TY  - JOUR
PY  - 2022//
TI  - Equitable implementation of S.A.F.E. Firearm: a multi-method pilot study
JO  - Preventive medicine
A1  - Hoskins, Katelin
A1  - Linn, Kristin A.
A1  - Ahmedani, Brian K.
A1  - Boggs, Jennifer M.
A1  - Johnson, Christina
A1  - Heintz, Jonathan
A1  - Marcus, Steven C.
A1  - Kaminer, Isabelle
A1  - Zabel, Celeste
A1  - Wright, Leslie
A1  - Quintana, LeeAnn
A1  - Buttenheim, Alison M.
A1  - Daley, Matthew F.
A1  - Elias, Marisa E.
A1  - Jager-Hyman, Shari
A1  - Lieberman, Adina
A1  - Lyons, Jason
A1  - Maye, Melissa
A1  - McArdle, Bridget
A1  - Ritzwoller, Debra P.
A1  - Small, Dylan S.
A1  - Westphal, Joslyn
A1  - Wolk, Courtney Benjamin
A1  - Zhang, Shiling
A1  - Shelton, Rachel C.
A1  - Beidas, Rinad S.
SP  - ePub
EP  - ePub
VL  - ePub
IS  - ePub
N2  - 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 stakeholders 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, we discovered that clinicians may be more likely to deliver the program to parents of males than females. 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.<p />  <p>Language: en</p>
LA  - en
SN  - 0091-7435
UR  - http://dx.doi.org/10.1016/j.ypmed.2022.107281
ID  - ref1
ER  -