Concept Analysis: Challenge Coins as a Caring Support Tool to Prevent Farmer Suicide.

Objectives: Challenge coins have a history in the military as symbolic tokens of belonging and appreciation. Members of some agricultural communities have recently expressed interest in using a challenge coin as a caring support tool to improve mental health among farmers. The objective of this analysis is to clarify the meaning and use of a challenge coin as an upstream suicide prevention caring support tool in agricultural communities.

Methods: A systematic search was performed in Google Scholar, PsycInfo, Sociological Abstracts, Web of Science, and PubMed following PRISMA guidelines, identifying literature available through October 2023. Thirty-five articles were included and analyzed using Rodger's Evolutionary Method for Concept Analysis.

Results: The attributes of challenge coins include its material presence (i.e. a medallion with official insignia) and its presentation as a recognition for contributions to society and signifying belonging to a group. The antecedents of the challenge coin were achievement, rank, or proficiency related to a role in public duty and membership in an occupational group facing unique challenges. The consequences were identified as improved morale and pride and fostering belongingness, connectedness, and community. These consequences can lead to the challenge coin serving as a cue for behavior change.

Discussion: This concept analysis provides additional understanding of a challenge coin when used as a caring support tool, particularly in agricultural communities. The challenge coin has historically been used in a military or first responder context, but it could be expanded to other service-oriented occupations such as farming.

Conclusion: Using a challenge coin for a mental health promotion intervention requires more community-based research to understand its efficacy in agricultural contexts. With the concept of a challenge coin clarified, a next step would be scientific efforts among mental health practitioners and industry leaders to support further development and testing of the challenge coin as a suicide prevention and caring support tool that fosters belongingness and appreciation within agriculture.