The informed study: a mixed methods study on efficacy of trauma screening, brief intervention and referral to treatment on trauma impact and patient engagement among adults with low-socioeconomic status in a primary care setting
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Addressing trauma⎯i.e., harmful response to harm and threat of harm—is critical. Need exists for primary care interventions. The INFORMED study evaluated the efficacy of a trauma screening, brief intervention, and referral to treatment (T-SBIRT) intervention compared to attention-control intervention on trauma impact and patient engagement among adults with low socioeconomic status in primary care. Founded on Beck’s generic cognitive model and influenced by the trauma-informed care framework, the study targeted biased beliefs, focus, and maladaptive behavior to improve patient engagement and trauma impact outcomes. The convergent mixed methods design included a randomized controlled trial and qualitative descriptive component. Eligible participants (N=147) were randomized using 1:1 random blocking to T-SBIRT (n=72) or attention-control (n=75). Both groups completed Post-Traumatic Maladaptive Beliefs Scale for trauma impact, Patient Activation Measure® (PAM®) and Self-Efficacy for Managing Chronic Disease Scale (SEMCDS) for patient engagement, pre-intervention and immediate- and 3-months postintervention. The intervention group received T-SBIRT: trauma screening and psychoeducation and behavioral health services referral. The attention-control group received a sleep hygiene brochure. Nine T-SBIRT participants completed semi-structured interviews at 3-months follow-up. Surveys and interviews, collected concurrently and analyzed separately, were subsequently merged in joint analysis. Independent and paired t-tests on data except PAM® scores were completed for between and within groups comparison as they met normality of distribution. Interview data were analyzed using directed content analysis. Participants were mostly non-Hispanic White (76.2%) and female (58.5%). Using intent-to-treat analysis, trauma impact between groups did not differ significantly at immediate (M diff=0.15, SD=-1.56, p=.950) and 3-months postintervention (M diff=2.99, SD=-1.20, p=.245). Patient engagement using PAM® and SEMCDS between-groups did not differ significantly at immediate (Mdn diff=2.5, p=.732; M diff=0.32, SD=-0.01, p=.236) and 3-months postintervention (Mdn diff=3.7, p=.650; M diff=-0.057, SD=0.26, p=.905). Participants reported changes in trauma impact and healthy behaviors. Joint analysis identified divergences in quantitative and qualitative findings. Post-hoc analysis showed differences within the intervention group for those with mental health and substance abuse disorders and females. The study contributes to literature on trauma impact and patient engagement, providing evidence that T-SBIRT has a role to play in primary care, though not equally across demographics.
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Introduction -- Review of the literature -- Methodology -- Results -- Discussion
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Ph.D. (Doctor of Philosophy)