It Starts with a Question: A Strategic Communication Case Study to Expand Suicide Prevention Training Uptake in the United States
S. A. Geegan, E. B. Hester, S. Guo, C. Rhein, D. JaffeIntroduction
In Kentucky, a US state with high suicide rates, an academic medical center launched a statewide initiative to improve access to Question, Persuade, Refer (QPR). Widespread adoption of suicide prevention trainings like QPR remains a challenge. This case explores how strategic communication was useded to bridge the awareness–action gap and scale QPR uptake at the community level.
Objectives
This case study evaluates the effectiveness of a communication campaign aimed at increasing online QPR uptake among adults in a high-risk, largely rural region of the US. Aims included assessing campaign reach, training completion, and the role of media integration and message framing.
Methods
The campaign was informed by two theoretical frameworks: cognitive dissonance and the PESO (paid, earned, shared, owned) media model. Cognitive dissonance theory posits that individuals are motivated to resolve psychological unease when they perceive inconsistencies between their values and behaviors. Campaign messaging intentionally evoked dissonance by highlighting tensions between the value people place on protecting loved ones and their lack of preparedness to intervene in a mental health crisis (see example post: Figure 1).
The PESO model structured campaign execution:
Paid:
digital advertisements on Google and Meta
Earned:
op-eds and news coverage in state/regional outlets
Shared:
community partnerships and third-party amplification
Owned:
institutional websites, newsletters, and podcasts.
A mixed-methods approach was used to evaluate campaign performance from Sept. 2024 to March 2025. Quantitative data on media reach, impressions, click-throughs, and training completions were collected through analytics tracking and training platform logs. Qualitative data, including field notes from community events and presentations, were analyzed thematically to understand audience reactions and barriers to engagement.
Results
Over the 6-month campaign period,
1,045 individuals completed the training
, marking a
181% increase
from the six months prior to the campaign (n = 372). Community participation rose from
112 to 445
—a
297% increase
. Internal stakeholder completions grew from 260 to 600. The campaign’s
cross-platform communication strategy
(summarized in Table 1) met or exceeded all objectives. Notably, surges in QPR uptake aligned with periods of heightened earned media.
Image 1: Long description.