mental health and suicide prevention published in Australia between 2010 and 2021. The data was extracted, compared to an existing translation model, and summated to demonstrate the evidence of co-creation-related concepts between government and stakeholders. RESULTS: 40 policy documents (nine at the Federal and 31 at the State and Territory level) were identified and included in the analysis. Only 63% of policy documents contained references to the concept of co-design. Six of the State policies contained references to the concept of co-production. Across all policy documents, there were no references to other concepts in the model adopted for this study, such as co-creation, co-ideation, co-implementation, and co-evaluation. CONCLUSION: Although the government at Federal, State and Territory levels appear to support collaborative practice through partnership and co-design, this study suggests a narrow approach to the theoretical model for co-creation at a policy level. Implications for both research and practice are discussed.

A mixed-methods systematic review of suicide prevention interventions involving multisectoral collaborations.

BACKGROUND: Governments and third-sector organizations (TSOs) require support to reduce suicide mortality through funding of suicide prevention services and innovative research. One way is for researchers to engage individuals and services in multisectoral collaborations, to collaboratively design, develop and test suicide prevention services and programmes. However, despite widespread support, to date, it remains unclear as to the extent to which stakeholders are being included in the research process, or if they are, how these partnerships occur in practice. To address this gap, the authors conducted a systematic review with the aim of identifying evidence of multisectoral collaborations within the field of suicide prevention, the types of stakeholders involved and their level of involvement. METHODS: The authors conducted a strategic PRISMA-compliant search of five electronic databases to retrieve literature published between January 2008 and July 2021. Hand-searching of reference lists of key systematic reviews was also completed. Of the 7937 papers retrieved, 16 papers finally met the inclusion criteria. Because of data heterogeneity, no meta-analysis was performed; however, the methodological quality of the included studies was assessed. RESULTS: Only one paper included engagement of stakeholders across the research cycle (co-ideation, co-design, co-implementation and co-evaluation). Most stakeholders were represented by citizens or communities, with only a small number of TSOs involved in multisectoral collaborations. Stakeholder level of involvement focused on the co-design or co-evaluation stage. CONCLUSION: This review revealed a lack of evidence of multisectoral collaborations being established between researchers and stakeholders in the field of suicide prevention research, even while such practice is being espoused in government policies and funding guidelines. Of the evidence that is available, there is a lack of quality studies documenting the collaborative research process. Also, results showed that the inclusion of co-researchers from communities or organizations is defined as co-creation, but further analysis revealed that collaboration was not consistent across the duration of projects. Researchers and practitioners should consider issues of power and equity in multisectoral collaborations and encourage increased engagement with TSOs, to rigorously research and evaluate suicide prevention services.

Informing the personalisation of interventions for parents of children with conduct problems: a qualitative study.

BACKGROUND: Parenting programmes aim to alleviate behavioural problems in children, including conduct disorder. This study was part of a multi-phase mixed-methods project seeking to extend the reach of parenting programmes for the treatment of conduct problems through developing an evidence base to inform a personalised approach. It explored the narratives of parents of children with behavioural and conduct problems about parenting programmes to identify how such programmes could be personalised in order to extend their reach to parents and children who do not currently benefit. METHODS: Face-to-face semi-structured interviews with a purposive sample of 42 parents, who had different experiences of parenting programmes. Interviews were conversational and informed by a topic guide. Analysis of transcripts of audio-recorded interviews drew on inductive thematic approaches and was framed largely within a phenomenological perspective. RESULTS: Parents' accounts demonstrated three themes: 1) a personalised approach needs to include the child; 2) a supportive school matters; and, 3) the programme needs to feel personal. Parents were more likely to have a positive experience at a parenting programme, and for their child to demonstrate positive behavioural changes, when they felt their concerns were validated within the group and they also felt supported by the child's teachers. Parents whose children had been assessed prior to undertaking the programme were also more likely to perceive the programme to be beneficial, compared to parents who felt their child's individual issues were never considered. CONCLUSIONS: Our findings point to the potential for personalised approaches to extend the reach of parenting programmes to parents and children who do not currently benefit from such programmes. Important in personalising parenting programmes is assessing children before parents are referred, to directly work with children as well as parents, and to work collaboratively with parents and children to identify which families are most suited to group support or one-to-one support and how this may change depending on circumstances.

