O2016: Evaluation of an AAP Firearm Safety Counseling Platform: Interim Analyses of Reach and Immediate Change in Self-efficacy

Background: Despite evidence that provider counseling improves safe firearm storage at home, pediatricians do not consistently provide firearm safety counseling. A team of firearm injury prevention experts developed the Safer: Storing Firearms Prevents Harm training portal with support from the AAP to provide data-informed, actionable tools focused on universal screening available for Maintenance of Certification (MOC). This study describes Safer’s reach and presents preliminary, interim comparisons of perceived self-efficacy, before and immediately after training completion.

Methods: The ongoing study (2/1/2022-5/31/2022) has a pre-post design, and participation includes brief (5-10-minute) optional surveys completed before and after completing the Safer training. All surveys were developed in an interactive process guided by AAP Periodic Survey 102 (2019). The perceived self-efficacy outcome is reported as a continuous variable from 0-100%, where higher scores indicate greater perceived self-efficacy. Initial reach was defined as the number of participants in the study population who access the Safer training from 2/1/2022-4/12/2022, overall, and for pre-specified groups defined by provider and practice characteristics (e.g., demographics, regionality, rurality, and firearm injury-related views). Descriptive statistics are reported using median (IQR), or frequency (proportion). Baseline-follow-up self-efficacy was compared using Wilcoxon matched-pairs signed-rank tests.

Results: To date, 210 participants have completed baseline survey, and 101 (48.1%) had sufficient follow-up data for inclusion in these interim analyses. When comparing excluded participants to those included in this analysis, there were no statistically significant differences in the baseline self-efficacy outcome or rurality. There were significant differences in the proportions of providers who are subspecialists, have treated a firearm-related injury within the past 12 month, and received previous firearm injury prevention training. However, data collection is still ongoing, the absolute differences were minimal, and it is unlikely the groups differed substantively. Among included participants, 75 (74.3%) were practicing clinicians and 26 (25.7%) were resident clinicians. Participants represented all geographic regions [Southeast (25.7%), Mid-West (23.8%), Northeast (17.8%), Pacific (17.8%), Southwest (7.9%), Rocky Mountain (6.9%)], rural/urban areas [Urban, Inner City (33.7%), Urban, Non-Inner City (25.7%), Suburban (29.7%), Rural (10.9%)], and the majority of states as displayed in Figure 1. Most survey respondents were female (67.3%), White (67.3%), non-subspecialists (68.3%), and had received prior firearm injury prevention training (72.3%). (Table 1) Compared to baseline, the follow-up self-efficacy distribution was significantly higher (median = 50 and 80, respectively; p< 0.001). Baseline-follow-up differences remained statistically significant when analyzing by provider type (practicing clinician median = 50 and 80, respectively; p< 0.001; resident median = 50 and 75, respectively; p< 0.001).

Conclusion: In this ongoing study, interim analyses indicated a broad geographic reach among early-adopter Safer study participants. Median self-efficacy preliminarily improved by 30 points immediately following training. Next steps include examining self-efficacy and counseling frequency at the one-month follow up time among all Safer study participants.