The goal of this randomized clinical trial is to determine whether a virtual reality (VR) training program can help healthcare providers improve their skills in discussing suicide prevention and safe storage of firearms and medications with Veterans. The study will test whether VR training increases providers' self-efficacy, confidence, and comfort in conducting lethal means safety counseling, and whether it improves their intention to use these counseling practices in their clinical work. Researchers will compare healthcare providers who complete the VR training to those who complete a 2D video training to determine whether the VR approach is more effective. Participants will complete online surveys before and after the training and again three months later. They will be randomly assigned to one of two groups: VR training group: Participants use a VR headset to interact with a virtual Veteran patient in a simulated rural clinic and practice suicide prevention counseling skills; Video training group: Participants use the same headset to watch a \~10-minute 2D video depicting the lethal means safety counseling session. After the training, participants will also provide feedback about their experience, including how realistic and useful they found the training.
Age 18 or older
healthcare providers serving rural Veterans in Texas (e.g., physicians, physician assistants, nurse practitioners, nurses, pharmacists, social workers, healthcare case managers)
English-speaking
Able to provide informed consent
Self-reported pregnancy
History of motor or balance disorders
Color blindness
Neurological or cognitive disorders
Parallel
Virtual Reality Lethal Means Safety Training
BehavioralAn immersive behavioral training program delivered through a Meta Quest 3 virtual reality headset. Participants enter a simulated rural health clinic and interact with a Veteran avatar at risk for suicide. The simulation incorporates realistic dialogue and decision points where providers practice skills in suicide risk identification, lethal means safety counseling (firearm and medication storage), and collaborative safety planning. The VR format allows repeated practice in a safe environment and provides a more engaging and realistic training experience than traditional methods.
2D Video Training
BehavioralA 10-minute video delivered through a VR headset that depicts a healthcare provider conducting lethal means safety counseling with a Veteran. This is a non-interactive training used as an active comparator.
Confidence in Lethal Means Safety Counseling
Measured by the Counseling on Access to Lethal Means (CALM) Core Scale (Sale et al., 2018) Confidence subscale ("How confident are you that …"). Items are rated on a 4-point scale and summed; higher scores indicate greater confidence (range = 5 - 20).
Comfortability in Lethal Means Safety Counseling
Measured by the Counseling on Access to Lethal Means (CALM) Core Scale (Sale et al., 2018) Comfortability subscale ("How comfortable are you talking about …"). Includes 3 items where 1 = Not Very Comfortable to 4 = Extremely Comfortable. Items are rated on a 4-point scale and summed (range = 3 - 12). Higher scores indicating greater comfort initiating suicide or means-restriction discussions.
Counseling Intentions
Measured by the Counseling on Access to Lethal Means (CALM) Core Scale (Sale et al., 2018) Counseling Intentions subscale ("If you recognize warning signs of suicide in an individual, how likely are you to…"). Includes 5 items where 1 = Not Very Likely to 4 = Extremely Likely. Items are rated on a 4-point scale and summed (range = 5-20). Higher scores indicate stronger intentions to engage in suicide-prevention and lethal-means safety counseling behaviors.
Spatial Presence
Measured by the ITC-Sense of Presence Inventory (Lessiter et al., 2001) Spatial Presence subscale ("During my experience of the displayed environment…"). Includes 19 items (e.g., "I felt as though I was in the same space as the characters and/or objects") rated on a 5-point scale where 1 = Strongly Disagree to 5 = Strongly Agree. Items are averaged to create a mean subscale score (range = 1 - 5). Higher scores indicate a stronger sense of "being there" or physical immersion within the virtual environment.
Engagement
Measured by the ITC-Sense of Presence Inventory (Lessiter et al., 2001) Engagement subscale ("During my experience of the displayed environment…"). Includes 13 items (e.g., "I felt myself being drawn in") rated on a 5-point scale where 1 = Strongly Disagree to 5 = Strongly Agree. Items are averaged to create a mean subscale score (range = 1 - 5). Higher scores indicate greater emotional and cognitive involvement in the displayed environment.
Feasibility of VR Training (Qualitative)
Feasibility (extent to which the intervention can be successfully used, delivered, or implemented as intended in a real-world setting) will be assessed through open-ended post-training survey questions and short debrief interviews. Participants will provide qualitative feedback on how realistic and useful they perceived the VR simulation (or 2D video) by responding to prompts such as: "What elements could be included to make the VR training more realistic and representative?" and "Please add any comments you'd like to make about your experience with the VR training." Responses will be coded thematically using qualitative analysis software to identify key themes related to feasibility (ease of use, technical functionality, time burden, and perceived fit for training or clinical settings), as well as related dimensions of realism, training value, and applicability to professional practice.
Acceptability (Qualitative)
Acceptability (extent to which participants find an intervention appropriate, satisfying, and relevant to their professional role or setting) will be measured by open-ended response to "How much do you agree that the VR training was representative of speaking with a veteran experiencing suicide/depression about lethal means safety?" and provide additional open-ended feedback describing their perceptions of training value, satisfaction, and authenticity. Responses will be coded thematically using qualitative analysis software to identify key themes related to acceptability (appropriateness, satisfaction, and perceived usefulness of the training).
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The University of Texas at Arlington
Lead sponsor
American Foundation for Suicide Prevention
Collaborator
