What contributes to abuse in health care? A grounded theory of female patients' stories

Background: In Sweden, 20% of female patients have reported lifetime experiences of abuse in any health care setting. Corresponding prevalence among male patients is estimated to be 8%. Many patients report that they currently suffer from these experiences. Few empirical studies have been conducted to understand what contributes to the occurrence of abuse in health care.

Objectives: To understand what factors contribute to female patients' experiences of abuse in health care.

Design: Constructivist grounded theory approach.

Settings: Women's clinic at a county hospital in the south of Sweden.

Participants: Twelve female patients who all had reported experiences of abuse in health care in an earlier questionnaire study.

Methods: In-depth interviews.

Results: The analysis resulted in the core category, the patient loses power struggles, building on four categories: the patient's vulnerability, the patient's competence, staff's use of domination techniques, and structural limitations. Participants described how their sensitivity and dependency could make them vulnerable to staff's domination techniques. The participants' claim for power and the protection of their autonomy, through their competence as patients, could catalyze power struggles.

Conclusions: Central to the participants' stories was that their experiences of abuse in health care were preceded by lost power struggles, mainly through staff's use of domination techniques. For staff it could be important to become aware of the existence and consequences of such domination techniques. The results indicate a need for a clinical climate in which patients are allowed to use their competence.