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Computer Administered Safety Planning for Individuals at Risk for Suicide: Development and Usability Testing
University of Massachusetts Medical School Faculty Publications
  • Edwin D. Boudreaux, University of Massachusetts Medical School
  • Gregory K. Brown, University of Pennsylvania
  • Barbara Stanley, New York State Psychiatric Institute
  • Rajani S. Sadasivam, University of Massachusetts Medical School
  • Carlos A. Camargo, Jr, Massachusetts General Hospital
  • Ivan W. Miller, Warren Alpert Medical School of Brown University
UMMS Affiliation
Department of Emergency Medicine; Department of Quantitative Health Sciences
Publication Date
Document Type
BACKGROUND: Safety planning is a brief intervention that has become an accepted practice in many clinical settings to help prevent suicide. Even though it is quick compared to other approaches, it frequently requires 20 min or more to complete, which can impede adoption. A self-administered, Web-based safety planning application could potentially reduce clinician time, help promote standardization and quality, and provide enhanced ability to share the created plan. OBJECTIVE: The aim of this study was to design, build, and test the usability of a Web-based, self-administered safety planning application. METHODS: We employed a user-centered software design strategy led by a multidisciplinary team. The application was tested for usability with a target sample of suicidal patients. Detailed observations, structured usability ratings, and Think Aloud procedures were used. Suicidal ideation intensity and perceived ability to cope were assessed pre-post engagement with the Web application. RESULTS: A total of 30 participants were enrolled. Usability ratings were generally strong, and all patients successfully built a safety plan. However, the completeness of the safety plan varied. The mean number of steps completed was 5.5 (SD 0.9) out of 6, with 90% (27/30) of participants completing at least 5 steps and 67% (20/30) completing all 6 steps. Some safety planning steps were viewed as inapplicable to some individuals. Some confusion in instructions led to modifications to improve understandability of each step. Ratings of suicide intensity after completion of the application were significantly lower than preratings, pre: mean 5.11 (SD 2.9) versus post: mean 4.46 (SD 3.0), t27=2.49, P=.02. Ratings of ability to cope with suicidal thoughts after completion of the application were higher than preratings, with the difference approaching statistical significance, pre: mean 5.93 (SD 2.9), post: mean 6.64 (SD 2.4), t27=-2.03, P=.05. CONCLUSIONS: We have taken the first step toward identifying the components needed to maximize usability of a self-administered, Web-based safety planning application. Results support initial consideration of the application as an adjunct to clinical contact. This allows for the clinician or other personnel to provide clarification, when needed, to help the patient build the plan, and to help review and revise the draft.
  • technology,
  • safety,
  • health planning,
  • suicide,
  • computers,
  • telemedicine,
  • suicidal ideation,
  • suicide attempts,
  • risk
Rights and Permissions
Copyright Edwin D Boudreaux, Gregory K Brown, Barbara Stanley, Rajani S Sadasivam, Carlos A Camargo Jr, Ivan W Miller. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited.
DOI of Published Version
J Med Internet Res. 2017 May 15;19(5):e149. doi: 10.2196/jmir.6816. Link to article on publisher's site.
Related Resources
Link to Article in PubMed
PubMed ID
Citation Information
Edwin D. Boudreaux, Gregory K. Brown, Barbara Stanley, Rajani S. Sadasivam, et al.. "Computer Administered Safety Planning for Individuals at Risk for Suicide: Development and Usability Testing" Vol. 19 Iss. 5 (2017) ISSN: 1438-8871 (Linking)
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