(PS13-4) Just-in-time Intervention for Promoting Coping Strategy Use for Suicidal Thoughts: Qualitative Indicators of Feasibility and Acceptability

Despite research spanning over half a century on suicidal thoughts and behaviors (STBs), suicide remains a leading cause of death. Identifying effective and scalable ways to reduce suicide risk, especially in the high-risk post-hospitalization period, is imperative. Previous research utilizing real-time monitoring methods has revealed that suicidal urges can fluctuate rapidly. Delivering “just-in-time” interventions via mobile devices during the high-risk post-hospitalization period is a promising adjunctive suicide risk reduction strategy.  

Our team recently developed and piloted, using a micro-randomized trial (MRT) design, a novel just-in-time intervention using automated, interactive smartphone-based messages aimed to promote in-the-moment coping strategy use for suicidal thoughts. Messages either provided reminders of specific coping strategies from the participant’s own safety plan (which were developed during inpatient hospitalization) or recommended other common coping strategies (coded across > 400 participant safety plans). A total of 77 adults hospitalized for STBs were enrolled in the MRT and prompted to complete 6 brief daily surveys on momentary suicidal thoughts for 4 weeks after discharge. When participants endorsed elevated suicidal thoughts on a momentary survey, they were randomized to immediately receive or not receive the just-in-time messages. Participants were invited to complete an end-of-study phone-based qualitative interview, during which a semi-structured interview guide was used to qualitatively assess the feasibility and acceptability of the just-in-time messages. General impressions, perceived helpfulness, and specific suggestions about message content, frequency, and timing were subsequently examined.

A total of 43 MRT participants (55.8%) ultimately participated in the end-of-study interview. Of those who completed the interview, 25 (58.1%) were randomized at least once to potentially receive the just-in-time messages, whereas 18 (41.9%) never met criteria for randomization. Examples of the messages were shown to all at the start of the interview. Audio recordings from the interviews were transcribed, and rapid coding –a high-level thematic extraction process that has been shown to be well suited to informing ongoing intervention development (Holdsworth et al, 2020) –was used to extract key themes. Initial findings from interviews coded to date (n=14) suggest overall positive views of the messages among those who were never randomized (n=8) and mixed views on message helpfulness, as well as preferred frequency and timing, among those who had been randomized to potentially receive messages during the study (n=6). Commonly endorsed themes across participants include the potential for messages to also be helpful outside of periods of suicidal thinking, but that messages must not be too frequent or add burden. Extracted themes from the full sample will be presented as coding of the remaining 29 transcripts is ongoing. This line of work underscores the importance of continuously soliciting and incorporating feedback from end users to inform the development and evaluation of new intervention approaches for suicide prevention during high-risk care transition periods.