Assessing the clinical and cultural impact of LifeKeepers Suicide Prevention Gatekeeper Training in a general community population: A multi-method evaluation including a randomised controlled trial across three modalities
Background: Suicide is a major global public health issue that disproportionately affects marginalised and Indigenous populations. Gatekeeper training (GKT), which focuses on early identification of people experiencing mental distress and referral to support, is a key component of multi-level suicide prevention strategies. LifeKeepers is Aotearoa New Zealand’s national GKT programme, developed for community and frontline populations and delivered across three training modalities: general in-person, e-learning, and a culturally tailored programme for Māori communities, Mana Akiaki. This thesis aimed to synthesise the evidence on GKT, evaluate the effectiveness and cultural relevance of LifeKeepers, and assess the impact of post-training boosters on LifeKeepers outcomes up to 12 months post training. Methods: Three studies were undertaken: a review of systematic reviews of GKT; a large pre-post evaluation of LifeKeepers across three modalities involving 5,981 participants; and a three-arm randomised controlled trial examining booster sessions over 12 months. Outcomes included knowledge, self-efficacy, acceptability, cultural relevance, and retention of effects over time. Results: The review of reviews found that GKT is associated with immediate improvements in knowledge, skills, and self-efficacy, but evidence for long-term retention, behavioural change, e-learning, and Indigenous-specific programmes remains limited. The LifeKeepers evaluation showed significant improvements in declarative knowledge, perceived knowledge, and self-efficacy across all three modalities, with more than 90% of participants rating the programme highly for satisfaction, safety, and cultural acceptability. The trial found no significant additional benefit of booster sessions compared with control conditions, although gains in knowledge and self-efficacy were maintained across groups to 12 months. Conclusion: This thesis provides the first comprehensive evaluation of a nationally delivered, community-based GKT programme in Aotearoa New Zealand and the first to include a Māori-specific training modality within a large-scale evaluation. Together, these findings underscore the importance of culturally responsive, community-based training that is grounded in safety and accessibility. The evidence provides a strong rationale for scaling and embedding the LifeKeepers programme within Aotearoa New Zealand’s national suicide prevention strategies.
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