Abstract
BACKGROUND: Firearms account for the majority of US Veteran suicides. Studies demonstrate that secure firearm storage can decrease risk of suicide. Veterans prefer to have discussions about secure firearm storage with familiar individuals, such as their caregivers. Providers in the Department of Veterans Affairs (VA) are well-positioned to engage caregivers of Veterans in firearm suicide prevention; however, challenges remain. OBJECTIVE: Elucidate healthcare system barriers to caregiver engagement in firearm suicide prevention, as seen by Suicide Prevention and Caregiver Support Program staff, to inform development of an intervention to increase involvement of caregivers in efforts to reduce Veteran firearm suicides. DESIGN: An Advisory Board consisting of key stakeholders provided input regarding study methods and interpretation of findings. PARTICIPANTS: Participants included 16 Caregiver Support Program and 14 Suicide Prevention staff recruited from 8 geographically diverse rural VA medical centers. APPROACH: Interview topics and data analyses were guided by the Consolidated Framework for Implementation Research (CFIR). Rapid analysis and a team-based approach were employed to identify key barriers; emergent themes were mapped onto relevant constructs of the CFIR inner setting domain. KEY RESULTS: Healthcare system barriers included structural characteristics (e.g., understaffing and heavy workloads), relational connections and communications (e.g., poor channels of communication between Caregiver Support Program and Suicide Prevention staff), culture (e.g., lack of recipient-centered care), and access to knowledge and information (e.g., lack of training in how to incorporate caregivers in Veteran care). CONCLUSIONS: The present study provides much needed perspective from VA staff in Suicide Prevention and Caregiver Support programs regarding barriers to involving caregivers in firearm suicide prevention efforts within the VA healthcare setting. Identifying these barriers and potential solutions is a critical step towards increasing engagement of caregivers in reducing firearm suicide among Veterans.