Exploring Adolescents’ Perspectives on and Experiences with Post-primary School-based Suicide Prevention: A Meta-Ethnography Protocol

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Herring, Jennifer McMahon This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1484675/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 11 Jan, 2023 Read the published version in Systematic Reviews → Version 1 posted 4 You are reading this latest preprint version Abstract Background Globally, suicide is the fourth leading cause of adolescent mortality. Although post-primary school-based suicide prevention (PSSP) interventions are an evidence-based strategy for targeting adolescent suicidal thoughts and behaviours (STBs), PSSP effectiveness does not easily translate to school settings. Although adolescents’ perspectives on PSSP are particularly important for: (1) intervention effectiveness and implementation in both research and practice, (2) addressing PSSP evidence-practice gaps, and (3) enhancing meaningful adolescent involvement in PSSP, there is gap in understanding adolescents’ experiences of engaging with PSSP. As such, this protocol outlines a meta-ethnography which will explore and synthesise adolescents’ perspectives on engaging with PSSP interventions, as participants/end-users, intervention advisors, facilitators, and co-designers and co-researchers. Methods The meta-ethnography protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. The meta-ethnography study design was guided by Noblit and Hares’ (1988) seven stage process for meta-ethnography. Searches of PsycINFO, Medline, Web of Science, CINAHL, ERIC, Scopus and study reference lists will identify peer-reviewed studies. Grey literature will be identified by searches in ProQuest, British Library EThOS, and DART-Europe E-theses Portal. The main reviewer will initially assess the eligibility of studies based on title and abstract, with full texts reviewed by at least two reviewers. Findings of the included studies will be synthesised in line with Noblit and Hare’s stages and evaluated using the Critical Appraisal Skills Programme (CASP) checklist. Discussion To our knowledge, this is the first proposed meta-ethnography to explore and integrate the findings of qualitative studies exploring adolescents’ perspectives on engaging with PSSP interventions. Understanding adolescents’ experiences of engaging with PSSP will impact the field of PSSP in several ways by: (1) enhancing research processes and intervention effectiveness and implementation, (2) informing decision-making and policymaking relevant to practice, (3) guiding meaningful adolescent involvement in PSSP, and (4) contributing to knowledge on the safety implications of engaging adolescents in PSSP. Finally, it is expected that the insights from this meta-ethnography will be widely applicable, given the growing demand for meaningful youth involvement in health-related fields. Registration This protocol is under submission with PROSPERO for preregistration. Post-primary school-based suicide prevention Adolescents Engagement Involvement Experiences Perspectives Evidence synthesis Meta-ethnography protocol Background Suicide is the fourth leading cause of mortality in 15-19-year-olds globally ( 1 ). Concerns of increased youth suicide beyond COVID-19 ( 2 – 4 ) necessitates the implementation of effective adolescent suicide prevention strategies. PSSP is an evidence-based approach for targeting adolescent STBs ( 5 , 6 ), which are prominent risk factors for death by suicide ( 7 ). Despite the potential of PSSP to be a key adolescent suicide prevention approach, there are persistent challenges to translating the effectiveness of PSSP research to school settings, resulting in evidence-practice gaps ( 8 , 9 ). Adolescents’ experiences of engaging with PSSP are largely unexplored but are yet likely paramount to bridging the evidence-practice gap in PSSP. How acceptable and suitable health interventions are perceived by individuals engaged in interventions is critical to both intervention effectiveness ( 10 ) and implementation ( 11 ). Engagement encompasses a variety of ways in which individuals are involved in interventions in research and practice, from participation as end-users to planning, design, analysis, translation and dissemination ( 12 , 13 ). Adolescents not only engage with suicide prevention as research participants and intervention end-users, but also as intervention facilitators ( 14 ) and advisors ( 15 , 16 ) and co-researchers ( 17 ). A review of school-based mental health interventions supported intervention fidelity components linked to adolescents’ perspectives (i.e., receptiveness to interventions) as stronger predictors of postvention mental health outcomes, in comparison to intervention fidelity components linked to the intervention itself (i.e., intervention quality), indicating that adolescents’ perspectives on school based mental health interventions are markedly important to intervention success. The particular importance of understanding adolescents’ experiences engaging with PSSP research is further exemplified by: ( 1 ) the common delivery of PSSP in classrooms or to groups of adolescents who are developmentally more susceptible to peer influence ( 18 , 19 ), ( 2 ) the links between adolescents’ difficulties in engaging with PSSP research as participants and participant drop out ( 20 ), ( 3 ) reports of a weak association between adolescents’ preintervention rates of STBs and perceiving a PSSP intervention as upsetting ( 21 ) and youth perceptions of PSSP interventions as intrusive ( 22 , 23 ), and ( 4 ) the sensitive nature of suicide as mental health topic ( 24 ). Furthermore, understanding adolescents’ perspectives on PSSP thus far is a fundamental step in progressing meaningful adolescent engagement in PSSP research, which can be understood as adolescents’ active and decisive involvement throughout the research process ( 25 ). One reason that patient and public involvement in research is gaining traction in recent times ( 26 ) is that interventions are more acceptable and suitable when target populations are meaningfully engaged in the research process ( 27 ). However, meaningful adolescent engagement in PSSP research disproportionately lacks; for the most part adolescents did not aid the design of or input on PSSP interventions in a recent review of studies investigating the impact of PSSP interventions on STBs ( 28 ) and partnerships between suicide prevention researchers and young people are sparse ( 29 ). Adultism has positioned youth passively in research leading to lack of agency and space for young people to contribute to research meaningfully ( 30 ). Young people are well-positioned to advise on and partake in decision-making and design processes in suicide prevention ( 31 , 32 ) and have expressed the importance of their voice in school mental health ( 33 ). Moreover, knowledge of adolescents’ perspectives on PSSP and enhancing meaningful adolescent involvement in PSSP research also responds to moral and socio-political obligations; the United National Human Rights’ Convention on the Rights of the Child mandates that adolescents’ views are forefront to