literary analysis essay on a worn path

• Ask LitCharts AI
• Discussion Question Generator
• Essay Prompt Generator
• Quiz Question Generator

• Literature Guides
• Poetry Guides
• Shakespeare Translations
• Literary Terms

A Worn Path

Eudora welty.

Ask LitCharts AI: The answer to your questions

• Quizzes, saving guides, requests, plus so much more.

A Summary and Analysis of Eudora Welty’s ‘A Worn Path’

By Dr Oliver Tearle (Loughborough University)

‘A Worn Path’ is a short story by the American writer Eudora Welty (1909-2001), first published in the Southern Review in 1937 and reprinted in Welty’s 1941 collection A Curtain of Green and Other Stories . ‘A Worn Path’ details the journey an elderly black woman makes into town one Christmas time, in order to get some medicine for her grandson.

Before we offer an analysis of this deeply symbolic story, it might be worth recapping the plot.

‘A Worn Path’: plot summary

One cold December morning, an elderly black woman named Phoenix Jackson walks into town to get some medicine for her grandson. She is very old and the journey is fraught with obstacles. At one point, a black dog appears and, although she tries to shoo it away, the sudden appearance of the dog forces her to fall into a ditch.

A white hunter appears and he helps her up, before going after the dog with his gun and his own dog. Phoenix hears shots fired, and steals a nickel from the man, which had fallen onto the ground without him realising. She pockets it before he comes back. He tells her she’s too old and frail to be walking so far and that she should go home, but she insists she must go into town.

When she arrives in town, all the Christmas decorations are up and a woman carrying presents passes Phoenix on the path. Phoenix asks the woman to lace up her shoe for her, and the woman does so. Phoenix goes to the hospital, where the attendant initially mistakes Phoenix for a charity case. Phoenix doesn’t respond when asked who she is, until mention of her grandson (by a nurse who comes in and recognises her) suddenly jogs her memory.

It turns out that she regularly makes this journey into town to get some medicine for her grandson, who swallowed some lye several years ago and remains bedridden as a result. Phoenix says it is just her and her grandson and she has to take care of him.

Once she has been given the medicine, she goes to leave, but the attendant gives her a nickel as it’s Christmas time. She places it next to the nickel she took from the hunter she met on the path, and announces that she will go and buy a paper windmill for her grandson, as he will not believe such a thing exists.

‘A Worn Path’: analysis

‘A Worn Path’ is a deeply symbolic story, in which the ‘worn path’ is both literal and metaphorical. Phoenix – whose very name summons the mythical bird that rose from the ashes of its own funeral pyre – is ageing and frail, and the worn path of life has taken its toll on her, but she nevertheless undertakes this journey, which is symbolic in other ways as well.

Usually, the hero who undertakes such a journey is seeking to find someone: Odysseus, in Homer’s Odyssey , wishes to seek Tiresias the seer, who can prophesy how the hero’s quest will unfold; Orpheus goes into Hades to retrieve his dead wife, Eurydice; and so on.

Phoenix is similarly on a quest, and, perhaps surprisingly, the quest she is undertaking may not be the search for a medicine for her grandson but for her grandson himself.

How can that be, when he is bedridden at home? One of the questions which the ending of ‘A Worn Path’ raises is whether Phoenix’s grandson is, in fact, already dead.

Although she denies this, there are some suggestions that he has already passed away from his illness: the repeated references to how the grandson’s throat ‘never heals’ and how ‘obstinate’ his condition is can be read as deliberately ambiguous, hinting at either a chronic and constant affliction or Phoenix’s refusal to accept that her grandson died of his ailments some time ago.

It also seems strange that Phoenix should forget why she had undertaken such a difficult journey, if her grandson’s health is truly dependent on receiving such life-preserving medicine.

Instead, Welty hints at an alternative interpretation, whereby ‘A Worn Path’ is the story of a woman’s psychological inability to give up her last living relative, and accept that he is, in fact, dead and she is now all alone. (As she has the responsibility of fetching his medicine, the boy’s own parents, we deduce, are either absent or dead.)

She performs this ritual on a regular basis, and the people at the hospital humour her out of charity, seeing how important this journey is for Phoenix, and perhaps even suspecting that it is the only thing that keeps her going, providing a reason to go on living.

The journey may be fraught with physical hardship, but the alternative is to give up altogether. The ‘worn path’, then, might be itself a metaphor for life: living is hard and we will find our fair share of obstacles and dangers lying in wait for us, but the alternative is not to walk the path at all.

Given how invested with symbolism ‘A Worn Path’ is, the final words – which describe another kind of ‘descent’, as Phoenix walks down the stairs, ‘going down’ – complicate and even problematise the more optimistic meaning lurking within her name.

She may be likened to a phoenix – a bird which rises from the ashes of its own funeral pyre – and this may imply that she will keep on going, no matter what. But has something changed during this particular journey and her encounter in the hospital?

Why does Welty focus on this journey: is it because it is the last time she will ever walk that worn path? Note how she not only forgets what she is doing there, but grows vacant, not even acknowledging the nurse’s questions. Has she finally realised he is no longer alive, and is she finally letting go? And if so, do those final words imply that she is ready to ‘go down’ herself, and descend from this life into the next?

Discover more from Interesting Literature

Subscribe to get the latest posts sent to your email.

Type your email…

Subscribe now to keep reading and get access to the full archive.

Continue reading

English Studies

This website is dedicated to English Literature, Literary Criticism, Literary Theory, English Language and its teaching and learning.

“A Worn Path” by Eudora Welty: Analysis

“A Worn Path” Eudora Welty, first published in The Atlantic Monthly in February 1941, gained popularity for its powerful portrayal of an elderly African American woman’s journey.

Introduction: “A Worn Path” by Eudora Welty

Table of Contents

“A Worn Path” Eudora Welty, first published in The Atlantic Monthly in February 1941, gained popularity for its powerful portrayal of an elderly African American woman’s journey through the rural South to a town where she intends to obtain medicine for her grandson. Over the years, the story has continued to resonate with readers and has been widely anthologized, becoming one of Welty’s most famous and enduring works. Its themes of perseverance, resilience, and the enduring strength of the human spirit have made it a timeless classic of American literature.

Main Events in “A Worn Path” by Eudora Welty

• An Elderly Woman’s Mission: Phoenix Jackson, an elderly Black woman, sets out on a long, familiar journey through the December countryside. Her strength and determination are evident despite her age and the challenges she will face.
• Obstacles Along the Path: Phoenix encounters various obstacles symbolizing life’s hardships: a thorny bush that snags her dress, a creek crossing on a log, and a barbed-wire fence that she must crawl under. She perseveres, speaking aloud to keep her spirits up.
• Facing the Past and Present: In a field, Phoenix comes across a scarecrow that she momentarily mistakes for a ghost. This encounter could represent the lingering shadows of the past and its hardships.
• An Unpleasant Encounter: A young white hunter disrupts Phoenix’s journey, condescendingly laughing at her and belittling her mission. He unknowingly drops a nickel, which Phoenix cleverly retrieves, hinting at her quiet resilience in the face of prejudice.
• Arrival in Town: Phoenix finally reaches Natchez, the bustling town decorated for Christmas. The stark contrast between the rural, natural world and the city environment can be seen as symbolic. She humbly asks a kind woman to tie her shoe, restoring some dignity for her entrance to the town.
• Seeking Help at the Clinic: Phoenix enters a medical clinic where she seeks the crucial medicine for her grandson. Initially dismissed by the attendant, she is recognized by a nurse who knows the reason for her recurring trips.
• A Moment of Forgetfulness: Phoenix briefly forgets her grandson and the medicine’s purpose. This temporary lapse of memory highlights her age and the difficult burden her journey represents.
• Medicine and Hope: Reminded by the nurse, Phoenix shares the ongoing struggle of her grandson, who suffers from the effects of accidentally swallowing lye. She receives the medicine and money from the attendant. Her purchase of a windmill with the money represents an enduring symbol of hope and love amidst hardship.
• Homeward Bound: Phoenix begins her long journey back, carrying both the physical medicine and the windmill – a small but joyous gift for the one she loves.

