JMIR Publications

ABSTRACT

Background:

Suicide is a major public health concern, and primary care has an important role in detecting and intervening in at-risk cases. However, many primary healthcare workers claim to feel inadequately prepared when it comes to properly identifying, preventing, and handling suicidal behaviour in clinical practice.

Objective:

The objective of this study is to develop and evaluate an intervention for improving primary healthcare workers ability to identify, prevent, and handle suicidal behaviour.

Methods:

This protocol describes the PROMESA study, which uses a multimethod design in four sequential phases, in line with some of the phases laid out in the Medical Research Council framework for developing and evaluating complex interventions. In phase 1, a qualitative study will be performed using four focus groups and at least 20 semi-structured interviews with primary healthcare professionals, people with lived experience, and bereaved family members, via a thematic analysis. Phase 2 will involve a retrospective case-control study covering the period 2019-2023. The analysis will focus on sociodemographic and clinical factors as well as patterns of use of healthcare services utilization among individuals who showed suicidal behaviour. Data will be obtained from Electronic Health Records to identify cases and matched controls, enabling the assessment of associations between these factors and suicidal behaviour. Two interventions will be designed for phase 3: (1) the specific training and delivery of a report with the results of the study from phase 2 to PC HCWs, and (2) the same intervention plus the inclusion of a tool in which patients self-evaluate their risk of suicide. Phase 4 will consist of a controlled, phase II, single-blind, randomized clinical trial with three parallel arms (intervention 1, intervention 2, and a control group), which will assess the feasibility and effectiveness of these interventions including 126 primary healthcare workers.

Results:

The study was funded in 2024, March. Recruitment of health care professionals is currently ongoing. The study findings will be reported in future publications.

Conclusions:

The epidemiological trends and documented gaps in primary care preparedness highlight the need for strengthened strategies in the early detection and management of suicidal behaviour. This study is expected to provide essential insights into the feasibility and acceptability of implementing tailored training and decision‑support tools for primary healthcare workers. By combining qualitative perspectives, epidemiological evidence, and a controlled feasibility trial, the project will help determine whether the interventions can be integrated into routine practice and whether they show promise for improving clinical response to suicidal behaviour. The findings will inform the refinement of the intervention and guide the development of a future full‑scale evaluation aimed at advancing suicide prevention efforts in primary care. Clinical Trial: Registration number ISRCTN8134762 on 25/04/2025.