Exploring Opportunities to Optimize Stress and Trauma-Focused Primary Care with Low-Income Midlife and Older Women

• Published in: Journal of health care for the poor and underserved 2022-11, Vol.33 (4), p.1721-1735
• Main Authors: Dickins, Kirsten A, Malley, Ann, Bartels, Stephen J, Baggett, Travis P, Looby, Sara E
• Format: Article
• Language: English
• Subjects: Content analysis; Fairness; Health behavior; Health care; Health disparities; Health promotion; Health services; Homeless people; Income; Interviews; Low income groups; Marginality; Medical screening; Middle age; Midlife; Morbidity; Older people; Older women; Post traumatic stress disorder; Preventive medicine; Primary care; Psychological trauma; Qualitative analysis; Qualitative research; Sociodemographics; Stress; Symptoms; Trauma; Vulnerability; Women
• ISSN: 1049-2089; 1548-6869; 1548-6869
• DOI: 10.1353/hpu.2022.0133

Trauma and trauma-related symptoms often remain hidden in the lives of low-income midlife and older women. In primary care encounters, midlife and older women are infrequently asked about trauma histories, and symptoms of trauma are commonly misinterpreted. As stress and trauma raise risk morbidity and mortality, under-recognition of trauma is a health equity issue. This secondary qualitative analysis explores stress and trauma as factors that affect primary/preventive care engagement in low-income midlife and older women. Semi-structured interviews were completed with 22 low-income midlife and older women from December 2020–January 2021. A deductive-inductive content analysis approach was guided by the Behavioral Model for Vulnerable Populations. Three categories were identified: (1) stress and competing demands; (2) history and impact of trauma; (3) integrated trauma-related behavioral health focus. Co-designing and culturally adapting stress and trauma screening and interventions may optimize stress and trauma-focused primary care while promoting health equity with socially marginalized women.