matters concerning them ( 34 ), and the Lancet Commission on Adolescent Health and Wellbeing advocates for adolescent voice in interventions concerning their well-being ( 35 ). There is a critical need to address the gap in understanding adolescents’ perspectives on engaging with PSSP. There is no known synthesis of the qualitative research exploring and collating the varied experiences of youth engaging with PSSP, despite the existence of qualitative research exploring adolescents’ perspectives on engaging with PSSP. Meta-ethnography is well-positioned to draw qualitative findings together, generate over-arching understandings of collective experiences and develop insights to inform decision-making ( 36 ). Aim This protocol outlines a meta-ethnography which will address an important gap in understanding adolescents’ experiences with PSSP, by exploring adolescents’ perspectives on and experiences of engaging with PSSP interventions, as participants/end-users, intervention advisors, facilitators, and co-designers and co-researchers. Methods/Design The meta-ethnography protocol follows the PRISMA-P guidelines (37). The meta-ethnography protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines (37) (see Table 1 for checklist). Study Design Meta-ethnography was identified as an appropriate methodology to synthesise qualitative research exploring experiences and perspectives of adolescents engaging with PSSP (36). Furthermore, meta-ethnography enables the generation of novel interpretations which both explain and go beyond the findings of individual studies included in the meta-ethnography (38, 39). This meta-ethnography will be guided by Noblit and Hare (36) and Campbell and colleagues (38), and will be presented in line with the eMERGe reporting guidance and the PRISMA statement guidelines (40, 41). The study design of this meta-ethnography was guided by Noblit and Hares’ (1988) seven stage process for conducting meta-ethnography, which includes the following stages: (1) getting started, (2) describing what is relevant to the initial interest, (3) reading included studies, (4) determining how the studies are related, (5) translating the studies into one another, (6) synthesising translations , and (7) expressing the synthesis . Stage (1) getting started was completed through discussion of the topic of interest by the co-authors, and the subsequent presentation of the literature in the background section of this protocol. Stage (2) describing what is relevant to the initial interest This end-goal of this stage is to develop an exhaustive list of studies to be included in the meta-ethnography (36). Search strategy The following inclusion criteria have been developed for this meta-ethnography: (1) English language studies, (2) peer-reviewed journal articles and grey literature, (3) qualitative and mixed-method studies reporting qualitative data collection methods and qualitative analysis, (4) studies containing interventions conducted in post-primary school settings targeting suicide-related outcomes (i.e., STBs, help-seeking behaviours) as both primary intervention outcomes and with other health and well-being outcomes, and (5) studies reporting 11-19-year-olds’ experiences with and perspectives on engaging with PSSP as participants/end-users, intervention advisors, facilitators, and co-designers and co-researchers. Exclusion criteria are as follows: (1) studies which do not include a method of qualitative data collection or analysis, (2) review and synthesis studies, (3) studies which sample participants engaging with PSSP located in third-level education or university settings. The following search string based on keywords ‘adolescents’, ‘post-primary school’, ‘prevention/intervention’, ‘suicide’, and ‘perspectives/experiences’ will be used for Scopus and adapted for other databases: adolescen* OR teen* OR young AND adult* OR youth OR student OR child* AND education* OR school OR high?school OR secondary school OR post?primary OR school?based OR middle?school AND prevention OR intervention OR program* AND suicid* AND perspective* OR perception* OR attitude* OR perceive* OR understanding OR experience* OR view* OR opinion. Studies available from database inception will be identified by searches in PsycINFO, Medline, Web of Science, CINAHL, ERIC, and Scopus. Grey literature will be identified by searches in ProQuest, British Library EThOS, and DART-Europe E-theses Portal. Where appropriate, MeSH, subject and wildcard terms and truncation will be applied to database search strings. Database searches will be supplemented by searches in Google Scholar and reference lists of screened studies. If full texts of studies are unavailable the corresponding author will be contacted, with a period of 21 days the maximum waiting time for studies. Retrieved studies from database searching will be exported to RAYYAN QCRI (Ouzzani, Hammady, Fedorowicz, and Elmagarmid, 2016). Initially, the main reviewer will initially assess the eligibility of studies based on title and abstract. Any uncertainty of eligibility will be discussed by the reviewers until consensus is met. Then, the main reviewer will assess the eligibility of all full-texts, with full-texts reviewed by at least two reviewers. Any discrepancies in full-text assessment will be discussed with the aim of reaching consensus. If necessary, where consensus cannot be met between the main reviewer and the other reviewer, a third reviewer will be consulted. Inter-rater reliability of full text assessment will be quantified using Cohen’s Kappa Measure of Agreement Coefficient (42). All excluded articles (including duplicates) will be recorded. This selection process will be detailed in the PRISMA flow diagram for systematic reviews (41). Stage (3) reading included studies Unlike other methods of syntheses, it is essential that an iterative process is followed for engaging with studies (36), therefore, included studies will be read multiple times by the main reviewer. CASP checklists (43) will be completed by two reviewers, to both assess quality of the included studies and enhance in-depth understanding of studies. An additional question will be added to the CASP assessment; “Are the interventions of interest clearly described?”, similar to the procedure of a meta-ethnography synthesis of young people’s experiences with mental health interventions (44). The consideration to data saturation as part of the CASP checklist criteria will only be given to studies employing qualitative methodologies which recognise data saturation as an appropriate conceptual tool (45). Any disagreement in CASP assessments between reviewers will be discussed until consensus is reached. If necessary, where consensus cannot be met between the two reviewers, a third reviewer will be consulted. The main reviewer will extract the following data in the included studies: school and participant demographics, intervention type/aims, method of data collection/analysis and data relating to adolescents’ experiences with and perspectives on PSSP. Participant data (i.e., first-order constructs) and study author data (i.e., second-order constructs) may include metaphors, ideas, concepts, phrases and themes (36, 