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NIH grant 1R01CE003784-01: Randomized trial of a shared decision-making intervention for families about firearm storage
Institute: {'code': 'CE', 'abbreviation': 'NCIPC', 'name': 'National Center for Injury Prevention and Control', 'admin_org_id': '12501083', 'admin_funding_url': ''}. PI: Emily Grace Kroshus-Havril. Award: $650000.
Start: 2026-09-30T00:00:00.
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 and is of particular concern in rural communities. 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 in a sample of families who live in rural
communities: (1) Assess the effectiveness of the Family Safety Check-In on safe firearm storage practices in a randomized
controlled trial. The primary effectiveness outcome is storage practices 6 months after randomization, classifying firearm
owners along a harm reduction continuum, with all firearms and ammunition stored safely at one end, and none stored
safely at the other. (2) Test the theory-driven mechanisms mediating intervention effectiveness in this unique population
and setting. Actor-partner analyses will test the pathways articulated in the logic model of change. The goal of these
analyses is to identify the individual, family dyad, and contextual drivers of intervention effectiveness. Results will be
used to inform potential intervention refinements for strength and efficiency. (3) Identify individual, dyadic, and
contextual determinants of successful implementation. We will characterize Family Safety Check-In implementation using
a mixed methods approach, including intervention completion data, participant-reported implementation experiences, and
qualitative interviews with a purposively recruited subset of participants. Interviews will be used to understand how
parenting dyads engaged with the intervention and with each other about firearm storage. Guided by our dyadic and
contextualized theory of change and the Consolidated Framework for Implementation Research,17 we will aim to identify
individual, dyadic and contextual determinants of implementation. Results will be used to consider whether modifications
are needed to better support successful family-level implementation. Completing the proposed aims will produce
necessary information about the impact of the Family Safety Check-In on firearm storage practices in rural families. If
effective, the decision aid could be scaled nationally, potentially positively impacting millions of families nationwide
through safer firearm storage practices. Research focused on the development of strategies to support clinic-led
dissemination and family-level implementation would be a necessary area for further study, pending results of the present
investigation.document fetched 2026-10-24 02:47