Literary Devices in “A Worn Path” by Eudora Welty

• Allegory : The entire story functions as an allegory for the resilience of the human spirit, particularly in marginalized communities like the rural Black South during the Jim Crow era. Phoenix’s repeated journey represents overcoming ongoing struggles and maintaining hope amid hardship.
• Alliteration : The use of repeated consonant sounds creates a musical effect: “Seem like there is chains about my feet…”
• Dialect : Welty uses a distinct dialect to represent Phoenix’s speech, grounding her character in a specific time and region: “…I the oldest people I ever know.”
• Foreshadowing : The scarecrow Phoenix mistakes for a ghost hints at a potential danger or death that she bravely faces.
• Imagery: Vivid sensory details bring the setting and Phoenix’s experience to life: “The sun made the pine needles almost too bright to look at…”
• Juxtaposition: The natural world’s beauty and harshness are contrasted with the bustle and potential indifference of the town, highlighting Phoenix’s journey across two worlds.
• Metaphor: Comparisons without using “like” or “as” enhance the story’s meaning: “Her eyes were blue with age.”
• Motif: The recurring image of the path symbolizes Phoenix’s continued determination and the cyclical nature of her journey and struggles.
• Personification: Giving non-human things human qualities, making the world seem alive and interactive for Phoenix: “Keep the big wild hogs out of my path. Don’t let none of those come running my direction.”
• Point of View: The third-person limited point of view takes us directly into Phoenix’s mind, revealing her internal thoughts and perceptions of the world.
• Repetition: Phoenix repeats phrases throughout, mirroring the cyclical nature of her journey and her determination: “…I got a long way.”
• Simile: Comparisons using “like” or “as” create vivid descriptions: “…a little tree stood in the middle of her forehead.”
• Symbolism: Various objects gain deeper meaning:
• The path: The journey of life, and specifically Phoenix’s ongoing struggles
• The windmill: Hope and love that endures
• The scarecrow: Potential dangers, remnants of the past
• Theme: Central ideas explored in the work:
• Perseverance: Phoenix’s journey embodies an enduring spirit despite hardship.
• Love: Her selfless love for her grandson motivates her.
• Overcoming Prejudice: Subtle hints at the racial prejudice Phoenix faces.
• Tone: The story’s overall emotional quality is one of both hardship and quiet determination, reflecting Phoenix’s perspective.

Characterization in “A Worn Path” by Eudora Welty

Major character.

• Physical Description: An elderly Black woman, small and frail, with age evident in her blue eyes and wrinkled skin. Her clothing is worn but neat.
• Personality: Determined, resilient, resourceful, and deeply loving. She talks to herself and to nature to maintain her strength. Her brief memory lapse reveals her age and the burden of her regular journey.
• Symbolic Role: Phoenix represents the enduring strength of marginalized communities, particularly Black women in the rural South, and the unwavering power of love to overcome hardship.

Minor Characters

• Physical Description: Young, white male carrying a gun and a dog.
• Personality: Condescending, dismissive, casually racist. His interaction with Phoenix highlights prejudice in the era.
• Role: Represents an obstacle and underscores the social realities Phoenix faces.
• Role: Initially disregards Phoenix, focused on procedure.
• Development: A subtle shift occurs after the nurse’s intervention, leading the attendant to offer a condescending act of “charity”.
• Role: Recognizes Phoenix and understands her reason for coming. Shows a degree of kindness and familiarity.
• Motivation: He is never seen, but his suffering from the effects of lye is the driving force behind Phoenix’s journey, representing the selfless love motivating her.

Major Themes in “A Worn Path” by Eudora Welty

Writing Style in “A Worn Path” by Eudora Welty

Dialect and Voice:

• Welty uses a distinct Southern dialect for Phoenix’s dialogue and internal thoughts. This adds authenticity, reflects the specific region and era, and brings the reader into Phoenix’s perspective.
• ·  Example: “Seem like there is chains about my feet, time I get this far…”

Imagery and Sensory Details:

• Vivid descriptions engage the reader’s senses.
• Emphasis on natural imagery: the path, trees, animals, creating a rich atmosphere.
• Example: “The sun made the pine needles almost too bright to look at…”
• Objects and events carry deeper significance beyond their literal meaning.
• The path: Represents life’s journey and ongoing struggles.
• The scarecrow: Potential dangers or the looming presence of death.
• The windmill: A symbol of hope and love for her grandson.

Point of View:

• Third-person limited perspective puts us directly in Phoenix’s mind.
• This allows insight into her thoughts, perceptions, and motivations, building empathy.

Stream-of-Consciousness Moments:

• Phoenix’s internal monologues reveal her determination, struggles, and relationship with nature.
• Example: “Out of my way, all you foxes, owls, beetles, jack rabbits, coons, and wild animals!…”

Juxtaposition:

• Contrasting elements are placed side-by-side to highlight differences and create depth.
• The natural world vs. the town.
• Phoenix’s inner strength vs. her physical frailty.

Literary Theories and Interpretation of “A Worn Path” by Eudora Welty

Questions and Thesis Statements about “A Worn Path” by Eudora Welty

1. Topic: Symbolism and Meaning

• Question: How does Eudora Welty use symbolism to create deeper meaning in “A Worn Path”? Choose two key symbols and analyze their significance.
• Thesis Statement: In “A Worn Path,” Welty employs the symbols of the path and the scarecrow to represent the ongoing challenges of life and Phoenix Jackson’s relentless determination to overcome them.

2. Topic: Perseverance and the Human Spirit

• Question: In what ways is Phoenix Jackson a symbol of perseverance? How does her journey reflect broader themes of the enduring human spirit?
• Thesis Statement: Phoenix Jackson embodies perseverance through her unwavering determination in the face of physical frailty, social obstacles, and a harsh environment, signifying the broader human capacity to overcome adversity.

3. Topic: Love and Sacrifice

• Question: How does the power of love motivate Phoenix Jackson’s repeated journey? Analyze the connection between her selfless actions and her grandson’s wellbeing.
• Thesis Statement: Phoenix’s unwavering love for her grandson motivates her arduous journey, demonstrating the immense sacrifices individuals make for those they love and the enduring power of love as a force for resilience.

4. Topic: Social Commentary and Race

• Question: How does “A Worn Path” subtly address issues of race and social inequality in the Jim Crow South?
• Thesis Statement: While not explicitly focused on racial conflict, “A Worn Path” offers nuanced commentary on the social dynamics of the Jim Crow era, highlighting Phoenix’s quiet resilience in the face of subtle discrimination and systemic barriers.

Short Question-Answer about “A Worn Path” by Eudora Welty

Literary Works Similar to “A Worn Path” by Eudora Welty

• Focus on an elderly woman reflecting on her life and facing mortality.
• Stream-of-consciousness style for internal thoughts.
• Exploration of family relationships, tradition, and heritage within African American families in the rural South.
• Themes of generational differences and the preservation of cultural identity.
• Explores hardship, suffering, and the search for meaning in marginalized communities.
• Themes of family, redemption, and the power of art in coping with struggle.
• Southern Gothic atmosphere with themes of isolation, the past’s influence, and a solitary protagonist.
• Explores the complexities of the human psyche and unexpected depths.
• Southern settings with explorations of morality, faith, and often-grotesque characters.
• Themes of grace, redemption, and unexpected twists.

Key Similarities (unchanged):

• Focus on marginalized characters: Often center on elderly protagonists, women, and/or African American characters.
• Exploration of Southern life and culture: Examine unique challenges and resilience within the American South.
• Themes of resilience, struggle, and the enduring human spirit: Characters face hardships with varying degrees of success.
• Rich language and complex symbolism: Employ literary devices with depth and symbolism

Suggested Readings: “A Worn Path” by Eudora Welty

• Bloom, Harold, ed. Eudora Welty (Bloom’s Modern Critical Views) . Chelsea House Publications, 2007.
• Gretlund, Jan Nordby. Eudora Welty’s Aesthetics of Place . University of Delaware Press, 1994.
• Vande Kieft, Ruth M. Eudora Welty . Twayne Publishers, 1987.
• Fordham, Michael. “Phoenix of the Fable: Narrative and Meaning in Eudora Welty’s ‘A Worn Path.'” Studies in Short Fiction , vol. 46, no. 4, 2009, pp. 563-572.
• Gillman, Susan. “The Habit of Being: Letters, Art, and the Performance of Self in Eudora Welty.” Critical Inquiry , vol. 31, no. 2, 2005, pp. 369-398.
• Weston, Ruth D. “The Way It Is With Some People’: Voice in Eudora Welty’s Short Fiction.” Modern Fiction Studies , vol. 13, no. 3, 1967, pp. 382-387.
• Contains scholarly articles, bibliographies, and resources for studying Welty’s work.
• Offers an overview of the story with historical and cultural context.

Related posts:

• “The Use of Force” by William Carlos Williams
• “Battle Royal” by Ralph Ellison
• “An Occurrence at Owl Creek Bridge” by Ambrose Bierce: Analysis
• “Civil Peace” by Chinua Achebe: Analysis

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

Save my name, email, and website in this browser for the next time I comment.

Jotted Lines

A Collection Of Essays

A Worn Path: Analysis

Eudora Welty’s “A Worn Path,” written in 1940, is one of the author’s most frequently anthologized stories, but this by no means indicates that it is her easiest. There is a depth of ambiguity in it. Twentieth-century critics have chosen, for the most part, to examine the role race plays in the story and through that to either condemn Welty or exalt her for her views. But race is certainly not the story’s only concern. Questions of age, service, dedication, and myth also inform the story. 

However, it is with race that any discussion of Welly’s story must begin. Welty comes from Mississippi, in many ways the most notoriously troubled of Southern states. Born there in 1909 (to Northern parents), she grew up and has spent most of her life in Jackson. She grew up in an era where the Civil War and Reconstruction were still remembered by many of her neighbors, and she herself has lived through the civil rights struggles of the 1950s and 1960s and the Southern renaissance of the 1980s and 1990s. However, politics very rarely enters her work directly. Her stories deal with race relations on a personal level. 

Welty has discussed the genesis of “A Worn Path” in numerous interviews. The inspiration for Phoenix Jackson was an ancient black woman whom Welty saw walking across the countryside as Welty was sitting under a tree near the Natchez Trace with a painter friend.”I watched her cross that landscape in the half-distance,” she explains,”and when I got home I wrote that story that she had made me think of.” In another interview, she added that “I knew she was going somewhere. I knew she was bent on an errand, even at that distance. It was not anything casual. It was a purposeful, measured journey she was making—you wouldn’t go on an errand like that—unless it were for someone else, you know. Unless it were an emergency.” 

