Center for Injury Research and Prevention

Stakeholder Perspectives on Implementing a Firearm Safety Intervention in Pediatric Primary Care as a Universal Suicide Prevention Strategy: A Qualitative Study

TitleStakeholder Perspectives on Implementing a Firearm Safety Intervention in Pediatric Primary Care as a Universal Suicide Prevention Strategy: A Qualitative Study
Publication TypeJournal Article
Year of Publication2018
AuthorsWolk CBenjamin, Van Pelt AE, Jager-Hyman S, Ahmedani BK, Zeber JE, Fein JA, Brown GK, Gregor CA, Lieberman A, Beidas RS
JournalJAMA Netw Open
Date Published11/2018

Importance  The rate of youth suicide has increased steadily over the past several decades due, in part, to an increase in suicide by firearm. Implementation of evidence-based approaches to increase safe firearm storage practices are important for reducing youth suicide.

Objective  To assess the needs of stakeholders who would be affected by implementing an evidence-based approach to firearm safety promotion—Firearm Safety Check, which includes screening for the presence of firearms in the home, brief motivational interviewing–informed counseling regarding safe firearm storage, and provision of free firearm locks—in pediatric primary care settings.

Design, Setting, and Participants  In this qualitative study, 58 stakeholders were interviewed over a 7-month period across 9 stakeholder groups from 2 large and diverse health systems. Participants included parents of youth; physicians; nurses and nurse practitioners; leaders of pediatric primary care practices, behavioral health, and quality improvement; system leaders; third-party payers; and members of national credentialing bodies. Data analysis were conducted from September 2017 to April 2018.

Main Outcomes and Measures  Interview guides were informed by the Consolidated Framework for Implementation Research. An integrated analysis approach was used in which a priori attributes of interest were identified (Consolidated Framework for Implementation Research constructs, eg, intervention characteristics), and an inductive approach was used with regard to new themes that emerged.

Results  A total of 58 stakeholders were interviewed (mean [SD] age, 48.38 [10.65] years; 27 men and 31 women). Stakeholders indicated that firearm safety promotion is a health system priority and reported favorable perceptions of the Firearm Safety Check approach for suicide prevention. The importance of leveraging existing infrastructures, such as electronic health record systems and brevity, were frequently noted. Distribution of firearm locks was endorsed as the most complicated component to implement.

Conclusions and Relevance  By including multiple service system stakeholder perspectives, these results support the development of implementation strategies to change clinician, organization, and system behaviors around firearm safety promotion in pediatric primary care as a universal suicide prevention strategy.