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2023 HSR&D/QUERI National Conference Abstract

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1115 — Veterans’ perceptions about firearm safety discussions in the VA

Lead/Presenter: Megan Lafferty,  COIN - Portland
All Authors: Lafferty MJ (Center to Improve Veteran Involvement in Care (CIVIC)), Wyse J. (Center to Improve Veteran Involvement in Care at VA Portland Healthcare System, Oregon Health and Science University, Portland State University School of Public Health) Mulcahy AC.(Center to Improve Veteran Involvement in Care at VA Portland Healthcare System, Oregon Health and Science University, Portland State University School of Public Health) Maxim L. (Center to Improve Veteran Involvement in Care at VA Portland Healthcare System) Carlson K. (Center to Improve Veteran Involvement in Care at VA Portland Healthcare System, Oregon Health and Science University, Portland State University School of Public Health)

Objectives:
The Veterans Health Administration (VA) serves more than 9 million Veterans each year, many of whom own firearms. Despite the patient population being at high risk for firearm injuries and death, some policy makers have expressed concerns that standardized firearm safety discussions, or lethal means counseling, could drive Veterans away from VA care. This concern may be most salient in relation to rural-residing Veterans, given the role of firearms in rural culture along with higher rates of firearm injuries and suicide. This study examines rural Veterans’ perceptions about firearm safety discussions to help inform healthcare-based harm reduction efforts.

Methods:
We conducted semi-structured interviews with 40 Veterans from four VA facilities that treat a relatively high rate of rural patients with firearm-related injuries. Interviews were audio-recorded and transcribed. We used a rapid analysis approach to understand patient perspectives and identify themes.

Results:
Participants had various experiences with firearms, shaped by cultural and physical environments as well as military service. We found most Veterans were agreeable to universal discussions of firearm safety. However, some voiced concerns, deeming it outside the scope of a provider’s role (‘who are you to ask?’) and saying it could raise suspicions if the intention is unclear and Veterans are worried about losing access to firearms (‘raises red liberal flag’). Those who voiced concerns pointed out they and other Veterans might not answer honestly; however, no participants said raising the topic would stop them from engaging with VA care. All participants thought lethal means counseling and safe storage were appropriate and necessary topics for providers to discuss in several at-risk situations, such as suicidal ideation/mental health or dementia. Preferences around the delivery and method of such discussions varied, but many Veterans emphasized timing, as well as provider trust and training, as being key.

Implications:
Our findings suggest that universal discussion of firearm safety will not turn existing Veteran patients away from care and could be incorporated into standard VA practice as part of a comprehensive firearm-focused harm reduction. Discussions will be most effective when incorporating Veterans’ preferences, such as having providers trained in the topic.

Impacts:
While lethal means counseling is currently utilized in many VA facilities, mandatory provider training about firearm safety discussions could help close the gap to reach all Veterans receiving VA care, while ensuring delivery of discussions are in line with Veteran preferences.