Pediatric Healthcare Worker Perspectives on Implementation of a Secure Firearm Storage Program: A Qualitative Study.

Area of Science:

• Public Health
• Implementation Science
• Pediatrics

Background:

• Firearm-related injury is the leading cause of death for US youth.
• Primary care settings are ideal for implementing firearm injury prevention programs.
• The S.A.F.E. Firearm program aims to increase secure firearm storage through clinician-parent discussions and free cable lock distribution.

Purpose of the Study:

• To qualitatively explore healthcare worker (HCW) perspectives on the implementation of the S.A.F.E. Firearm program.
• To identify factors influencing the successful adoption of a universal, evidence-based secure firearm storage program in pediatric clinics.

Main Methods:

• Conducted semi-structured qualitative interviews with 38 leaders, change agents, and clinicians involved in program implementation (2023-2024).
• Utilized the Consolidated Framework for Implementation Research to inform the interview guide.
• Employed an abductive, integrated (deductive and inductive) approach for coding and analysis, achieving strong inter-rater reliability (Kappa = 0.87).

Main Results:

• Healthcare workers affirmed their role in promoting pediatric firearm safety across diverse community and healthcare cultures.
• The S.A.F.E. Firearm program's non-judgmental, universal approach, respecting family autonomy and privacy, enhanced program acceptability and delivery.
• Clear understanding of the privacy-focused harm reduction strategy by HCWs was crucial for successful implementation.

Conclusions:

• Health systems should leverage HCWs' commitment to firearm safety by implementing brief, privacy-preserving programs.
• Recommendations for scaling evidence-based approaches include providing clear training and adapting programs to meet the needs of HCWs and families.