An Automated Virtual Reality Intervention to Enhance Firearm Safety Counseling in Pediatrics

PROJECT SUMMARY Studies have identified a lower fatality risk in households that secure their firearms locked and unloaded when compared to those where firearms are stored unlocked and loaded. Such findings are consistent across populations, firearm types, and injury outcomes. Though clinician-provided storage counseling on firearms has

high acceptability with patients and is efficacious in enhancing secure storage practices , most pediatric clinicians are not providing firearm safety counseling despite firearm related injury being the leading cause of death among children and adolescents. Reported barriers to counseling include a lack of knowledge related to

storage strategies and counseling techniques. Thus, a screen-based virtual reality (VR) intervention grounded in education and behavior change theory was developed to support mastery of firearm safety counseling behaviors among pediatric clinicians. Within VR, a user can interact with graphical characters in a seemingly

realistic way to deliberately practice skills through receipt of immediate feedback. Dr. Real led the development, usability testing, and preliminary efficacy testing of a human-facilitated version of the VR intervention. Given the promising preliminary data, Dr. Real has developed a prototype for an automated

version of the intervention to promote scale and spread. Dr. Real’s long-term goal is to establish an independent research career in the field of firearm injury and mortality prevention. The overall objective of the application is to adapt the automated VR intervention and assess preliminary outcomes including acceptability,

feasibility, and usability to prepare for a future effectiveness-implementation trial. The rationale for the proposed research is that an evaluation of an automated VR intervention will inform scalable strategies to train clinicians to provide storage counseling, resulting in increased secure storage practices by patients and

caregivers, resulting in decreased access to firearms among children and adolescents, and ultimately lower rates of firearm related injuries and deaths. To achieve our objective, we will accomplish these specific aims: (1) adapt the automated VR intervention by conducting formative evaluations with stakeholders and (2) assess

implementation outcomes at multiple sites. To accomplish these aims and his long-term career goals, Dr. Real requires training in (1) firearm injury prevention research, (2) community engagement, and (3) implementation science. This training will occur through a combination of didactic, writing, and experiential research activities .

He will receive mentorship from leading researchers at University of Michigan and Harvard Medical School, with Dr. Patrick Carter as the primary mentor. The scientific environment at Cincinnati Children’s Hospital Medical Center strongly supports experienced investigators such as Dr. Real with an abundance of resources.

The expected outcomes of this work include foundational data to inform a technology-based intervention easily accessible to clinicians to curb the leading cause of death among children and adolescents.