(PS2-D87) Perpetrating Harm in Healthcare: The Impact of Provider-specific Betrayal on Young Adults’ Healthcare Experiences

Although college is a time of increased autonomy and maturation, many students minimize or outright avoid their healthcare-related responsibilities (Gigler et al., 2022; Tran & Silvestri-Elmore, 2021). This is concerning as early adult behavior sets the stage for future health and medical compliance (Peters et al., 2011). Timely healthcare, which requires reduced healthcare avoidance, may also facilitate college student health, well-being, and academic success.

One factor impacting student healthcare utilization is a history of healthcare institutional betrayal, which occurs when a trusted healthcare institution does not act in their patient's best interest or fails to protect the patient from harm (Langhinrichsen-Rohling et al., 2021; Smith & Freyd, 2014). Betrayal trauma theory posits that the degree of pre-existing trust with the institution/provider has more impact on the betrayal experience than the betrayal behavior (Freyd, 1996). As medical providers are vital to treatment options and health outcomes and may be presumed trustworthy, examining their impact on students’ worst self-reported healthcare experiences is crucial.

Thus, the current study compared college students whose worst healthcare experience included betrayal by a specific provider to students whose worst healthcare experience did not. The sample consisted of 474 college students (M=19.54, SD= 2.99) who identified primarily as White (50.6%), women (65.1%), and privately insured (57%). Participants provided information about their worst healthcare experience, including whether a specific provider perpetrated harm. Independent samples t-tests compared whether identifying a specific provider as harmful or problematic during their worst healthcare experience was significantly related to healthcare distress, future healthcare avoidance, fear, or changes in future utilization.

As expected, those who identified a specific provider as perpetrating betrayal versus those who did not, reported significantly more distress (M= 7.07, SD=1.95; M= 5.32, SD= 2.64) t(363)= 7.96, p<.001, d= .71, avoidance (M= 3.49, SD=2.05; M=2.74, SD=2.00), t(466)= 3.74, p<.001, d= .37, fear (M=3.38, SD=1.93; M=2.68, SD=1.89), t(466)= 3.71, p<.001, d= .37, and were more likely to endorse changing their approach to healthcare utilization (M=3.59, SD=1.78; M=3.15, SD=1.96), t(466)= 2.32, p=.021, d= .23.

These results suggest that college students who experience negative healthcare experiences associated with a specific provider may be particularly impacted in ways likely to change their future healthcare utilization. Improving healthcare utilization and well-being among college students may be enhanced by addressing and repairing historical provider-related betrayal.