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.

摘要 从2008年到2019年，军人自杀率上升了61%，而且美国空军的自杀率增长更快 部队(USAF)与其他分支机构相比。目前，主要的军事自杀预防方法是 在有自杀倾向的人被确认后，试图补救自杀风险。没有经过随机对照试验验证的通用计划 被广泛使用来降低自杀的易感性。为了填补这一空白，Wingman-Connect计划是一个 以团体为基础的干预，加强保护关系网络和管理职业和 个人挑战，以减少广大美国空军人口的自杀倾向。这项建议 混合有效性-实施试验测试Wingman-Connect计划的有效性 个人自杀风险和基层自杀企图。我们将考察理论驱动的调解人和 由美国空军(而不是研究)人员主持和实施该计划 两个连续的职业早期阶段的真实世界条件。这一有效性研究是下一阶段的关键 在向大规模推广以防止自杀死亡的转化管道中。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一项两阶段随机设计。(一)第一阶段 在最初的技术培训中将随机进行，其中将有396级美国空军人员 随机进行配对或主动对照(N=2,970名飞行员)，并跟踪一年。这些 班级将高比例的毕业生送到8个作战基地。(2)第二阶段随机化将 在这8个业务基地中发生，将成对随机开始执行WC-4- 月份间隔(阶梯形楔形设计)。一旦在每个基地启动了WC，所有人都进入了第一学期 飞行员将接受WC，所有基地总共有17,400名飞行员接受培训。这两个阶段的设计将产生 强大的、多层次的有效性调查结果。 目标1：测试WC在降低(A)自报自杀风险和(B)基本水平方面的有效性 自杀未遂的比率。我们将评估(A)自杀风险、抑郁和 1岁以下的职业问题；和(B)自杀未遂的基层行政记录。 目的2：评估理论建议的网络健康调解人和主持人。预计WC将 增强飞行员积极的社会纽带、群体凝聚力、士气和健康的社会应对规范 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：审查执行决定因素和机制，完善执行 包裹。关键实施成果将是美国空军实施者的忠诚度，提供WC(n=24-30)和 参与培训/技术支持。实施者的忠诚度和参与度预计将通过 基地实施气候和WC融入基地通信和支助活动。