Key informant analysis of facilitators and barriers to implementing a hospital-based firearm violence intervention programme

BACKGROUND: Interpersonal firearm injury (FI) is a leading cause of morbidity and mortality among Americans. Those who experience FI are at increased risk of reinjury. Hospital-based violence intervention programmes (HVIPs) provide case management to interrupt the cycle of violence. The objective of this study was to analyse facilitators and barriers in the implementation of a novel HVIP: the Interrupting Violence in Youth and Young Adults (IVYY) Project. METHODS: Semistructured interviews were performed with 27 key informants including hospital staff, IVYY team members and violence intervention specialists (VIs) to elicit awareness, facilitators and barriers. Data were analysed with MAXQDA software. Themes were mapped to Consolidated Framework for Implementation Research domains. Domains include: intervention characteristics (programme itself), outer setting (external systems affecting the programme), inner setting (where the programme is implemented), individual characteristics (roles of individuals involved) and the implementation process. RESULTS: Within the intervention characteristics domain, IVYY's knowledgeable leadership was a facilitator. One outer setting facilitator was the local demand for violence prevention, and a barrier was local attitudes about gun violence as a 'poor problem'. The inner setting (the hospital) facilitated implementation by providing space for the programme. In the individual characteristics domain, one strong facilitator was the VIs; hiring credible messengers with lived experiences is integral to programme success. CONCLUSIONS: HVIPs are increasingly used as an integral component of treating victims of FI. By highlighting the facilitators and barriers to IVYY implementation, we offer insight and recommendations on best practices for HVIP implementation and replication.