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.