“A Worn Path” traces the journey of an ancient black woman who walks to Natchez, Mississippi, in order to obtain medicine for her grandson, who permanently injured himself by swallowing lye. On this, most of her critics agree, but that is as far as they go. One group holds that Welly’s portrayal of the black race through her main character, Phoenix Jackson, is eminently sympathetic; another feels that Welty shares with many other Southern writers a tendency to portray blacks as long-suffering and enduring, and in doing so robs them of their true complexity as human beings. 

Crucial to any assessment of this question is whether Phoenix Jackson is intended to stand as a representative of her race. Certainly, she plays into one stereotypical Southern image of blacks: the ancient, plodding, superstitious grandmother who talks to herself. Welty seems to undercut this image by introducing the hunter, who treats Jackson as precisely that kind of a stereotype.”I know you old colored people!” he tells her. “Wouldn’t miss going to town to see Santa Claus!” He seems like a buffoon here, but when he drops his nickel and she picks it up, critics see the action as either indicative of another pejorative stereotype of blacks (craftiness and dishonesty) or as illustrative of her superiority over him. Similarly, critics disagree on the significance of the white woman in Natchez tying Jackson’s shoe. Is this an indication, as one critic holds, of “courtesy warranted by virtue of her age and her ‘fealty’ to the white race,” or is it a comical representation of black helplessness? 

The position that Welty’s characterization of Jackson relies heavily on stereotypes is quite convincing. There is a long tradition of white Southern writers exalting the primitiveness of blacks: a move that, while not racist in intent (their primitiveness is used to teach more “sophisticated” whites about the virtues of simplicity), is somewhat demeaning in effect. If Jackson is meant to represent blacks as a whole, what are we to make of her “naivete and helplessness”? If her great age is in one respect an asset, does it not also suggest that blacks are changeless and eternal? The final words in William Faulkner’s The Sound and the Fury, “They endure,” is his summary assessment of the state of blacks in the South. Certainly, he has respect for their “endurance,” but is it not also patronizing to confer only this compliment upon an entire race of people? Welty’s critics still wrestle over whether she grants blacks sufficient human diversity, or whether, like her fellow Mississippian Faulkner, she treats them too much as simple symbols of endurance. 

Welty herself, in 1965, anticipated this conflict, and argued that it was off the mark. In her essay “Must the Novelist Crusade?” she shifts the question, saying that the relationship between the races cannot be separated from other relationships between people.”There are relationships of blood, of the passions and affections, of thought and spirit and deed. This is the relationship between the races. How can one kind of relationship be set apart from the others? Like a great root system of an old and long-established growing plant, they are all tangled up together; to separate them you would have to cleave the plant itself from top to bottom.” The very nature of her metaphor of the “long-established plant,” though, seems to many critics to subtly defend a slow pace of change in the South: this situation is very old, she seems to be saying, and we cannot rush things. 

The other primary approach to this story has been to examine its mythological underpinnings. Phoenix Jackson’s name is a reference to the mythological “phoenix”—a mythical bird that lives in the desert for 500-600 years and then sets itself on fire, only to rise again from its own ashes, and is a popular symbol for immortality. Certainly, age plays a significant part in the story. If we accept that the story is set in Welty’s present, i.e. at the time when she wrote the story, then the “present” is 1940. Jackson tells the scarecrow: “My senses is gone. I too old. I the oldest people I ever know.” When the hunter asks her how old she is, she replies,”There is no telling, mister.” However, if what she tells the nurse is true—that she was too old to go to school when Lee surrendered in 1865—then she must be nearly a hundred years old. Yet, like the phoenix, she rises to makes periodic trips to Natchez to get medicine for her grandson. 

The season in which the story takes place— Christmas time—reinforces the theme of rebirth. If we see the story as a Christian allegory, then the marble cake that Jackson dreams of suggests the Communion wafers and her crossing of the cornfield suggests the parting of the Red Sea. Also, the soothing medicine which she gives to her permanently sick grandson can be seen as God’s grace, and Jackson herself as a Christ figure. In addition, the difficulties which Jackson endures on her way to Natchez can either represent the temptations of Christ in the desert or the stations of the cross. 

A number of critics have questioned whether or not Jackson’s grandson is even alive. The story is especially affecting if we know that he is already dead, Roland Bartel proposes, and Jackson’s apparent bout of forgetfulness and senility in the doctor’s office could be her nagging realization that her grandson is, in fact, dead. Welty responded personally to this question in a 1974 essay, acknowledging the possibility that Jackson’s grandson is no longer alive, but insisting that she “must assume that the boy is alive” and admonishing readers that”it is the journey—that is the story.” Given that, we must return to the story’s mythological resonances. In addition to the aforementioned Christian parallels, the story also suggests Dante, the Italian author of the epic Divine Comedy. The dog, the hunter, and even the descent down the stairs at the end of the story parallel incidents in Dante’s Inferno. 

“A Worn Path” is finally a simple story, though. Welly’s short tale of an old woman’s journey to get medicine for her grandson is valuable simply as that, and the starkness of its simplicity is too often undervalued. That very simplicity gives it the ability to support so many political and mythological interpretations. Welty even suggests another, far more personal analogy for Phoenix’s journey: her own journey towards the creation of “great fiction.” “Like Phoenix, you work all your life to find your way, through all the obstructions and the false appearances and the upsets you may have brought on yourself, to reach a meaning—And finally too, like Phoenix, you have to assume that what your are working in aid of is life, not death.” 

Source Credits:

Short Stories for Students, Volume 2, Eudora Welty, Edited by Kathleen Wilson, Published by Gale Research, New York, 1997.

Greg Barnhisel, for Short Stories for Students, Gale Research, 1997. 

Related Posts:

• A Worn Path: Setting
• A Worn Path: Themes
• A Worn Path – Eudora Welty
• A Worn Path: Symbolism & Literary Devices
• A Worn Path: Summary
• Livvie by Eudora Welty

A Worn Path

29 pages • 58 minutes read

A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more.

Story Analysis

Character Analysis

Symbols & Motifs

Literary Devices

Important Quotes

Essay Topics

Summary and Study Guide

Summary: “a worn path”.

Eudora Welty’s short story “A Worn Path” is considered one of the author’s finest works and a classic in the repertory of American Southern literature. First published in 1941 as a stand-alone piece in The Atlantic Monthly , it was also included in her first short story collection, A Curtain of Green and Other Stories , published that same year. The story established Welty as a notable new voice in American literature. In addition to short stories, she wrote several novels, including The Optimist’s Daughter (1972), which won the Pulitzer Prize for fiction. Welty was a native of Jackson, Mississippi, and her observations and deep familiarity with the land informed her writing style and the characters she portrayed. This guide cites the 1980 edition of The Collected Stories of Eudora Welty published by Harcourt Brace, which includes a preface by the author.

“A Worn Path” begins on an early December morning near Christmas, likely in the 1930s. Phoenix Jackson , an elderly Black woman of uncertain age, makes her way through the rural woods outside of Natchez, Mississippi. She is small and frail and has failing eyesight. She walks slowly across the frozen ground, supported by a small cane constructed from an umbrella, which she uses to guide her way.

Despite her advanced age and wrinkled appearance, Phoenix retains a youthful fire. She announces that all the animals should keep clear because she “got a long way” to go (142). As she travels, she talks to herself “in the voice of argument old people keep to use with themselves” (143). Upon encountering a hill, she laments, “Seem like there is chains about my feet, time I get this far” (143). She preservers and crests the hilltop. On the descent, her skirt gets caught in a thorny bush. Though it’s a struggle, she frees herself and continues onward.

At the bottom of the hill, she encounters a creek with a log in it. She closes her eyes and marches across the log, arriving safely on the other side. She reflects that perhaps she isn’t as old as she thought but takes a moment to rest regardless. As she sits on the bank, a boy with a slice of marble cake appears before her. When she moves to accept the cake, “there was just her own hand in the air” (143).

Phoenix continues her journey, crawling under a barbed-wire fence and passing massive dead trees, “like black men with one arm, […] standing in the purple stalks of the withered cotton field” (144). She walks through the cotton field and then a cornfield, which she calls a “maze.” Among the stalks, she encounters a mysterious figure that she imagines is a dancing man. On closer inspection, Phoenix realizes it is only a scarecrow. She laughs at herself, saying, “My senses is gone. I too old. I the oldest people I ever know. Dance, old scarecrow, […] while I dancing with you” (144).

Continuing, Phoenix soon exits the cornfield. She passes by weathered and boarded cabins before coming upon a ravine. Drinking from the spring there, she reflects, “Nobody know who made this well, for it was here when I was born” (144).

After trekking across a mossy swamp, she meets a big black dog. Startled, she falls over into a nearby ditch, where she drifts, imagining that a dream visits her. Again, she reaches out her hand, only to find that nothing is there. Eventually, a white man—a hunter accompanied by his chained dog—comes upon the scene. He laughs at her predicament but pulls Phoenix to her feet.

