NCT Number: NCT07219355
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.
Interested in participating?
Request Info18 year and older
All sexes
Interventional
Not applicable
Arlington, Texas, 76019, United States
Location status: Recruiting
Benjamin Wagley, MFA
SUB_INVESTIGATOR
Donna L. Schuman, PhD, LCSW
CONTACT
J. SuLynn Mester, DNP, RN
CONTACT
Micki Washburn, PhD, LMSW, LPC
SUB_INVESTIGATOR
Regina Praetorius, PhD, LMSW-ACP-S
SUB_INVESTIGATOR
This study will test whether a virtual reality (VR) training program can improve healthcare providers' ability to talk with Veterans about suicide prevention and safe storage of firearms and medications. Rural Veterans have suicide rates much higher than the national average, and providers in rural areas often do not receive enough training in suicide risk identification or lethal means safety counseling.
This project builds on our prior Veteran Suicide Assessment in Virtual Reality (VET-SAVR) study, which showed that VR can be a feasible and acceptable way to deliver suicide prevention training. In the current study, called the Virtual Reality Lethal Means Safety Training (VR-LMST) project, we will compare an immersive VR training simulation to a 2D video training.
Study Aims
Aim 1: Develop a VR training simulation focused on suicide prevention counseling with rural Veterans.
Aim 2: Test whether VR-LMST improves provider confidence (primary), and comfortability and intention (secondary) to engage in lethal means safety counseling.
Aim 3: Assess user experience of the VR simulation, including presence, realism, acceptability, feasibility, and tolerability.
Study Design
This is a randomized controlled trial. Participants will be assigned to one of two groups:
VR-LMST group: Participants will use a VR headset (Meta Quest 3) to enter a simulated rural clinic visit with a Veteran avatar who presents with thoughts of suicide. They will practice counseling skills related to safe firearm and medication storage.
2D Video group: Participants will use a VR headset to view a 10-minute video showing a provider having a lethal means safety conversation with a Veteran.
Assessments
Pre-test, post-test, and 3-month follow-up surveys will be completed online.
The Counseling on Access to Lethal Means (CALM) Core Scale (13 items) will measure provider confidence (1-5), comfortability (6-8), and intentions (9-13). An additional two items measure counseling behavior at 3 months (14-15).
The ITC-Sense of Presence Inventory (ITC-SOPI) will measure presence, naturalness, engagement, and negative effects.
Open-ended questions will gather feedback about realism, acceptability, and feasibility.
Demographic and professional background information will also be collected.
Sample Size and Timeline We will recruit 36 participants (18 per group). Power analysis indicates this sample size is sufficient to detect moderate effects with 80% power for the primary outcome.
Phase 1 (completed): Recruited 11 healthcare providers for qualitative interviews; conducted coding and analysis; developed and refined VR and 2D scripts.
Phase 2 (completed): Prototype VR clinic environment developed through iterative meetings with VR developers.
Phase 3 (completed): Pilot playtesting in October 2025 with 5 participants.
Phase 4 (planned): Randomized trial enrollment to begin mid-November 2025.
Phase 5 (planned): 3-month follow-ups to begin January 2026.
Oversight IRB approval was received September 27, 2024, from the University of Texas at Arlington. This study is funded by the American Foundation for Suicide Prevention (AFSP).
Significance This project will test a novel, scalable training method to give allied healthcare providers repeated opportunities to practice suicide prevention counseling in a safe environment. By equipping rural providers with the skills and confidence to have culturally sensitive, Veteran-centered conversations about firearm and medication safety, VR-LMST has the potential to improve clinical practice and reduce suicide risk among rural Veterans.
Healthy volunteers accepted: Yes
Only the study team can determine whether someone qualifies for participation.
Inclusion criteria
Exclusion criteria
An 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.
A 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.
Time frame: Baseline (pre-test), immediately after intervention (post-test), and 3-month follow-up
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).
Time frame: Baseline (pre-test), immediately after intervention (post-test), and 3-month follow-up
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.
Time frame: Baseline (pre-test), immediately after intervention (post-test), and 3-month follow-up
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.
Time frame: Immediately after intervention (post-test only)
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.
Time frame: Immediately after intervention (post-test only)
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.
Time frame: Immediately after intervention (post-test only)
Measured by the ITC-Sense of Presence Inventory (Lessiter et al., 2001) Ecological Validity / Naturalness subscale ("During my experience of the displayed environment…"). Includes 5 items (e.g., "The scenes depicted could really occur in the real world") 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 perceived realism and naturalness of the virtual environment.
Time frame: Immediately after intervention (post-test only)
Tolerability will be measured by the ITC-Sense of Presence Inventory (Lessiter et al., 2001) Negative Effects subscale ("During my experience of the displayed environment…"). Includes 6 items (e.g., "I felt dizzy," "I felt nauseous") 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 discomfort or simulator-related side effects (e.g., dizziness, eyestrain, nausea) and thus, lower tolerability.
Time frame: Immediately after intervention (post-test only)
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.
Time frame: Immediately after intervention (post-test only)
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).
Contact information is provided by the study sponsor or research team.
Donna L. Schuman, PhD, LCSW
CONTACT
J. SuLynn Mester, DNP, RN
CONTACT
The University of Texas at Arlington
Other
Expanding Provider Capacity to Prevent Rural Veteran Suicide: Virtual Reality Lethal Means Safety Training
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