Table 1 provides demographic information for the 107 survey participants, noting the number of available responses for each measure after accounting for missing answers. The majority of the sample identified as male (81%), Black/African American (67%), and non-Hispanic/Latino (70%). Most respondents (66%) were unemployed with a high school education (57%) or less (30%). The majority of participants reported income of less than $10,000 each year (58%) and most individuals were unmarried and not in a committed relationship (57%). The average age of respondents was 39 years old.

Table 1 Sample characteristicsHealth Challenges

Many of the survivors in our study grapple with physical and mental changes after their injury, often inhibiting activities of daily life or requiring medical treatment. Table 2 depicts the health challenges experienced by survivors. A little more than a quarter of participants said they were either very or fairly dissatisfied with their health, whereas roughly 52% said they were satisfied or very satisfied with their health. About two-thirds of the participants indicated that pain prevents them from doing what they need to do either a moderate amount, a great deal, or an extreme amount. Roughly 22% of the sample said they do not need any amount of medical treatment to function in daily life, while nearly 60% of the sample indicated needing a moderate amount, a great deal, or an extreme amount of medical treatment to function.

Table 2 Health challenges among shooting survivors

Participants who responded to questions about functional disabilities (N = 61) indicated these disabilities were relatively common. For instance, about 1 in 4 said they experience a visual disability whereas more than a third experience some type of cognitive disability. Approximately 1 in 5 participants indicated trouble walking or climbing stairs (ambulatory disability) while 15% indicated difficulty with self-care (e.g., bathing or dressing). Finally, 1 in 4 participants indicated difficulties with independent living including running errands alone like going shopping or to a doctor’s appointment.

One participant spoke about transitioning from walking to using a wheelchair following their injury, sharing their exercise efforts and daily routine changes. Another participant discussed breathing challenges and activity limitations:

Before I was injured, I was physically fit. Like I was able to, you know, do everything that I wanted to do. Like now, … my doctor’s like, I can’t, he don’t want me to do running because he said, my lung, it’s a chance that it can collapse. So like that [is] slowing me down, going to work ‘cause I can’t, you know - they don’t want me to take the risk of lifting something too heavy or being out there on my own [at work] and something happens and I’m by myself.

Participant narratives discussed changes in physical ability that can also be interpreted as a partial loss of bodily autonomy. Participants discussed how their physical injuries, and this potential loss, were also connected to mental health challenges. After their injury, one participant never used the words “mental health” but rather described their psychological well-being in the form of a dark cloud. Another participant hinted at being depressed but having the ability to not “stay in it for long,” as they were committed to ensuring they could “get out of it” on their own. Two participants recalled specific physical reactions in their bodies post-injury and how their mindsets shifted:

I experienced cold sweats. I think about the shit, and I try not to think about the shit. You feel me? The psychiatrist, she did tell me ‘You may not feel things now or you may not go through things in a couple of years.’ This could be PTSD.

Every time I wake up, I feel like I am going to get shot again. My anxiety is crazy and my mindset is different. Now, I feel like it’s gonna have me going crazy.

Other participants felt that post-injury, their mental health actually became stronger and that their outlook on life was more positive. Two individuals shared:

It didn’t make me depressed, it just made me more on point… I know people who got shot worse. Like, it ain’t like I had to go through therapy or anything like that, or physical therapy. I look at that as a blessing.

My mental health was good before, now it seems a lot stronger. I’m more motivated to do what I have to do ‘cause I know I had a second chance at life. It comes and goes, you know. You go through depression, and I mean I still have PTSD. As long as you stay focused, surround yourself with positive people, positive imaging since we got social media, your mental could be stronger.

Healthcare Needs

Figure 1 illustrates the healthcare needs among the 87 participants that responded to the survey prompt. More than half of respondents indicated that they lacked access to free or low-cost medical care, while about 40% indicated a need for specialist services like dental and eye care. Roughly 1 in 4 respondents indicated a need for a primary care provider or family doctor, while about 15% of the sample said they needed access to physical/occupational therapy or mental/behavioral health services.

