“Nothing seems normal anymore”: a study of black male firearm violence survivors in a hospital-based violence intervention program

Problem Statement: While homicide is the leading cause of death among young Black men between the ages of 15 and 34, non-fatal violent injury is a major cause of death and disability for this group as well. Despite this, very little research focuses on the experiences of African American/Black male survivors of firearm injury. There is also a limited body of qualitative research assessing the effectiveness of hospital-based violence intervention programs (HVIPs) that seek to identify and reduce risk factors within this group. Methodology: This mixed-methods study explored life post-firearm injury among ten African American/Black male firearm violence survivors enrolled in an HVIP. The study was guided by the following research questions: 1. What are the day-to-day experiences of African-American/Black men living with firearm injuries? 1a. How does Felitti’s adverse childhood experiences (ACE) questionnaire align with or depart from the narratives of African-American/Black male firearm violence survivors? 1b. How do survivors conceptualize themselves after being injured? 2. Is the HVIP effective in addressing the risk behaviors of African-American/Black male firearm violence survivors in the program? 2a. How does the program align with or depart from the perceptions and priorities of African American/Black male firearm survivors? 2b. What can this tell us about designing firearm violence interventions? 3. What does the PROMIS-29 questionnaire tell us about urban firearm violence survivors' experiences recovering from a life-changing encounter? Telephone interviews were conducted with all 10 study participants, who also completed the original Felitti ACES questionnaire and the PROMIS-29. The constant comparative method was used to analyze the qualitative data and SPSS was utilized to analyze the results of the PROMIS-29; Excel was used to analyze the results of the ACEs questionnaire. Results: Three key themes described how these men’s lives have been significantly impacted post-firearm injury: 1) the experience of disability and the physical injuries that they must live with forever, 2) how masculinity is expressed as injured men perform their respective gender norms and roles and construct social identities, and 3) the profound impact of firearm violence on their mental and emotional health. Analysis also indicated that the HVIP in this study appears to be effective in addressing risk behaviors within this group. Further, study findings showed that Felitti's ACEs questionnaire departed significantly from participants' childhood narratives. After analyzing ACE scores and comparing them with participant narratives, it is evident that this questionnaire cannot provide an accurate indication of childhood trauma in this group. Analysis of the PROMIS-29 yielded inconclusive results. Conclusion: These findings make it clear that living with firearm injuries affects African American/Black men in every respect, taking a profound toll on their self-esteem and self-image, and leaving them at great risk of feeling diminished as human beings. It also highlights the importance of discharge planning for survivors, especially if they are returning to the same communities in which they were victimized. Finally, these results underscore the importance of listening to the stories of firearm violence survivors in order to fully incorporate their priorities into HVIPs and other interventions.Ph.D.Includes bibliographical reference