Community resistance to innovative public health interventions: A case study of one community's experience with a suicide prevention campaign

Montana has one of the highest suicide rates in the nation and the suicide rate for youths in 2010 and 2011 was double the national average.  To address this public health issue among teenagers, ages 14 to 18, an innovative suicide prevention campaign that used theater performances was implemented in one of the largest communities in Montana in 2013.  Community leaders and school district officials refused to allow the project to take place on school premises or during regular school hours, despite the project’s proven track record in neighboring communities and the passionate support of media, universities, and international global health organizations. This resistance was circumvented by implementing the project on a smaller scale, in partnership with local after-school programs.  A case study approach was employed to understand the factors leading to a community’s resistance to innovative public health interventions.  The analysis of this experience indicates one of the first applications of the Extended Parallel Process Model to communities, as opposed to individuals only, whereby communities confronted with extreme threats but little hope for effective solutions may react with fear control, or defense avoidance strategies.  The primary reasons given by this community for not participating in the intervention include fear of lawsuits, youths being over-researched, requests for research from other organizations, and youth participation leading to suicidal ideation and behavior.  These results indicate the need for those implementing innovative public health interventions to start small and build the project from within a community through grassroots efforts and interpersonal networks.