Feasibility and Acceptability of a Web-Based Caregiver Decision Aid (Safety in Dementia) for Firearm Access: Pilot Randomized Controlled Trial

Abstract

Background Firearms are common in the households of persons with Alzheimer disease and related dementias (ADRD). Safety in Dementia (SiD) is a free web-based decision aid that was developed to support ADRD caregivers in addressing firearm access. Objective We aimed to evaluate the feasibility and acceptability of SiD among a web-based sample of ADRD caregivers. Methods SiD was tested in 2 phases by using participants who were recruited from a web-based convenience sample (Amazon Mechanical Turk participants). In phase 1, caregivers were randomized to view either the intervention (SiD) or the control (Alzheimer’s Association materials), and the blinding of participants to the study arms was conducted. In phase 2, caregivers of individuals with ADRD and firearm access were recruited; all of these participants viewed the firearm section of SiD. In both phases, participants viewed SiD independently for as long as they wanted. Measures for evaluating decision-making and SiD acceptability were used, and these were assessed via a self-administered web-based questionnaire. Results Participants were recruited for phases 1 (n=203) and 2 (n=54). Although it was feasible to collect the study outcome data in a web-based format, in phase 1, there were no significant differences between SiD and the control in terms of decision-making and self-efficacy. The majority (137/203, 67.5%) of phase 1 participants spent between 5 and 10 minutes reviewing the resources. In phase 2, 61% (33/54) of participants spent 5 to 10 minutes viewing the firearm section, and 31% (17/54) spent 10 to 20 minutes viewing this section. Usability and acceptability were high across the phases. Conclusions SiD represents a new resource for promoting safety among people with dementia, and high acceptability was achieved in a pilot trial. In this sample, SiD performed similarly to Alzheimer’s Association materials in supporting decision-making and self-efficacy.

A Web-Based Decision Aid for Caregivers of Persons With Dementia With Firearm Access (Safe at Home Study): Protocol for a Randomized Controlled Trial

“…Transformed scores range from 0 (extremely low) to 100 (extremely high self-efficacy). In the SiD pilot trial, participants had a mean score of 77.6 (SD 17.2) after viewing the SiD firearm section [ 37 ] ( Table 1 ).…”

“…The target sample size for this study (n=500), which includes recruitment via social media (n=250) and relevant organizations (n=250), was powered conservatively for the primary outcome to allow comparisons by recruitment groups and other participant characteristics. In the pilot trial of 15 caregivers, the mean Preparation for Decision Making scores (using 9 constructs) was 3.9 (SD 0.7) after SiD versus 3.6 (SD 0.2) in the control group; this corresponds to a standardized effect size of 0.42 (3.9 vs 3.6 with a pooled SD of 0.7; d =0.3/0.7=0.42) [ 37 , 64 ]. Based on a t test, with the proposed sample size of 500 participants, the analysis will be able to detect a d =0.42 effect size with a very high power of >99% (α=.05) between SiD and control for the primary outcome (preparation for decision-making).…”

“…The SiD tool was translated into Spanish using a rigorous translation process including independent back-translation to English by certified translators with adjudication of any discrepancies [ 35 , 36 ]. The pilot trial of SiD, in a national convenience sample of caregivers of community-dwelling people with ADRD, found 44% of caregivers reported safety concerns regarding firearm access and approximately 30% were currently considering options for what to do about firearm access [ 37 ].…”

The influence of web‐based decision aids on informal caregivers of people with dementia: A systematic mixed‐methods review

“…Professionals used messaging to provide personalized recommendations to caregivers and people with dementia, support informal caregivers in preparation for decision making, and improve interaction between professionals and informal caregivers (Schaller et al, 2015(Schaller et al, , 2016. However, Betz et al (2021) presented Safety in Dementia, which had high scores for decision preparation but no significant difference in the control group.…”

Taking Aim at the Injury Prevention Curriculum: Educating Residents on Talking to Patients About Firearm Injury

“…47 Ideally, outcome measures would include either theoretically based survey assessments or actual provider behavior assessments, such as through direct observation, electronic health record audits, or patient assessments of physician counseling and interventions. 25,[48][49][50][51] It is also important to measure patients' own perceptions, trust, intentions, and self-efficacy in behavior change. 49,52 Should further research show that the program described by Rickert et al has real clinical outcomes, dissemination would be essential.…”