Primary Sclerosing Cholangitis and Psychological Wellbeing: A Scoping Review.

Primary sclerosing cholangitis (PSC) is a chronic liver disease resulting from the inflammation and scarring of an individual's hepatic bile ducts. With no curative treatment available and a risk of potentially severe complications and death, it is likely that those diagnosed with the illness may experience impairments in their psychological wellbeing. The aim of this scoping review is to locate, chart, and summarize all available literature on how PSC affects mental health and psychological wellbeing, as well as the factors that may or may not impact on the psychological wellbeing of those who have this diagnosis. This exercise identified five key themes within the literature: prevalence and characteristics of mental health problems, quality of life, unmet needs, medical treatment, and biomarkers. Three key recommendations for clinical practice emerge from this review.

Colorectal Cancer Outcomes in a Large Negative Computed Tomography Colonography Screening Cohort.

INTRODUCTION: At our institution, the most common cohort of individuals having computed tomography colonography (CTC) are those that require primary screening for colorectal cancer and were unable to tolerate or failed optical colonoscopy (OC). CTC is an efficient method for detecting polyps, masses, flat-lesions, and overt colorectal cancer, serving as a viable alternative to colonoscopy. This study follows patients with negative CTC results to evaluate the number of clinically significant lesions that may have been potentially missed by CTC. We suspect this number will be exceedingly low given the high sensitivity of this technique. METHODS: All patients with negative CTC screening (n = 509) in the Eastern Health Medical Health Region, located in Newfoundland and Labrador, Canada were included. An electronic medical record review was undertaken, encompassing provider, colonoscopy, imaging, and histopathology reports. Subjects were also checked through the Newfoundland Cancer Clinic Registry Database. All incidents of colorectal cancer were recorded. RESULTS: The study cohort comprised 509 subjects. These subjects were followed for an average of 7.88 years. Two colorectal adenocarcinomas in this cohort were identified representing a crude cancer incidence rate of 0.49 cancers per 1000 patient years, and a rate of 0.39% following a normal CTC. CONCLUSIONS: Colorectal cancer presenting clinically is rare in the 7.88 years following a negative CTC, suggesting CTC is equally effective for colorectal screening compared to OC. Furthermore, current guidelines that recommend interval CTC screening every 5 years is conservative, and interval screening can likely be recommended over a longer time frame.

Advocacy and luck: Australian healthcare experiences following a suicide attempt.

High quality mental healthcare after a suicide attempt is a key strategy for preventing subsequent suicide attempts and deaths, yet little is known about how people navigate the healthcare system following a suicide attempt. This paper focuses on the stories told by 20 people who had attempted suicide. Five themes emerged: fitting into the healthcare system; need for advocacy; consistent care; lucky to find help; and, small kindnesses. Positive and empathetic healthcare experiences, as well as connected services, assisted the recovery of people who have attempted suicide.

Informed consent in a vulnerable population group: supporting individuals aging with intellectual disability to participate in developing their own health and support programs.

