ABSTRACT

The BITTEN theoretical framework of trauma-informed healthcare proposes that each patient presents to a healthcare encounter with a baseline level of historical institutional Betrayal and trauma exposure that interacts with their Indicator for healthcare engagement to potentially Trigger trauma symptoms, impacting patients’ Trust in healthcare providers and shaping their current and future Expectations of and Needs for healthcare. The current study sought to test and extend components of the BITTEN theoretical framework to better understand the link between trauma exposure (childhood trauma and institutional betrayal) and healthcare engagement. Results largely supported the propositions of the BITTEN theoretical framework: childhood trauma was directly related to healthcare avoidance behaviors. The relation between childhood trauma and healthcare avoidance was partially mediated by patients’ reduced trust in healthcare providers. Further, the relation between childhood trauma and reduced trust in healthcare providers was potentiated by experiences of institutional betrayal. Interpreting patients’ interactions with healthcare providers and the healthcare system as a whole in light of their interpersonal and institutional trauma histories is needed to more fully embody trauma-informed healthcare. The BITTEN theoretical framework of trauma-informed healthcare appears to be a viable foundation for developing a trauma-informed understanding of patients’ healthcare engagement.

摘要

创伤知情的医疗保健被咬的理论框架，提出了每个患者出现与历史制度的基线水平的医疗保健遇到乙etrayal和创伤暴露，与他们的相互作用我为医疗保健参与ndicator潜在牛逼索具创伤症状，影响患者的牛逼锈病医疗服务提供者和塑造其当前和未来Ë和xpectations ñ用于医疗保健。当前的研究试图测试和扩展 BITTEN 理论框架的组成部分，以更好地理解创伤暴露（童年创伤和机构背叛）与医疗保健参与之间的联系。结果在很大程度上支持了 BITTEN 理论框架的命题：童年创伤与医疗回避行为直接相关。儿童创伤与医疗回避之间的关系部分是由患者对医疗保健提供者的信任度降低所介导的。此外，童年创伤与对医疗保健提供者信任度降低之间的关系因机构背叛的经历而得到加强。需要根据患者的人际关系和机构创伤历史来解释患者与医疗保健提供者和整个医疗保健系统的互动，以更充分地体现创伤知情医疗保健。创伤知情医疗保健的 BITTEN 理论框架似乎是发展对患者医疗保健参与的创伤知情理解的可行基础。