Scholarlink

Objective <p>Primary care-based secure firearm storage programs are well-positioned to prevent firearm-related injury, the leading cause of death for young people in the United States. While recommended by the American Academy of Pediatrics and US Surgeon General, these programs have yet to become routine practice. Our cluster randomized hybrid effectiveness-implementation trial studied implementation of a universal evidence-based secure firearm storage program, <i>S.A.F.E. Firearm (Suicide and Accident Prevention through Family Education)</i> across 30 clinics in two large health systems. <i>S.A.F.E. Firearm</i> includes a brief discussion between a clinician and parent on secure firearm storage and an offer of free cable locks at pediatric well-child visits for youth ages 5–17. The ASPIRE trial demonstrated meaningful clinician behavior change, with <i>S.A.F.E. Firearm</i> delivered to 49% of patient families in the clinics that received both trial implementation strategies. The present study qualitatively explores factors broadly influencing the successful implementation of <i>S.A.F.E. Firearm</i>, centering healthcare worker (HCW) perspectives.</p> Methods <p>Semi-structured qualitative interviews were conducted with leaders, clinic change agents, and clinicians involved in implementation from 2023 to 2024 (<i>N</i> = 38). The interview guide was informed by the original and updated Consolidated Framework for Implementation Research. Interviews were coded and analyzed using an abductive, integrated (i.e., deductive and inductive) approach. Inter-rater reliability (Kappa = 0.87) was strong.</p> Results <p>Interviews elucidated four interconnecting themes. HCWs unanimously expressed pediatric HCWs’ responsibility to promote firearm safety (<i>role of pediatrics in firearm safety</i>) across heterogeneous <i>community and healthcare firearm cultures</i>. By preserving families’ <i>autonomy and privacy</i> around firearms, <i>S.A.F.E. Firearm</i>’s nonjudgemental and universal approach promoted program acceptability and delivery. Consequently, HCWs’ understanding versus <i>confusion around this universal</i>,<i> privacy-focused harm reduction approach</i> was foundational to implementation.</p> Conclusion <p>Health systems can harness HCWs’ shared commitment to firearm safety by deploying brief programs that preserve recipient autonomy and privacy. To scale these evidence-based approaches, we recommend offering clear, simple trainings and collaboratively adapting programs to meet the needs of HCWs and recipients.</p> Trial registration <p>Registry <a href="https://clinicaltrials.gov/study/NCT04844021">https://clinicaltrials.gov/study/NCT04844021</a>, TRN NCT04844021, first registered on April 14, 2021.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Pediatric healthcare worker perspectives on implementation of a secure firearm storage program: a qualitative study

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年5月20日

查看全文
  • Claire R. Waller,
  • Mallika Pandey,
  • Jennifer M. Boggs,
  • Arne Beck,
  • Ruth P. Bedoy,
  • Alison M. Buttenheim,
  • Marisa E. Elias,
  • Katelin Hoskins,
  • Shari Jager-Hyman,
  • Christina Johnson,
  • Melissa Maye,
  • Bridget McArdle,
  • Celeste Pappas,
  • Dylan S. Small,
  • LeeAnn M. Quintana,
  • Courtney Benjamin Wolk,
  • Leslie A. Wright,
  • Nathaniel J. Williams,
  • Brian K. Ahmedani,
  • Rinad S. Beidas

摘要

Objective

Primary care-based secure firearm storage programs are well-positioned to prevent firearm-related injury, the leading cause of death for young people in the United States. While recommended by the American Academy of Pediatrics and US Surgeon General, these programs have yet to become routine practice. Our cluster randomized hybrid effectiveness-implementation trial studied implementation of a universal evidence-based secure firearm storage program, S.A.F.E. Firearm (Suicide and Accident Prevention through Family Education) across 30 clinics in two large health systems. S.A.F.E. Firearm includes a brief discussion between a clinician and parent on secure firearm storage and an offer of free cable locks at pediatric well-child visits for youth ages 5–17. The ASPIRE trial demonstrated meaningful clinician behavior change, with S.A.F.E. Firearm delivered to 49% of patient families in the clinics that received both trial implementation strategies. The present study qualitatively explores factors broadly influencing the successful implementation of S.A.F.E. Firearm, centering healthcare worker (HCW) perspectives.

Methods

Semi-structured qualitative interviews were conducted with leaders, clinic change agents, and clinicians involved in implementation from 2023 to 2024 (N = 38). The interview guide was informed by the original and updated Consolidated Framework for Implementation Research. Interviews were coded and analyzed using an abductive, integrated (i.e., deductive and inductive) approach. Inter-rater reliability (Kappa = 0.87) was strong.

Results

Interviews elucidated four interconnecting themes. HCWs unanimously expressed pediatric HCWs’ responsibility to promote firearm safety (role of pediatrics in firearm safety) across heterogeneous community and healthcare firearm cultures. By preserving families’ autonomy and privacy around firearms, S.A.F.E. Firearm’s nonjudgemental and universal approach promoted program acceptability and delivery. Consequently, HCWs’ understanding versus confusion around this universal, privacy-focused harm reduction approach was foundational to implementation.

Conclusion

Health systems can harness HCWs’ shared commitment to firearm safety by deploying brief programs that preserve recipient autonomy and privacy. To scale these evidence-based approaches, we recommend offering clear, simple trainings and collaboratively adapting programs to meet the needs of HCWs and recipients.

Trial registration

Registry https://clinicaltrials.gov/study/NCT04844021, TRN NCT04844021, first registered on April 14, 2021.