Objective The aim of the present study was to explore the use of complementary consent methodologies to support a potentially vulnerable group of people, namely those aging with intellectual disability, to provide personal input. It was premised on the view that processes to determine capacity for consent, appropriately modified to account for individual capabilities and current circumstances, could facilitate meaningful participation in the development of personal health care plans of people previously excluded from contributing. Methods The present descriptive case study research was undertaken in New South Wales, Australia. A seven-step process for determining capacity for consent was developed, and 10 participants aged between 54 and 73 years with lifelong intellectual disability and health comorbidities were involved. A variety of assistive communication tools was used to support individuals to demonstrate their capacity for giving informed consent. Results After being provided with tailored support mechanisms, seven participants were considered to meet all seven components for determining capacity for consent. Three participants were deemed not to have capacity to give consent regardless of the type of support provided. Conclusions Three critical factors for facilitating personal involvement in decision making for individuals with an intellectual disability were identified: (1) defining consent specifically for the target outcome; (2) outlining the criteria needed for consent to be obtained; and (3) using appropriately modified alternative communication mechanisms as necessary. What is known about the topic? Self-determination is one of the fundamental principles of human rights legislation around the world and, as such, it is considered desirable to have personal input by individuals into the development of their own health care plans. However, this is not always considered feasible if the person comes from a group in the community perceived to be vulnerable to exploitation and viewed as lacking capacity to give informed consent. This results in the use of proxy respondents, who may not accurately represent the desires and life aspirations of the individual. What does this paper add? This paper examines the development and implementation of a targeted program to support individuals aging with lifelong intellectual disability to demonstrate their capacity to provide informed consent. Specifically, it outlines how alternative communications methods, tailored to personal needs and capacity, can assist an individual to both understand and then confirm their understanding of consent in order to participate in developing health care plans. What are the implications for practitioners? People with intellectual disability are now living longer and are increasingly at risk of serious health conditions. The development of long-term health management plans has traditionally not included individuals with more complex needs and moderate intellectual disability, but the present study shows that members of this cohort can successfully understand and consent to participate in health care decision making. By proactively supporting this process, community and healthcare settings may be able to directly facilitate contribution from more individuals, therefore better meeting the goal of person-centred support.

Holding on to hope: A review of the literature exploring missing persons, hope and ambiguous loss.

When a person goes missing, those left behind mourn an ambiguous loss where grief can be disenfranchised. Different to bereavement following death, hope figures into this experience as a missing person has the potential to return. This review explores hope for families of missing people. Lived experience of ambiguous loss was deconstructed to reveal responses punctuated by hope, which had practical and psychological implications for those learning to live with an unresolved absence. Future lines of enquiry must address the dearth of research exploring the role of hope, unresolved grief, and its clinical implications when a person is missing.

MRCP imaging of duplicate gallbladder: a case report and review of the literature.

PURPOSE: Duplicate gallbladder is a rare congenital abnormality of the hepatobiliary system that has an incidence of roughly 1 in 4000. Many surgical studies have demonstrated that congenital anomalies of the gallbladder and anatomical variations of its position are associated with an increased risk of complications after laparoscopic cholecystectomy. METHODS: Using ultrasound, MRCP and 3D reconstructions, we report a case of a 29-year-old female who was incidentally revealed to have a duplicated gallbladder. A review of the literature surrounding this variant, its anatomical classifications and relevance to surgical practice is included. CONCLUSION: The double gallbladder is a rare congenital condition that is often not considered in the differential diagnosis for a patient with gallbladder disease or intraoperatively. At present, it is only detected via pre-operative imaging in 50% of cases, but an understanding of the limitations of ultrasound combined with more frequent and thorough use of MRCP before surgical intervention could prevent serious complications of laparoscopy in these patients.

Suicide and accidental death in Australia's rural farming communities: a review of the literature.

