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J Behav Med. 2019 Aug;42(4):691-701. doi: 10.1007/s10865-019-00074-9. Epub 2019 Aug 1.

Perspectives from firearm stakeholders on firearm safety promotion in pediatric primary care as a suicide prevention strategy: a qualitative study.

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Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd Floor, Philadelphia, PA, 19104, USA.
Henry Ford Health System, Center for Health Policy and Health Services Research and Behavioral Health Services, One Ford Place, Suite 3A, Detroit, MI, 48202, USA.
School of Public Health, University of Massachusetts at Amherst, 317 Arnold House, Amherst, MA, 01003, USA.
Department of Research, Central Texas Veterans Health Care System, 1901 1st Street, Temple, TX, 76502, USA.
Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, The Perelman School of Medicine at The University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd Floor, Philadelphia, PA, 19104, USA.
Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, 19104, USA.


The primary objective of the current study was to examine the perspective of firearm stakeholders, including firearm safety course instructors, members of law enforcement, and firearm retailers, with regard to the implementation of an evidence-based approach to firearm safety promotion, the Firearm Safety Check, as a universal suicide prevention strategy in pediatric primary care. Twelve firearm stakeholders participated in semi-structured interviews. Using an integrated analytic approach, several themes emerged from the interviews. With regard to acceptability of the intervention, participants generally found counseling caregivers to store firearms safely and the provision of firearm locking mechanisms to be acceptable, but expressed concern about screening for firearm ownership in health systems. Participants identified distinct roles of responsibility for firearm advocacy groups, firearm owners, healthcare clinicians, and caregivers with regard to the promotion and execution of safe firearm storage. Participants called for partnerships between healthcare systems and firearm stakeholders, and also identified potential threats to these partnerships, including lack of trust firearm owners may have in health systems and the government. Finally, participants suggested strategies for preventing firearm-related suicides. Findings support a growing body of literature suggesting the value in researchers, health systems, and firearm stakeholders partnering around a shared agenda of firearm safety promotion as a strategy to prevent suicide.


Evidence-based practice; Firearm safety; Primary care; Suicide prevention


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