# Contextualisation of the safeTALK™ Suicide Prevention Program: A Descriptive Qualitative Study

## TL;DR

This study adapts the safeTALK™ suicide prevention program for use in Nepal by incorporating local cultural and socioeconomic factors.

## Contribution

The study provides a culturally contextualized adaptation of a suicide prevention program for Nepalese adolescents using community-based participatory research.

## Key findings

- Participants emphasized the high need for adolescent suicide prevention in Nepal due to cultural and socioeconomic factors.
- Stigma around suicide was identified as a barrier preventing adolescents from seeking help.
- Modifications such as translating the program into Nepali and incorporating local cultural practices were suggested.

## Abstract

Suicide prevention programmes have effectively reduced suicidal behaviours, increased knowledge and fostered help‐seeking. However, suicide is a complex phenomenon, and its risk and protective factors differ across cultures.

To contextualise the LivingWorks safeTALK™ suicide prevention programme for secondary school students in Nepal.

A qualitative descriptive approach using focus groups informed by the Socio‐Ecological Model and guided by Community‐Based Participatory Research (CBPR) was used. The study was conducted in Nepal via Zoom™ from Australia, from September 15–30, 2024. Five focus groups were conducted with 18 participants, including adolescents, schoolteachers, parents, healthcare providers, and policymakers. Data were transcribed, translated to English and uploaded to NVivo v.14. A hybrid content analysis approach was used.

Data were presented across seven categories: 1. Factors contributing to suicide in Nepal, 2. The need for adolescent suicide prevention programmes in Nepal, 3. Stigma around suicide in Nepal, 4. Attitude towards adolescent suicide and the safeTALK™ suicide prevention programme, 5. Recommended modifications to the safeTALK™ programme 6. Readiness to implement an adolescent suicide prevention programme in Nepal, and 7. Challenges in implementing an adolescent suicide prevention programme in Nepal. Participants reported the need for adolescent suicide prevention in Nepal is high, and contributing factors to suicide are influenced by cultural practices and socioeconomic conditions. Further stigma around suicide prevents adolescents from seeking help. Some modifications to the existing programme were suggested by the participants. Some of the suggestions included translating the programme to Nepali and inclusion of Nepalese cultural practices. Minor modifications were made following approval from LivingWorks Australia.

Suicide prevention is a major issue and requires further research to develop a culturally appropriate suicide prevention programme, especially among at‐risk adolescents in Nepal.

Adapted CBPR gave voice to the community, and led to dialogue and learning, and participatory decision‐making that were reflected in the contextualised safeTALK™ suicide prevention programme.