INTRODUCTION: Australia's farmers constitute a heterogeneous group within the rural population. This literature review incorporates four broad areas: an understanding of farming communities, families and individuals and the contexts in which they live and work; an exploration of the challenges to morbidity and mortality that these communities face; a description of the patterns of suicide and accidental death in farming communities; and an outline of what is missing from the current body of research. Recommendations will be made on how these gaps may be addressed. METHODS: In developing this comprehensive literature review, a snowballing and saturation approach was adopted. Initial search terms included suicid*, farm*, accident*, fatal*, death, sudden death, rural OR remote, Australia and NOT Australia. Databases searched included SCOPUS, PubMed, Proquest and SafetyLit; research from 1995 onwards was examined for relevance. Earlier seminal texts were also included. Reference lists of retrieved articles were searched and citations explored for further relevant research material. The primary focus was on Australian peer-reviewed research with supplementary grey literature. International material was used as examples. RESULTS: The literature variously describes farmers as members of both rural farming communities and farming families, and as individuals within an occupational classification. Within each of these classifications, there is evidence of the cumulative impact of a multiplicity of social, geographical and psychological factors relating to work, living and social arrangements that impact the health and wellbeing of Australia's farmers and their families, particularly accidental death and suicide. Research consistently demonstrates traumatic death to be at a greater rate than in the general Australian population, with reductions found more recently in some modes of farming-related accidental death. Patterns of accidental death and suicide are commonly linked to the changing shape of contemporary farming. Suicide rates are also frequently described in relation to lethality and accessibility of means. The limitations of suicide and accidental death data are considerable. CONCLUSION: While there is consistent reporting of heightened levels of risk for suicide and accidental death in farming communities the limitations of the research remain significant. There are substantial gaps in current knowledge, and the body of research to date lacks clarity, inclusiveness and contextual specificity. Absent from the literature is any investigation of the impact of these frequently preventable deaths on the families and communities in which they occur. Recommendations for future research are suggested.

Watch Me Play!: protocol for a feasibility study of a remotely delivered intervention to promote mental health resilience for children (ages 0-8) across UK early years and children's services.

BACKGROUND: Half of mental health problems are established by the age of 14 years and 75% by 24 years. Early intervention and prevention of mental ill health are therefore vitally important. However, increased demand over recent years has meant that access to child mental health services is often restricted to those in severest need. Watch Me Play! (WMP) is an early intervention designed to support caregiver attunement and attention to the child to promote social-emotional well-being and thereby mental health resilience. Originally developed in the context of a local authority mental health service for children in care, it is now also delivered online as a low intensity, scalable, preventative intervention. Although WMP shows promise and is already used in some services, we do not yet know whether it is effective. METHODS: A non-randomised single group feasibility study with embedded process evaluation. We propose to recruit up to 40 parents/carers of children aged 0-8 years who have been referred to early years and children's services in the UK. WMP involves a parent watching the child play and talking to their child about their play (or for babies, observing and following signals) for up to 20 min per session. Some sessions are facilitated by a trained practitioner who provides prompts where necessary, gives feedback, and discusses the child's play with the caregiver. Services will offer five facilitated sessions, and parents will be asked to do at least 10 additional sessions on their own with their child in a 5-week period. Feasibility outcomes examined are as follows: (i) recruitment, (ii) retention, (iii) adherence, (iv) fidelity of delivery, (v) barriers and facilitators of participation, (vi) intervention acceptability, (vii) description of usual care, and (viii) data collection procedures. Intervention mechanisms will be examined through qualitative interview data. Economic evaluation will be conducted estimating cost of the intervention and cost of service use for child and parents/carers quality-adjusted life years. DISCUSSION: This study will address feasibility questions associated with progression to a future randomised trial of WMP. TRIAL REGISTRATION: ISRCTN13644899 . Registered on 14th April 2023.

Thinking Time, Shifting Goalposts and Ticking Time Bombs: Experiences of Waiting on the Gender Identity Development Service Waiting List.

LOGiC-Q is a prospective longitudinal qualitative study that explores the experiences of children and young people, and their families, who have been referred to the Gender Identity Development Service (GIDS) in the UK. This paper describes the experiences of children and young people and their parents while they are on the waiting list to be seen. Semi-structured interviews were undertaken with 39 families who had been referred to GIDS and were waiting for their first appointment with the service. Both parent and child/young person were interviewed. Analysis of the anonymised interview transcripts was informed by both narrative and thematic approaches, and three predominant narratives around waiting were identified: 1. Positive experiences attached to waiting; 2. Feelings of distress and stuckness; 3. Suggestions for support while waiting. Findings from this study indicate variations in how waiting is experienced depending on the age of the child, and how distressed their body makes them feel. Young people and their parents offered suggestions for how the service could support families on the waiting list. These suggestions related primarily to ways of checking in and providing reassurance that they were at least still on the list as well as ideas about how to make the wait less distressing, rather than necessarily making the wait shorter, which was more spoken about in terms of an ideal rather than a realistic option.

