District health management teams as champions for implementing the WHO LIVE LIFE suicide-prevention framework in Rural Uganda: a pre-implementation qualitative study.

Abstract

Background: Suicide is a major public-health challenge globally and in Uganda, where criminalization, stigma, and weak surveillance hinder prevention. The WHO LIVE LIFE framework offers evidence-based strategies, but there is limited experience implementing it at the district level in low-resource settings. Guided by the i-PARIHS framework, the "WHO LIVE LIFE with District Health Management Team as Champions for Suicide Prevention across the Lifespan in Rural Uganda (WLLDC-SP)" initiative positions District Health Management Team (DHMT) members as implementation champions. This study explored perceptions of the proposed champion strategy, operationalization pathways, facilitation needs, and contextual influences on adoption.

Methods: We conducted a pre-implementation exploratory descriptive qualitative study in a rural district in southwestern Uganda. Criterion-based purposive sampling identified nine participants from the DHMT and community-based partner organizations. In September 2025, semi-structured interviews were conducted in English using an i-PARIHS-informed guide. Participants received a brief overview of the WHO LIVE LIFE framework before discussing anticipated fit and readiness. Interviews were audio-recorded, transcribed verbatim, and analyzed using a framework-guided matrix approach with deductive coding to i-PARIHS constructs and inductive refinement of sub-themes within each domain.

Results: Four implementation domains emerged. First, participants viewed the DHMT as a credible and motivated champion platform because of its mandate for planning, supervision, and district coordination. Second, they identified opportunities to operationalize LIVE LIFE through existing systems, including Village Health Teams, schools, faith-based organizations, media, routine health education, supervision structures, and district reporting processes. Third, participants emphasized that implementation success would require facilitation through training, practical tools, mentorship, transport, airtime, and integration into district plans and budgets. Fourth, participants identified contextual threats, including stigma, criminalization, weak surveillance, limited mental-health staffing, competing priorities, and resource constraints. Means restriction was viewed as important but requiring adaptation because of widespread pesticide access.

Conclusions: District leaders and partners demonstrated high motivational readiness and perceived system fit for implementing the WHO LIVE LIFE framework through a DHMT-champion approach. Realizing this potential will require facilitation, logistical support, and policy alignment. Although conducted in one district, these findings may inform other decentralized health systems seeking to embed suicide prevention through district leadership structures.