13 Impact of child maltreatment and other adverse childhood experiences (aces) on trust in health information and support services – the consequences for public health and health care interventions across the life course

<h3>Background</h3> A major factor associated with individuals’ adoption of public health advice, or engagement with health, social and other services, is level of trust in information sources and service providers. Individuals exposed to child maltreatment and other ACEs often have poorer health outcomes across the life course and consequently, may benefit disproportionately from accessing and accepting health advice and support. However, little information is available on how ACEs impact trust in health advice and support services. Such information is critical when considering how best to reach such vulnerable populations and mitigate inequities associated with ACEs. <h3>Objective</h3> Using a national survey sample (Wales) we examine relationships between exposure to ACEs and levels of trust in different sources of information and support services across the life course. <h3>Methods</h3> Data were collected using a randomised, stratified face to face survey delivered in peoples’ homes across Wales (n=2007). ACEs measured included: verbal, physical and sexual abuse; parental separation/divorce; witnessing domestic violence; and living within a household where mental illness, alcohol or drug misuse was present, or where a household member was incarcerated. <h3>Results</h3> Individuals with ≥4 ACEs (vs. 0 ACEs) were between two and three times more likely to have low trust in GPs, hospital doctors, nurses and pharmacists. For health services in general those with ≥4 ACEs were 3.23 time more likely to report low trust in such services. Moreover, increasing ACE counts were also significantly associated with lower trust in social services, police, charities and government. Thus, adjusted prevalence of low trust in police increased from 17.0% (0 ACEs) to 43.8% (≥4 ACEs). <h3>Conclusions</h3> Public health and care systems rely on trust as a mechanism to ensure advice is followed and for fidelity to treatment. Those with ACEs may require disproportionate amounts of public sector or charitable support and may benefit more from services but results here suggest they are less likely to trust such services and the advice they provide. Trauma informed approaches are required that understand, for those with ACEs, who are the most credible communicators and how best to develop trust in essential support services.