Understanding College Students’ Healthcare Avoidance: From Early Maladaptive Schemas, through Healthcare Institutional Betrayal and Betrayal Trauma Appraisal of Worst Healthcare Experiences
Abstract
:1. Introduction
1.1. BITTEN Model
1.2. Current Study
2. Methods
2.1. Procedures
2.2. Measures
2.2.1. Demographics
2.2.2. Early Maladaptive Schemas
2.2.3. Worst Healthcare Experience
2.2.4. Institutional Betrayal
2.2.5. Trauma Appraisal Questionnaire
2.2.6. Healthcare Avoidance
2.3. Planned Analyses
2.3.1. Preliminary Analysis
2.3.2. Primary Analyses
3. Results
3.1. Primary Results
3.2. Impaired Autonomy Performance
3.3. Disconnection and Rejection
4. Discussion
5. Clinical Implications
6. Limitations
7. Future Directions
8. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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n | % | |
---|---|---|
Race/Ethnicity ** | ||
White | 823 | 59.5 |
Black/African American | 262 | 18.9 |
Hispanic/Latino | 89 | 6.4 |
Asian | 99 | 7.2 |
Other | 55 | 4.0 |
American Indian/Alaskan Native | 5 | 0.4 |
Native Hawaiian/Pacific Islander | 5 | 0.4 |
Missing | 45 | 3.3 |
Gender | ||
Female | 845 | 61.1 |
Male | 488 | 35.3 |
Prefer not to say | 5 | 0.4 |
Prefer to self-describe | 6 | 0.4 |
Year in College | ||
Freshmen | 661 | 47.8 |
Sophomore | 430 | 31.1 |
Junior | 130 | 9.4 |
Senior | 110 | 8.0 |
Chose not to answer | 15 | 1.1 |
n | Min–Max | M (SD) | |
---|---|---|---|
Healthcare Avoidance | 1177 | 2.00–12.00 | 6.00 (2.50) |
EMS: Impaired Autonomy Performance | 1152 | 6.00–74.00 | 31.45 (12.86) |
EMS: Disconnection and Rejection | 1157 | 5.00–140.00 | 57.09 (23.78) |
Trauma Appraisal | 1135 | 6.00–35.00 | 14.39 (7.37) |
Healthcare Institutional Betrayal | 1383 | 0.00–11.00 | 1.41 (1.74) |
Age | 1251 | 18.00–65.00 | 19.86 (3.64) |
1 | 2 | 3 | 4 | 5 | 6 | |
---|---|---|---|---|---|---|
1. Healthcare Avoidance | - | |||||
2. Impaired Autonomy Performance | 0.25 *** | - | ||||
3. Disconnection and Rejection | 0.28 *** | 0.76 *** | - | |||
4. Healthcare Institutional Betrayal | 0.37 *** | 0.14 *** | 0.19 *** | - | ||
5. Betrayal Trauma Appraisal | 0.37 *** | 0.22 *** | 0.21 *** | 0.43 *** | - | |
6. Race | 0.05 | 0.09 | 0.09 ** | −0.09 *** | 0.03 | - |
7. Gender | −0.12 *** | −0.08 ** | −0.03 | −0.13 *** | −0.07 * |
Antecedent | Step One | Step Two | Final Model | ||||||
---|---|---|---|---|---|---|---|---|---|
M1 (HIB) | M2 (BTA) | Y (HAV) | |||||||
b | SE | p | b | SE | p | b | SE | p | |
X (EMS-IAP) | 0.02 | 0.00 | 0.000 | 0.09 | 0.02 | 0.000 | 0.03 | 0.01 | 0.000 |
M1 (HIB) | — | — | — | 1.71 | 0.11 | 0.000 | 0.34 | 0.04 | 0.000 |
M2 (BTA) | — | — | — | — | — | — | 0.07 | 0.01 | 0.000 |
Gender | −0.61 | 0.11 | 0.000 | 0.04 | 0.42 | 0.923 | −0.24 | 0.14 | 0.082 |
Race | −0.37 | 0.11 | 0.001 | 0.76 | 0.42 | 0.067 | 0.28 | 0.14 | 0.039 |
Constant | 1.46 | 0.15 | 0.000 | 8.27 | 0.60 | 0.000 | 3.31 | 0.22 | 0.000 |
R2 | R2 = 0.05 | R2 = 0.22 | R2 = 0.23 | ||||||
F(3,1066) = 21.20, p = 0.000 | F(4,1065) = 73.22, p = 0.000 | F(5,1064) = 62.30, p = 0.0000 | |||||||
Antecedent | Step One | Step Two | Final Model | ||||||
M1 (HIB) | M2 (BTA) | Y (HAV) | |||||||
b | SE | p | b | SE | p | b | SE | p | |
X (EMS-Disc-Rej) | 0.01 | 0.00 | 0.000 | 0.04 | 0.01 | 0.000 | 0.02 | 0.00 | 0.000 |
M1 (HIB) | — | — | — | 1.70 | 0.12 | 0.000 | 0.32 | 0.04 | 0.000 |
M2 (BTA) | — | — | — | — | — | — | 0.08 | 0.01 | 0.000 |
Gender | −0.65 | 0.11 | 0.000 | −0.13 | 0.42 | 0.759 | −0.30 | 0.14 | 0.032 |
Race | −0.43 | 0.11 | 0.000 | 0.72 | 0.42 | 0.085 | 0.23 | 0.14 | 0.103 |
Constant | 1.27 | 0.15 | 0.000 | 8.97 | 0.58 | 0.000 | 3.28 | 0.21 | 0.000 |
R2 | R2 = 0.07 | R2 = 0.21 | R2 = 0.23 | ||||||
F(3,1072) = 29.54, p = 0.000 | F(4,1071) = 70.30, p = 0.000 | F(5,1070) = 64.55, p = 0.000 |
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Rastegar, P.J.; Langhinrichsen-Rohling, J. Understanding College Students’ Healthcare Avoidance: From Early Maladaptive Schemas, through Healthcare Institutional Betrayal and Betrayal Trauma Appraisal of Worst Healthcare Experiences. Healthcare 2024, 12, 1126. https://doi.org/10.3390/healthcare12111126
Rastegar PJ, Langhinrichsen-Rohling J. Understanding College Students’ Healthcare Avoidance: From Early Maladaptive Schemas, through Healthcare Institutional Betrayal and Betrayal Trauma Appraisal of Worst Healthcare Experiences. Healthcare. 2024; 12(11):1126. https://doi.org/10.3390/healthcare12111126
Chicago/Turabian StyleRastegar, Pedram J., and Jennifer Langhinrichsen-Rohling. 2024. "Understanding College Students’ Healthcare Avoidance: From Early Maladaptive Schemas, through Healthcare Institutional Betrayal and Betrayal Trauma Appraisal of Worst Healthcare Experiences" Healthcare 12, no. 11: 1126. https://doi.org/10.3390/healthcare12111126