38). NVivo 12 software will record first- and second- order construct data. Stage (4) determining how the studies are related The main reviewer will lead data analysis, with at least one other reviewer providing critique and guidance on analysis through discussion until consensus is met. Line-by-line coding of first- and second-order constructs will be undertaken, using an a priori coding frame based on the review question, similar to the procedure of Gilmour, Ring (46). First- and second-order constructs and their relationships with other first- and second-order constructs will be recorded for each study and juxtaposed. Stage (5) translating the studies into one another Studies will be translated into each other by identifying key first- and second-order constructs in studies and their relations with other first- and second-order constructs in that study, which will be further compared across studies. The identification of study-level similarities and disagreements will guide the subsequent synthesis approaches (i.e., reciprocal translations as syntheses and refutational synthesis) (36). Stage (6) synthesising translations It will be determined if first- and second-order constructs and their respective translations encompass those in other studies, leading to analysis of competing translations and translation into each other (36). The synthesis will be expressed as third-order constructs (i.e., meta-ethnography outcomes which go beyond the findings of the individual studies), which may include key meta-themes and line-of-argument (i.e., third-level constructs) will be recorded in NVivo. ‘Line-of-argument’ may lead to a new model or theory about an overarching phenomenon beyond the individual interpretations of the included studies (36, 38, 47). Stage (7) expressing the synthesis. The manuscript will be submitted for peer review publication. It is expected that key findings from the meta-ethnography will be presented to academic and lay audiences. Discussion To our knowledge, this is the first proposed meta-ethnography which will explore and synthesise qualitative studies documenting adolescents’ perspectives on engaging with PSSP, as participants/end-users, intervention advisors, facilitators, and co-designers and co-researchers. Insights from this meta-ethnography will address a key gap in the field of PSSP by enhancing understanding of the experiences of adolescents’ engaging with PSSP, such as how acceptable and suitable (or not) PSSP may be perceived by adolescents and the potential barriers to and facilitators of engaging with PSSP. The generation of a ‘line-of-argument’ will result in a novel and overarching understanding of adolescents’ experiences with PSSP, which may reveal interpretations which were not apparent in the individual studies ( 36 ). These insights have potential to have considerable impact in guiding decision-making and policymaking in the field of PSSP ( 38 ), which could be formative in addressing the longstanding PSSP evidence-practice gap. Given that qualitative analysis of experiences is critical for informing intervention research and highlighting important information relating to intervention context and implementation ( 48 , 49 ), the application of insights generated from this meta-ethnography could contribute to enhancing PSSP research outcomes, intervention effectiveness and implementation in practice. Furthermore, it is expected that insights from this meta-ethnography will inform guidance on how adolescents should be involved in PSSP, as participants/end-users, intervention advisors, facilitators, and co-designers and co-researchers, which is necessary to alter the trajectory of adolescents’ lack of meaningful involvement in PSSP research. No known comprehensive guidance of this kind exists. To enhance meaningful youth involvement in youth mental health research in general, research must move away from a focus of young people engaging in research as passive subjects, towards a view of young people as central to research ( 25 ). Collated insights on how adolescents perceive their involvement in PSSP research, generated through meta-ethnography, will be pivotal for re-focusing the PSSP research field towards the experiences of adolescents involved in PSSP. Given that meta-ethnography allows for the identification of insights beyond individual studies, potential absences and misinterpretations of knowledge in the literature may be highlighted ( 36 , 38 ), which is particularly important to counter adultism in research and the fact that adolescents’ perspectives are typically presented through adult lenses in research ( 50 ). Although evidence does not indicate harmful effects after exposure to suicide research in assessment ( 51 ), screening ( 52 , 53 ), content ( 54 ); and participatory-based research ( 55 – 57 ), risks of harm of researching suicide remains a steadfast barrier for progressing research on suicide prevention ( 24 , 52 ), particularly with youth ( 57 , 58 ). Insights from this meta-ethnography are essential to understanding the safety implication of engaging adolescents in PSSP. There is increasing momentum for understanding the involvement of young people involved in research in wider-health related fields ( 59 ). As such, it is expected that the insights from this meta-ethnography will transcend the field of PSSP, given the international calls for enhancing meaningful youth voice and involvement in youth in suicide prevention ( 31 ), school mental health practice ( 60 ) and wider-health related research ( 35 ). With respect to operational issues, initially adolescents’ experiences with and perspectives on PSSP will be synthesised with respect to whether adolescents engaged with PSSP as participants/end-users, intervention advisors, facilitators, and co-designers and co-researchers. Data will be fully integrated, similar to the procedure of Evans and Hurrell ( 48 ), provided that how adolescents engaged with PSSP is subordinate to the similarities and differences across the studies. Finally, amendments to the protocol will be described in the completed review publication. Abbreviations PSSP: Post primary school-based suicide prevention; STBs: suicidal thoughts and behaviours. PRISMA-P: Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. CASP: Critical Appraisal Skills Programme. Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Availability of data and materials Not applicable. Competing interests The authors have no competing interests to declare. Funding The first author is a funded National Institute of Studies in Education PhD student. This funding body did not have any involvement in the design and preparation of this review. The authors have no financial conflicts of interest to declare. Authors' contributions EHW and JMM contributed to the protocol conception. EHW drafted the protocol with supervision from JMM and MPH. EHW is the guarantor of the review. All authors revised the protocol and approved the final version for submission. Acknowledgements Not applicable. References World Health Organisation. Suicide 2021 [Available from: https://www.who.int/news-room/fact-sheets/detail/suicide . National Child Mortality Database. Child Suicide Rates during the COVID-19 Pandemic in England: Real-time Surveillance. 