Fig. 1The alternative text for this image may have been generated using AI.

Missing healthcare needs among shooting survivors (N = 87)

Qualitative data spoke less directly to the cost burden of healthcare and instead to overall avoidance of the healthcare system. Participants discussed how their injury required them to see a doctor, although many participants pre-injury and at times post-injury did not often seek care. Multiple participants discussed engaging in homeopathic remedies, saying:

I started following my own remedies and guidelines. Like, I used to like watch [medical] videos and stuff. Find like little like herbs and stuff to take. Like, say, if I did have a cold or something, I would drink tea.

…I don’t go to the doctor…I’m straight vegetarian. Like I cure myself. Anything element that I got to do with me, I’m gonna go research it and take care of myself naturally.

These quotes highlight participants’ medical autonomy and may also speak to potential distrust of healthcare institutions or unfamiliarity with how to engage in certain healthcare processes (e.g., follow-up care, finding a specialist).

Others changed their health care habits overall post-injury, one person sharing:

I never used to go to the doctors, never. Like none so far. I ain’t even have a primary doctor or none of that stuff, that type of stuff. But I do now.

Firearm violence has a lasting impact on one’s mental health, and the use of substances and alcohol are common coping mechanisms for some survivors [11]. About 10% of the sample indicated a need for substance use and rehabilitation services, although only a few participants shared that they use alcohol and drug use to cope with their injury recovery. Examples included having a beer after waking up from a nightmare or using marijuana to feel calmer and relaxed.

Multiple participants expressed their infrequent use of pain medication (e.g., aspirin and related over-the-counter medicines prior to injury) pre-injury and many discussed limiting use post-injury, except when injury pain was immense. One participant spoke about avoiding prescribed pain medications because they were afraid of becoming addicted, while another participant shared, “I ain’t really big on pain medicine anyway. Even when they gave me pain medicine, I probably altogether probably took six pills, maybe.” Infrequent pain medication use could also be a rebuke of reliance on external help, instead relying on inner strength to heal from injury.

Barriers to Healthcare Access

Figure 2 shows participants’ barriers to healthcare access among 92 respondents. The most common barrier was the inability to afford out-of-pocket costs (47%), followed by having limited or no health insurance (37%). No qualitative data spoke explicitly about health insurance except for one participant who discussed health insurance as a necessity for their children, but not for themselves. Other significant barriers to healthcare access included unreliable transportation (21%), lack of primary care physicians (22%), and unreliable Internet access (13%).

Fig. 2The alternative text for this image may have been generated using AI.

Barriers to healthcare access among shooting survivors (N = 92)

In the interviews, participants discussed the transportation and logistical help they often needed to attend physical therapy, attend medical follow-ups, and get prescription refills. One person shared:

A lot of stuff could be better inside this healthcare system. Like transportation could be better…when this injury first started and I first started going to the hospital, I missed a lot of appointments due to [transportation agency] not showing up.

Participants also spoke about challenges with refilling prescriptions and finding transportation to pick up medication. One participant mentioned leaving the hospital with pain medication and the challenge of trying to access pain medications once he completed the prescribed dosage, sharing, “They give me medicine for a week so when the week was over, I got to try to call and get back in touch with them [for a refill] and it is just a hassle.” Together, these narratives highlight potential gaps in the continuum of care for patients following injury.

Participants expressed appreciation for the community violence prevention specialists who offered social support and completed logistical tasks with them, such as driving them to appointments, running errands, and helping them fill out paperwork post-injury. While assisting a participant at the hospital, a CVPS offered their advice, sharing, “’Cause you can call me anytime, bro. Seriously.” The participant responded, “No, I know. And I’ve called you before, and you don’t be quick to hang up or nothing like most people do. You be talking. I realize that from the hospital.”

About 10% of participants said they could not access care because it was hard to understand the healthcare system, whereas about 8% said they are afraid of the outcome of a healthcare visit. Shooting survivors we spoke with engaged with the health care system often involuntarily through transport to a trauma center and through various follow-up appointments and surgeries.