Abstract
BACKGROUND: Suicide is a significant public health concern globally, with disproportionate impacts in low- and middle-income countries. Thailand's suicide rate has risen steadily, particularly in northern provinces such as Lamphun. In response, the Lamphun Provincial Health Office developed the "Four Pillars," a community-based, multisectoral suicide prevention strategy. This study evaluates the feasibility and effectiveness of the Four Pillars using the RE-AIM framework. METHODS: A convergent parallel mixed-methods study was conducted across three districts in Lamphun Province. Quantitative data included suicide surveillance reports from 2020-2022 and a community survey of 600 adults. Qualitative data were collected through in-depth interviews (n = 36), three focus group discussions (n = 21), and document reviews. The RE-AIM framework guided tool development, data collection, and analysis, evaluating the strategy across five dimensions: Reach, Effectiveness, Adoption, Implementation, and Maintenance RESULTS: Reach: A total of 2,876 individuals at suicide risk were identified and received integrative interventions. EFFECTIVENESS: None subsequently exhibited suicidal behavior. Suicide rates in Lamphun declined modestly post-implementation, though not significantly (p = 0.331). Adoption: Adoption varied due to cultural beliefs, resource limitations, and stigma; survey findings revealed lower suicide literacy and persistent stigma in ethnic communities (p < 0.01). IMPLEMENTATION: Community-based surveillance was successfully adapted across contexts (e.g., via local language dissemination, engaging monks and street vendors as gatekeepers) with high fidelity to the model's core principles. Strong partnerships were critical. CONCLUSIONS: The Four Pillars strategy is a feasible and promising approach to reduce suicide risk through a community-based integrated surveillance and response system. Strategic local adaptations enhanced its feasibility without compromising core components. Addressing stigma, improving literacy, and strengthening multisectoral capacity are critical for broader scale-up and sustainability in Thailand and similar settings.