2020. Robinson J, Kolves K, Sisask M. 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A systemic, whole-school approach to mental health and well-being in schools in the EU: analytical report2021. Supplementary Files PRISMAPchecklist.docx Cite Share Download PDF Status: Published Journal Publication published 11 Jan, 2023 Read the published version in Systematic Reviews → Version 1 posted Reviewers agreed at journal 17 Jun, 2022 Reviewers invited by journal 30 May, 2022 Editor assigned by journal 08 May, 2022 First submitted to journal 24 Mar, 2022 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1484675","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":109799959,"identity":"605a9305-0ea2-4f63-8de0-d6044e1be0bc","order_by":0,"name":"Eibhlin Helen Walsh","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIiWNgGAWjYDACZh42hgcGDAkM7CBeBUiEuYGwlgSQFmYQ7wxIhJGAFgaQFgaoFsY2kAgBLfzsvMceJBTcyeNnZj72mHdebTR/O1DLj4ptOLVINvOlGyQYPCuWbGZLN+bddjx3xmHGBsaeM7dxajE4zGMmkWBwOHEDkCGdu+1YbgNQCzNjG24t9jAt+w/zf5POnXMsdz4hLQbMMFuAQSed21CTu4GQFonDfGlgLTMOs5lJ/zl2IHcjUMtBfH7h7z97TOLDn8OJ/e3NzyRn1NTlzjt/+OCDHxW4taCDw2DyANHqgaCOFMWjYBSMglEwQgAACHlYFoBwXRsAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0002-8300-2997","institution":"University of Limerick","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Eibhlin","middleName":"Helen","lastName":"Walsh","suffix":""},{"id":109799960,"identity":"f2729815-534b-4cce-8a29-7ce621c2b9db","order_by":1,"name":"Matthew P. Herring","email":"","orcid":"","institution":"University of Limerick","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Matthew","middleName":"P.","lastName":"Herring","suffix":""},{"id":109799961,"identity":"e2f9a6b5-eb59-407f-8b55-15dada816075","order_by":2,"name":"Jennifer McMahon","email":"","orcid":"","institution":"University of Limerick","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jennifer","middleName":"","lastName":"McMahon","suffix":""}],"badges":[],"createdAt":"2022-03-24 09:10:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1484675/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1484675/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13643-022-02166-1","type":"published","date":"2023-01-11T18:18:50+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":44716777,"identity":"fd647eea-3344-404b-af87-c7b4828e812d","added_by":"auto","created_at":"2023-10-16 18:30:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":323653,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1484675/v1/245a9d98-ea51-4af8-8a87-6e7628ded3a6.pdf"},{"id":22148288,"identity":"c77598c4-2eac-40f5-b8b1-8ba8425ec27f","added_by":"auto","created_at":"2022-06-01 18:54:08","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":34853,"visible":true,"origin":"","legend":"","description":"","filename":"PRISMAPchecklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-1484675/v1/e26944b97c7b77f308d825dc.docx"}],"financialInterests":"","formattedTitle":"Exploring Adolescents’ Perspectives on and Experiences with Post-primary School-based Suicide Prevention: A Meta-Ethnography Protocol","fulltext":[{"header":"Background","content":"\u003cp\u003eSuicide is the fourth leading cause of mortality in 15-19-year-olds globally (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e). Concerns of increased youth suicide beyond COVID-19 (\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e) necessitates the implementation of effective adolescent suicide prevention strategies. PSSP is an evidence-based approach for targeting adolescent STBs (\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e), which are prominent risk factors for death by suicide (\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e). Despite the potential of PSSP to be a key adolescent suicide prevention approach, there are persistent challenges to translating the effectiveness of PSSP research to school settings, resulting in evidence-practice gaps (\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eAdolescents\u0026rsquo; experiences of engaging with PSSP are largely unexplored but are yet likely paramount to bridging the evidence-practice gap in PSSP. How acceptable and suitable health interventions are perceived by individuals engaged in interventions is critical to both intervention effectiveness (\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e) and implementation (\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e). Engagement encompasses a variety of ways in which individuals are involved in interventions in research and practice, from participation as end-users to planning, design, analysis, translation and dissemination (\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e). Adolescents not only engage with suicide prevention as research participants and intervention end-users, but also as intervention facilitators (\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e) and advisors (\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e) and co-researchers (\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eA review of school-based mental health interventions supported intervention fidelity components linked to adolescents\u0026rsquo; perspectives (i.e., receptiveness to interventions) as stronger predictors of postvention mental health outcomes, in comparison to intervention fidelity components linked to the intervention itself (i.e., intervention quality), indicating that adolescents\u0026rsquo; perspectives on school based mental health interventions are markedly important to intervention success. The particular importance of understanding adolescents\u0026rsquo; experiences engaging with PSSP research is further exemplified by: (\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e) the common delivery of PSSP in classrooms or to groups of adolescents who are developmentally more susceptible to peer influence (\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e), (\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e) the links between adolescents\u0026rsquo; difficulties in engaging with PSSP research as participants and participant drop out (\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e), (\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e) reports of a weak association between adolescents\u0026rsquo; preintervention rates of STBs and perceiving a PSSP intervention as upsetting (\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e) and youth perceptions of PSSP interventions as intrusive (\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e), and (\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e) the sensitive nature of suicide as mental health topic (\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eFurthermore, understanding adolescents\u0026rsquo; perspectives on PSSP thus far is a fundamental step in progressing meaningful adolescent engagement in PSSP research, which can be understood as adolescents\u0026rsquo; active and decisive involvement throughout the research process (\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e). One reason that patient and public involvement in research is gaining traction in recent