Across the 5 participant groups, 150 pharmacists completed the training. 109 participants completed at least 1 of the 3 surveys, 96 completed the pre-training survey, 55 completed the post-training survey, and 26 completed the 6-months post-training survey. Twelve participants completed all 3 surveys. Participants’ age ranged from younger than 25 to older than 65, with majority identifying as female (75%). Aligning with the target population, most participants were community pharmacists (64.2%). 55 participants (58.5%) reported no previous participation in suicide prevention training. Demographic data are presented in Table 1.

Table 1 Participant demographics

Repeated measures ANOVA analyses indicated that participants’ suicide prevention self-efficacy significantly improved across timepoints (F(2,20) = 20.48, p < 0.001, partial η2 = 0.672), and remained significant after adjusting for previous suicide prevention training (F(2, 20) = 7.84, p = 0.003, partial η2 = 0.439). Attitudes towards suicide prevention also significantly improved across timepoints (F(2, 20) = 5.03, p = 0.017, partial η2 = 0.335), remaining significant after adjusting for the covariate (F(2, 20) = 4.12, p = 0.032, partial η2 = 0.292). Differences in the appropriateness and inappropriateness of participants’ responses to suicide prevention scenarios across the 3 timepoints were non-significant (F(2, 20) = 0.43, p = 0.656, partial η2 = 0.041; F(2, 20) = 0.60, p = 0.559, partial η2 = 0.056). These differences remained non-significant after adjusting for previous suicide prevention training (F(2, 20) = 0.17, p = 0.844, partial η2 = 0.017; F(2, 20) = 0.73, p = 0.496, partial η2 = 0.068). The difference in the proportion of suicides perceived as preventable by participants across the 3 timepoints was also non-significant before (F(2, 20) = 1.62, p = 0.222, partial η2 = 0.140), and after (F(2, 20) = 0.66, p = 0.528, partial η2 = 0.062), adjusting for previous training. Pairwise comparisons are presented in Table 2.

Table 2 Repeated measures ANOVA pairwise comparisons of the variables of interest across pre-training, post-training, and 6-months post-training timepoints

Paired samples t-test analyses indicated that participants’ knowledge, confidence, suicide prevention self-efficacy, and attitudes towards suicide prevention significantly improved between pre-training and post-training, as did the number of appropriate responses (p < 0.05; see Table 3). Differences in inappropriate responses and the proportion of suicides viewed as preventable were non-significant (p > 0.05). Paired samples t-tests conducted on the pharmacist intervention statements revealed that participants’ perceptions of support, feasibility, and appropriateness significantly decreased between post-training and 6-months post-training (p < 0.05; see Table 4). Differences in participants’ perceptions of acceptability to other healthcare professionals and patients were non-significant (p > 0.05).

Table 3 Paired samples t-tests examining differences in the variables of interest across pre-training and post-training timepoints Table 4 Paired samples t-tests examining differences in responses to pharmacist intervention statements regarding the implementation of suicide prevention, across post-training and 6-month follow-up timepoints Open-ended responses: Pharmacist feedback

Participants provided short answers to questions related to what aspects of the training were helpful or could be improved. Pharmacy-specific sections of the training were viewed as helpful. Specifically, identifying warning signs of suicidality, how to initiate conversations about suicidality, and the video demonstrating how pharmacists might implement these practices with a patient. Participants also valued the ability to share experiences and approaches to suicide prevention. One participant described that “the personal approach allowed attendees to feel welcome and realise that not everyone is an expert.”

In comparison, some participants felt the content could be further tailored to address the pharmacist role in suicide prevention and suggested including more example scenarios to capture patients’ differing circumstances. Additionally, participants wanted clearer steps to follow once an at-risk patient is identified. With practising conversations and role-playing highlighted as beneficial, participants recommended that the time spent outlining the support services available to pharmacists could be supplemented with take-home materials and reallocated to practical components.

Improvements were also suggested regarding the delivery format and the number of training sessions provided. Some participants found the online format “challenging,” describing that the format may negatively impact participants’ abilities to role play and share knowledge. Participants advised additional training sessions, with the benefits of this captured by this response: “A follow-up [training] will reinforce how others are applying this knowledge … The more we do this, the better we will be.”

Pharmacists’ perceived barriers and facilitators to identifying and initiating conversations

To guide ongoing training development, participants provided their perspectives on the barriers and facilitators to identifying at-risk individuals and initiating conversations surrounding suicidality. The key barriers identified were the pharmacy setting, personal discomfort, and societal perceptions of pharmacists’ role in suicide prevention. Participants described various constraints within the pharmacy setting, including excessive workloads, understaffing, and inadequate compensation, privacy, and time to conduct conversations about suicide with patients. Without these resources, participants felt it could be inappropriate to initiate or could compromise the quality of these conversations: “there is a risk that pharmacists will have other workplace pressures leading to less-than-optimal conversations.” Furthermore, personal discomfort deterred participants from initiating conversations. One participant reflected: “Personal discomfort hidden behind excuses, such as too busy, not the right time… Not being confident that you will be able to successfully navigate the conversation.” Participants appeared to relate their personal discomfort to a lack of training and experience in initiating conversations surrounding suicidality, suggesting that with training, comfort to initiate conversations about suicide could be improved.

While pharmacists’ confidence and skills were key to engaging in conversations about suicide with patients, societal perceptions of whether this is within a pharmacist’s scope of practice was an identified barrier. They shared that some patients did not categorise pharmacists as trusted health professionals and, therefore, may be reluctant to disclose personal information, making conversations regarding suicidality difficult. Additionally, some participants described that their role within suicide prevention was not respected by other healthcare professionals. One participant stated, “we need other health professionals to accept the idea that pharmacists are an acceptable go between.” As such, participants felt greater collaboration between healthcare professionals was necessary to fortify the relationships between healthcare professionals and strengthen the support networks available to patients. Participants were hopeful for more collaborative relationships with healthcare professionals in future, noting “Qualifications aside, we are all community.”

Participants identified positive patient-professional relationships and adequate training/education as key facilitators to identifying at-risk individuals. Participants emphasised the importance of developing rapport with patients. Once established, they suggested that this enabled conversation openness, facilitating changes in patients’ behaviour to be observed and more confident conversations regarding suicidality. One participant shared that “training has been essential to give confidence in approaching the issue [suicide].” Participants also expressed that training had facilitated behaviour change, such as directly asking individuals about their mental health and thoughts of suicide.