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OBJECTIVE: To examine the perceptions of suicide among a sample of adolescents from Gilgit-Baltistan and Chitral (GBC), a northern province of Pakistan. METHODS: A qualitative, descriptive, exploratory design was employed to study the phenomenon by examining secondary data from an asynchronous, online student discussion forum at a University in Karachi. All the participants, originally from GBC, were enrolled from June-December 2019 using a purposive sampling technique. based on their experiences of losing a loved one (adolescent sibling or cousin or a friend) because of suicide. The narratives were content analyzed using Creswell framework resulting categories and an overarching theme. Study was approved by ethical committee of university. Pseudonyms were assigned to ensure anonymity and confidentiality of the participants. RESULTS: Out of 10 participants, 8 were females and 2 were males aged 18-20 years. Participants shared their perceptions/experiences about suicide among adolescents in GBC, probable root causes of suicide and recommendation/suggestions in context of GBC. The analysis revealed an overarching theme “cry for help”, which was further divided into five categories including: (i) cultural norms; (ii) parents as a whistle for the rat race; (iii) psychological issues; (iv) seeking mental help - a challenge; and (v) how can I be helped? CONCLUSION: Study findings provided insights into factors leading to suicide among young adults in GBC region. The contributing factors highlight the need to develop infrastructure to increase accessibility to healthcare centers, and predominantly access to mental healthcare workers for undertaking risk assessment, and managing the cases promptly is needed.

IntroductionBuilding capacity to improve sex/gender knowledge and strengthen patient engagement in clinical trials requires training and support. The overall goal of this 2-year project is to refine, translate and evaluate two web-based open-access patient and investigator decision aids aimed to improve patient engagement partnerships in clinical trials.Methods and analysisTwo decision aids were designed in Phase 1 of this programme of research and this protocol describes a subsequent sequential phased approach to refine/translate (Phase 2A) and conduct alpha/usability (Phase 2B) and beta/field (Phase 3) testing. Decision aid development is guided by the International Patient Decision Aid Standards, User-Centred Design, Ottawa Decision-Support Framework and the Ottawa Model of Research Use. We have integrated patient-oriented research methods by engaging patient partners across all phases of our programme of research. Decision aids will first be refined and then translated to French (Phase 2A). Eight iterative cycles of semistructured interviews with 40 participants (20 patient partners and 20 investigators) will be conducted to determine usability (Phase 2B). A pragmatic pre/post pilot study design will then be implemented for field/beta testing using another purposive sample of 80 English-speaking and French-speaking participants (40 patients and 40 investigators). The samples are purposive to ensure an equal representation of English-speaking and French-speaking participants and an equal representation of men and women. Since sex and/or gender differences in utilisation and effectiveness of decision aids have not been previously reported, Phase 3 outcomes will be reported for the total sample and separately for men and women.Ethics and disseminationEthics approval has been granted from the University of Toronto (41109, 28 September 2021). Informed consent will be obtained from participants. Dissemination will include co-authored publications, conference presentations, educational national public forums, fact sheets/newsletters, social media sharing and videos/webinars.