The white man questions her, asking where she lives and where she’s going. When Phoenix explains that she’s going to town, he remarks, “Why, that’s too far! […] Now you go on home, Granny!” (145). When Phoenix remains true to her purpose, he laughs, saying, “I know you old colored people! Wouldn’t miss going to town to see Santa Claus!” (145).

Suddenly, Phoenix sees something fall from his pocket: a nickel. Quickly, she redirects the man’s attention to the stray black dog, then claims the nickel for herself. After scaring off the stray, the white man returns, pointing a gun at Phoenix, who stands steadfast and unafraid. The man says, “you must be a hundred years old, and scared of nothing. I’d give you a dime if I had any money with me. But you take my advice and stay home, and nothing will happen to you” (146). They go their separate ways.

Phoenix arrives in Natchez. First she passes cabins, then paved streets decorated for Christmas. She doesn’t worry about getting lost, confident that her feet will carry her safely to her destination. Eventually, she stands before a large building. After summoning her strength to climb the stairs, she recognizes her intended destination by the gold-colored document hanging above the doorway, which recalls something she once saw in a dream. Upon entering the room, her memory fails her. She stands there blankly, unable to recall why she traveled all this way.

The desk attendant grows impatient with Phoenix’s trancelike state, but a nurse recognizes her and asks if her grandson’s throat is any better. Phoenix remains silent until the nurse asks if her grandson has died. This snaps Phoenix from her trance, and she speaks. The exchange between Phoenix and the nurse reveals that Phoenix’s grandson swallowed lye two to three years ago and periodically suffers from a constricted throat that makes it difficult to breathe.

Phoenix apologizes for her lapse in memory, explaining, “I was too old at the Surrender […]. I’m an old woman without an education” (148). Her memory may fail, but her grandson remains unchanged. Unprompted, Phoenix details their situation: “We is the only two left in the world” (148). Though her grandson suffers, it never seems to dampen his spirits. She insists that “[h]e going to last” and that she won’t forget him again because she “could tell him from all the others in creation” (148).

The nurse hushes Phoenix and hands over the medicine, marking it down as charity. The attendant gives her a nickel out of sympathy, and Phoenix claims that she will use the two nickels she now has to buy a paper windmill for her grandson, who will “find it hard to believe there such a thing in the world” (149). Medicine and nickels in hand, she leaves the clinic and descends back down the stairs.

Related Titles

By Eudora Welty

A Visit of Charity

Death of a Traveling Salesman

Delta Wedding

Losing Battles

One Writer's Beginnings

Petrified Man

The Optimist's Daughter

The Ponder Heart

The Robber Bridegroom

Why I Live at the P.O.

Featured Collections

Allegories of Modern Life

View Collection

Required Reading Lists

Home — Essay Samples — Literature — A Worn Path — Analysis Of A Worn Path Short Story

Analysis of a Worn Path Short Story

• Categories: A Worn Path Family Therapy Short Story

About this sample

Words: 1382 |

Published: Nov 8, 2019

Words: 1382 | Pages: 3 | 7 min read

A Worn Path

Works cited.

• Welty, E. (1941). A worn path. The Atlantic Monthly, 168(2), 1-9.
• Hall, J. R. (1985). "A worn path" retrospect: the conflict between black womanhood and patriarchal domination. Black American Literature Forum, 19(4), 171-175.
• Jones, E. (2011). 'A Worn Path' by Eudora Welty. In Short Stories for Students (Vol. 32, pp. 1-14). Gale.
• Howard, J. H. (2010). Welty’s “A Worn Path” and the slave narrative tradition. Mississippi Quarterly, 63(4), 531-544.
• Bontemps, A. (1942). Review of A curtain of green and other stories by Eudora Welty. The New York Times.
• Jackson, B. (1995). 'A Worn Path': Literary analysis. Retrieved from http://ezinearticles.com/?A-Worn-Path-Literary-Analysis&id=6744762
• Munro, H. (2009). Eudora Welty and the Narrative Theory of the Southern Grotesque. Cambridge Scholars Publishing.
• Renner, S. (2007). “A Worn Path”: The Eternal Quest of Welty’s Phoenix Jackson. Studies in Short Fiction, 44(3), 283-289.
• Wright, J. C. (2004). The Art of Words and Images: A Study of Eudora Welty's "A Worn Path". Southern Quarterly, 42(1), 108-118.
• Evans, R. C. (1991). Eudora Welty's 'A Worn Path' and the slave narrative tradition. The Mississippi Quarterly, 45(3), 413-420.

Cite this Essay

To export a reference to this article please select a referencing style below:

Let us write you an essay from scratch

• 450+ experts on 30 subjects ready to help
• Custom essay delivered in as few as 3 hours

Get high-quality help

Dr. Karlyna PhD

Verified writer

• Expert in: Literature Psychology

+ 120 experts online

By clicking “Check Writers’ Offers”, you agree to our terms of service and privacy policy . We’ll occasionally send you promo and account related email

No need to pay just yet!

Related Essays

2 pages / 944 words

1.5 pages / 780 words

2 pages / 1012 words

3 pages / 1428 words

Remember! This is just a sample.

You can get your custom paper by one of our expert writers.

121 writers online

Still can’t find what you need?

Browse our vast selection of original essay samples, each expertly formatted and styled

Related Essays on A Worn Path

In Eudora Welty's poignant short story, "A Worn Path," the themes of resilience and sacrifice stand as central pillars that shape the narrative and resonate deeply with readers. The story follows an elderly African American [...]

"A Worn Path" by Eudora Welty is a story that follows the journey of an elderly African American woman named Phoenix Jackson as she travels a familiar path to town to obtain medicine for her sick grandson. Throughout the story, [...]

Eudora Welty's short story "A Worn Path" is a work rich in symbolism, offering readers a thought-provoking exploration of the human experience. The story follows an elderly African American woman named Phoenix Jackson as she [...]

In the pantheon of American literature, few characters embody the spirit of resilience, determination, and undying love as effectively as Phoenix Jackson in Eudora Welty's short story "A Worn Path." Through a meticulous "Phoenix [...]

Life is filled with different twists and turns, unexpected obstacles, and experiences never forgotten. Eudora Welty writes A Worn Path with a sense of symbolism that captures the struggles and pleasures of life. Welty uses [...]

Ernest Hemingway called his novel A Farewell to Arms his “Romeo and Juliet.” The most obvious similarity between these works is their star-crossed lovers, as noted by critic Carlos Baker; another is that the deaths of both [...]

Related Topics

By clicking “Send”, you agree to our Terms of service and Privacy statement . We will occasionally send you account related emails.

Where do you want us to send this sample?

By clicking “Continue”, you agree to our terms of service and privacy policy.

Be careful. This essay is not unique

This essay was donated by a student and is likely to have been used and submitted before

Download this Sample

Free samples may contain mistakes and not unique parts

Sorry, we could not paraphrase this essay. Our professional writers can rewrite it and get you a unique paper.

Please check your inbox.

We can write you a custom essay that will follow your exact instructions and meet the deadlines. Let's fix your grades together!

Get Your Personalized Essay in 3 Hours or Less!

We use cookies to personalyze your web-site experience. By continuing we’ll assume you board with our cookie policy .

• Instructions Followed To The Letter
• Deadlines Met At Every Stage
• Unique And Plagiarism Free

A Worn Path

by Eudora Welty

A worn path literary elements.

Short Story

Setting and Context

Mississippi, early 20th century

Narrator and Point of View

Limited third-person omniscient

Tone and Mood

Tone: sympathetic, poignant, placid, mischievous

Mood: determined, dreamy, sympathetic, apprehensive

Protagonist and Antagonist

Protagonist: Phoenix Antagonist: Hunter, Attendant

Major Conflict

Will Phoenix make it safely to pick up the medicine for her grandson?

There isn't a traditional climax, but it is most likely when Phoenix finally makes it to Natchez.

Foreshadowing

1. Phoenix's interaction with the hunter, the first other human she's met, foreshadows her troubles with the women she deals with at the clinic. She is able to navigate nature easily enough, but the white townspeople are more antagonistic to her than animals or branches or logs. 2. When Phoenix sees a little boy bring her a slice of cake, this foreshadows the reader's learning what the point of her journey is—to procure medicine for her grandson.

Understatement

When the hunter asks Phoenix if she is scared of his gun, she replies, "No, sir, I seen plenty go off closer by, in my day, and for less than what I done." This is an understatement because it suggests that Phoenix has witnessed, or perhaps experienced, threats or acts of violence that her words belie.

1. "The Surrender" is when the South surrendered to the North in 1865, ending the Civil War. 2. Phoenix evokes God, saying "the good Lord made his snakes to curl up and sleep in the winter."

The imagery in this text serves to reinforce Phoenix's association with the natural world and her relative ease in navigating it, as well as demonstrate the subtle but important shifts for her when she arrives in Natchez.

Phoenix is described as very old, wearing unlaced shoes, and frail and unstable; yet, she skillfully crosses a log and makes it through a maze. She is also described as having eyes "blue with age," not being able to discern the scarecrow immediately, and that her "senses is gone." Yet, "without warning, she had seen with her own eyes a flashing nickel fall out of [the hunter's] pocket onto the ground."

Parallelism

Metonymy and synecdoche, personification.

