Parents' Attitudes Toward Firearm Injury Prevention Counseling in Urban Pediatric Clinics

Haught, Karen; Grossman, David C.; Connell, Frederick A.

doi:10.1542/peds.96.4.649

Cited by 58 publications

(8 citation statements)

References 4 publications

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“…First, respondents understood and valued the prevention potential of the firearm access question. This finding aligns with our cross-sectional research demonstrating most patients receiving mental health care will answer this question, and prior research indicating that people are generally receptive to firearm injury/suicide prevention practices . Second, respondents described a nuanced understanding of challenges that may drive under-reporting access.…”

Section: Discussionsupporting

confidence: 83%

“…These findings, in combination with prior qualitative stakeholder-informed research, provide a road map for addressing barriers clinical teams may experience with firearm access assessment. This study underscored the need to communicate that the intended purpose of routine questions about firearm access is to support conversations about suicide prevention, not to limit patient autonomy .…”

Section: Discussionmentioning

confidence: 76%

“…This finding aligns with our cross-sectional research demonstrating most patients receiving mental health care will answer this question, 40 and prior research indicating that people are generally receptive to firearm injury/suicide prevention practices. 30 , 38 , 49 , 50 , 51 , 52 , 56 , 62 , 63 Second, respondents described a nuanced understanding of challenges that may drive under-reporting access. Our recent retrospective cohort study found that over half the patients who died by firearm suicide during a 4-year period reported no firearm access in the year prior to death.…”

Section: Discussionmentioning

confidence: 99%

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Patient and Clinician Perspectives of a Standardized Question About Firearm Access to Support Suicide Prevention

et al. 2022

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ImportanceUS residents report broad access to firearms, which are the most common means of suicide death in the US. Standardized firearm access questions during routine health care encounters are uncommon despite potential benefits for suicide prevention.ObjectiveTo explore patient and clinician experiences with a standard question about firearm access on a self-administered mental health questionnaire routinely used prior to primary care and mental health specialty encounters.Design, Setting, and ParticipantsQualitative semistructured interviews were conducted from November 18, 2019, to October 8, 2020, at Kaiser Permanente Washington, a large integrated care delivery system and insurance provider. Electronic health record data identified adult patients with a documented mental health diagnosis who had received a standard question about firearm access (“Do you have access to guns? yes/no”) within the prior 2 weeks. A stratified sampling distribution selected 30% who answered “yes,” 30% who answered “no,” and 40% who left the question blank. Two groups of clinicians responsible for safety planning with patients at risk of suicide were also sampled: (1) licensed clinical social workers (LICSWs) in primary and urgent care settings and (2) consulting nurses (RNs).Main Outcomes and MeasuresParticipants completed semistructured telephone interviews, which were recorded and transcribed. Directive (deductive) and conventional (inductive) content analyses were used to apply knowledge from prior research and describe new information. Thematic analysis was used to organize key content, and triangulation was used to describe the intersections between patient and clinician perspectives.ResultsThirty-six patients were interviewed (of 76 sampled; mean [SD] age, 47.3 [17.9] years; 19 [53%] were male; 27 [75%] were White; 3 [8%] were Black; and 1 [3%] was Latinx or Hispanic. Sixteen participants had reported firearm access and 15 had reported thoughts of self-harm on the questionnaire used for sampling. Thirty clinicians were interviewed (of 51 sampled) (mean [SD] age, 44.3 [12.1] years; 24 [80%] were female; 18 [60%] were White; 5 [17%] were Asian or Pacific Islander; and 4 [13%] were Latinx or Hispanic) including 25 LICSWs and 5 RNs. Key organizing themes included perceived value of standardized questions about firearm access, challenges of asking and answering, and considerations for practice improvement. Clinician interview themes largely converged and/or complemented patient interviews.Conclusions and RelevanceIn this qualitative study using semistructured interviews with patients and clinicians, a standardized question about firearm access was found to encourage dialogue about firearm access. Respondents underscored the importance of nonjudgmental acknowledgment of patients’ reasons for firearm access as key to patient-centered practice improvement.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

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Patient and Clinician Perspectives of a Standardized Question About Firearm Access to Support Suicide Prevention

et al. 2022

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“…Previous research indicates that race may differentiate firearm owners from one another. Some studies have found that race does not impact firearm ownership (e.g., Haught et al, 1995), while others found that those who identified as White were more likely to own firearms (e.g., Farah et al, 1999). Even though the research on race and ownership is inconclusive, there is evidence that subgroups of firearm owners may differ by race.…”

