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Exploring Equity Barriers Before a Firearm Safety Trial

When evaluating the success or failure of efforts to implement evidence-based interventions, ensuring that implementation is equitable across populations is important. The need to attend to equity has been widely accepted but little guidance has been offered with regard to how to do so within the context of implementation trials. Before launching a hybrid effectiveness-implementation trial focused on firearm safety promotion in pediatric primary care, an interdisciplinary research team including investigators from University of Pennsylvania, Northwestern University, Henry Ford Health, and Kaiser Permanente Colorado developed a unique five-step engagement process to prospectively ground the trial in an equity lens.

In an article in the journal Preventive Medicine, lead author Katelin Hoskins, PhD, MBE, CRNP, Assistant Professor in the University of Pennsylvania School of Nursing Department of Biobehavioral Health Sciences, explains the focus of the process. “Attention to health equity in implementation ensures that evidence-based interventions reach and benefit all individuals,” she says. “Our process highlights that prospective, rigorous, exploratory work is vital for equity-informed implementation trials.”

Through descriptive pilot work, the researchers examined potential inequities prior to launch of the ASPIRE (Adolescent and child Suicide Prevention in Routine clinical Encounters) trial using the Health Equity Implementation Framework. They engaged with clinician partners and leveraged a multi-method pilot study across two health systems to examine whether delivery of an evidence-based firearm storage program differed by patients’ medical complexity, race, ethnicity, and sex assigned at birth.

“With rising rates of suicide among racially and ethnically minoritized youth, we must ensure that firearm safety programs deployed in health care settings reach all populations to meet the goal of keeping children and teens safe,” says Hoskins. “Beyond clinical research, our work highlights the potential for health systems to engage in data-driven monitoring for inequities to ensure that implementation of firearm violence prevention programs translates into meaningful impact for all families.”

The article “Equitable Implementation of S.A.F.E. Firearm: A Multi-method Pilot Study” is available online. Rinad S. Beidas, PhD of Northwestern University is the senior author and principal investigator of the ASPIRE trial. Co-authors of the article include: Alison M. Buttenheim, PhD, MBA, the Patricia Bleznak Silverstein and Howard A. Silverstein Term Endowed Professorship in Global Women’s Health, Penn Nursing; Jonathan Heintz, Kristin A. Linn, Christina Johnson, Isabelle Kaminer, Shari Jager-Hyman, Adina Lieberman, and Courtney Benjamin Wolk all of the Perelman School of Medicine, University of Pennsylvania; Steven C. Marcus of the School of Social Policy and Practice, University of Pennsylvania; Dylan S. Small of the Wharton School of Business, University of Pennsylvania; Jennifer M. Boggs, Leslie Wright, LeeAnn Quintana, Matthew F. Daley, Jason Lyons, and Debra P. Ritzwoller, all of Kaiser Permanente Colorado; Brian K. Ahmedani, Celeste Zabel, Melissa Maye, Joslyn Westphal, Shiling Zhang, Marisa E. Elias and Bridget McArdle, all of Henry Ford Health; and Rachel C. Shelton of Columbia University.

The National Institute of Mental Health funded this study 3R01MH123491-02S1 and the prime project, 3R01MH12349; Researchers listed additional funding as follows: National Institute of Mental Health Training Fellowship (T32 MH109433). Kaiser Permanente Colorado and Henry Ford Health are both part of the National Institute of Mental Health Mental Health Research Network (U19 MH092201). The funders had no role in the design of the study and will have no role in data collection, analysis, interpretation, or manuscript writing.