1. "Thorns, you doing your appointed work. Never want to let folks pass—no, sir." 2. Phoenix describes the field as "whispering." 3. "A dream visited her . . . "

A Worn Path Questions and Answers

The Question and Answer section for A Worn Path is a great resource to ask questions, find answers, and discuss the novel.

Phoenix is old; she has trouble with mobility and vision. Phoenix must face many obstacles on the worn path on the way to town. She has trouble seeing a scarecrow, she thinks it might be a ghost, and she doesn't see a black dog approach her.

How is the name of the central character significant in the narrative?

The phoenix is an immortal bird associated with Greek mythology that cyclically regenerates or is otherwise born again. The central character demonstrates this by repeating an arduous journey.

Who did the hunter think Phoenix was going to town to see?

During her journey, Phoenix has an altercation with a dog that comes after her. She hits the dog wih her cane, but falls over in turn. At this point, a white man—a hunter—helps her from the spill she took into the ditch. He starts out nicely by...

Study Guide for A Worn Path

A Worn Path study guide contains a biography of Eudora Welty, literature essays, quiz questions, major themes, characters, and a full summary and analysis.

• About A Worn Path
• A Worn Path Summary
• Character List

Essays for A Worn Path

A Worn Path essays are academic essays for citation. These papers were written primarily by students and provide critical analysis of A Worn Path by Eudora Welty.

• Inspiration Through Storytelling: Eudora Welty's "A Worn Path"
• Symbolism in "A Worn Path"

Wikipedia Entries for A Worn Path

• Introduction

• Open access
• Published: 12 September 2024

Primary healthcare practitioners’ perspectives on trauma-informed primary care: a systematic review

• Eleanor Bulford 1 ,
• Surriya Baloch 1 ,
• Jennifer Neil 1 , 2 &
• Kelsey Hegarty 1 , 3  

BMC Primary Care volume  25 , Article number:  336 ( 2024 ) Cite this article

Metrics details

Exposure to domestic and family violence is a pervasive form of complex trauma and a major global public health problem. At the frontline of the health system, primary healthcare practitioners are uniquely placed to support individuals with experiences of trauma, yet their views on trauma-informed primary care are not well understood. This systematic review of qualitative literature sought to explore primary healthcare practitioners’ perspectives on trauma-informed primary care.

Eight databases were searched up to July 2023. Studies were included if they consisted of empirical qualitative data, were conducted in general practice or equivalent generalist primary healthcare settings, and included the perspectives of primary healthcare practitioners where they could be distinguished from other participants in the analysis. Thematic synthesis was used for analysis.

13 papers met inclusion criteria, representing primary care settings from the United States, Canada, Australia, and Norway. Three key themes were developed: Changing the paradigm, Building trust, and Navigating the emotional load. Findings shed light on how primary healthcare practitioners perceive and strive to practise trauma-informed primary healthcare and the challenges of navigating complex, trauma-related work in the primary care environment.

Conclusions

This review supports the need for recognition of the value of primary care in supporting patients with histories of trauma and violence, the development of interventions to mitigate the emotional load worn by primary healthcare practitioners, and further work to develop a deep and consistent understanding of what trauma-informed primary care encompasses.

Peer Review reports

Introduction

Trauma is a public health issue of epidemic proportions [ 1 ]. In the 1990s, the landmark Adverse Childhood Experiences (ACEs) Study shed light on the strong associations between early life traumatic experiences and a wide range of mental and physical health outcomes, including depression, cardiac and respiratory disease, and cancers [ 2 ]; findings which are now supported by an increasingly large body of research [ 3 , 4 , 5 ]. One of the most pervasive forms of trauma is exposure to domestic violence, affecting approximately 1 in 3 women worldwide [ 6 ] and frequently constituting complex trauma, or trauma which is repetitive and cumulative [ 7 ]. Domestic violence is a leading cause of morbidity and mortality among women of child-bearing age, with significant health consequences including higher rates of depression, chronic pain, and harmful substance use [ 8 ]. Children, too, are profoundly affected by domestic violence within a family, with a range of impacts upon health both in childhood and later in life [ 9 ]. Particularly when exposure occurs in childhood, complex trauma such as domestic violence also frequently has neurodevelopmental impacts upon domains such as sense of self, somatic awareness, and emotional regulation [ 7 ].

For healthcare providers, trauma therefore is not only relevant as an important risk factor for mental and physical health outcomes, but may also have complex impacts upon the therapeutic relationship. While trauma and domestic violence do not discriminate, both historical and ongoing structural factors such as gender inequities, colonisation, racism, and poverty intersect to disproportionately affect specific populations, particularly women and First Nations communities [ 8 , 10 , 11 ]. The impacts of trauma can extend across generations, contributing to cycles of health inequity and social disadvantage [ 12 , 13 ]. There is a critical urgency to optimise the response to trauma across healthcare systems.

The increasing recognition of trauma as a public health issue has led to the conceptualisation of trauma-informed approaches to healthcare [ 14 ]. The Substance Abuse and Mental Health Services Administration (SAMHSA) outlines four key assumptions for trauma-informed services: a basic realisation of trauma and its impacts; a recognition of the signs of trauma; responding through applying trauma-informed principles across all areas of service delivery; and resisting re-traumatisation of both clients and staff members through providing a safe environment [ 15 ]. Key principles of trauma-informed care include safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice, and choice; and cultural, historical, and gender issues [ 15 ]. A strengths-based approach, trauma-informed healthcare aims to build patients’ sense of resilience and of agency, to reduce the risk of causing patients harm, and to offer opportunities for healing [ 14 , 16 , 17 ].

As the frontline of the healthcare system, primary healthcare practitioners are likely to be regularly seeing and managing the health consequences of trauma [ 17 , 18 , 19 ]. General practitioners (GPs) are one of the most common groups that women tell about their experiences of domestic violence [ 20 ] and primary care has been highlighted internationally as a priority setting for the healthcare response to domestic violence [ 8 ]. However, primary healthcare practitioners may face a range of systemic and personal barriers to identifying and addressing their patients’ experiences of abuse [ 21 , 22 ]. Primary healthcare services that do not adequately recognise or understand trauma not only miss opportunities to optimise health outcomes for their patients, but also risk causing further trauma [ 15 , 17 ].

Nonetheless, primary healthcare environments such as general practice are in many ways uniquely positioned to support individuals with experiences of trauma and violence. The generalist lens, community setting, and potential for long-term therapeutic relationships and continuity of care arguably align well with the key principles of trauma-informed care [ 23 , 24 , 25 , 26 ]. Evidence has been building to support the value of trauma- and violence-informed primary healthcare for First Nations women [ 10 ] and limited studies of trauma-informed training interventions in primary healthcare have shown promise [ 27 , 28 , 29 ]. However, the practicalities of how the principles of trauma-informed care should be implemented in primary healthcare remain an area of limited evidence [ 30 , 31 ]. In order to understand how trauma-informed approaches to healthcare can be put into practice, understanding the perspectives and first-hand experiences of frontline practitioners is essential. There is currently very little insight into how primary healthcare practitioners understand and view trauma-informed primary healthcare, with no previous systematic reviews focusing on this. To help address this gap, we conducted a systematic review of qualitative literature exploring primary healthcare practitioners’ perspectives on trauma-informed care.

Search strategy

Eight databases were searched in July 2023: ASSIA, MEDLINE, CINAHL, Embase, Global Health, PsycINFO, SocINDEX, and Web of Science. The MEDLINE search strategy was initially designed using subject headings and keywords for trauma-informed care and primary healthcare and was subsequently translated to fit other databases. The MEDLINE search strategy is outlined in Table  1 .

Inclusion criteria

We included empirical studies that used qualitative methodology and analysis, were conducted in general practice or equivalent generalist primary healthcare settings, and included the perspectives of primary healthcare practitioners. We chose to include qualitative research only, to allow an in-depth analysis of practitioners’ perspectives and experiences. Studies that included other groups, such as patients, were included only if primary healthcare practitioners could be separated from other participants in the analysis. If the perspectives of healthcare practitioners from other disciplines were explored, a paper was included if at least 50% of healthcare practitioner participants were from primary care settings. We only included studies published in English and did not apply a date range limit. Studies were excluded if they were conducted in non-generalist primary healthcare settings, were non-empirical papers such as commentaries or reviews, if they did not include the perspectives of primary healthcare practitioners, or if primary healthcare practitioners were unable to be distinguished from other participants in the analysis.

Selection of studies

Two reviewers (EB and SB, and subsequently EB and JN) independently screened each title and abstract against inclusion criteria using the software program Covidence [ 32 ]. Following initial screening, full-text papers were independently reviewed and identified for inclusion or exclusion. Any disagreements about study inclusion were resolved through discussion with a third reviewer (KH). The flow of studies is displayed in Fig. 1 .

Flowchart of the study selection

Data extraction and synthesis

EB and SB extracted data into a standardised form, including details on study date, country, aims, methodology, setting, and sample size and characteristics. We imported results data into the qualitative data analysis software NVivo [ 33 ]. EB conducted a thematic synthesis as guided by the methodology of Thomas and Harden [ 34 ], in consultation with SB, JN, and KH. Primary data from each results section, including participant quotes and authors’ interpretations, were read and re-read, assessed on a line-by-line basis, and coded. Codes were organised into descriptive themes and finally, developed into analytical themes based on further careful examination and analysis through the lens of the research question.

