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Citation
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Hoskins K, Johnson C, Davis M, Pettit AR, Barkin S, Jager-Hyman S, Rivara F, Walton M, Wolk CB, Beidas RS. J. Appl. Res. Child. 2021; 12(2): e2. |
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Abstract
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Limiting unauthorized youth access to firearms is essential for preventing both unintentional injury and suicide.1-5 Despite recommendations from the American Academy of Pediatrics6 and other organizations7 that firearms be stored locked, unloaded, and separately from ammunition, an estimated 4.6 million children live in homes with at least 1 firearm stored unlocked and loaded.8 A national survey found that at least 1 firearm is present in 42% of U.S. households,9 and firearm sales have surged since the onset of the COVID-19 pandemic.10 The availability of firearms, coupled with their lethality, amplifies the importance of firearm storage programs directed to parents and caregivers of youth (hereon referred to as "parents"). Pediatric primary care is an optimal setting for implementation of such programs, given the reach of well-child care.11
Suicide and Accident prevention through Family Education ("S.A.F.E Firearm") is an adaptation of the firearm storage component of the Safety Check violence prevention program.12 Safety Check was found to be effective in a large clinical trial,12 but core components have not yet been widely adopted in routine practice.13 Aligning with implementation science recommendations to adapt evidence-based interventions for use in new populations and to improve program-setting fit,14,15 we used the ADAPT-ITT framework16 to adapt Safety Check to reach a broader age group (i.e., youth up to age 18, expanded from ages 2-11) and to serve as a universal suicide prevention strategy in pediatric primary care.17 The adapted program retains the core components of the original program: (1) brief counseling provided by pediatric primary care clinicians on secure firearm storage and (2) offering free cable firearm locks. The adapted program changes the entry point of the counseling conversation from an identified parental concern to universal counseling for all parents. Self-disclosure about ownership is not documented in the electronic medical record, and parents are offered additional resources (e.g., a handout describing alternative storage options).17
Although parent input was obtained for key program elements (i.e., name, logo) during prior stages of adaptation,17-19 the present study sought to obtain a comprehensive view of parent perspectives on the full S.A.F.E. Firearm program following the last stage of adaptation, in keeping with parents' role as end users. This reflects principles of user-centered design, which focuses on redesigning and adapting interventions with end users in mind,20 with the goals of maximizing "usability in context",21 patient- (or family-) centered care,20 and acceptability, or the perception that a program is agreeable, palatable, or satisfactory.20,22
Acceptability is a key determinant of program effectiveness...
Language: en |