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

Abstract

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.

Conflict of interest statement

Conflict of Interest Disclosures: Dr Benjamin Wolk is an investigator with the Implementation Research Institute, George Warren Brown School of Social Work, Washington University in St Louis, Missouri, through award 5R25MH08091607 from the National Institute of Mental Health and the Department of Veterans Affairs, Health Services Research & Development Service, Quality Enhancement Research Initiative; and reported receiving grants from the National Institute of Mental Health outside the submitted work. Drs Benjamin Wolk, Jager-Hyman, Zeber, and Beidas reported receiving grants from the National Institute of Mental Health during the conduct of the study. Dr Ahmedani reported receiving grants from the National Institutes of Health during the conduct of the study. Dr Fein reported grants from The Children’s Hospital of Philadelphia during the conduct of the study. Dr Beidas reported receiving consulting fees from Temple University, University of Michigan, Merck Sharpe & Dohme, Camden Coalition of Healthcare Providers, and the Oregon Social Learning Cente; honoraria from the National Institutes of Health, University of Michigan, University of Delaware, University of Texas, University of Washington, New York University, American Psychological Association, and University of Pittsburgh; an award from the Association for Behavioral and Cognitive and the American Psychological Association Therapies; and royalties from the Oxford University Press. No other disclosures were reported.