Article ; Online: Equitable implementation of S.A.F.E. Firearm: A multi-method pilot study.
2022 Volume 165, Issue Pt A, Page(s) 107281
Abstract: ... our understanding of contextual determinants (i.e., barriers and facilitators). In Step 3, we leveraged ... context. In Step 4, we interrogated equity considerations (e.g., why and how do these inequities exist ...
| Abstract | Attention to health equity is critical in the implementation of firearm safety efforts. We present our operationalization of equity-oriented recommendations in preparation for launch of a hybrid effectiveness-implementation trial focused on firearm safety promotion in pediatric primary care as a universal suicide prevention strategy. In Step 1 of our process, pre-trial engagement with clinican partners and literature review alerted us that delivery of a firearm safety program may vary by patients' medical complexity, race, and ethnicity. In Step 2, we selected the Health Equity Implementation Framework to inform our understanding of contextual determinants (i.e., barriers and facilitators). In Step 3, we leveraged an implementation pilot across 5 pediatric primary care clinics in 2 health system sites to study signals of inequities. Eligible well-child visits for 694 patients and 47 clinicians were included. Our results suggested that medical complexity was not associated with program delivery. We did see potential signals of inequities by race and ethnicity but must interpret with caution. Though we did not initially plan to examine differences by sex assigned at birth, we discovered that clinicians may be more likely to deliver the program to parents of male than female patients. Seven qualitative interviews with clinicians provided additional context. In Step 4, we interrogated equity considerations (e.g., why and how do these inequities exist). In Step 5, we will develop a plan to probe potential inequities related to race, ethnicity, and sex in the fully powered trial. Our process highlights that prospective, rigorous, exploratory work is vital for equity-informed implementation trials. |
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| MeSH term(s) | Infant, Newborn ; Humans ; Male ; Child ; Female ; Pilot Projects ; Prospective Studies ; Firearms ; Research Design ; Suicide Prevention |
| Language | English |
| Publishing date | 2022-09-30 |
| Publishing country | United States |
| Document type | Journal Article ; Research Support, N.I.H., Extramural |
| ZDB-ID | 184600-0 |
| ISSN | 1096-0260 ; 0091-7435 |
| ISSN (online) | 1096-0260 |
| ISSN | 0091-7435 |
| DOI | 10.1016/j.ypmed.2022.107281 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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