Section: Introductionmentioning

confidence: 99%

Determining subgroups that exist among US firearm owners

Bond

Bandel

Anestis

2022

Suicide & Life Threat Behav

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Objective To identify and verify classes of firearm owners that exist within the United States and determine the sources that classes deemed credible to discuss firearm safety for suicide prevention. Methods The study is composed of two parts. Part 1 (N = 1018) utilizes a nationally representative sample of firearm owners. Part 2 (N = 1064) consists of firearm owners from Mississippi, Minnesota, and New Jersey. Results Four unique classes were identified in Sample 1: multiple firearms class, single handgun class, few firearms class, and long‐gun class. A three‐class solution was found for sample 2. Two of the classes from sample 1 replicated: multiple firearms class and single handgun class. Although many of the classes differed in the ranking of credible sources, a combination of The American Foundation for Suicide Prevention, law enforcement officers, and family members was ranked as credible sources among all classes. Conclusions Findings provide evidence of the heterogenous nature of firearm owners and can be utilized to better understand the subgroups of firearm owners. Additionally, the findings from the credible sources analyses can be leveraged to create more effective safe firearm storage messaging which may increase adherence with safe storage suggestions and ultimately reduce suicide rates.

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“…According to guidelines for qualitative syntheses (25,26), we included only peer-reviewed studies. We excluded two studies that briefly summarized preliminary qualitative data collected for another study (27,28). Papers that were from the same parent study were marked as such (Table 1).…”

Section: Inclusion and Exclusion Criteriamentioning

confidence: 99%

Stakeholder perceptions of lethal means safety counseling: A qualitative systematic review

Khazanov

Keddem²,

Hoskins³

et al. 2022

Front. Psychiatry

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IntroductionLethal means safety counseling (LMSC) is an evidence-based suicide prevention intervention during which providers encourage patients to limit their access to lethal means (e.g., firearms, medications). Despite agreement about the importance of LMSC, it is underutilized in clinical practice.MethodsTo better understand the individual and contextual factors that influence LMSC and its implementation, we conducted a systematic review of qualitative studies examining stakeholder perceptions of the intervention. PubMed and PsycInfo were searched up to February 2021 using terms related to: (1) LMSC, firearms, or medications; (2) suicide, safety, or injury; and (3) qualitative methodology. Two coders used thematic synthesis to analyze findings from eligible papers, including developing a codebook and coding using an inductive and iterative approach (reliability k > 0.70). Confidence in review findings were evaluated using the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) Approach. Subthemes were assigned to domains in the Consolidated Framework for Implementation Research.FindingsOf the 19 papers identified, 18 discussed LMSC for firearms and 1 focused exclusively on LMSC for medications. The firearm-related studies explored perspectives of a variety of stakeholders (patients, providers, members of the firearms community, healthcare leaders, and family members) across multiple settings (emergency departments, pediatric and adult primary care, and outpatient mental health). Seven overarching themes emerged, including the: (1) importance of firearms to owners’ identities and perceptions of ownership as a value and right, which can lead to perceived cultural tensions in clinical settings; (2) importance of patients understanding the context and rationale for LMSC; (3) value of providers showing cultural competency when discussing firearms; (4) influence of safety and risk beliefs on firearm behaviors; (5) need to navigate logistical concerns when implementing LMSC; (6) value of individualizing LMSC; (7) potential for trusted family members and friends to be involved in implementing LMSC.ConclusionThis synthesis of the qualitative literature informs clinical, operational, and research endeavors aimed at increasing the reach and effectiveness of LMSC. Future research should address the perspectives of individuals underrepresented in the literature (e.g., those from racial/ethnic minority groups) and further examine stakeholders’ perceptions of LMSC for medication. [-2pt]Systematic review registration[https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021237515], identifier [CRD42021237515].

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Parents' Attitudes Toward Firearm Injury Prevention Counseling in Urban Pediatric Clinics

Cited by 58 publications

References 4 publications

Patient and Clinician Perspectives of a Standardized Question About Firearm Access to Support Suicide Prevention

Patient and Clinician Perspectives of a Standardized Question About Firearm Access to Support Suicide Prevention

Determining subgroups that exist among US firearm owners

Stakeholder perceptions of lethal means safety counseling: A qualitative systematic review

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