Quality appraisal

EB used the Critical Appraisal Skills Programme (CASP) tool to appraise the quality of each included study [ 35 ]. The tool assesses each study’s aim, research design, recruitment, data collection, reflexivity, ethics, data analysis, statement of findings, and overall value. For each domain, it was assessed whether each paper fully, partially, or did not meet expected standards or if it was unclear.

Review author reflexivity

The review team consisted of researchers working in domestic and family violence and primary healthcare research. All authors are also medical practitioners with clinical experience in general practice and women’s health. At the outset of the review, all authors believed in the importance of trauma-informed approaches to care and in the valuable role that primary healthcare can play in the response to trauma and abuse. The authors’ views and experiences may influence the analysis of this review.

Overview of studies

We identified 13 studies (Table  2 ) that met inclusion criteria, published between 2011 and 2023. Studies were conducted in the United States (seven studies), Canada (three studies), Australia (two studies), and Norway (one study). Settings included a veteran affairs primary care clinic [ 36 ]; a general practice clinic for young women in a socially disadvantaged community [ 37 ]; First Nations health services in Australia [ 38 ], Canada [ 39 ], and the United States [ 40 ]; and both urban and rural generalist primary healthcare clinics, five of which were described as serving low socio-economic or marginalised communities [ 41 , 42 , 43 , 44 , 45 ]. Data was collected via both individual interviews (nine studies) and focus groups (seven studies), with several studies using both methods. One study used yarning interview methodology [ 38 ]. Participants included doctors, nurses, social workers, and non-clinical staff working in primary healthcare. All studies used qualitative data analysis methodology, with most using thematic analysis. The overall quality of papers was high, although many papers did not discuss their consideration of the relationship between researchers and participants (Table  3 ).

Three key themes were developed that described primary healthcare practitioners’ perspectives on trauma-informed care: Changing the paradigm , Building trust and Navigating the emotional load. The key themes and sub-themes are discussed in detail as follows.

Changing the paradigm: “I’m at the same level as they are”

A key theme identified across 10 of the 13 studies was the ways in which trauma-informed care could encompass shifts in how primary care practitioners saw the meaning, purpose, and framework of their work [ 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 46 , 47 ]. This theme is explored across three subthemes: shifting the biomedical lens, recognising and understanding trauma, and being an advocate.

Shifting the biomedical lens

Primary healthcare practitioners described how trauma-informed care involved a shift in the traditional biomedical lens, towards a more holistic viewpoint that encompassed a strong awareness of the impacts of trauma and of the broader psychosocial, spiritual, societal, and historical influences on their patients’ health [ 39 , 43 ]. Primary care practitioners in several studies discussed the importance of acknowledging and challenging power imbalances, including both within the clinical relationship and between healthcare disciplines [ 38 , 39 , 41 ]. One practitioner at a Canadian Aboriginal health centre said:

“I want to make this person feel that even though I’m a [provider] , I am at the same level as they are. I don’t place myself above them or anything like that. There is no status of power when I work with people. I try to keep that as minimal as possible.” [ 39 ].

In some cases, this led to changes in dynamics among the interdisciplinary staff working within the clinic. In a Canadian study on the impacts of an equity-oriented primary healthcare intervention, which included a significant trauma- and violence-informed care component, one staff member observed:

“In the meetings , it’s starting to shift , which is really big , because for years , we’ve been saying , ok , we need the psychosocial piece to come out in the meetings and not talk three quarters of the time about the medical stuff.” [ 41 ].

In First Nations health settings, staff discussed the fundamental importance of recognising colonisation and racism as major ongoing structural sources of trauma and violence impacting upon their patients’ health [ 38 , 39 ]. In contrast to other included studies, however, one study of Norwegian GPs’ perceptions of the medical relevance of their patients’ adverse life experiences [ 48 ] found some different perspectives. While some GPs were confident in taking a holistic approach that acknowledged their patients’ experiences of trauma, others were sceptical of connections between trauma and health and maintained more of a traditional biomedical perspective in their role:

Some GPs in all three focus groups expressed uncertainty as to whether work with painful and adverse experiences fits into the scope or mandate of a busy GP’s clinical practice , irrespective of the stories’ potential medical relevance. [ 48 ]

Recognising and understanding trauma

Most studies explored the ways in which primary care practitioners picked up on patient indicators that may suggest an underlying history of trauma. These included both clinical presentations such as chronic pain [ 39 , 44 , 47 ] and non-specific somatic symptoms [ 42 , 43 , 47 , 48 ], but also patient behaviours and clinical interactions [ 36 , 37 , 46 ]:

“I had... a prenatal patient and I was doing an... initial pelvic exam on her , she just started breaking down in tears... when I’m putting a speculum in... and then I asked her , because that totally went off in my head , ‘Okay , there’s something really off here.’” [ 46 ].

For some practitioners, recognition of underlying trauma shifted their perspective on their patients’ care, particularly for so-called “difficult” patients:

“If the primary provider can recognize that this poor difficult patient is in fact a person in pain with huge problems and will need quite a bit of attention... It’s much more complicated than just heart failure or diabetes. This is what they call pain heart. Pain hearts need a lot of attention; a lot of love.” [ 36 ].

Being an advocate

Primary care practitioners described their role in providing trauma-informed care as extending beyond the provision of immediate medical care to being an advocate for their patients more broadly [ 37 , 38 , 43 ]. Practitioners discussed how they supported patients to access housing, social security, employment, and education and their role in helping patients to navigate complex systems [ 37 , 38 ]. Using their positions to advocate at broader systems and societal levels was also seen as important [ 38 , 43 ]. In one study at an Australian clinic for young women, the authors stated:

Staff saw advocacy as another crucial aspect of trauma-informed care. GPs often wrote letters or made phone calls on behalf of clients , pressing for affordable housing , affordable care with medical specialists , as well as advocacy with Centrelink , employment agencies , schools , university and TAFE (Technical and Further Education institutions). [ 37 ]

In Levine and colleagues’ interviews with primary healthcare staff about the impact of interprofessional education on trauma- and violence-informed care, one doctor described how the framework had given them greater confidence to advocate around broader structural issues affecting their patients:

“It made me sort of feel confident enough to start doing something about [trauma and violence] when I see it. So we had a discussion today about , in a sharing circle , about First Nations people and their interactions with police.” [ 43 ].

Practitioners spoke about involving other practitioners and services in the care of patients with histories of trauma, particularly mental health services [ 36 , 42 , 46 , 47 ]. Multiple problems with referral pathways were discussed, including not enough services [ 36 , 40 , 44 , 47 ], long wait times [ 40 ], the potential for fragmentation of care [ 36 ], and other providers providing services in a manner that was not trauma-sensitive [ 38 , 39 ]. Having a strong knowledge of local services; strong partnerships and communication between services; and being prepared to advocate for patients to be seen in a timely manner were all explored as important facilitators [ 36 , 38 , 42 , 47 ].

Building trust: “Just moving one step at a time”

The central importance of building a strong, trusting relationship with patients was highlighted across seven studies [ 36 , 37 , 40 , 45 , 46 , 47 , 48 ]. Allowing appropriate time and space, sensitively approaching physical examinations, and communicating effectively were sub-themes that illustrated the process of building trust with patients.

Allowing time and space

Primary care practitioners in several studies described how building trusting relationships with their patients required moving away from a need to solve their patients’ problems towards being prepared to meet patients where they were at, and sometimes to simply listen [ 37 , 40 , 46 , 48 ]. This required allowing time and space to work with patients at their own pace:

“Establish rapport with the patient. Some sense of relationship. Trust in that provider. I guess seeking just what the patient is willing to acknowledge they need help with… just moving one step at a time.” [ 40 ].

One GP at the Australian young women’s clinic described the concept of “holding”:

“As a doctor you want to be able to fix someone or solve their problems and then move on , but a lot of the time with Young Women’s Clinic it is about keeping them safe , reduction of harm , minimising other outside impacts on their lives until they get to a stage where they are able to move on. So that holding is a very important part of it…” [ 37 ].

In Rønneberg and colleagues’ study with Norwegian GPs, however, several participants expressed a different view that was less aligned with the concept of allowing time and space:

“[Working with stories of painful and adverse experiences] doesn’t fit with my daily routines as a GP. Problems have to be solved then and there.” [ 48 ].

While allowing adequate time for consultations was considered important by many, practitioners stressed the challenges of time pressures in the primary care environment [ 36 , 43 , 45 , 47 , 48 ]. These included insufficient time to manage the complexity of trauma-related issues, to provide appropriate counselling and support, to carefully navigate sensitive physical examinations, and for practitioners to have the opportunity to critically reflect on their own practice:

“The [clinic] time I needed , I didn’t get. They [women veterans who screen positive for a history of sexual trauma] really need counselling and we are the first line of people as primary care. It’s so easy to lose them after the first visit.” [ 36 ]. “You cannot help them in a 15-minute appointment” [ 45 ].

