The elephant in the room: A concept analysis of communication and childhood adversity among adults

Kimberly A. Strauch, Jane M. Carrington, Marylyn M. McEwen

Research output: Contribution to journalArticlepeer-review


Background:Effective communication by those providing clinical care to adult patients is required to identify and address health disparities associated with childhood adversity. Many primary care NPs are unaware of these relationships, often lacking the communication skills and training needed to elicit this clinically relevant information.Objectives:A systematic review in the form of a concept analysis was undertaken to increase our understanding about patient-to-provider communication of childhood adversity in the context of the primary care setting. Two key concepts, communication and childhood adversity, were examined using the procedures outlined by Walker and Avant.Data sources:A focused literature search using the search engines CINAHL, PubMed, and PsycINFO with inclusion criteria of "adverse childhood experiences (ACE)," "childhood adversity," and "communication" provided boundaries for this analysis. No results were found using the defined conceptual terms. Therefore, concept synthesis was driven by the exploration of seminal and current literature from several disciplines.Conclusions:Findings revealed that effective communication about childhood adversity is an integral and understated element when addressing ACE-related health disparities among adults. Further synthesis is warranted to explore how primary care NPs apply the concepts of effective communication when providing clinical care to adult patients with histories of childhood adversity.Implications for practice:This concept analysis will serve as a catalyst for informing future research and theory development focused on enhancing ACE-specific communication between NPs and adult patients, which will lead to more personalized approaches to developing novel, ACE-specific interventions, a reduction in health disparities, and improved health outcomes.

Original languageEnglish (US)
Pages (from-to)1131-1138
Number of pages8
JournalJournal of the American Association of Nurse Practitioners
Issue number12
StatePublished - Dec 7 2021
Externally publishedYes


  • Adverse childhood experiences
  • childhood adversity
  • communication
  • concept analysis
  • nurse practitioners
  • primary care

ASJC Scopus subject areas

  • Nursing(all)


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