Department of Psychological Science, University of North Carolina at Charlotte, Charlotte, North Carolina, USA.
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.
J Trauma Dissociation. 2024 May-Jun;25(3):299-314. doi: 10.1080/15299732.2022.2120151. Epub 2022 Sep 7.
Healthcare-related institutional betrayal has been used to examine how patients' previous negative healthcare experiences influence their current provider-level trust and future interactions with the healthcare system. However, healthcare-related institutional betrayal has rarely been considered among emerging independent users of the healthcare system: college students. Moreover, it is unknown whether healthcare-related institutional betrayal is associated with future healthcare expectations among this population. Using a trauma-informed framework, this study examined the relations among self-reported experiences of healthcare-related institutional betrayal, trust in healthcare providers, and subsequent expectations for healthcare among college students ( = 967). Analyses considered whether greater past healthcare-related institutional betrayal during one's worst healthcare experience predicts i) lower current trust in healthcare providers and ii) greater negative expectations for future healthcare above and beyond trauma symptoms and the perceived severity of participants' worst healthcare experiences. Sixty-nine percent of participants endorsed having experienced at least one act of institutional betrayal, the most common being the institution not taking proactive steps to prevent unpleasant healthcare experiences (28.5%). As predicted theoretically, greater experiences of institutional betrayal accounted for 16% of the variance in current trust in healthcare providers, even after accounting for trauma symptoms and the severity of the worst healthcare experience. Greater endorsement of institutional betrayal experiences were also significantly associated with negative expectations for future healthcare. Given the youthfulness of the sample, it is noteworthy that 41.4% of participants endorsed at least one negative expectation for future healthcare. Future research should examine how negative expectations are related to healthcare avoidance behaviors.
医疗相关机构背叛被用于研究患者先前的负面医疗体验如何影响他们当前对医疗服务提供者的信任以及未来与医疗系统的互动。然而，在新兴的独立使用医疗系统的人群中，如大学生中，很少考虑医疗相关机构背叛。此外，在这一人群中，医疗相关机构背叛是否与未来的医疗期望有关尚不清楚。本研究使用创伤知情框架，考察了大学生（n=967）中自我报告的医疗相关机构背叛经历、对医疗服务提供者的信任与随后对医疗的期望之间的关系。分析考虑了在最糟糕的医疗经历中，过去的医疗相关机构背叛经历是否更大地预测了 i）当前对医疗服务提供者的信任较低，以及 ii）对未来医疗的负面期望更大，超出了创伤症状和参与者最糟糕医疗经历的感知严重程度。69%的参与者表示至少经历过一次机构背叛行为，最常见的是机构没有采取主动措施预防不愉快的医疗体验（28.5%）。正如理论预测的那样，即使考虑了创伤症状和最严重医疗经历的严重程度，机构背叛经历也解释了当前对医疗服务提供者信任的 16%的差异。对机构背叛经历的更多认可也与对未来医疗的负面期望显著相关。考虑到样本的年轻化，值得注意的是，41.4%的参与者对未来医疗至少有一个负面期望。未来的研究应该探讨负面期望与医疗回避行为的关系。
