Adaptation and implementation of safety planning for suicide prevention among youth in botswana

The National Institute of Mental Health (NIMH) awarded the University of Botswana $614,921 under the Mental Health Research Grants program (CFDA 93.242) to adapt and implement the Safety Planning Intervention (SPI) for suicide prevention among youth in Botswana. The award, issued September 23, 2025, with a completion date of September 22, 2028, will deliver culturally adapted suicide prevention materials and implementation strategies designed specifically for high school and university-age students in Botswana's public educational sector. Key deliverables include linguistically and content-modified SPI materials adapted through World Health Organization guidelines; implementation strategies co-designed with school stakeholders, Ministry of Education and Skills Development officials, and guidance and counseling teachers; and training and piloting of task-shifted SPI delivery by school-based educators.

The three-year project will produce evidence-based implementation guidance for scaling SPI across Botswana's educational system, addressing disproportionately high suicide rates among youth in low- and middle-income countries. Deliverables will include documented linguistic and content adaptations, semi-structured interview findings on implementation barriers and facilitators, expert consensus recommendations for effective implementation, and pilot implementation data demonstrating feasibility and effectiveness of the adapted intervention in the school setting. The research partnership leverages the University of Botswana's Office of Research and Development and local public schools to ensure culturally appropriate and contextually viable suicide prevention services for the target population.

Abstract

Reducing the high burden of death by suicide in low- and middle-income countries requires the effective implementation of evidence-based practices for suicide prevention. In botswana, suicide disproportionately affects youth. Specifically, high school and university-age students experience elevated rates of suicide-related thoughts and behaviors. The safety planning intervention (SPI) is an established practice for suicide prevention. To maximize successful implementation of SPI among youth in botswana, there is a need to adapt SPI for use in the target setting and to use participatory methods to CO-design implementation strategies. Schools offer an ideal setting to implement SPI to increase reach to individuals in greatest need. This research will focus on youth aged 15-24 years in the public educational sector. Through a partnership with the university of botswana and local public schools, we will employ rigorous participatory methods to culturally adapt SPI and inform implementation of SPI. Specifically, over the three-year period, we will adapt SPI through linguistic and content modifications, task-shift delivery of SPI to guidance and counselling (g & c) teachers, CO-create strategies to implement the adapted SPI into schools, and pilot implementation strategies. First, we will apply the world health organization guidelines to employ a three-step process of forward translation, back translation, and focus group discussions to complete linguistic and content adaptations. Second, we will develop implementation strategies for SPI. We will elicit perspectives on determinants of implementation (e.g., barriers and facilitators) of SPI through semi-structured interviews with a multi-partner group of implementers (e.g., teachers) and leadership (e.g., ministry of education and skills development (moesd) officials). A group of experts (e.g., implementation scientists, ministry of health and wellness leadership, moesd leadership, g & c teachers, mental health clinicians, youth, and educational leadership) will operationalize the input gleaned from the interviews through the systematic process of implementation mapping that integrates theory, participatory input, and context. This work will yield a menu of contextually and partner-informed implementation strategies for the adapted SPI among youth in schools in botswana. Third, we will conduct a pilot hybrid type III effectiveness-implementation trial to test the implementation strategies among six public schools in the south east region of botswana, during which we will measure the impact on feasibility, acceptability, appropriateness, fidelity, and preliminary effectiveness (suicidal ideation and behavior). This work will yield generalizable insights for other regions and community engagement engendered through the research process. Leveraging the new partnerships formed for this proposal, future efforts can systematically evaluate the impact of the strategies on reducing death by suicide and increasing the uptake of SPI across botswana.