Development of the healthcare triggering questionnaire in adult sexual abuse survivors

Objective: One in 4 women and 1 in 10 men in the United States are survivors of sexual abuse (SA). For these survivors, healthcare experiences may trigger memories, thoughts, feelings or sensations related to this past abuse. Such triggering can be associated with negative responses to healthcare (e.g., anxiety, avoidance). However, to date, no healthcare triggering assessment tool exists. Therefore, the study goal was to describe the prevalence of healthcare triggering, to develop a brief Healthcare Triggering Questionnaire (HTQ), and to examine its initial validity. Method: An initial pool of 117 items was developed based on previous research. Two-parameter logistic item response theory models were used to develop the scales. SA survivors [male (n = 233), female (n = 222)] and a comparison group of non-SA individuals [male (n = 114), female (n = 106)] were recruited through Amazon Mechanical Turk and completed the study anonymously online. Results: Three 10-item scales were developed: (a) the HTQ-M for males; (b) the HTQ-F for females; and (c) the HTQ-U (unisex) for all respondents. The results supported the utility and initial validity of the gender-specific and unisex scales. Conclusions: The HTQ scales are a psychometrically sound approach to evaluating healthcare triggering experienced by adult sexual abuse survivors. The HTQ may be considered for use by researchers interested in studying healthcare triggering, healthcare retraumatization, and healthcare adherence. The HTQ may also be of use to clinicians interested in identifying trauma survivors who are more likely to experience triggering in healthcare settings.