Co-creation of new knowledge: Good fortune or good management?

BACKGROUND: Potential solutions to bridging the research practice gap include collaborative frameworks and models. Yet there is little evidence demonstrating their application in practice. In addressing this knowledge gap, this in-depth case study explored how the co-creation of new knowledge framework and its four collaborative processes (co-ideation, co-design, co-implementation, and co-evaluation) are utilised to support people who had attempted suicide through an Australian psychoeducational program known as Eclipse. METHODS: Using a case study design and a thematic analysis methodology, multiple sources of qualitative data (collaborative group discussion, personal communications) were analysed inductively and deductively to examine the implementation of co-creation and explore the perspectives of researchers and stakeholders about co-creation and collaborative relationships. RESULTS: Three broad themes were identified: (1) understanding the language and practice of co-creation, (2) perception of trust formation, and (3) the value of co-creation opportunities. Ultimately, implementing co-creation with or between researchers, industry and people with lived experience requires trust, reciprocity, good fortune, and good management. While implementing co-creation, the co-creation framework was revised to include additional elements identified as missing from the initially proposed framework. CONCLUSION: Co-creation of new knowledge poses many challenges to researchers and stakeholders, particularly regarding its "messiness" and non-linear approach to implementation and evaluation. However, as this case study demonstrates, it has the potential to become an alternative framework of best practice for public health interventions in third sector organisations, most notably as it eliminates the often-lengthy gap reported between research evidence and translation into practice. The research highlights the need for co-creation to further study its effectiveness in integrating research and service delivery to generate new knowledge. This may lead to a cultural and behavioural change in the service provider's approach to research, offering better outcomes for providers, clients, policymakers, universities, and funders.

Organisations and researchers need to collaborate to produce new knowledge of health interventions. The literature identifies that there is a substantial evidence gap between producing knowledge and improving health outcomes. Here we reflect, via a case study methodology, on ways to co-create new knowledge by following a four-step collaborative process. The case study reviews the evaluation of an Australian-based psychoeducational program for people who attempt suicide by analysing multiple qualitative data sources to explore the perspectives of researchers and stakeholders. We discovered the need for a shared language of co-creation that focuses on experiences of collaboration while seeking out new value-creation opportunities and dismantling barriers. We learnt that implementing co-creation requires trust and good fortune within collaborative relationships alongside good management. Using the alternative collaboration framework of best practice for public health interventions in third sector organisations may eliminate gaps between research evidence and translation into practice, assisting health providers, clients, policymakers, universities, and funders.

"Sometimes I think my frustration is the real issue": A qualitative study of parents' experiences of transformation after a parenting programme.

INTRODUCTION: Parenting programmes help to alleviate conduct problems in children, but ensuring that all parents feel supported to attend, complete and learn from these programmes has proven difficult. Parents can feel overwhelmed and struggle to change their parenting. This article aims to inform the future refinement of parenting programmes by examining parents' narratives of how programmes motivated them to change and enabled them to put changes into practice. METHOD AND RESULTS: Forty-two parents, most of whom had attended Incredible Years group sessions, were interviewed about their views and experiences of parenting programmes that focused on positive parenting practices. Analysis of interview transcripts drew on thematic approaches. Parents perceived that parenting programmes helped them to better understand their child and themselves and to let go of anxieties surrounding their child's behaviour. Better understanding included greater awareness of emotions and of behaviours their child could and could not control. Parents believed this awareness helped them to change the ways that they interacted with their child, which, in turn, helped them and their child to feel calmer. With greater understanding and calmness parents believed they became more able to see for themselves the changes that they could make in their parenting and everyday lives, and to feel more confident in putting these into practice. DISCUSSION: By supporting parents to reflect on their own and their child's situation, parents perceived that programmes enabled them to improve interactions with their children without getting stuck in self-blame or feeling overwhelmed. Parents of children whose behaviour remained challenging believed that programmes led to beneficial changes in the way they felt about their child's behaviours. Enhanced support for reflection by parents could potentially help more families to benefit from parenting programmes.

