OBJECTIVE: To identify characteristics that facilitate trust in the patient-provider relationship among survivors of intimate partner violence (IPV).
DESIGN: Semistructured, open-ended interviews were conducted to elicit participants’ beliefs and attitudes about trust in interactions with health care providers. Using grounded theory methods, the transcripts were analyed for common themes. A community advisory group, composed of advocates, counselors and IPV survivors, helped interpret themes and interview exerpts. Together, key components of trust were identified.
SETTING: Eastern Massachusetts.
PARTICIPANTS: Twenty-seven female survivors of IPV recruited from community-based IPV organizations.
MAIN RESULTS: Participants’ ages ranged from 18 to 56 years, 36% were African American, 32% Hispanic, and 18% white. We identified 5 dimensions of provider behavior that were uniquely important to the development of trust for these IPV survivors: 1) communication about abuse: provider was willing to openly discuss abuse; 2) professional competency: provider asked about abuse when appropriate and was familiar with medical and social histories; 3) practice style: provider was consistently accessible, respected confidentiality, and shared decision making; 4) caring: provider demonstrated personal concern beyond biomedical role through nonjudgmental and compassionate gestures, empowering statements, and persistent, committed behaviors; 5) emotional equality: provider shared personal information and feelings and was perceived by the participant as a friend.
CONCLUSIONS: These IPV survivors identified dimensions of provider behavior that facilitate trust in their clinical relationship. Strengthening these provider behaviors may increase trust with patients and thus improve disclosure of and referral for IPV.
trust domestic violence physician-patient relations patient-centered care participatory research
Thom DH, Bloch DA, Segal ES. An intervention to increase patients’ trust in their physicians. Stanford Trust Study Physician Group. Acad Med. 1999;74:195–8.PubMedCrossRefGoogle Scholar
Mechanic D. The functions and limitations of trust in the provision of medical care. J Health Polit Policy Law. 1998;23:661–86.PubMedGoogle Scholar
Freund K. Domestic violence. In: Carr PF, Freund KM, Somani S, eds. The Medical Care of Women. Philadelphia, Pa: W.B. Saunders Company; 1995:722–8.Google Scholar
Gerbert B, Caspers N, Bronstone A, Moe J, Abercrombie P. A qualitative analysis of how physicians with expertise in domestic violence approach the identification of victims. Ann Intern Med. 1999;131:578–84.PubMedGoogle Scholar
McCauley J, Yurk RA, Jenckes MW, Ford DE. Inside “Pandora’s Box”: abused women’s experiences with clinicians and health services. J Gen Intern Med. 1998;13:549–55.PubMedCrossRefGoogle Scholar
Rodriguez MA, Quiroga SS, Bauer HM. Breaking the silence: battered women’s perspectives on medical care. Arch Fam Med. 1996;5:153–8.PubMedCrossRefGoogle Scholar
Strauss A, Corbin JM. Basics of Qualitative Research: Grounded Theory Procedures and Techniques. Newbury Park, Calif: Sage Publications; 1990.Google Scholar
McCauley J, Kern DE, Kolodner K, et al. The “Battering Syndrome”: prevalence and clinical characteristics of domestic violence in primary care internal medicine practices. Ann Intern Med. 1995;123:737–46.PubMedGoogle Scholar
Friedman LS, Samet JH, Roberts MS, Hudlin M, Hans P. Inquiry about victimization experiences. Arch Intern Med. 1992;152:1186–90.PubMedCrossRefGoogle Scholar
Thom DH, Ribisl KM, Stewart AL, Luke DA. Further validation and reliability testing of the Trust in Physician Scale. The Stanford Trust Study Physicians. Med Care. 1999;37:510–7.PubMedCrossRefGoogle Scholar
Butterfield MI, Frayne SM. Boundary issues in the management of patients with previous victimization. In: Liebschutz JL, Frayne SM, Saxe GN, eds. Violence Against Women: A Physician’s Guide to Identification and Management. Philadelphia, Pa: ACP-ASIM Press; 2003:253–61.Google Scholar
Mead N, Bower P. Patient-centeredness: a conceptual framework and review of the empirical literature. Soc Sci Med. 2000;51:1087–110.PubMedCrossRefGoogle Scholar
Stewart M, Brown JB, Donner A, et al. The impact of patient-centered care on outcomes. J Fam Pract. 2000;49:796–804.PubMedGoogle Scholar