Effectiveness Trial of Wingman-Connect Implemented Across Career Phases

Wingman-Connect 跨职业阶段实施的有效性试验

• 批准号: 10723587
• 负责人: Peter A Wyman
• 金额: $ 176.14万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-16 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10723587
• 关键词: Address; Air; Air Force Personnel; Climate; Communication; Data; Diffusion; Effectiveness; Exposure to; Funding; Health; Human Resources; Individual; Intervention; Leadership; Mediating; Mediation; Mediator; Mental Depression; Military Personnel; Morale; Occupational; Outcome; Patient Self-Report; Periodicals; Phase; Population; Prevention approach; Prevention program; Process; Randomized; Records; Reporting; Research Personnel; Severities; Social Network; Suicide; Suicide attempt; Suicide prevention; Surveys; Techniques; Testing; Training; Vision; Work; active control; base; career; cohesion; computerized; coping; design; digital; effectiveness study; effectiveness testing; effectiveness trial; effectiveness/implementation trial; experience; follow-up; implementation determinants; implementation measures; implementation outcomes; programs; reducing suicide; remediation; scale up; secondary analysis; skills; social attachment; suicidal behavior; suicidal individual; suicidal morbidity; suicidal risk; suicide rate; theories; therapy development; translational pipeline; universal prevention; usability

ABSTRACT Military suicide rates increased 61% from 2008 – 2019 and rates have increased faster in the U.S. Air Force (USAF) compared to other branches. Currently, the predominant military suicide prevention approach is to try to remediate suicide risk after suicidal individuals are identified. No RCT-validated universal programs shown to reduce vulnerability to suicide are in wide use. To fill this gap, the Wingman-Connect Program is a group-based intervention that strengthens protective relationship networks and skills for managing career and personal challenges, to reduce vulnerability to suicide across the broad USAF population. This proposed Hybrid Effectiveness-Implementation trial tests the effectiveness of the Wingman-Connect Program on individual suicide risk and on base-level suicide attempts. We will examine theory-driven mediators and moderators and implementation of the program as delivered by US Air Force (not research) personnel under real world conditions across 2 sequential early career phases. This effectiveness study is the critical next stage in the translational pipeline toward large-scale roll-out to prevent suicide deaths. To rigorously test effectiveness, we co-developed with USAF partners a 2-stage randomized design. (1) The first stage of randomization will be at Initial Technical Training, in which 396 classes of USAF personnel will be randomized to Wingman-Connect or to an active control (N=2,970 Airmen) and followed for one year. These classes send a high proportion of graduates to 8 operational bases. (2) The second stage of randomization will occur among these 8 operational bases, which will be randomized in pairs to start implementing WC at 4- month intervals (stepped wedge design). Once WC has been initiated at each base, all entering first-term Airmen will receive WC, with ~17,400 total Airmen trained across all bases. This 2-stage design will yield robust, multi-level effectiveness findings. Aim 1: Test effectiveness of WC on reducing (a) self-reported suicide risk and (b) base-level rates of suicide attempts. We will evaluate (a) individual level outcomes of suicide risk, depression, and occupational problems up to 1 yr; and (b) base-level administrative records of suicide attempts. Aim 2: Evaluate theory-proposed network health mediators and moderators. WC is expected to increase Airmen's positive social bonds, group cohesion, morale, and healthy coping norms in their social networks; those changes will contribute to reduced suicide risk, depression and occupational problems. Aim 3: Examine implementation determinants and mechanisms, and refine Implementation Package. Key implementation outcomes will be USAF implementers' fidelity delivering WC (n=24-30) and engagement in training/technical support. Implementer fidelity and engagement is expected to be predicted by base implementation climate and WC embeddedness into base communications and support activities.

抽象的 2008 年至 2019 年，军人自杀率上升了 61%，美国空军的自杀率上升更快 部队（美国空军）与其他军种相比。目前，军队预防自杀的主要方法是 在确定自杀者后尝试补救自杀风险。没有经过 RCT 验证的通用程序 已被证明可以减少自杀的可能性，并被广泛使用。为了填补这一空白，Wingman-Connect 计划是 基于群体的干预措施，加强保护性关系网络和职业管理技能 个人挑战，以减少广大美国空军人口的自杀风险。这个提议 混合有效性实施试验测试了 Wingman-Connect 计划的有效性 个人自杀风险和基本自杀企图。我们将研究理论驱动的中介因素 主持人和该计划的实施由美国空军（非研究）人员根据 跨越两个连续的早期职业阶段的现实世界条件。这项有效性研究是下一阶段的关键 正在大规模推广以防止自杀死亡。严格测试 为了提高有效性，我们与美国空军合作伙伴共同开发了两阶段随机设计。 （一）第一阶段 随机化将在初始技术培训中进行，其中 396 类美国空军人员将被随机分配 随机分配至 Wingman-Connect 组或主动对照组（N=2,970 名飞行员）并随访一年。这些 班级将高比例的毕业生输送至8个运营基地。 (2) 第二阶段随机化 发生在这 8 个作战基地中，这些基地将随机成对地在 4 点开始实施 WC 月间隔（阶梯楔形设计）。每个基地启动WC后，所有人员都进入第一学期 飞行员将接受 WC，所有基地共有约 17,400 名飞行员接受训练。这种两阶段设计将产生 稳健、多层次的有效性研究结果。 目标 1：测试 WC 在降低 (a) 自我报告的自杀风险和 (b) 基本水平方面的有效性 自杀未遂率。我们将评估 (a) 自杀风险、抑郁症和抑郁症的个体水平结果 长达 1 年的职业问题； (b) 自杀未遂的基层行政记录。 目标 2：评估理论提出的网络健康中介和调节因素。预计WC 增加飞行员积极的社会纽带、群体凝聚力、士气和健康的社交应对规范 网络；这些变化将有助于降低自杀风险、抑郁症和职业问题。 目标3：检查实施决定因素和机制，完善实施 包裹。主要实施成果将是美国空军实施者交付 WC 的忠诚度 (n=24-30) 和 参与培训/技术支持。预计实施者的忠诚度和参与度可以通过以下方式预测 基地实施氛围和 WC 嵌入基地通信和支持活动中。