Strengths and limitations
communication behaviors
There were several strengths in taking a codesign approach for the development of suicide prevention training for pharmacy staff. One such strength was that a codesign approach helped provide a framework in which feedback from one session guided and informed future meetings. Although a general meeting schedule and broad topic outline were created at the beginning of the project, allowing for adaptation of topic material based on participant feedback was useful in module development. Information gathered in each session, could be evaluated by the study team, and helped inform the development timeline, module content, and set benchmarks in the development process to reach the overall end‐goal. This is a similar approach taken by other codesign driven pharmacy interventionsSince meetings were conducted virtually, it allowed more stakeholders to attend despite their busy work schedules. Likewise, the pharmacy stakeholders were from different areas of NC and were able to participate, which allowed for a dynamic view of pharmacy experiences from across the state of NC. Furthermore, virtual meetings allowed for the inclusion of the VREB panel organized out of the VA in New York, which allowed us to gather veterans' perspectives. Additionally, Zoom teleconferencing afforded the study team an opportunity to interact with suicide prevention experts nationally who provided critical input about module content without the need for costly travel or delays due to COVID‐19. All these factors helped result in a more comprehensive product that included input from pharmacy stakeholders who represent the target user, considerations from the VREB panel who represent potential recipients of the intervention as pharmacy consumers, and expert guidance that improved content accuracy and best practices.Another key to success was having a consistently scheduled meeting time planned one month in advance. Pharmacy staff are quite busy, so the advanced scheduling promoted good attendance. At the first stakeholder meeting, a monthly meeting time was decided on. And the study postdoc sent a reminder 1 week before each meeting. Additionally, all stakeholders were emailed a meeting agenda in advance, and meetings were kept to 1 h. Having an agenda and a time limit helped keep the study team, and stakeholders focused and increased productivity.Despite the overall success of our approach, this process was not without challenges. One challenge was soliciting feedback on written documents via email. In general, stakeholders were more responsive during in‐person meetings. Overall, the amount of written feedback received on documents was low. Even when given multiple days or weeks to review documents, very few stakeholders provided written feedback to emailed documents. This usually resulted in review of documents during the virtual meetings. Given low engagement with emailed feedback, an alternative approach that may have been more successful would be to provide mock‐ups of these documents during virtual meetings. Although this may have increased the number of total meetings, it may have ultimately been more efficient.Another challenge we faced was receiving timely feedback. In addition to stakeholders, we also sought feedback from suicide research experts. Due to the time it takes to build a website and develop content, we did not seek outside expert input until near completion of the development process. This led to several iterations of edits that delayed website completion. In the future, including external suicide prevention education experts earlier and more frequently in the process would be beneficial.To further evaluate the impact of the codesign process and effectiveness of the suicide prevention training, the online module described here (Pharm‐SAVES) is currently being evaluated in a randomized controlled trial. The purpose of randomized control trial is to examine whether it improves the suicide prevention knowledge, gatekeeper self‐efficacy, and communication behaviors of pharmacy staff. Additionally, information from the results of this trial will be used to improve the training module and expand access to additional community pharmacy settings to continue to build a useable, up‐to‐date training resource.