Using Photovoice to Understand Survivors' Healthcare Experiences and Strategies.

The unique, individual nature of traumatic experiences and trauma symptoms and the limited healthcare resources typically allocated for individual patients pose barriers to implementing trauma-informed care. Developing knowledge on how survivors of violence engage in healthcare and self-advocate can lead to more empowering and efficient implementation of trauma-informed care. However, survivor perspectives on trauma-informed care are underrepresented in current literature and survivors' strategies for navigating healthcare are understudied. The aims of this participatory Photovoice study were to describe the healthcare experiences of female survivors of violence and their strategies for dealing with difficult healthcare experiences, healthcare providers, and the healthcare system. A sample of community-based women participated in an iterative series of five Photovoice meetings. Participants discussed multifaceted vulnerability in healthcare settings with regard to past traumatic violence, triggering or retraumatizing health care experiences, medical knowledge, and provider-patient relationships. They agreed that providers believing their symptoms, health concerns, and trauma disclosures was essential for positive provider-patient relationships and healthcare experiences. Findings on the importance of perceived belief with regard to trauma disclosure and health concerns and survivors' healthcare strategies are unique contributions to the literature. Providers should be accountable for integrating survivors' self-knowledge in collaborative healthcare decision-making, for making medical records and information easily accessible, and for expressing belief in trauma disclosures and health concerns. Future research should continue using participatory methods to assess evolving trauma-informed practices and patient engagement among survivors and to hasten progress toward trauma-informed care that effectively meets the needs of survivors.