Table 2.
Barriers and facilitators to the implementation of a standardized psychological autopsy.
| CFIR domain | Inner setting | Outer setting | Characteristics of the individual | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Barriersa | Resources (time, money) of organizations (9) | Health care professionals fear of being judged and held accountable (7) | Increasing work pressure (3) | Rigid/no open-to-change culture in mental health care (3) | Obstructive privacy laws (17) | Fluctuating political support (5) | Complex decentralized healthcare system with regional differences in priorities (3) | Limited public funds (2) | Perceived risk to wellbeing of bereaved and interviewers (21) | Taboo on talking about suicide (4) | Emotional involvement and feelings of guilt of healthcare professionals and bereaved (4) | Difficult to reach people with migration background (3) and other hard-to-reach groups (2) | Major skill requirements for interviewer/ self-efficacy (2) |
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| Facilitatorsa | Aligning needs of involved stakeholders (7) | A good infrastructure for process and valorisation (6) | Clear ownership of a single organization (4) | Effective collaborative use of funds (4) | Prove effect within setting (pilot) (9) | Early involvement of different stakeholders (5) | Bottom-up approach (2) | Strong legal framework (2) | Create awareness, reduce stigma (2) | Supportive current political climate (2) | A trustworthy ‘brand,’ focused on added value and positive experience (4) | Increase visibility of intervention by campaigns (2) | |||
| CFIR domain | Characteristics of the intervention | Implementation processes | |||||||||||||
| Barriersa | Expensive intervention (15) | Relative advantage limited (9) | Data limitations: difficult to translate to meaningful interventions (7) | Selection bias (6) | Name of the intervention has clinical/forensic implications (5) | Interpretation bias (4) | Validity of qualitative interview data (4) | Evidence base for specific goals is limited (3) | Recall bias of retrospective approach (2) | Learning effect decreases over time (2) | No evaluation parameters and variables (8) | Long term intervention without fixed period (2) | |||
| Facilitatorsa | Proper interviewer training and guidance (7) | Trauma and grief sensitive language: connect on the level of the bereaved (4) | Follow-up after interview (2) | Triangulation of sources (multiple interviews, documentation) (2) | Focus on objective data in aggregation (2) | Multiple regional interview teams (1) | Early engagement of bereaved and bereaved organizations in the process (3) | Change agents for hard-to-reach populations (2) | Support regional comparison (1) | ||||||
a The numbers in brackets indicate how many stakeholders reported this barrier or facilitator.