times (\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e) is that interventions are more acceptable and suitable when target populations are meaningfully engaged in the research process (\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e). However, meaningful adolescent engagement in PSSP research disproportionately lacks; for the most part adolescents did not aid the design of or input on PSSP interventions in a recent review of studies investigating the impact of PSSP interventions on STBs (\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e) and partnerships between suicide prevention researchers and young people are sparse (\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e). Adultism has positioned youth passively in research leading to lack of agency and space for young people to contribute to research meaningfully (\u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e). Young people are well-positioned to advise on and partake in decision-making and design processes in suicide prevention (\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e) and have expressed the importance of their voice in school mental health (\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eMoreover, knowledge of adolescents\u0026rsquo; perspectives on PSSP and enhancing meaningful adolescent involvement in PSSP research also responds to moral and socio-political obligations; the United National Human Rights\u0026rsquo; Convention on the Rights of the Child mandates that adolescents\u0026rsquo; views are forefront to matters concerning them (\u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e), and the Lancet Commission on Adolescent Health and Wellbeing advocates for adolescent voice in interventions concerning their well-being (\u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThere is a critical need to address the gap in understanding adolescents\u0026rsquo; perspectives on engaging with PSSP. There is no known synthesis of the qualitative research exploring and collating the varied experiences of youth engaging with PSSP, despite the existence of qualitative research exploring adolescents\u0026rsquo; perspectives on engaging with PSSP. Meta-ethnography is well-positioned to draw qualitative findings together, generate over-arching understandings of collective experiences and develop insights to inform decision-making (\u003cspan class=\"CitationRef\"\u003e36\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"Section2\" id=\"Sec2\"\u003e\n \u003ch2\u003eAim\u003c/h2\u003e\n \u003cp\u003eThis protocol outlines a meta-ethnography which will address an important gap in understanding adolescents\u0026rsquo; experiences with PSSP, by exploring adolescents\u0026rsquo; perspectives on and experiences of engaging with PSSP interventions, as participants/end-users, intervention advisors, facilitators, and co-designers and co-researchers.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Methods/Design","content":"\u003cp\u003eThe meta-ethnography protocol follows the PRISMA-P guidelines (37). The meta-ethnography protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines (37) (see Table 1 for checklist).\u003c/p\u003e\n\u003ch2\u003eStudy Design\u003c/h2\u003e\n\u003cp\u003eMeta-ethnography was identified as an appropriate methodology to synthesise qualitative research exploring experiences and perspectives of adolescents engaging with PSSP (36). Furthermore, meta-ethnography enables the generation of novel interpretations which both explain and go beyond the findings of individual studies included in the meta-ethnography (38, 39). This meta-ethnography will be guided by Noblit and Hare (36) and Campbell and colleagues (38), and will be presented in line with the eMERGe reporting guidance and the PRISMA statement guidelines (40, 41).\u003c/p\u003e\n\u003cp\u003eThe study design of this meta-ethnography was guided by Noblit and Hares\u0026rsquo; (1988) seven stage process for conducting meta-ethnography, which includes the following stages: \u003cem\u003e(1) getting started, (2) describing what is relevant to the initial interest, (3) reading included studies, (4) determining how the studies are related, (5) translating the studies into one another, (6) synthesising translations\u003c/em\u003e, and \u003cem\u003e(7) expressing the synthesis\u003c/em\u003e. \u003cem\u003eStage (1) getting started\u003c/em\u003e was completed through discussion of the topic of interest by the co-authors, and the subsequent presentation of the literature in the \u003cem\u003ebackground\u003c/em\u003e section of this protocol.\u003c/p\u003e\n\u003ch2\u003eStage (2) describing what is relevant to the initial interest\u003c/h2\u003e\n\u003cp\u003eThis end-goal of this stage is to develop an exhaustive list of studies to be included in the meta-ethnography (36).\u003c/p\u003e\n\u003ch2\u003eSearch strategy\u003c/h2\u003e\n\u003cp\u003eThe following inclusion criteria have been developed for this meta-ethnography: (1) English language studies, (2) peer-reviewed journal articles and grey literature, (3) qualitative and mixed-method studies reporting qualitative data collection methods and qualitative analysis, (4) studies containing interventions conducted in post-primary school settings targeting suicide-related outcomes (i.e., STBs, help-seeking behaviours) as both primary intervention outcomes and with other health and well-being outcomes, and (5) studies reporting 11-19-year-olds\u0026rsquo; experiences with and perspectives on engaging with PSSP as participants/end-users, intervention advisors, facilitators, and co-designers and co-researchers. Exclusion criteria are as follows: (1) studies which do not include a method of qualitative data collection or analysis, (2) review and synthesis studies, (3) studies which sample participants engaging with PSSP located in third-level education or university settings.\u003c/p\u003e\n\u003cp\u003eThe following search string based on keywords \u0026lsquo;adolescents\u0026rsquo;, \u0026lsquo;post-primary school\u0026rsquo;, \u0026lsquo;prevention/intervention\u0026rsquo;, \u0026lsquo;suicide\u0026rsquo;, and \u0026lsquo;perspectives/experiences\u0026rsquo;\u003cem\u003e\u0026nbsp;\u003c/em\u003ewill be used for Scopus and adapted for other databases: \u003cem\u003eadolescen* OR teen* OR young AND adult* OR youth OR student OR child* AND education* OR school OR high?school OR secondary school OR post?primary OR school?based OR middle?school AND prevention OR intervention OR program* AND suicid* AND perspective* OR perception* OR attitude* OR perceive* OR understanding OR experience* OR view* OR opinion.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eStudies available from database inception will be identified by\u0026nbsp;searches in PsycINFO, Medline, Web of Science, CINAHL, ERIC, and Scopus. Grey literature will be identified by searches in ProQuest, British Library EThOS, and DART-Europe E-theses Portal. Where appropriate, MeSH, subject and wildcard terms and truncation will be applied to database search strings. Database searches will be supplemented by searches in Google Scholar and reference lists of screened studies. If full texts of studies are unavailable the corresponding author will be contacted, with a period of 21 days the maximum waiting time for studies. Retrieved studies from database searching will be exported to RAYYAN QCRI (Ouzzani, Hammady, Fedorowicz, and Elmagarmid, 2016).