Asarnow Joan R, Zullo Lucas, Ernestus Stephanie M, Venables Chase W, Goldston David B, Tunno Angela M, Betz Marian E
Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States.
Department of Psychology, Stonehill College, Easton, MA, United States.
Front Psychiatry. 2021 Oct 6;12:736236. doi: 10.3389/fpsyt.2021.736236. eCollection 2021.
Reducing access to lethal methods is an effective suicide prevention strategy that is often neglected in routine care. Digital interventions have shown promise for addressing such gaps in care; and decision aids have proven useful for supporting complicated health-related decisions, like those involving lethal means restriction. This article describes a parent/caregiver-facing web-based decision aid, the development process, and user testing. A user-centered, participatory, mixed methods development design was employed. Beginning with an adult-focused decision aid developed by members of our team, we assessed ten iterations of the parent/caregiver decision aid with stakeholders ( = 85) using qualitative interviews and quantitative surveys. Stakeholders included: parents/caregivers whose children had histories of suicidal episodes before age 25, young adults with histories of suicidal thoughts/behaviors, firearm owners/representatives from firearm stores/ranges/groups, mental and medical health care providers, and emergency responders. The final "Lock and Protect" decision aid was viewed as "useful for changing access to lethal means" by 100% of participants. Ninety-four percent of participants rated the information on reducing access to lethal means as good to excellent, and 91% rated the information on storage options as good to excellent. Qualitative feedback underscored a preference for offering this digital tool with a "human touch," as part of safety and discharge planning. "Lock and Protect" is a user-friendly web-based tool with potential for improving rates of lethal means counseling for parents/caregivers of suicidal youth and ultimately reducing pre-mature deaths by suicide.
减少获取致命手段的机会是一种有效的自杀预防策略，但在常规护理中常常被忽视。数字干预已显示出有望填补此类护理空白；决策辅助工具已被证明有助于支持复杂的健康相关决策，比如那些涉及限制致命手段的决策。本文介绍了一种面向家长/照顾者的基于网络的决策辅助工具、其开发过程及用户测试。采用了以用户为中心、参与式的混合方法开发设计。从我们团队成员开发的一个以成人为重点的决策辅助工具开始，我们使用定性访谈和定量调查对家长/照顾者决策辅助工具与利益相关者（n = 85）进行了十次迭代评估。利益相关者包括：其子女在25岁之前有自杀发作史的家长/照顾者、有自杀想法/行为史的年轻人、枪支所有者/枪支商店/靶场/团体的代表、精神和医疗保健提供者以及急救人员。100%的参与者认为最终的“锁定并保护”决策辅助工具“有助于改变获取致命手段的情况”。94%的参与者将关于减少获取致命手段的信息评为良好到优秀，91%的参与者将关于储存选择的信息评为良好到优秀。定性反馈强调，作为安全和出院计划的一部分，人们更倾向于提供带有“人性化关怀”的这种数字工具。“锁定并保护”是一个用户友好的基于网络的工具，有可能提高为自杀青少年的家长/照顾者提供致命手段咨询的比例，并最终减少自杀导致的过早死亡。
