Lethal Means Safety
Conditions
Keywords
Firearms, Suicide Prevention, Lethal means safety, Veterans
Brief summary
Family and friends are trusted by Veterans, and can play a vital role in supporting Veteran suicide prevention. Veterans are more likely to adopt secure firearm storage if their loved ones discuss firearm safety with them and if they are exposed to compelling personal stories. "Worried About a Veteran" (WAV) is an online resource that contains 13 powerful, video-based vignettes designed to empower loved ones to initiate life-saving conversations about safeguarding firearms in the homes of Veterans at risk for suicide. The primary objective of this study is to evaluate the effectiveness of WAV in encouraging loved ones to discuss safe firearm storage with Veterans.
Detailed description
Significance to VA: Firearms are involved in 71% of Veteran suicides. Lethal means safety (LMS)-the intentional practice of limiting access to lethal means, such as firearms, to reduce suicide risk-is key to Veteran suicide prevention. Veterans are more likely to adopt secure firearm storage if their loved ones discuss firearm safety with them and if they are exposed to compelling personal stories. Worried About a Veteran (WAV) is a novel, acceptable intervention that includes 13 compelling, Veteran-centered video vignettes about secure firearm storage told from the perspective of Veterans' loved ones. WAV has not undergone formal evaluation and awareness of WAV has been limited. VA Office of Suicide Prevention has called for strategies to support and amplify messaging on LMS. Innovation and Impact: LMS approaches that leverage loved ones are lacking, which makes WAV unique. Knowledge generated about loved ones' firearms discussions and behaviors further enhances project impact. Specific Aim: Evaluate the impact of WAV videos on behavioral outcomes related to safe storage of household firearms. Hypotheses are: 1) Exposure to WAV videos will be associated with talking with Veterans about safe firearm storage by end of trial, compared to the active or inactive control; and 2) Exposure to WAV videos will be associated with safe firearm storage practices by end of trial, compared to the active or inactive control. Methodology: Using a social media campaign, loved ones of Veterans with household firearms will be recruited, randomized to multiple exposures to WAV videos, VA News videos (inactive control), or an electronic copy of a VA LMS brochure (active control), and changes will be evaluated over 8 weeks in discussing safe firearm storage with Veterans (primary outcome). Secondary outcomes will include firearm storage practices, knowledge, intentions, and attitudes. Path to Translation/Implementation: WAV videos are freely accessible online, making the intervention ideal for large-scale implementation. Next steps may include using the intervention in suicide prevention campaign efforts led by the Office of Suicide Prevention and facilitating use by community-based military and Veteran organizations that have expressed interest in WAV. Project methods can also be applied to other Veteran health issues.
Interventions
BEHAVIORALWAV videos
13 "Worried About a Veteran" video vignettes. The videos are brief (\< 3 minutes), professionally developed, and involve vignettes of Veterans' family members that teach warning signs of suicidal crisis, practical guidance for LMS, and how to collaboratively discuss lethal means and secure storage.
BEHAVIORALVA News videos
VA News videos range in topic, such as VA benefits, research highlights, and Veteran interest stories (e.g., Veteran hockey league). Videos will be current at the time of study launch and unrelated to firearms and suicide prevention.
BEHAVIORALVA LMS brochure
2-page VA educational brochure on lethal means safety (LMS). The brochure is titled "Reducing Firearm and Other Household Safety Risks for Veterans and Their Families," and it provides information on the importance of reducing access to lethal means such as firearms and medications for individuals at risk of suicide.
Sponsors
VA Office of Research and Development
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
TRIPLE (Subject, Investigator, Outcomes Assessor)
Masking description
Information about study hypotheses will not be provided to participants, and the study biostatistician will be blinded.
Intervention model description
The investigators will randomly assign participants in a 1:1:1 allocation to intervention or one of the two control conditions using a block-randomization scheme without stratification. To maintain allocation concealment, the investigators will use random block sizes. The block-randomization schemes will be created using the R package, blockrand. Randomization will occur after baseline survey and assessments are completed, as our prior work with participants recruited via social has found this helpful to maintain balance in study arms. Following recommendations for blinding in behavioral interventions, the investigators will not provide information about study hypotheses to participants, and the study biostatistician will be blinded.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Living in U.S. * Family member, caregiver, or friend of a Veteran * Social contact at least once a week with a Veteran who possesses a household firearm, and * Access to a household firearm
Exclusion criteria
* Not providing a valid phone number and email address * No internet access * Indication of duplicate study entry
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Discussions of safe firearm storage | 8 week follow-up | Yes/No question about whether they recently discussed safe firearm storage with a Veteran. Answering "Yes" indicates a better outcome. If they answer in the affirmative, they will be asked follow-up questions to gauge frequency, mode (e.g., by phone, text, in-person), length, number of Veterans, and outcome of the conversation(s) (i.e., behavior change). Higher frequency and longer length of conversations, larger number of Veterans spoken to, and behavior change indicate successful discussions of safe firearm storage. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Attitudes | 8 week follow-up | Eight-item scale of attitudes toward discussing safe firearm storage adapted from the Perceptions about Services Scale (PASS). Responses are rated on a 7-point Likert-type scale. A mean score (range 1 to 7) is calculated across all items, with higher scores indicating a better attitude towards suicide prevention and safe firearm storage discussions. |
| Norms | 8 week follow-up | Four-item scale of descriptive (i.e., what others think/do) and injunctive (i.e., what close others want me to think/do) norms related to discussing safe firearm storage adapted from the Perceptions about Services Scale (PASS). Responses are rated on a 7-point Likert-type scale. A mean score (range 1 to 7) is calculated across all items, with higher scores indicating stronger perceived norms supporting discussions about safe firearm storage. |
| Knowledge of firearm injury/suicide | 8 week follow-up | Five-item series of True/False questions on risks associated with access to lethal means, including unsecured firearms, and awareness of firearm injury and firearm suicide. Responses are totaled across all five items, ranging from 0 to 5, with a correct response receiving a score of "1." Higher scores indicate greater knowledge of lethal means safety and secure firearm storage. |
| Behavioral intentions | 8 week follow-up | Three-item scale of intentions to discuss safe firearm storage with Veterans in the next month adapted from the Perceptions about Services Scale (PASS). Responses are rated on a 7-point Likert-type scale. A mean score (range 1 to 7) is calculated across all items, with higher scores indicating stronger intentions to discuss safe firearm storage. |
| Firearm storage practices | 8 week follow-up | Series of Yes/No/Not sure questions about the participants' personal firearms storage practices and practices in the Veteran. First, it will be determined if there is any access in or around the home (e.g., "kept in a garage, outdoor storage area, or motor vehicle") and the number of firearms. For individuals with access to firearms, subsequent questions will assess whether all firearms are stored safely: a) locked (defined as needing a "key or a combination or a hand/fingerprint to get the gun or to fire it"), b) loaded, and/or c) stored separately from ammunition. Safe firearm storage practices (locked, unloaded, and stored separately from ammunition) indicate a better outcome. |
| Perceived behavioral control | 8 week follow-up | Three-item scale of capability and confidence related to discussing safe firearm storage adapted from the Perceptions about Services Scale (PASS). Responses are rated on a 7-point Likert-type scale. A mean score (range 1 to 7) is calculated across all items, with higher scores indicating greater capability and confidence related to safe firearm storage discussions. |
Countries
United States
Contacts
CONTACTKeeley R Blackie
CONTACTAaron A Call
PRINCIPAL_INVESTIGATORAlan R. Teo, MD MS
VA Portland Health Care System, Portland, OR
Outcome results
None listed