Longitudinal outcomes of gender identity in children (LOGIC): a study protocol for a prospective longitudinal qualitative study of the experiences and well-being of families referred to the UK Gender Identity Development Service.

INTRODUCTION: Gender Identity Development Services (GIDS) worldwide have experienced a significant increase in referrals in recent years. However, little is currently known about the experiences of the children and young people (CYP) and their families attending these services and the influences on their well-being. Most published qualitative studies have explored gender identity and gender questioning CYP from either a parental perspective or in an adolescent sample. Consequently, there is a need for research to explore the voices of younger children and adolescents who are referred to GIDS. This study aims to address current gaps in understanding of the experiences of CYP referred to the UK GIDS, specifically regarding the personal, familial, educational, and social contexts in which CYP and their parents/caregivers are navigating gender identity, social and physical transition, and the healthcare system. METHODS AND ANALYSIS: A prospective longitudinal qualitative study examining the experiences and well-being of CYP referred to the UK GIDS. A purposive sample of up to 40 families will be recruited. Families will be eligible for the study if the child or young person was aged 3-14 years at the time of referral to the GIDS. Semistructured interviews will be conducted with both the child/young person and their parents/caregivers. Analysis of anonymised interview transcripts will be interpretive and pluralistic, informed by both narrative and thematic approaches. This study forms part of a wider programme of research investigating longitudinal outcomes of gender identity in children (the LOGIC Study). ETHICS AND DISSEMINATION: The proposed study has been approved by the UK Health Research Authority and London-Hampstead Research Ethics Committee as application 19/LO/0857. The study findings will be published in peer-reviewed journals and presented at both conferences and stakeholder events.

Fears, Reassurance, and Milestones: A Twitter Analysis around World Prematurity Day during the COVID-19 Pandemic.

Preterm birth (birth <37 completed weeks' gestation) is common, affecting 10.6% of live births globally (nearly 15 million babies per year). Having a new baby admitted to a neonatal unit often triggers stress and anxiety for parents. This paper seeks to explore experiences of preterm birth via Twitter. The intermingling of COVID-19 restrictions and World Prematurity Day allows for an understanding of both the additional stresses incurred as a consequence of the pandemic and the more "everyday" experiences in the NICU and beyond. The content analysis of the data included 3161 tweets. Three themes were identified: 1. COVID-19 was not the only trauma; 2. Raising awareness, especially World Prematurity Day; and, 3. Baby milestones. These themes highlight the multi-level challenges faced by parents of premature babies and the healthcare professionals involved in their care. The COVID-19 pandemic and the consequent restrictions imposed on parents' contact with their babies have resulted in immense emotional strain for families. The reported COVID-19 pandemic "baby blind spot" appears to particularly impact this group of babies. Improved understanding of the lived experiences of preterm babies and their families should inform greater awareness and improved support.

"At Least until the Second Wave Comes ": A Twitter Analysis of the NHS and COVID-19 between March and June 2020.

In the UK, tweets around COVID-19 and health care have primarily focused on the NHS. Recent research has identified that the psychological well-being of NHS staff has been adversely impacted as a result of the COVID-19 pandemic. The aim of this study was to investigate narratives relating to the NHS and COVID-19 during the first lockdown (26 March-4 July 2020). A total of 123,880 tweets were collated and downloaded bound to the time period of the first lockdown in order to analyse the real-time discourse around COVID-19 and the NHS. Content analysis was undertaken and tweets were coded to positive and negative sentiments. Five main themes were identified: (1) the dichotomies of 'clap for carers'; (2) problems with PPE and testing; (3) peaks of anger; (4) issues around hero worship; and (5) hints of a normality. Further research exploring and documenting social media narratives around COVID-19 and the NHS, in this and subsequent lockdowns, should help in tailoring suitable support for staff in the future and acknowledging the profound impact that the pandemic has had.

