Table 3.

Determinants and Illustrative quotations from clinician interviews organized by Health Equity Implementation Framework domains.

Domain	Illustrative Quotations
Characteristics of the Innovation Explicit non-judgmental approach Relative advantage of universal delivery Free/no-cost/low barrier	“I take care of all kinds of people. So not to make them think that I'm the gun police or making any judgment. I'm not asking. I don't really want to know. I just want to know, ‘Do you want one [free cable firearm lock]? Because we're giving them out for free. And so it's free, so I'm not screening you.’” (Site 1, P42)
Recipients: Patient (and Parent) Factors Parent preferences Medical conditions	“I don't think that there was really much association between any of their underlying conditions and the conversation with the safe firearms, just because the way I had it in our template. We were discussing any of their underlying medical disorders, and then, when we talk about safety, it just came underneath that safety sort of category. So I don't think that there was much association in my mind." (Site 1, P41)
Recipients: Provider Factors Comfort and self-efficacy Communication skills	“I think initially, I had that fear that there was going to be-- the people were either going to get upset and-- in either direction, that there was going to be people who were going to feel like, "Well, why is he asking me about guns?" Like, "I have a gun, I'm going to be judged." Or like, "What kind of family do you think we are that we would have guns?" So initially, I had this preconceived idea that I didn't want to upset people or insult people on either side of the spectrum. But actually fairly quickly, now I feel like that is a fear that has gone to the side because I don't see that that's happened at all.” (Site 2, P111)
Clinical Encounter Competing demands Clinician reliance on the EHR Sensitive topic normalization Use of interpreter services	"But I think having that prompt is really important, and that's part of medicine, fortunately these days, because we can be a lot more consistent with our application of our care if we utilize technology to help us make sure that we're doing that." (Site 2, P40) I think there's been no difference in who we deliver that [firearm safety] message to. And I would say there's been no consistent differences in terms of reception across multiple different variations of parents and patients. And I think it's been pretty uniform. (Site 2, P112) “I'm asking everyone, regardless of any underlying race or ethnicity.” (Site 1, P40) “[…] I don't feel like I personally change the way that I deliver the information based on socioeconomic status, race, whatever. I still try to at least get that one-liner in there, more so because, I think, it's in my note and I need to click through it. So […] it's like, "I just have to address it." Whether I spend a lot of time on it and whether the patient wants to know more about it is different, and I can kind of extend or shorten the amount of counseling that I do. But I think just knowing that it's in the note, I try to just address it for everybody. So the prompting, I think, works.” (Site 1, P31) "And I think [families are] much more inclined to listen to that additional topic of conversation when it's included in that part of the guidance that we provide, as opposed to kind of incorporating it into discussion in a way that makes it feel, I think, hyper-focused or hypersensitive to families, because they may or may not feel singled out. So I think normalizing the discussion has been a really big help for a lot of our providers when it comes to tailoring their own discussions with families." (Site 2, P112)
Local & Organizational Level Lock location and accessibility Organizational culture	“[Equitable program delivery] really depends upon the culture of the company, because if equity and care delivery is important to the company and they emphasize that and they look at the disparities that exist, then I think that you're a lot more likely to be able to achieve closing that gap. If the company doesn't consider it a priority, then I think you're a lot less likely to see those impacts.” (Site 2, P40)
Social Influence Local high school shooting COVID-19 pandemic and mental health sequelae	"And so I live the next town over from [town]. So where we live, we were very impacted. And actually, our school was closed for a few days after the shooting […] We are literally like the next district over. It's probably ten minutes to [town] from my house. And so a lot of the mental health issues in regards to that have been, just in our local community, very difficult." (Site 1, P41)