\u003c/p\u003e\n\u003cp\u003eInitially, the main reviewer will initially assess the eligibility of studies based on title and abstract. Any uncertainty of eligibility will be discussed by the reviewers until consensus is met. Then, the main reviewer will assess the eligibility of all full-texts, with full-texts reviewed by at least two reviewers. Any discrepancies in full-text assessment will be discussed with the aim of reaching consensus. If necessary, where consensus cannot be met between the main reviewer and the other reviewer, a third reviewer will be consulted. Inter-rater reliability of full text assessment will be quantified using Cohen\u0026rsquo;s Kappa Measure of Agreement Coefficient (42). All excluded articles (including duplicates) will be recorded. This selection process will be detailed in the PRISMA flow diagram for systematic reviews (41).\u003c/p\u003e\n\u003ch2\u003eStage (3) reading included studies\u003c/h2\u003e\n\u003cp\u003eUnlike other methods of syntheses, it is essential that an iterative process is followed for engaging with studies (36), therefore, included studies will be read multiple times by the main reviewer. CASP checklists (43) will be completed by two reviewers, to both assess quality of the included studies and enhance in-depth understanding of studies. An additional question will be added to the CASP assessment; \u003cem\u003e\u0026ldquo;Are the interventions of interest clearly described?\u0026rdquo;,\u0026nbsp;\u003c/em\u003esimilar to the procedure of a meta-ethnography synthesis of young people\u0026rsquo;s experiences with mental health interventions (44). The consideration to data saturation as part of the CASP checklist criteria will only be given to studies employing qualitative methodologies which recognise data saturation as an appropriate conceptual tool (45). Any disagreement in CASP assessments between reviewers will be discussed until consensus is reached. If necessary, where consensus cannot be met between the two reviewers, a third reviewer will be consulted.\u003c/p\u003e\n\u003cp\u003eThe main reviewer will extract the following data in the included studies: school and participant demographics, intervention type/aims, method of data collection/analysis and data relating to adolescents\u0026rsquo; experiences with and perspectives on PSSP. Participant data (i.e., first-order constructs) and study author data (i.e., second-order constructs) may include metaphors, ideas, concepts, phrases and themes (36, 38). NVivo 12 software will record first- and second- order construct data.\u003c/p\u003e\n\u003ch2\u003eStage (4) determining how the studies are related\u003c/h2\u003e\n\u003cp\u003eThe main reviewer will lead data analysis, with at least one other reviewer providing critique and guidance on analysis through discussion until consensus is met. Line-by-line coding of first- and second-order constructs will be undertaken, using an \u003cem\u003ea priori\u003c/em\u003e coding frame based on the review question, similar to the procedure of Gilmour, Ring (46). First- and second-order constructs and their relationships with other first- and second-order constructs will be recorded for each study and juxtaposed.\u003c/p\u003e\n\u003ch2\u003eStage (5) translating the studies into one another\u003c/h2\u003e\n\u003cp\u003eStudies will be translated into each other by identifying key first- and second-order constructs in studies and their relations with other first- and second-order constructs in that study, which will be further compared across studies. The identification of study-level similarities and disagreements will guide the subsequent synthesis approaches (i.e., reciprocal translations as syntheses and refutational synthesis) (36).\u003c/p\u003e\n\u003ch2\u003eStage (6) synthesising translations\u003c/h2\u003e\n\u003cp\u003eIt will be determined if first- and second-order constructs and their respective translations encompass those in other studies, leading to analysis of competing translations and translation into each other (36). The synthesis will be expressed as third-order constructs (i.e., meta-ethnography outcomes which go beyond the findings of the individual studies), which may include key meta-themes and line-of-argument (i.e., third-level constructs) will be recorded in NVivo. \u0026lsquo;Line-of-argument\u0026rsquo; may lead to a new model or theory about an overarching phenomenon beyond the individual interpretations of the included studies (36, 38, 47).\u003c/p\u003e\n\u003ch2\u003eStage (7) expressing the synthesis.\u003c/h2\u003e\n\u003cp\u003eThe manuscript will be submitted for peer review publication. It is expected that key findings from the meta-ethnography will be presented to academic and lay audiences.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo our knowledge, this is the first proposed meta-ethnography which will explore and synthesise qualitative studies documenting adolescents\u0026rsquo; perspectives on engaging with PSSP, as participants/end-users, intervention advisors, facilitators, and co-designers and co-researchers. Insights from this meta-ethnography will address a key gap in the field of PSSP by enhancing understanding of the experiences of adolescents\u0026rsquo; engaging with PSSP, such as how acceptable and suitable (or not) PSSP may be perceived by adolescents and the potential barriers to and facilitators of engaging with PSSP. The generation of a \u0026lsquo;line-of-argument\u0026rsquo; will result in a novel and overarching understanding of adolescents\u0026rsquo; experiences with PSSP, which may reveal interpretations which were not apparent in the individual studies (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). These insights have potential to have considerable impact in guiding decision-making and policymaking in the field of PSSP (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e), which could be formative in addressing the longstanding PSSP evidence-practice gap.\u003c/p\u003e \u003cp\u003eGiven that qualitative analysis of experiences is critical for informing intervention research and highlighting important information relating to intervention context and implementation (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e), the application of insights generated from this meta-ethnography could contribute to enhancing PSSP research outcomes, intervention effectiveness and implementation in practice. Furthermore, it is expected that insights from this meta-ethnography will inform guidance on \u003cem\u003ehow\u003c/em\u003e adolescents should be involved in PSSP, as participants/end-users, intervention advisors, facilitators, and co-designers and co-researchers, which is necessary to alter the trajectory of adolescents\u0026rsquo; lack of meaningful involvement in PSSP research. No known comprehensive guidance of this kind exists.