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Abstract

Statement of Purpose:

Pediatric firearm access is a significant risk factor for unintentional injury and suicide. This study investigated parents’ perspectives on an adapted firearm safety program, S.A.F.E. Firearm, to ensure acceptability and optimize effectiveness prior to the launch of an upcoming hybrid effectiveness-implementation trial.

Methods/Approach:

We administered a cross-sectional survey with a convenience sample of U.S. parents to measure the acceptability of S.A.F.E. Firearm and other key variables (e.g., relationship with pediatrician) that may impact our implementation approach. The sample included 97 participants (52 firearm-owning and 45 non-owning) from across the country. We also conducted semi-structured interviews using a Think Aloud exercise with 11 survey participants that were analyzed with directed content analysis.

Results:

The mean acceptability score was 4.35 [SD 0.52] on a 1-5 Likert scale, indicating that participants viewed S.A.F.E. Firearm as highly acceptable. Most participants (84%) either agreed or completely agreed with recommending that a friend receive S.A.F.E. Firearm. No significant differences in acceptability scores were found by firearm ownership status, gender, race and ethnicity, or region of residence. Parent-pediatrician depth of relationship was associated with acceptability (r= 0.21, p=.038). Interviews indicated that a collaborative approach to decision-making, neutral messaging, and provision of tangible resources were key factors that contributed to the program’s overall high acceptability scores.

Conclusion & Significance:

The present study served as the final check in our process of adapting an evidence-based safe firearm storage program to increase reach and effectiveness as a universal suicide prevention strategy in pediatric primary care. Convergent parent feedback confirms that S.A.F.E. Firearm is highly acceptable and ready for implementation. Moreover, our findings suggest that family-centeredness may be enhanced through explicit integration of parents’ needs and preferences into program refinements. Use of qualitative Think Aloud exercises with end user groups can add value when actual implementation of firearm safety programs can only be approximated.

Key Take Away Points

  • Using an established adaptation framework, our team adapted the firearm storage component of the Safety Check violence prevention program to expand its reach and serve as a universal suicide prevention strategy in pediatric primary care.
  • In this mixed methods study, we investigated parents’ perspectives on the adapted program, S.A.F.E. Firearm, to ensure acceptability and optimize effectiveness prior to upcoming trial launch.
  • The mean acceptability score was 4.35 [SD 0.52] on a 1-5 Likert scale, indicating that survey participants viewed S.A.F.E. Firearm as highly acceptable. No significant differences in acceptability scores were found by firearm ownership status, gender, race and ethnicity, or region of residence.
  • Interviews findings indicated that a collaborative approach to decision-making, neutral messaging, and provision of tangible resources are key factors that contributed to the program’s acceptability.
  • Our approach provided insights for pre-implementation preparation, like clinician training and creation of parent-facing materials, to inform S.A.F.E. Firearm trial launch.

Author Biography

Katelin Hoskins, PhD, CRNP is a NIMH T32 postdoctoral fellow at the Penn Center for Mental Health and Penn Medicine Nudge Unit. She is an Associate Fellow at the Leonard Davis Institute of Health Economics at the University of Pennsylvania. Christina Johnson, BS is a Senior Project Manager at the Penn Medicine Nudge Unit. Molly Davis, PhD is a Research Psychologist in the Department of Child and Adolescent Psychiatry at the Children’s Hospital of Philadelphia and an Associate Fellow at the Leonard Davis Institute of Health Economics at the University of Pennsylvania. Amy R. Pettit, PhD is a research and program development consultant and a clinical psychologist. Shari Barkin, MD, MSHS is the William K. Warren Foundation Chair, Professor of Pediatrics, and Chief of the Division of General Pediatrics at Vanderbilt University Medical Center. Shari Jager-Hyman, PhD is an Assistant Professor in the Department of Psychiatry at the University of Pennsylvania. Frederick P. Rivara, MD, MPH is the Seattle Children's Guild Association Endowed Chair in Pediatric Research; Vice Chair and Professor, Department of Pediatrics; and Adjunct Professor, Department of Epidemiology at the University of Washington. Maureen Walton, PhD, MPH is Professor, Department of Psychiatry; Associate Chair for Research and Research Faculty Development; Associate Director for Child Research, U-M Addiction Center; and Associate Director, Injury Prevention Center at the University of Michigan. Courtney Benjamin Wolk, PhD is an Assistant Professor in the Department of Psychiatry, a Senior Fellow at the Leonard Davis Institute of Health Economics, and an Associate Fellow at the Center for Public Health Initiatives at the University of Pennsylvania. Rinad S. Beidas, PhD is Director of the Penn Medicine Nudge Unit and Director of the Penn Implementation Science Center at the Leonard Davis Institute of Health Economics; Associate Director of the Center for Health Incentives and Behavioral Economics; and Professor of Psychiatry, Medical Ethics and Health Policy, and Medicine at the University of Pennsylvania. She is a Senior Fellow at the Leonard Davis Institute of Health Economics.

Acknowledgements

We would like to thank our stakeholder participants, the FACTS Consortium, Dr. Dorothy Novick, Dr. Cheryl King, Dr. Eric Sigel, Dr. Ben Hoffman, Ms. Adina Lieberman, Ms. Lynn Massey, and Dr. Jessica Fishman for their valuable contributions to this work. This work was supported by the National Institute of Child Health and Human Development (5R24HD087149-03; Cunningham PI) and the National Institute of Mental Health (1R01MH123491-01; Beidas PI). Katelin Hoskins and Molly Davis are supported by a National Institute of Mental Health Training Fellowship (T32 MH109433; Mandell/Beidas MPIs). The granting agencies were not involved in the study design; data analysis, collection, or interpretation; the writing of the manuscript; or the decision to submit this manuscript for publication.

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