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Table 7 Examples of trauma-specific issues identified

From: Adaptation of the barriers to help-seeking for trauma (BHS-TR) scale: a cross-cultural cognitive interview study with female intimate partner violence survivors in Iceland

Issues Description Meaning unit Revisions
Post-trauma context Difficulties deciding how to answer due to the complex nature of the trauma and a multistep help-seeking journey was a common problem (14 of 17 participants). “Some of these barriers are also really descriptive when you are trying to leave an abusive relationship, so my mind always went there. When I think about seeking help for my PTSD or you know everything after … there can be different barriers, so I would answer differently.” The scale was designed to measure barriers to seeking help for trauma recovery, which was included in the scale instructions. However, this issue made it apparent that it needed to be more clearly defined. It furthermore supported the change of adding the specific time frame of asking about the last 12 months.
Post-trauma context Some (8 of 17) participants felt that the following item “Professionals from my own cultural or ethnic group were not available” should rather be about the gender of professionals than about their culture or ethnicity. Hence, this problem was also classified as a cultural issue, but the primary meaning was related to the post-IPV context (also relevant to other types of interpersonal trauma). “I do not relate and actually it doesn’t matter to me what their ethnicity is or culture, cultural … uhm … I don’t even know what my cultural group is, you know we don’t talk like this, anyway … what was really a barrier for me was being forced to have a health professional of the same gender as my perpetrator.” The adapted version of the item became “Suitable professionals were not available,” which could include the cultural and ethnic background as well as gender.
Sensitive to wording The wording “your decisions not to seek help” in the scale instructions was thought to be offensive by many (10 of 17) participants. “It is not this simple, I did not sit down and made this thought out decision to not get the help that I needed.” The instructions were rephrased using the word “reasons” instead of “decisions.”
Victim- blaming wording Several (7 of 17) participants thought some of the items had victim-blaming wording. “My problems, my situation, my my my … you are taking all of the responsibility from the perpetrator and putting it all on the survivor like it is my fault.” Revisions involved changing the word “my” to “the” in the problematic sentences that reflect negative aspects (such as problem and situation) while maintaining “my” in those sentences that reflect respondent autonomy (such as reasons, feelings, or actions).
Sensitive to word order Few (5 of 17) participants were sensitive to the order of words in the following item “I was worried that if others discover my health problems or my situation, I could lose housing, security, or my children.” “I would never put housing and my security before my children … so I would not want to answer this.” The order was changed to “my children, security, or housing.”