Developing a culturally relevant community suicide needs assessment tool for rural Hispanic Veterans in Puerto Rico
Abstract: Background: Over the last two decades, suicide rates among Hispanics Veterans have increased most rapidly among those living in rural areas and little is known about how to prevent suicide in this population. The island of Puerto Rico (PR), a commonwealth of the U.S., has the second largest Hispanic population in the U.S. Due to the decades-long socio-political and fiscal crisis in PR, its geogra- phical composition and the ongoing exodus of medical professionals, health and socials resources are limited in the island. In addition, PR- specific data sources are not as readily available compared to data for the U.S. mainland. To address the increasing suicide rate among rural Hispanic Veterans, adequate tools to help identify gaps related to suicide prevention resources in the community are needed. Purpose: To develop a culturally relevant community suicide needs assessment tool to identify suicide prevention needs and inform suicide prevention efforts in PR. Methods: We conducted a cultural adaptation of a community suicide needs assessment tool (CSNAT) originally developed in English for the U.S. First, we translated the CSNAT into Spanish and identified suitable data sources. The translated tool was exam- ined for cultural relevance by 8 native Spanish speakers, five of these native from PR. We then conducted nine usability tests using the think aloud method. Testing was recorded for transcription purposes and feedback was used to inform additional modifications. We also conducted 3 interviews to evaluate the acceptability of the tool. Thematic analysis was utilized to analyze interview data. Results: A version of the Community Suicide Needs Assessment Tool - PR version was developed. The tool consists of 14 evidence- based indicators to assess community needs related to suicide prevention efforts by municipality in PR. Conclusion: To our knowledge, this is the first culturally adapted Spanish tool developed to identify and assess the needs and gaps of local communities’ suicide prevention resources. Cultural considera- tions are critical when developing resources to help mitigate the specific needs of these communities and improve suicide prevention efforts. Enhancing suicide prevention efforts from a culturally relevant community-based approach can lead to the development and implementation of tailored suicide prevention approaches for rural-dwelling Hispanics.