Randomized trial of a shared decision-making intervention for families about firearm storage

PROJECT SUMMARY In the United States, firearm ownership is a protected right and valued by many people. Firearms are also the leading cause of pediatric mortality. It is essential that in homes with children all firearms are consistently stored safely—which means being stored locked and, in the safest scenario, unloaded. Firearm storage is a family-level safety practice, typically involving multiple adults and more than one firearm, and safe storage is most likely when both members of parenting dyads are involved in storage decision making. The American Academy of Pediatrics has highlighted the need for non- judgmental family-centered interventions to help increase the proportion of firearms stored safely. To address this need, we partnered with firearm-owning parents to develop the Family Safety Check-In, which is an interactive web-based shared decision-making support tool that is tailored to different family structures and ages of children in the home. Pilot data suggests that it helps facilitate informed, value-consistent decision making about storage in which all adult family members are engaged in the decision-making process. Building from a successful pilot trial of the intervention, we will address the following aims: (1) Translate and adapt the Family Safety Check-In to meet the needs of Hispanic, Spanish- speaking families, working in partnership with an advisory board of eight Spanish-speaking Hispanic parents who have firearms in the home. (2) Assess the effectiveness of the Family Safety Check-In on safe firearm storage practices in a randomized controlled trial. Families will be recruited in conjunction with well-child/adolescent visits from practices in the Washington, Wyoming, Alaska, Montana, Idaho Practice and Research Network (WPRN). All trial participants will receive a firearm lock or lock box, with half also receiving the Family Safety Check-In for completion at home. The primary outcome will be the change in storage practices at 6-month follow-up compared with baseline. (3) Test the theory- driven family-level and dyadic mechanisms mediating intervention effectiveness. Actor-partner analyses will test the pathways articulated in the logic model of change, including individual factors (e.g., feeling adequately informed) and dyadic factors (e.g., communication satisfaction). Completing the proposed aims will produce necessary information about the impact of the Family Safety Check-In on storage practices. Pending intervention effectiveness, clinic-based dissemination and implementation will be a critical area for further study, including developing strategies to support clinic-led dissemination.