Table 1.

Stakeholder Feedback on Proposed Adaptations and Themes Across Adaptations

Proposed Adaptation or Theme	Example Quotes
Proposed Adaptations
1: Remove Screening Step	203: When somebody feels like you’re trying to single them out as a gun owner, then some of that dialogue starts to shut down, but if you generalize a little bit, and at the same time you’re kind of making it more…cause you’re talking about, “I don’t care where the gun is, you need to be thinking safety.” 103: I know from where I’m at…there definitely has been a lot of, from what we’ve seen recently or generally, concern from individuals about being asked about owning firearms…
2: State that Firearm Ownership Status Will Not be Documented	301: … I know there are some people out there that feel very strongly about having [firearm ownership] documented. They feel it’s their personal right to bear a firearm, regardless if it’s a handgun, a long rifle shotgun, that sort of thing. And they don’t want it documented.
3: Change the Program Name	101: And so if it’s generic, and just descriptive, that makes me a little bit more comfortable. 401: It’s not about the gun. It’s about, it’s one more child. Lock up the guns. Because one is too many. I’ve been using that phrase a lot. One is too many.
4: Provide Free Cable Locks and Resources Describing Alternative Locking Options	201: So there are a lot of options out there. And I suppose, you know, you can’t have one size fitting all, obviously. Firearms are different, people are different, homes are different, locations are different. 101: So I think having the lock on hand is, there is value in that. It’s often a conversation starter, even if it’s not the preferred method of secure storage. And it can lead people to a discussion of, say, a lock box, which we can’t assume, we have some focus group research that says we can’t assume that people know about lock boxes because we found out that many people didn’t, when we assumed that they did.
5: Use Strategies from Behavioral Science to Promote Behavior Change	101: …about the sticker, the date-time to use the lock—I wasn’t quite sure. I mean, really that only works one time, right? That’s—when you give them the lock you put down “install this at 5 PM today” or something like that. Well that—the lock is going to go on the gun, and then off the gun, and then on the gun, and then off the gun. You know, the number of times that people are using the firearm. Or, like I said, it only sort of works one time. And it’s a little—seems a little odd. It seems to me that if you’re going to do something like that, that maybe a verbal pledge or something like that might suffice. A written pledge might be, some people might respond to that, and for others, that might be a little off-putting.
6: Emphasize the Shared Goal of Keeping Children Safe	401: …you wear a seatbelt, because it’s safer. Lock up the gun, because it’s safer. 501: And the main thing I say is, regardless of what your stance is on firearms, don’t come across from a judgmental or a critical perspective. And find common ground, which is the safety of the child. You know, that’s the main thing, the safety of the child.
7: Offer Additional Resources from Firearm Experts	201: … information is power and I think that the informed decision on the part of the parents and I see us as being the facilitators of resources, making it available. 501: …give parents a link to a video that includes credible firearms experts talking about the importance—fantastic. But I think that as important as credible sources, there should also be individuals that have been affected by gun tragedies. Nothing speaks to that population as people who have been there and have done that. So parents of kids who have gotten hurt, individuals that have hurt themselves because of improperly stored firearms.
8: Follow-up	101: But I think it’s more palatable if it’s optional. Somebody gives you permission or asks you to follow up. I think that makes it much more palatable.
Overarching Themes Autonomy	201: So, I guess the goal would be to provide as much information as possible, and let the parent decide what fits for their situation.
Privacy	301: But I think of it this way…Are you more likely to ask for condoms or ask for other sorts of prophylactics or you know, “Hey, there’s a bin there, I can grab a few of them.” You know what I mean? Without having to have that conversation.
Communication	102: I would just caution against anything that’s going to make people think you are being cute with the language, you know. I think it should be very transparent… 301: …at least having it in in print material and having a set script, because what I’ve also experienced is that everybody has their own personal opinions. I’ve had some pretty opinionated physicians of my own and for my children over time. You don’t want them to be interjecting their own personal feelings into it.
Knowledge	101: …And I think, you know, particularly the suicide angle may be something that some parents have not thought about. I think it’s a much more powerful argument. Not that, obviously, keeping a young child safe from accessing a gun is not a powerful argument. But the fact that those numbers are growing rapidly, and there are a lot of external factors…
Safe Storage	202: So safe storage to me is different than what 201 just said. Just not allowing, you know I have a young [child], access to my weapon and knowing where my weapon is at all times and making sure it’s in a position where [they] can’t get ahold of it.
Situational Awareness	202: I think it is important to do at your well checks, because I think at times we do get complacent. So, and you know, we need to be reminded that we need to put these things away too. 501: You think your kids don’t know where your guns are? That is just a fallacy.
Environment	301: The culture that is coming through is so scared of firearms. You know, that’s just my opinion, but I see a lot of this fear of firearms instead of [recognizing] it has a purpose. You know, respect it, treat it appropriately, and it’s not an issue. But, there’s so many people that just have this fear, like the gun is going to jump up and do something to you. It’s not. 401: Because certainly a doctor knows his patients, and some of them hunt together. You get some of these communities and it’s like, “hey, I know ‘Jim’ has all these guns. Tell him to lock them up, and there’s ten gun locks in there. Take them home to ‘Jim,’ and tell him I’m going to be over for bourbon, and I’m going to make sure they’re locked up.” I mean some of these doctors have this kind of relationship…