Can patients be ‘attached’ to healthcare providers? An observational study to measure attachment phenomena in patient–provider relationships

• Published in: BMJ open Vol. 6; no. 5; p. e011068
• Main Authors: Maunder, Robert G, Hunter, Jonathan J
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 13.05.2016; BMJ Publishing Group
• Subjects: Adult; Adults; Anxiety; Babies; Behavior; Canada; Communication; Factor Analysis, Statistical; Female; Health Personnel; Humans; Hypotheses; Male; Middle Aged; Object Attachment; Patient Satisfaction; Patient-Centred Medicine; Perceptions; Professional-Patient Relations; attachment; provider-patient relationship; therapeutic alliance
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2016-011068

ObjectivesTo develop and assess the validity of measures of patients' attachment-related perceptions of experiences with healthcare providers (HCPs).SettingOnline survey.Participants181 people provided consent and 119 completed the survey (66%). Most participants were women (80%).Primary and secondary outcome measuresQuestions were developed to assess possible attachment functions served by an HCP and patients' attachment-related attitudes towards an HCP. Scales were constructed based on exploratory factor analysis. Measures of adult attachment, therapeutic alliance, perceived HCP characteristics and health utilisation were used to validate scales.ResultsPossible safe haven and secure base functions served by HCPs were strongly endorsed. A model with good fit (root mean square error of approximation=0.056) yielded 3 factors: ‘HCP experienced as supportive and safe’ (SUPPORT, α=0.94), ‘HCP experienced as aversive’ (AVERSE, α=0.86) and ‘more and closer contact wanted with HCP’ (WANT, α=0.85). SUPPORT was correlated with positive HCP characteristics and not with attachment insecurity. AVERSE was inversely correlated with positive HCP attributes and correlated with attachment insecurity. WANT was unrelated to positive HCP attributes, but correlated with attachment insecurity. Frequency of HCP contact was related to WANT (Kruskal-Wallis=21.9, p<0.001) and SUPPORT (Kruskal-Wallis=13.2, p=0.02), but not to AVERSE (Kruskal-Wallis=1.7, p=0.89).ConclusionsPatients attribute attachment functions of secure base and safe haven to HCPs. SUPPORT is related to positive appraisal of HCP characteristics; AVERSE is associated with discomfort in the HCP relationship that is related with perceived HCP characteristics and patients' insecure attachment; WANT is associated with unmet needs for connection with an HCP related to insecure attachment, but not to perceived HCP characteristics. These scales may be useful in studying the application of attachment theory to the HCP–patient relationship.