Tailoring Implementation Strategies for School-Based Gatekeeper Training: A Pre-implementation Case Study Using Multiple Implementation Frameworks

Abstract Gatekeeper training is a widely used approach in suicide prevention, yet successful implementation in school settings remains challenging. There are particular gaps in vocational and alternative educational contexts with elevated vulnerability among students, structured pre-implementation work is rarely described, leaving limited guidance for tailoring implementation strategies to context. This study aimed to explore how multiple implementation frameworks can be applied together to inform the pre-implementation and planning of a school-based gatekeeper training program. We conducted a pre-implementation case study in Danish preparatory basic education schools, drawing on findings from previous empirical studies and contextual data. The Implementation Stages Framework guided the overall process, while Implementation Drivers and the Behaviour Change Wheel were used to identify implementation determinants and tailor strategies during the exploration and installation phases. The combined use of implementation frameworks supported a structured translation of contextual determinants into tailored implementation strategies at organisational and staff levels. Key strategies addressed leadership engagement, role clarification, staff capability, and alignment with existing school practices. The frameworks served complementary functions, supporting both systematic planning and attention to context-specific barriers and facilitators. This study illustrates how multiple implementation frameworks can be used synergistically to support pre-implementation planning of suicide prevention interventions in complex school settings. The findings provide practical and conceptual insights for researchers and practitioners seeking to improve the ability to implement of gatekeeper training prior to large scale roll out.