Development and preliminary psychometric evaluation of a patient-reported trauma-informed care measure: The novel "PP-TIC".

Abstract

Trauma-informed care is an important clinical approach given the high prevalence of trauma and adverse childhood experiences in the general population. However, there is currently no validated patient-reported measure assessing patients' perceptions of trauma-informed care delivery by physicians. We aimed to develop and conduct a preliminary psychometric evaluation of the Patient Perspectives on Trauma-Informed Care Scale (PP-TIC). We also sought to characterize patient perspectives on trauma-informed care to inform future refinement of the scale. We developed the PP-TIC based on literature review, the Substance Abuse and Mental Health Services Administration (SAMHSA) six trauma-informed care principles, and the Be Trauma I.N.F.O.R.M.E.D. We surveyed 90 (53% response rate) hospitalized adult patients using the PP-TIC, a 10-item Adverse Childhood Experiences (ACEs) questionnaire, and the Trust in Physician Scale (TPS). We conducted in-depth interviews with a diverse subset of participants (10%) and analyzed transcripts using thematic analysis. Across all 20 items, Cronbach's alpha was 0.90 and corrected item-total correlations ranged from 0.30 to 0.75. We removed three reverse-scored items; this resulted in the Cronbach's alpha increasing to 0.91 and the lowest corrected item-total correlation increased to 0.36. PP-TIC scores demonstrated strong convergent validity with the TPS (r = 0.64, p < 0.01), while also suggesting the PP-TIC captures distinct relational and experiential dimensions of care. PP-TIC scores were not associated with ACE scores (r = 0.004, p = 0.97). Qualitative analysis identified five major themes related to trauma-informed care, including (1) listening; (2) transparency; (3) recognizing the impact of prior health care experiences; (4) care coordination; and (5) attentiveness. The PP-TIC demonstrates promising preliminary evidence supporting reliability and validity as a patient-reported measure of trauma-informed care. Larger studies are needed to further evaluate dimensionality, response category functioning, and psychometric performance across healthcare settings and populations.