Youth Suicide Bereavement and the Continuum of Risk.

Background: There is limited research investigating the risks for young friends exposed to the suicide of peers. Aims: This study aimed to better understand the impact of suicide bereavement on rural young people. Method: Participants in this a mixed-method study were 18 young people who had been exposed to a friend's suicide and who resided in rural Australia. Quantitative data were analyzed with SPSS and qualitative data were analyzed thematically. Results: Participants reported high levels of depression, anxiety, and alcohol use. Key themes were communication about the death, responses to the death, and coping with the death. Young people identified as close friends with the person who died were at less risk of their own suicidal behavior, but demonstrated increased mental health concerns. More peripheral friends were identified at greater risk of suicide. Limitations: The limitations of the study were the purposeful sampling open to selection bias, lack of randomization, and results from one point in time. Conclusion: These findings support that guidelines and interventions following a youth suicide need to better target both the peripheral friends, owing to their greater suicide risk, and the closer friends, owing to other mental health concerns.

How is Participating in Suicide Prevention Activities Experienced by Those with Lived and Living Experiences of Suicide in Australia? A Qualitative Study.

: People with a lived experience of suicide are commonly included within suicide prevention research. This includes participation in conferences, policy development, research and other activities. Yet little is known about the impact on the person in the long term of regularly sharing one's experience to different audiences and, in some cases, to a schedule not of your choosing. This qualitative study asked twenty people to share their reflections of being lived experience representatives within suicide prevention. Participants varied in the length of time they had been sharing their stories, and how they shared with different audiences. These narratives were thematically analysed within a reflective framework, including field notes. Four broad themes were noted that highlighted participants' recommendations as to how the lived experience speaker training could grow alongside suicide prevention activities to facilitate safe activities that include a shared understanding of the expected outcome from participation. The environment for people with lived experience of suicide to tell their stories already exists, meaning that the suicide prevention sector needs to move quickly to ensure people understand the variety of spaces where lived experience needs to be incorporated, evaluated and better supported. When lived experience is a valued inclusion in the creation of effective and appropriate suicide prevention research and interventions, those who share their experience must be valued and supported in a way that reflects this. This study recommends strategies to practically and emotionally support speakers, including ways to ensure debriefing and support, which can enhance the longevity of the speakers in the suicide prevention space by valuing the practical and emotional labour required to be suicide prevention representatives, with an outcome recommendation for best practice guidelines for those who engage people with lived experience in suicide prevention activities.

What Is the Co-Creation of New Knowledge? A Content Analysis and Proposed Definition for Health Interventions.

Co-creation of new knowledge has the potential to speed up the discovery and application of new knowledge into practice. However, the progress of co-creation is hindered by a lack of definitional clarity and inconsistent use of terminology. The aim of this paper is to propose a new standardised definition of co-creation of new knowledge for health interventions based on the existing co-creation literature. The authors completed a systematic search of electronic databases and Google Scholar using 10 of the most frequently used co-creation-related keywords to identify relevant studies. Qualitative content analysis was performed, and two reviewers independently tested the categorisation of papers. Of the 6571 papers retrieved, 42 papers met the inclusion criteria. Examination of the current literature on co-creation demonstrated how the variability of co-creation-related terms can be reduced to four collaborative processes: co-ideation, co-design, co-implementation and co-evaluation. Based on these four processes, a new definition of co-creation of new knowledge for health interventions is proposed. The analysis revealed the need to address the conceptual ambiguity of the definition of "co-creation of new knowledge". The proposed new definition may help to resolve the current definitional issues relating to co-creation, allowing researchers and policymakers to progress the development of co-creation of new knowledge in research and practice.