Healthcare Experiences, Needs, and Strategies of Survivors of Violence
The long-term and multi-faceted consequences of trauma are well documented and health conditions associated with traumatic life events are often those that benefit from early and regular attention from a healthcare provider. However, for many trauma-exposed women, seeking out and receiving healthcare is associated with physical and psychological intrusions that are linked to their traumatic experiences. Implementing trauma-informed care, based in knowledge and understanding of trauma that sensitively meets the needs of survivors, is an effective way to improve trauma survivors’ healthcare experiences. However, implementing such changes in practice to improve care for survivors is often made difficult by the current prevailing characteristics of patient-provider relationships and the U.S. healthcare system. Further, relying on providers to change practice is a disempowering position for survivors; supporting survivors to advocate for their needs within healthcare interactions and the healthcare system could be an efficient, effective and empowering solution to attaining widespread trauma-informed care.
This dissertation addresses current knowledge deficits through: 1) description and comparison of lifetime trauma exposure among community-based women from diverse locations and backgrounds; 2) examination of existing trauma-informed care practices for survivors of physical and sexual violence; and 3) descriptions of the healthcare experiences, needs, and strategies of female survivors of physical and sexual violence with regard to navigating healthcare experiences, provider interactions, and the healthcare system. A descriptive, correlational analysis and a synthesis of current literature were used to address the first and second research aims. Original qualitative interview and participatory Photovoice studies were conducted to address the third research aim.
Findings from the statistical analysis of trauma exposure among four community-based samples of women in Colombia, Hong Kong, and the United States indicate that trauma exposure is more similar than different and that trauma and its effects are pervasive in the lives of women across diverse locations. The synthesis of literature elucidates five thematic elements of trauma-informed care including: sensitive and universal screening, provider-patient relationships, minimizing distress, maximizing autonomy, and providing appropriate collaboration and referral. Findings from the qualitative interview and participatory Photovoice studies highlight imbalances in power dynamics and lack of mutual belief and trust as the most significant challenges to positive provider-patient relationships and healthcare experiences. These findings also indicate that survivors of violence use a variety of strategies to navigate healthcare encounters in the face of system-, agency- and provider-level barriers to positive healthcare experiences.
This dissertation adds to existing evidence on trauma exposure and trauma-informed care, and data on the engagement behaviors and healthcare strategies of survivors of violence addresses substantive gaps in the literature. Further, these findings generate useful frameworks and foundations for future research to continue to explore survivors’ healthcare desires, provider-survivor relationships, and provider- and survivor-led interventions to support the implementation of trauma-informed care.
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.
Rights for Collection: Duke Dissertations