Feasibility of recruitment and retention in a remote trial of gatekeeper training for close supports of military veterans: Mixed methods study

Background: VA S.A.V.E. (Signs; Ask; Validate; Encourage/Expedite) is a gatekeeper training, designed to teach individuals how to identify and assist military veterans at risk for suicide. The aim of this pilot was to determine feasibility, barriers, and facilitators of recruitment and retention in a remote trial of VA S.A.V.E. Methods: We recruited close supports (family and friends) of veterans through Facebook sponsored ads, automatically randomized them to VA S.A.V.E. or an unrelated video training, and followed them for six months. A subgroup completed interviews, and we used a mixed methods framework to integrate quantitative and qualitative findings. Results: Of 214 participants, 61% were spouses or partners of veterans and 48% knew at least one veteran who had died by suicide. Of the three a priori feasibility benchmarks, two were achieved (enrollment, on average, of twenty participants per week and less than 50% loss to follow-up at the 6-month study endpoint) and one was not (enrollment of at least 50% of eligible individuals). There were three barriers (generic ads, ad text referring to “research,” and Facebook as an ad platform) and five facilitators (audience segmentation focused on veterans’ family members and friends, an urgent call to action to help a veteran, prior exposure to suicide, emphasizing the benefit of receiving training, and using a university as the campaign messenger) to study participation. Conclusion: A fully remote trial of VA S.A.V.E. gatekeeper training was feasible in a population of close supports of veterans. Several strategies may further enhance study participation.