\u003c/p\u003e \u003cp\u003eTo enhance meaningful youth involvement in youth mental health research in general, research must move away from a focus of young people engaging in research as passive subjects, towards a view of young people as central to research (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Collated insights on how adolescents perceive their involvement in PSSP research, generated through meta-ethnography, will be pivotal for re-focusing the PSSP research field towards the experiences of adolescents involved in PSSP. Given that meta-ethnography allows for the identification of insights beyond individual studies, potential absences and misinterpretations of knowledge in the literature may be highlighted (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e), which is particularly important to counter adultism in research and the fact that adolescents\u0026rsquo; perspectives are typically presented through adult lenses in research (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlthough evidence does not indicate harmful effects after exposure to suicide research in assessment (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e), screening (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e), content (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e); and participatory-based research (\u003cspan additionalcitationids=\"CR56\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e), risks of harm of researching suicide remains a steadfast barrier for progressing research on suicide prevention (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e), particularly with youth (\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e). Insights from this meta-ethnography are essential to understanding the safety implication of engaging adolescents in PSSP.\u003c/p\u003e \u003cp\u003eThere is increasing momentum for understanding the involvement of young people involved in research in wider-health related fields (\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e). As such, it is expected that the insights from this meta-ethnography will transcend the field of PSSP, given the international calls for enhancing meaningful youth voice and involvement in youth in suicide prevention (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), school mental health practice (\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e) and wider-health related research (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWith respect to operational issues, initially adolescents\u0026rsquo; experiences with and perspectives on PSSP will be synthesised with respect to whether adolescents engaged with PSSP as participants/end-users, intervention advisors, facilitators, and co-designers and co-researchers. Data will be fully integrated, similar to the procedure of Evans and Hurrell (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e), provided that \u003cem\u003ehow\u003c/em\u003e adolescents engaged with PSSP is subordinate to the similarities and differences across the studies. Finally, amendments to the protocol will be described in the completed review publication.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003ePSSP: Post primary school-based suicide prevention; STBs: suicidal thoughts and behaviours. PRISMA-P: Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. CASP: Critical Appraisal Skills Programme.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors have no competing interests to declare.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThe first author is a funded National Institute of Studies in Education PhD student. This funding body did not have any involvement in the design and preparation of this review. The authors have no financial conflicts of interest to declare.\u003c/p\u003e\n\u003ch2\u003eAuthors\u0026apos; contributions\u003c/h2\u003e\n\u003cp\u003eEHW and JMM contributed to the protocol conception. EHW drafted the protocol with supervision from JMM and MPH. EHW is the guarantor of the review. All authors revised the protocol and approved the final version for submission.\u003c/p\u003e\n\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organisation. Suicide 2021 [Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/suicide\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/suicide\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNational Child Mortality Database. 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BMC Med Res Methodol. 2019;19(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePage MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20(1):37\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCritical Appraisal Skills Programme. CASP qualitative checklist. 2013.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShaw L, Moore D, Nunns M, Thompson Coon J, Ford T, Berry V, et al. Experiences of interventions aiming to improve the mental health and well-being of children and young people with a long‐term physical condition: A systematic review and meta‐ethnography. Child: Care, Health and Development. 2019;45(6):832 \u0026ndash; 49.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBraun V, Clarke V. To saturate or not to saturate? Questioning data saturation as a useful concept for thematic analysis and sample-size rationales. Qualitative Research in Sport, Exercise and Health. 2019:1\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGilmour L, Ring N, Maxwell M. Review. The views and experiences of suicidal children and young people of mental health support services: a meta-ethnography. Child and Adolescent Mental Health. 2019.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAtkins S, Lewin S, Smith H, Engel M, Fretheim A, Volmink J. Conducting a meta-ethnography of qualitative literature: Lessons learnt. BMC Med Res Methodol. 2008;8(1):21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEvans R, Hurrell C. The role of schools in children and young people\u0026rsquo;s self-harm and suicide: systematic review and meta-ethnography of qualitative research. BMC Public Health. 2016;16(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLorenc T, Pearson M, Jamal F, Cooper C, Garside R. The role of systematic reviews of qualitative evidence in evaluating interventions: a case study. Res Synthesis Methods. 2012;3(1):1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMontreuil M, Bogossian A, Laberge-Perrault E, Racine E. A Review of Approaches, Strategies and Ethical Considerations in Participatory Research With Children. Int J Qualitative Methods. 2021;20:160940692098796.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCoppersmith DD, Fortgang R, Kleiman E, Millner A, Yeager A, Mair P, et al. Frequent assessment of suicidal thinking does not increase suicidal thinking: Evidence from a high-resolution real-time monitoring study. PsyArXiv. 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDeCou CR, Schumann ME. On the iatrogenic risk of assessing suicidality: A meta-analysis. Suicide and Life‐Threatening Behavior. 