“I'm not here to take anyone's guns away:” provider perspectives and strategies for addressing the fear of firearm seizure among rural-residing Veterans

Rural-residing Veterans experience higher rates of fatal and nonfatal firearm injury than their urban or civilian counterparts. Discussing firearm safety in clinical settings is a promising strategy for firearm injury prevention. In rural contexts especially, firearm safety discussions with Veterans—the acceptability, efficacy, and reach of these discussions—are often complicated by Veterans’ perceived risk of firearm seizure. Drawing on semi-structured interviews with Veterans Health Administration (VA) providers at three separate rural-serving VA sites, this study examines the factors that contribute to fear of firearm seizure to a) understand how the fear of firearm seizure informs Veteran attitudes and behaviors, and b) identify strategies to inform firearm safety interventions for rural-residing Veterans. Our results suggest that fear of firearm seizure is informed by several interlocking factors, including rural cultures and identities of firearm ownership, distrust in government, and misconceptions about VA care. Notably, we found that these beliefs drive Veteran attitudes and behaviors, particularly when it comes to adopting firearm safety strategies and seeking mental health care. Based on their experience working with rural-residing Veterans, providers shared strategies for addressing fears about firearm seizure which have the potential to improve Veteran engagement in VA care, enhance suicide and firearm injury prevention interventions, and ensure the health and safety of Veterans and their families. • Perceived risk of firearm seizure has impacts on Veteran engagement in VA care. • Rural cultures of firearm ownership, distrust of government, and misconceptions about VA care contribute to fear of firearm seizure among Veterans. • VA providers have developed key strategies for discussing firearm safety with rural-residing Veterans. • Expanding firearm safety discussions may prevent intentional and unintentional firearm injury among Veterans.