Navigating physical examinations

Conducting sensitive and respectful physical examinations was highlighted in several studies as an important, yet at times challenging aspect of providing trauma-informed primary care and building trust with patients [ 36 , 37 , 46 ]. Intimate examinations such as pelvic and breast examinations and procedures such as cervical screening tests were highlighted as an especially complex area to approach, particularly with patients who had experienced sexual trauma [ 36 , 37 , 46 ]. Practitioners described the importance of allowing appropriate time to prepare for and conduct physical examinations, but were often faced with uncertainty about the most appropriate way to proceed.

A staff member in the Australian young women’s clinic recounted:

“I remember one woman where the nurse met with her for six months , just talking about Pap smears... She had a very strong child sexual assault history and I don’t think she’d ever had a Pap smear , and she did finally get there.” [ 37 ].

Being mindful of communication

Practitioners in several studies described being careful in their choice of language when discussing trauma-related issues with their patients [ 36 , 46 ], and being aware of their verbal and non-verbal signals and the potential for these to evoke a patient’s trauma [ 40 , 41 , 43 , 48 ]. Listening in a non-judgemental way, being patient, and providing validation were all highlighted as important parts of communicating with patients in a trauma-informed manner [ 36 , 39 , 40 , 48 ].

Reflecting on the impact of interprofessional trauma- and violence-informed care education, one clinician said:

“Before it was like , I know I’ve got to get all this stuff done before I go... but then I realize I’m going well wait a minute , if I’m just spewing something back or I’m not making eye contact , you know , I’m causing that person trauma” [ 43 ].

Another practitioner in the veterans’ healthcare setting described the need to be careful with their communication:

“It’s a challenge to take care of her [patient] because…she cancels appointments. So , sometimes I can be irritated or whatever. She’s very , very sensitive to my verbal cues. And so , I’ve got to really tone it down.” [ 36 ].

Two studies touched on how discussing the links between adverse life experiences and health with patients could at times lead to complex and challenging conversations, particularly when resources to help address underlying trauma and social determinants were limited [ 44 , 48 ]:

“People are very focused on kind of physical causes or a specific thing. And it’s a hard conversation to have about how that pain arises...and they often see that as [...] “you just don’t want me to take these medicines [opioids] that would help me”” [ 44 ].

Navigating the emotional load: “Your brain is working, your heart is working”

Ten papers described the emotional load that primary care practitioners carried in their work, including experiences of secondary trauma [ 37 , 39 , 41 , 43 , 45 ] and feelings of uncertainty and being overwhelmed [ 36 , 42 , 43 , 44 , 46 , 48 ]. A small number of studies highlighted sources of personal support that some practitioners drew upon [ 43 , 45 ].

Secondary trauma

Experiences of secondary or vicarious trauma among primary care practitioners arose in several studies [ 37 , 39 , 41 , 45 ]. These experiences were described as leading to staff distress [ 37 ], compassion fatigue [ 41 ], burnout [ 41 ], exhaustion [ 45 ], and challenges with staff retention [ 39 ].

As one practitioner, who was working at an urban primary care clinic in a low socioeconomic community, described:

“It’s wearing. It’s hard. You can’t keep up. It’s emotionally and physically draining. Your brain is working , your heart is working , you’re physically working.” [ 45 ].

Feeling uncertain and overwhelmed

Primary care practitioners described how the complexity of navigating trauma-related issues in primary care could leave them feeling apprehensive, anxious, and uncertain of how best to proceed [ 36 , 43 , 46 , 48 ]. Particular areas of uncertainty included how to approach conversations related to trauma [ 36 , 46 , 48 ], conducting examinations on patients with a trauma history [ 36 ], and navigating a tension between addressing a patient’s immediate needs and the underlying experiences of trauma or violence perpetuating their medical issues [ 43 , 44 ]. At times practitioners doubted their own abilities [ 36 , 46 , 48 ], could feel overwhelmed by the complexity of the work [ 42 , 46 ], and were frustrated at a perceived powerlessness to help their patients [ 41 , 44 , 45 , 46 ].

“When you’re dealing with trauma sometimes you wonder how much you should be doing at any particular moment. Somebody comes in because their ankle is sprained and they sprained their ankle fleeing an abusive partner... do you just... help the person with the ankle because that’s what they came in for or do you try to remove them from a violent situation?” [ 43 ]. “I feel more apprehensive overall…basically unsure and kind of nervous when I do take care of a patient who has had a history of military sexual trauma.” [ 36 ]. “Oh God , there’s really nothing you can do for them , you just want to leave , then you can’t do that , that’s not right , so you’ve got to do something.” [ 46 ].

Sources of personal support

Despite the challenges of a heavy emotional load, two studies found a sense of personal meaning that supported primary care practitioners in their ability to provide trauma-informed primary care. Practitioners in one study described how the framework of trauma-informed care aligned to their personal values and sense of vocation [ 43 ], while others described feelings of fulfilment [ 45 ] and the importance of support from colleagues and peers [ 43 , 45 ]:

“We have a work environment that allows us to be supportive of each other so that we can have the emotional reserves to be able to provide trauma informed care. I think we’re flexible: if you have somebody that comes in that’s in a particular trauma or crisis , our colleagues are always really good about accommodating that time.” [ 43 ]. “I think when I can finish a day having helped somebody... that’s what keeps me going.” [ 45 ].

This review of 13 qualitative studies sheds light on primary care practitioners’ perspectives on trauma-informed care in general practice and equivalent primary healthcare settings. The three main themes developed were: Changing the paradigm, Building trust, and Navigating the emotional load. These concepts have been discussed in the trauma literature to some extent but have not previously been synthesised from the voices of primary healthcare practitioners [ 10 , 30 , 49 , 50 ].

Primary care practitioners in the included studies saw trauma-informed care as requiring a shift from a typical biomedical viewpoint towards a more holistic lens, which recognised indicators of trauma in their patients’ presentations and considered the impacts of structural factors and power dynamics. Taking a trauma-informed approach also meant the practitioner’s role broadening to include a strong advocacy component, supporting their patients to navigate complex systems and using their role to help patients to access basic needs such as housing and social services. This demonstrated a recognition of the impact of ongoing social determinants on the health of patients with experiences of trauma and the practitioner’s ability to support their patients as an ally as much as a clinician. Being an ally and providing patient-centred, practical support have consistently been emphasised by women with experiences of domestic and sexual violence as one of the most important things they seek from healthcare professionals [ 50 , 51 ]. For the clinician themselves, adopting an advocacy lens is also known to be a key supportive factor in addressing domestic violence and abuse [ 21 ].

Primary care practitioners across the studies in this review emphasised the importance of building trust with their patients, highlighting both the unique challenges and opportunities that the general practice setting provided. Developing trust has been highlighted repeatedly as an essential element to caring for people affected by trauma and violence [ 10 , 21 , 49 , 51 , 52 ], recognising that individuals may have prior experiences of betrayal of trust and of disrupted attachment. Investing the time to build a strong clinical relationship, taking a non-judgemental approach, and being prepared to sit with patients where they were at all supported practitioners in their provision of trauma-informed care. This again reflected moving away from the traditional medical mindset of solving a patient’s problems and reflected the value of the long-term care that is frequently possible in primary care settings. Accepting this shift away from the need to be a ‘fixer’ has previously been found to support practitioners to feel more confident and ready to address domestic violence [ 21 ].

The concept of “holding” in general practice has been described in limited literature [ 37 , 53 ] and refers to the development of trusting patient-clinician relationships, general practice as a ‘safe space’, and ongoing empathic support and advocacy without expectation of cure. Recent research around responding to child abuse and neglect in primary care settings has described how clinicians use holding strategies to navigate a ‘grey zone’ of clinical uncertainty; striving to create emotionally safe spaces, build an ongoing therapeutic relationship, and implement practical strategies to address families’ vulnerability [ 54 ]. While ‘holding’ may be simply putting a name to an approach that many primary care clinicians have instinctively understood for years [ 53 ], there is room to build our understanding of this concept and to recognise the unique value that primary care adds to the care of patients with complex trauma-related health issues. A small number of studies in this review did, however, report on feelings of frustration experienced by some clinicians when they felt unable to quickly solve their patients’ trauma-related issues. There may be varying degrees of comfort across the profession with taking a ‘holding’ approach and as such, strategies to build primary care practitioners’ capacity and confidence with the role they can play within such ‘grey zones’ may be of value.

The paradigm shift described across the studies in this review partly mirrors the growing understanding of generalism as a skillset in its own right [ 25 ]. In their exploration of the craft of generalism, Lynch and colleagues (2022) describe four key principles: whole person scope, relational process, healing orientation, and integrative wisdom [ 25 ]. The practice of trauma-informed primary healthcare as explored through the first-hand experiences and perspectives of practitioners in this review indicates a close alignment between generalist and trauma-informed philosophies, supporting the unique value of generalist healthcare such as general practice in supporting patients with experiences of trauma and violence.

Consistent with other literature around managing complex issues in general practice [ 22 , 55 , 56 ], time constraints were highlighted as a key challenge that practitioners were constantly navigating as they strove to build a trusting clinical relationship with their patients. Conducting physical examinations in a trauma-informed way was also an important challenge for primary care clinicians, reflecting the unique nature of a generalist speciality where both mental and physical healthcare must be sensitively navigated. While trauma-informed physical examination is starting to be integrated into some medical education curricula [ 57 ], literature exploring trauma-informed physical examinations for primary care professionals remains limited at present.