2018;48(5):531\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGould MS, Marrocco FA, Kleinman M, Thomas JG, Mostkoff K, Cote J, et al. Evaluating iatrogenic risk of youth suicide screening programs: a randomized controlled trial. JAMA. 2005;293(13):1635\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlades CA, Stritzke WGK, Page AC, Brown JD. The benefits and risks of asking research participants about suicide: A meta-analysis of the impact of exposure to suicide-related content. Clin Psychol Rev. 2018;64:1\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaddad K, Lindquist-Grantz R, Vilvens H, Jacquez F, Vaughn L. Empowering Youth to Build BRIDGES: Youth Leadership in Suicide Prevention. Collaborations: A Journal of Community-Based Research and Practice. 2020;3(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRobinson J, Bailey E, Hetrick S, Paix S, O'Donnell M, Cox G, et al. Developing Social Media-Based Suicide Prevention Messages in Partnership With Young People: Exploratory Study. JMIR Mental Health. 2017;4(4):e40-e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThorn P, Hill NT, Lamblin M, Teh Z, Battersby-Coulter R, Rice S, et al. Developing a suicide prevention social media campaign with young people (the #Chatsafe Project): co-design approach. JMIR Ment Health. 2020;7(5):e17520.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBallard ED, Stanley IH, Horowitz LM, Cannon EA, Pao M, Bridge JA. Asking Youth Questions About Suicide Risk in the Pediatric Emergency Department: Results From a Qualitative Analysis of Patient Opinions. Clin Pediatr Emerg Med. 2013;14(1):20\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSellars E, Pavarini G, Michelson D, Creswell C, Fazel M. Young people\u0026rsquo;s advisory groups in health research: scoping review and mapping of practices. Archives of Disease in Childhood. 2020:archdischild-2020-320452.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEuropean C, Directorate-General for Education YS, Culture, Sim\u0026otilde;es C, Caravita S, Cefai C. A systemic, whole-school approach to mental health and well-being in schools in the EU: analytical report2021.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"systematic-reviews","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sysr","sideBox":"Learn more about [Systematic Reviews](http://systematicreviewsjournal.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/sysr/default.aspx","title":"Systematic Reviews","twitterHandle":"@MedicalEvidence","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Post-primary school-based suicide prevention, Adolescents, Engagement, Involvement, Experiences, Perspectives, Evidence synthesis, Meta-ethnography protocol","lastPublishedDoi":"10.21203/rs.3.rs-1484675/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1484675/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eGlobally, suicide is the fourth leading cause of adolescent mortality. Although post-primary school-based suicide prevention (PSSP) interventions are an evidence-based strategy for targeting adolescent suicidal thoughts and behaviours (STBs), PSSP effectiveness does not easily translate to school settings. Although adolescents’ perspectives on PSSP are particularly important for: (1) intervention effectiveness and implementation in both research and practice, (2) addressing PSSP evidence-practice gaps, and (3) enhancing meaningful adolescent involvement in PSSP, there is gap in understanding adolescents’ experiences of engaging with PSSP. As such, this protocol outlines a meta-ethnography which will explore and synthesise adolescents’ perspectives on engaging with PSSP interventions, as participants/end-users, intervention advisors, facilitators, and co-designers and co-researchers.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThe meta-ethnography protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. The meta-ethnography study design was\u0026nbsp;guided by Noblit and Hares’ (1988) seven stage process for meta-ethnography. Searches of PsycINFO, Medline, Web of Science, CINAHL, ERIC, Scopus and study reference lists will identify peer-reviewed studies. Grey literature will be identified by searches in ProQuest, British Library EThOS, and DART-Europe E-theses Portal. The main reviewer will initially assess the eligibility of studies based on title and abstract, with full texts reviewed by at least two reviewers. Findings of the included studies will be synthesised in line with Noblit and Hare’s stages and evaluated using the Critical Appraisal Skills Programme (CASP) checklist. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eDiscussion\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eTo our knowledge, this is the first proposed meta-ethnography to explore and integrate the findings of qualitative studies exploring adolescents’ perspectives on engaging with PSSP interventions. Understanding adolescents’ experiences of engaging with PSSP will impact the field of PSSP in several ways by: (1) enhancing research processes and intervention effectiveness and implementation, (2) informing decision-making and policymaking relevant to practice, (3) guiding meaningful adolescent involvement in PSSP, and (4) contributing to knowledge on the safety implications of engaging adolescents in PSSP. Finally, it is expected that the insights from this meta-ethnography will be widely applicable, given the growing demand for meaningful youth involvement in health-related fields. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eRegistration \u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThis protocol is under submission with PROSPERO for preregistration.\u003c/p\u003e","manuscriptTitle":"Exploring Adolescents’ Perspectives on and Experiences with Post-primary School-based Suicide Prevention: A Meta-Ethnography Protocol","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-06-01 18:54:06","doi":"10.21203/rs.3.rs-1484675/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2022-06-17T07:47:17+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2022-05-30T12:32:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2022-05-08T23:32:57+00:00","index":"","fulltext":""},{"type":"submitted","content":"Systematic Reviews","date":"2022-03-24T05:09:20+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"systematic-reviews","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sysr","sideBox":"Learn more about [Systematic Reviews](http://systematicreviewsjournal.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/sysr/default.aspx","title":"Systematic Reviews","twitterHandle":"@MedicalEvidence","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"62e6453b-c8b4-476d-bb3b-d1224658dede","owner":[],"postedDate":"June 1st, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-10-16T18:26:19+00:00","versionOfRecord":{"articleIdentity":"rs-1484675","link":"https://doi.org/10.1186/s13643-022-02166-1","journal":{"identity":"systematic-reviews","isVorOnly":false,"title":"Systematic Reviews"},"publishedOn":"2023-01-11 18:18:50","publishedOnDateReadable":"January 11th, 2023"},"versionCreatedAt":"2022-06-01 18:54:06","video":"","vorDoi":"10.1186/s13643-022-02166-1","vorDoiUrl":"https://doi.org/10.1186/s13643-022-02166-1","workflowStages":[]},"version":"v1","identity":"rs-1484675","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1484675","identity":"rs-1484675","version":["v1"]},"buildId":"-HB7Z8yhvgn0wM9Nzuekk","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}