Dissertation
Health care and re-traumatization: an examination of support as uncertainty management for survivors of sexual assault during pelvic exams
University of Iowa
Doctor of Philosophy (PhD), University of Iowa
Spring 2022
DOI: 10.17077/etd.006425
Abstract
Pelvic exams are notoriously anxiety-producing for patients, but the uncertainty can be heightened for survivors of sexual assault who often experience symptoms of re-traumatization during pelvic exams. When facing this heightened anxiety and re-traumatization, it can complicate attempts at uncertainty management; thus, more nuanced management strategies are warranted. Health care providers are well-positioned to assist survivors by providing support to collaboratively manage survivors’ uncertainty. Prior research on uncertainty management has predominantly focused on information seeking or avoidance and thus overlooked more nuanced management processes. Research has also examined uncertainty in health through the lens of a chronic illness, which neglects the uncertainties that arise in day-to-day clinical encounters. Accordingly, this project addresses gaps in literature by exploring survivors’ uncertainties about the pelvic exam and examining how support from a health care provider facilitates survivors’ uncertainty management. I completed a two-part study while integrating uncertainty management theory (UMT; Brashers, 2001) with theorizing on support gaps (Xu & Burleson, 2001) to investigate my hypotheses and research questions.
Study 1 employed an online questionnaire with open-ended questions to explore the questions and concerns endured by survivors of sexual assault during pelvic exams. A thematic analysis of the raw data revealed four main themes that encompassed survivors’ uncertainty. Survivors described their uncertainty about the pelvic exam, the health care provider conducting the exam, re-traumatization, and the utility of pelvic exams. Study 2 utilized an online survey with closed-ended questions about survivors’ uncertainty, support gaps, and intention to attend future pelvic exams. The results showed that survivors experienced large gaps in informational, emotional, and distraction support. Fewer support gaps were related to decreased uncertainty, such that survivors encountered reduced pelvic exam uncertainty when they received support that matched their desires. Deficits in support were particularly detrimental to survivors’ uncertainty management, whereas surpluses in emotional and distraction support were beneficial. Support gaps moderated the relationship between uncertainty and intention to attend future pelvic exams.
The findings contribute to UMT by highlighting collaborative uncertainty management as a unique information behavior (Hogan & Brashers, 2009). This study also advances theorizing on UMT by exhibiting the relationship between uncertainty and support gaps. Uncertainty management was more successful when health care providers offered the type and amount of support desired by a survivor. This project also has practical implications for how health care providers and clinics can enact more sensitive care for their patients who have endured sexual assaults. Future directions for research are suggested so that additional investigations can continue to explore the health care needs of survivors.
Details
- Title: Subtitle
- Health care and re-traumatization: an examination of support as uncertainty management for survivors of sexual assault during pelvic exams
- Creators
- Lauren Elizabeth Peters
- Contributors
- Sylvia L Mikucki-Enyart (Advisor)Rachel M McLaren (Committee Member)Natalie Fixmer-Oraiz (Committee Member)Amy C Butler (Committee Member)
- Resource Type
- Dissertation
- Degree Awarded
- Doctor of Philosophy (PhD), University of Iowa
- Degree in
- Communication Studies
- Date degree season
- Spring 2022
- DOI
- 10.17077/etd.006425
- Publisher
- University of Iowa
- Number of pages
- viii, 196 pages
- Copyright
- Copyright 2022 Lauren Elizabeth Peters
- Language
- English
- Description illustrations
- Tables, charts, graphs
- Description bibliographic
- Includes bibliographical references (pages 141-161).
- Public Abstract (ETD)
Pelvic exams are vital to maintaining reproductive health and detecting cervical cancer; however, the invasiveness of these exams can be triggering and anxiety-inducing for survivors of sexual assault. Although survivors are likely to have many questions during the pelvic exam, they may experience re-traumatization or increased distress that complicates how they cope with their concerns. Accordingly, help from health care providers is important to support survivors with managing their questions and concerns. A two-part study was conducted to determine what questions survivors experience during the pelvic exam, along with how support from health care providers helps them manage these concerns.
The first study utilized an online survey that asked survivors to list the questions they experienced during a memorable pelvic exam following a sexual assault. Next, data revealed four major themes of uncertainty: uncertainty about the pelvic exam, the health care provider conducting the exam, re-traumatization, and the utility of pelvic exams. The second study was an online questionnaire that asked about survivors’ concerns during pelvic exams and support from a health care provider. Survivors desired significantly more support than they received from health care providers during pelvic exams. Those who received more of the support they desired from a provider had fewer concerns about pelvic exams. Survivors were more likely to attend future pelvic exams when they had fewer questions or concerns and received the support they desired from a provider. These findings have important implications for health care providers treating patients who have been sexually assaulted.
- Academic Unit
- Communication Studies
- Record Identifier
- 9984270954402771
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