This review also highlighted the emotional load that primary care practitioners were navigating. Many of the practitioners interviewed across the included studies were working in marginalised communities with high rates of trauma. Being prepared to allow time and space and take a slow approach to building trust, while managing challenging trauma-related health issues, meant practitioners were often carrying a heavy burden of uncertainty and complexity. Several studies reported on experiences of secondary trauma and of feeling overwhelmed. Time, resourcing, and other systems-level barriers continued to add additional pressures to already complex work. The emotional labour of navigating trauma-related issues in general practice, and how this can lead to burnout and vicarious trauma, has been described previously in limited literature [ 58 , 59 ], but the evidence base for how to best support primary care practitioner wellbeing is currently minimal [ 60 ]. A small number of studies in this review, however, reported on a personal sense of meaning that helped to support practitioners in their work. This is again consistent with systematic review data which indicates that having a personal commitment to addressing domestic and family violence, such as through a feminist or human rights lens, is a strong supporting factor for health practitioners who feel prepared to engage with trauma and violence-related issues [ 21 ].

Strengths and limitations

To our knowledge, this is the first systematic review of qualitative studies exploring primary care practitioners’ perspectives on trauma-informed care. A robust search strategy yielded a large number of papers that were independently screened by two reviewers. Several limitations may apply. The number of papers that met inclusion criteria is small. Studies explored trauma-informed care from slightly different angles, including in the context of specific interventions, which may impact the application of the findings to other settings.

A number of different primary healthcare settings were represented, including urban, rural, and First Nations health services, as were the perspectives of primary healthcare staff from several different professional disciplines (including medicine, nursing, social work, and administration). However, all studies were from high income, Western countries. This is likely to also limit the transferability of the findings. While this review was focused on healthcare professional perspectives, the voices of consumers and community members, including those from diverse backgrounds and with different and intersecting life experiences must be central to the ongoing conceptualisation of trauma-informed primary care.

While the contemporary understanding of the complex impacts of trauma and violence is ever evolving, there remains a lack of robust evidence around trauma-informed interventions in primary care [ 30 ]. In this review, while consistent themes were able to be identified across the small number of included studies, it is not possible to be certain that each study reflects a shared understanding of trauma-informed care across primary healthcare. Furthermore, while this review focused on trauma-informed care, we recognise and also support the broader concept of trauma- and violence-informed care, which builds on trauma-informed care to add a stronger focus on the intersection of structural inequities and systemic violence with interpersonal violence [ 10 , 39 , 61 ]. Ongoing research that further defines what trauma- and violence-informed healthcare looks like and builds an evidence base for the primary care setting is needed.

Implications and conclusion

The conceptualisation of trauma-informed care as a paradigm shift inevitably requires all levels of the healthcare system to understand and adopt this approach. While primary care practitioners discussed many ways in which they built trauma-informed principles into their own practice, several systems-level factors such as time structures, resourcing, and referral pathways did not consistently support them in undertaking this work [ 21 , 26 ]. Working towards a shared understanding of trauma-informed principles and integration of these across all services and systems is essential and requires ongoing focus. Funding structures must recognise and reflect the value of primary care and the generalist approach in providing care to patients with complex, trauma-related physical and mental health issues.

Secondly, the heavy emotional load that primary care practitioners wear in relation to trauma-related work must be addressed. Understanding how practitioners can be supported as they navigate the complexity of their work is essential not only to promote clinician wellbeing and prevent burnout, but for the sustainability of the primary care workforce and long-term implementation of trauma-informed primary healthcare. Further research into how healthcare systems and services can be structured in a way that supports the wellbeing of primary care clinicians is needed.

Finally, further research, including further studies exploring practitioner and patient perspectives and evaluations of trauma-informed approaches, should continue to build an in-depth understanding of what high quality, evidence-based, trauma-informed primary healthcare looks like.

Data availability

All data and materials used during this systematic review are available from the corresponding author upon request.

Abbreviations

Adverse childhood experiences

General practitioner

Substance Abuse and Mental Health Administration

Critical Appraisal Skills Programme

Magruder KM, McLaughlin KA, Elmore Borbon DL. Trauma is a public health issue. Eur J Psychotraumatology. 2017;8(1):1375338.

Article   Google Scholar  

Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the adverse childhood experiences (ACE) study. Am J Prev Med. 1998;14(4):245–58.

Article   CAS   PubMed   Google Scholar  

Bellis MA, Hughes K, Leckenby N, Hardcastle K, Perkins C, Lowey H. Measuring mortality and the burden of adult disease associated with adverse childhood experiences in England: a national survey. J Public Health. 2015;37(3):445–54.

Article   CAS   Google Scholar  

Hughes K, Bellis MA, Hardcastle KA, Sethi D, Butchart A, Mikton C, et al. The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. Lancet Public Health. 2017;2(8):e356–66.

Article   PubMed   Google Scholar  

Pechtel P, Pizzagalli DA. Effects of early life stress on cognitive and affective function: an integrated review of human literature. Psychopharmacology. 2011;214:55–70.

World Health Organisation. Violence against women prevalence estimates, 2018: global, regional and national prevalence estimates for intimate partner violence against women and global and regional prevalence estimates for non-partner sexual violence against women. Executive summary. Geneva; 2021.

Courtois CA, Ford JD. Treating complex traumatic stress disorders: an evidence-based guide. Guilford Press New York; 2009.

World Health Organisation. Responding to intimate partner violence and sexual violence against women. 2013.

Holt S, Buckley H, Whelan S. The impact of exposure to domestic violence on children and young people: a review of the literature. Child Abuse Negl. 2008;32(8):797–810.

Cullen P, Mackean T, Walker N, Coombes J, Bennett-Brook K, Clapham K, et al. Integrating trauma and violence informed care in primary health care settings for First Nations women experiencing violence: a systematic review. Violence, & Abuse: Trauma; 2021. p. 1524838020985571.

Google Scholar  

World Health Organization and London School of Hygiene and Tropical Medicine. Preventing intimate partner and sexual violence against women: taking action and generating evidence. Geneva; 2010.

Gartland D, Giallo R, Woolhouse H, Mensah F, Brown S. Intergenerational impacts of family violence-mothers and children in a large prospective pregnancy cohort study. EClinicalMedicine. 2019;15:51–61.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Howell KH, Miller-Graff LE, Martinez-Torteya C, Napier TR, Carney JR. Charting a course towards resilience following adverse childhood experiences: addressing intergenerational trauma via strengths-based intervention. Children. 2021;8(10):844.

Article   PubMed   PubMed Central   Google Scholar  

Harris M, Fallot R. Envisioning a trauma-informed service system: a vital paradigm shift. New Dir Ment Health Serv. 2001;2001(89):3–22.

Substance Abuse and Mental Health Services Administration. Concept of Trauma and Guidance for a Trauma-Informed Approach. Rockville, MD; 2014.

Hopper EK, Bassuk EL, Olivet J. Shelter from the storm: trauma-informed care in homelessness services settings. open Health Serv Policy J. 2010;3(1).

Machtinger EL, Cuca YP, Khanna N, Rose CD, Kimberg LS. From treatment to healing: the promise of trauma-informed primary care. Women’s Health Issues. 2015;25(3):193–7.

García-Moreno C, Hegarty K, d’Oliveira AFL, Koziol-McLain J, Colombini M, Feder G. The health-systems response to violence against women. Lancet. 2015;385(9977):1567–79.

Hegarty K, Bush R. Prevalence and associations of partner abuse in women attending general practice: a cross-sectional survey. Aust N Z J Public Health. 2002;26(5):437–42.

Australian Institute of Health and Welfare. Family, domestic and sexual violence in Australia 2018. Canberra; 2018.

Hegarty K, McKibbin G, Hameed M, Koziol-McLain J, Feder G, Tarzia L, et al. Health practitioners’ readiness to address domestic violence and abuse: a qualitative meta-synthesis. PLoS ONE. 2020;15(6):e0234067.

Hudspeth N, Cameron J, Baloch S, Tarzia L, Hegarty K. Health practitioners’ perceptions of structural barriers to the identification of intimate partner abuse: a qualitative meta-synthesis. BMC Health Serv Res. 2022;22(1):1–20.

Gunn JM, Palmer VJ, Naccarella L, Kokanovic R, Pope CJ, Lathlean J, et al. The promise and pitfalls of generalism in achieving the Alma-Ata vision of health for all. Med J Aust. 2008;189(2):110–2.

Jeffers H, Baker M. Continuity of care: still important in modern-day general practice. Br J Gen Pract. 2016;66(649):396–7.

Lynch JM, van Driel M, Meredith P, Stange KC, Getz L, Reeve J, et al. The craft of generalism clinical skills and attitudes for whole person care. J Eval Clin Pract. 2022;28(6):1187–94.

Lynch JM, Thomas HR, Askew DA, Sturman N. Holding the complex whole: generalist philosophy, priorities and practice that facilitate whole-person care. Australian J Gen Pract. 2023;52(7):428–33.

Green BL, Saunders PA, Power E, Dass-Brailsford P, Schelbert KB, Giller E, et al. Trauma-informed medical care: a CME communication training for primary care providers. Fam Med. 2015;47(1):7.

Green BL, Saunders PA, