Gunshot Prevention Through Secure Firearm Storage Devices and Information
Project status
Collaborators
Elinore Kaufman, MD, MSHP
Sunny Jackson, MSN
Katelin Hoskins, PhD, MBE, CRNP
Jeremy Souder, MD, MBA
Vivek Ahya, MD, MBA
Terrence Betsill
Bryan Anthony
Rodney Babb
Krishleen Kohli
Innovation leads
Funding
Accelerate Health Equity
Pennsylvania Department of Health
External partners
Accelerate Health Equity
Opportunity
More than one in three American households own a firearm, making secure storage a critical opportunity to prevent firearm-related suicide, homicide, and unintentional injury. Hospitals can play a key role in promoting secure storage.
Intervention
In partnership with Penn Medicine hospital security teams, the Nudge Unit launched a program to distribute information and devices for secure firearm storage at hospital entrances. From 2022 to 2023, security staff offered cable locks and safety brochures to firearm owners – who were identified through the standard weapons screening – at the end of their hospital visits.
After November 2023, the program shifted from screening-based engagement to broader promotion through signage posted at the hospital entrances, brochures, and appointment reminders. Individuals could request a firearm secure storage device through a website form shared in these materials via a QR code or hyperlink. We conducted a randomized controlled trial with 51 people who requested a storage device. One study arm received a cable lock, and other received the participant’s choice of a cable lock or lock box.
Beginning in late 2024, we expanded our efforts to distribute firearm storage devices in collaboration with Penn’s Trauma Center, handing out storage devices and demonstrating and demonstrating their use at events at hospitals and other sites in Philadelphia.
Impact
Security personnel distributed more than 300 secure storage devices in the first phase of the program.
With the digital promotion campaign, we distributed 20–30 firearm storage devices per entrance monthly. The randomized trial showed that device distribution improved secure storage rates among firearm owners, increasing from 57 percent to 87 percent among participants in the cable lock group and from 65 percent to 83 percent among those who had the choice of lock after two weeks. After four weeks, self-reported secure storage rates remained high for the cable lock group; however, the rate for the choice-of-lock group dropped to 63 percent. Notably, all of the participants in the choice-of-lock group opted for a lock box rather than a cable lock.
The QR code–based distribution system was accessible and efficient, integrating seamlessly into hospital workflows. Overall, this initiative demonstrates the potential for health systems to contribute to injury prevention through scalable, low-burden interventions.
Banner image photo courtesy of Kimberly Paynter/WHYY
Innovation Methods
Show me
Show me
We conducted onsite interviews and observations to assess appropriateness, attitudes, and feasibility of the gun lock workflow with the security team and visitors. Both the security team and visitors saw the program as positive for the hospital and expressed a desire for expansion of the project.
Show me
Instead of relying on a verbal recount of experience, ask users to show you how they use a product or service. What people say they do is often quite different than what they do.
Observing users in action will help you understand the spectrum of experiences users can have with the same product or service.
Surveys, interviews, questionnaires, and focus groups don’t tell you what you need to know. Prompting users to show instead of tell often reveals what others have missed.
Fake front end
Fake front end
Based on findings during discovery research, we developed mock-ups of new study assets and conducted feedback sessions with security team to further iterate. Gathering additional feedback was critical to ensuring language and presentation of the study assets were appropriate and approachable.