Abstract
Objective
The presence of unlocked firearms in the home is associated with increased risk of
suicide and unintentional injury in youth. We adapted an evidence-based program for
promoting safe firearm storage, Safety Check, to enhance its acceptability as a universal suicide prevention strategy in pediatric
primary care.
Methods
We applied ADAPT-ITT, an established adaptation framework, to guide iterative program
adaptation with ongoing input from key stakeholders. The present study describes 2
phases of ADAPT-ITT: the Production phase (generating adaptations) and the Topical
Experts phase (gathering stakeholder feedback on adaptations). After generating proposed
program adaptations based on 3 inputs (stakeholder feedback collected in a prior study,
the behavioral science literature, and best practices in pediatric medicine), we elicited
feedback from stakeholders with firearm expertise. The adaptations included changes
such as clarifying firearm ownership will not be documented in the medical record
and offering follow-up reminders. We also crowdsourced feedback from 337 parents to
select a new name and program logo.
Results
Saturation was reached with 9 stakeholders. Feedback confirmed the value of adaptations
that: 1) considered context (eg, reason for ownership), 2) promoted parent autonomy
in decision-making, and 3) ensured privacy. The most preferred program name was Suicide and Accident prevention through Family Education (SAFE) Firearm.
Conclusions
Guided by an established adaptation framework that prioritized multistage stakeholder
feedback, adaptations to the original Safety Check were deemed acceptable. We plan to test the SAFE Firearm program as a universal suicide prevention strategy in pediatric primary care via
a hybrid effectiveness-implementation trial.
Keywords
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Article Info
Publication History
Published online: April 23, 2021
Accepted:
April 18,
2021
Received:
November 23,
2020
Footnotes
Conflicts of Interest: Rinad Beidas receives royalties from Oxford University Press, has provided consultation to the Camden Coalition of Health Care Providers, and currently provides consultation to United Behavioral Health. She also serves on the Optum Behavioral Health Clinical Scientific Advisory Council. Cheryl King serves on the Scientific Advisory Council of the American Foundation for Suicide Prevention. The authors have no other conflicts of interest to disclose.
Identification
Copyright
Copyright © 2021 by Academic Pediatric Association
