The purpose of the current study was to collaborate with local firearm owners and instructors to adapt and expand Utah’s learning module (Barber et al. 2019) to develop a culturally competent suicide prevention learning module that could be used in Louisiana firearm safety and concealed carry courses. A secondary purpose of this study was to assess the feasibility and acceptability of such a module among local firearm owners (the target audience in a firearm course) and instructors. Focus group feedback indicated a desire for relatable and representative messengers, and messages that align with firearm owner values (e.g., safety and responsibility). Following the development of the adapted module, focus group feedback suggested that participants found the module to be relatable, feasible, and acceptable.
Focus group feedback highlighted the value of using credible, relatable messengers. Focus group members viewed veterans as excellent messengers in the adapted learning module, indicating that they came across as knowledgeable, passionate, and genuine. This feedback aligns with previous research indicating that firearm owners and non-firearm owners view military veterans as highly credible messengers about firearm safety for suicide prevention (Anestis et al. 2021; Crifasi et al. 2018). Thus, the current study built upon the Utah learning module’s foundation by incorporating veteran perspectives in the adaptation and presentation of our learning module, which appears to have had a positive effect on module acceptability. Harnessing veteran perspectives and voices in this area may be particularly important, as veterans are more likely to own firearms (Lambert and Fowler 1997) and use less safe firearm storage practices (Anestis et al. 2020; Bryan et al. 2019; Simonetti et al. 2019) than individuals in the general population. The current study also highlighted the importance of other aspects of the messenger that augment credibility, including representation of multiple groups (e.g., women), incorporation of emotional closeness to the issue (e.g., suicide loss survivor, general passion for suicide prevention), and messenger tone (e.g., conversational vs lecturing). Furthermore, elements of the visual experience proved to be important to messenger credibility and overall acceptability, such as using correct firearm technique in video sequences involving shooting.
Importantly, prior research has highlighted the importance of incorporating certain themes into lethal means safety messaging, such as acknowledging the strong safety culture within the firearm-owning community and emphasizing firearm owners’ agency and responsibility in suicide prevention (Pallin et al. 2019). Findings from the current study support this perspective, as focus group members favored messaging that emphasized firearm owners’ responsibility to be knowledgeable about the risks of firearm suicide. Several motivations for such messaging were salient among firearm owner and instructor focus group members, including concern for the welfare of friends and family members, as well as the importance of addressing problems without government involvement. These messages were consistent with the Utah learning module and shed light on two potentially important values within firearm culture: personal accountability and autonomy. Accordingly, many firearm owners and instructors expressed a desire for more information, resources, and training in suicide prevention to support the preference to decrease firearm suicide through individual-level actions.
As with any study, several limitations should be noted. The suicide prevention module developed during the current study was tailored to an audience within Louisiana. Thus, the messages and associated impact of this module may not generalize to audiences in other states. Also of note, although firearm suicide is a substantial problem in Louisiana, firearm homicide accounts for a greater proportion of firearm-related deaths in this state (Centers for Disease Control and Prevention, National Center for Injury Prevention and Control 2005). As such, the module may be less impactful in Louisiana than in most other states where firearm suicide accounts for the majority of firearm-related deaths. Further, a limited number of participants provided feedback on the perceived acceptability of the module, so these views may not be representative of all Louisiana firearm owners and instructors. Relatedly, many participants in the current study were recruited from VISION, a project focused on Veteran firearm suicide prevention. As a result, there may have been a selection bias that influenced some participants’ views on the module, which may further limit the generalizability of our findings. Additionally, those who participated in the first round of focus groups (during which the Utah module was shown) were invited back for the second round of focus groups (during which the adapted module was shown). Although engaging participants in iterative focus groups is an acceptable qualitative research method (e.g., Bennett et al. 2020), it may have led to bias, given that these individuals had an additional point of reference when viewing the adapted module. Similarly, providing suggestions for improving the module during the first focus group may have led some participants to perceive personal investment in the resulting product, thereby biasing their feedback on the adapted module. Finally, the current study did not assess the efficacy of the adapted learning module on student outcomes. Thus, we cannot conclude whether the current module improves knowledge surrounding firearm suicide or impacts firearm storage-related behavior change.
Previous research has highlighted the importance of incorporating numerous stakeholder perspectives to craft culturally competent and credible firearm safety messages (Pallin et al. 2019; Barber et al. 2019). More recently, a literature review identified incorporating lethal means safety education into concealed carry curricula as a major opportunity for intervention to decrease veteran suicide (Consolino and Yarvis 2022). This study answers that call and builds on previous literature by engaging firearm owners and instructors, both veteran and non-veteran, in developing a suicide prevention learning module that was viewed as representative, accurate, and acceptable to Louisiana firearm owners and instructors. Given our limited ability to identify those at risk for suicide prior to an attempt (Franklin et al. 2017), it is critical to reach firearm owners with information about firearm suicide prevention on a large scale, regardless of acute suicide risk. Thus, this module is consistent with the broad public health approach to suicide prevention that is promoted by the US government (Office of the Surgeon General 2021; United States Government 2021). Although the module developed in this study was designed with Louisiana concealed carry classes in mind, there are other possible outlets for dissemination (e.g., law enforcement agencies, mental health outreach events, hunter safety courses, and firearm conferences), which could facilitate even greater reach. Indeed, the lethal means safety and suicide prevention strategies discussed in the module are applicable on a national level and could be used outside the context of Louisiana concealed carry courses.
Future studies should examine the impact of this learning module on relevant outcomes (e.g., firearm storage practices, knowledge about firearms and suicide) to determine its utility in suicide prevention efforts. Indeed, the authors are currently collaborating with Louisiana firearm instructors, collecting data with students in their concealed carry classes, and examining the effectiveness of this learning module on outcomes such as openness to changing firearm storage practices, knowledge about firearms and suicide, and actual behavior change following exposure to the learning module. If research supports the utility of this learning module, it may represent a critical resource for Louisiana firearm instructors interested in preventing firearm suicide. As previously noted, this module may be effective on a national level and outside the context of concealed carry courses. Therefore, another important consideration for future research is determining the various contexts in which this module is acceptable and effective. The learning module, including the brief video and downloadable PowerPoint slide deck, can be found on the VISION website (True 2022).