{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T17:53:01Z","timestamp":1791913981899,"version":"4.3.4"},"reference-count":88,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Canadian Institutes of Health Research Doctoral Research Award","id":[{"id":"https:\/\/ror.org\/01gavpb45","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Canadian Behavioural Intervention and Trials Network Doctoral Studentship"},{"name":"Registered Nurses\u2019 Foundation of Ontario Research in Mental Health Award"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Emergency departments (EDs) play a crucial role in suicide prevention, with evidenced-based safety planning interventions (SPI) playing an important role. Traditional safety plans, which are often paper based, come with challenges (i.e., not easily accessible, or easy to misplace). Digital safety planning tools offer an alternative mode of intervention delivery, but clinical implementation remains limited. Using behavioural change frameworks, we aim to provide insights into the factors influencing app adoption. These insights will be used as a knowledge base to design behavior change strategies to promote the implementation of a SPI app in a psychiatric ED.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used a qualitative descriptive design to conduct semi-structured interviews with clinicians in a psychiatric ED in Toronto, Canada. Participants encompassed all ED staff, irrespective of their SPI app usage. The semi-structured interview guide was developed using the Theoretical Domains Framework (TDF) and the capability (C), opportunity (O), motivation (M) and behavior (B) (COM-B) model. We then used directed content analysis, identifying findings within the TDF and COM-B domains as barriers, facilitators, or both.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>A total of 29 ED clinicians were interviewed, including nurses, psychiatrists, social workers, program assistants, and a pharmacist. The majority had not used the app. We observed strong motivation among clinicians across all disciplines to use the app, and they considered SPI as a high-priority ED care strategy closely linked to their professional identity and responsibility. Anticipated barriers regarding the app as a new mode of SPI delivery in routine practice included: documentation, communication, care efficiency, and patient access to smartphones. Some barriers were attributable to the lack of interoperability between the app and the electronic health record and documentation infrastructure for the app.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We identified key behavioral factors influencing the implementation of the SPI app in the psychiatric ED. As such, we found that tailored strategies that can mitigate barriers by targeting capability, motivation, and opportunity are essential, while facilitators that can sustain implementation should be leveraged. Additionally, ongoing monitoring and adaptation of strategies are necessary, as new barriers may arise or facilitators may weaken over time, impacting the sustained use of the app in the ED. We will use these findings to inform the next phase of this work, which involves co-designing targeted and tailored implementation strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0355517","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T17:27:52Z","timestamp":1791912472000},"page":"e0355517","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Barriers and facilitators to using an app-based tool for suicide safety planning in a psychiatric emergency department: A qualitative descriptive study using the Theoretical Domains Framework and COM-B model"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4037-4464","authenticated-orcid":true,"given":"Hwayeon Danielle","family":"Shin","sequence":"first","affiliation":[{"name":"Centre for Addiction and Mental Health","place":["Toronto, Ontario, Canada"],"department":["Krembil Centre for Neuroinformatics"]},{"name":"University of Toronto","place":["Toronto, Ontario, Canada"],"department":["Institute of Health Policy, Management, and Evaluation"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keri","family":"Durocher","sequence":"additional","affiliation":[{"name":"Centre for Addiction and Mental Health","place":["Toronto, Ontario, Canada"],"department":["Krembil Centre for Neuroinformatics"]},{"name":"Western University","place":["London, Ontario, Canada"],"department":["Arthur Labatt Family School of Nursing"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iman","family":"Kassam","sequence":"additional","affiliation":[{"name":"Centre for Addiction and Mental Health","place":["Toronto, Ontario, Canada"],"department":["Krembil Centre for Neuroinformatics"]},{"name":"University of Toronto","place":["Toronto, Ontario, Canada"],"department":["Institute of Health Policy, Management, and Evaluation"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0776-9545","authenticated-orcid":true,"given":"Sridevi","family":"Kundurthi","sequence":"additional","affiliation":[{"name":"Centre for Addiction and Mental Health","place":["Toronto, Ontario, Canada"],"department":["Krembil Centre for Neuroinformatics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Torous","sequence":"additional","affiliation":[{"name":"Harvard Medical School","place":["Boston, Massachusetts, United States of America"],"department":["Department of Psychiatry, Beth Israel Deaconess Medical Center"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gillian","family":"Strudwick","sequence":"additional","affiliation":[{"name":"Centre for Addiction and Mental Health","place":["Toronto, Ontario, Canada"],"department":["Krembil Centre for Neuroinformatics"]},{"name":"University of Toronto","place":["Toronto, Ontario, 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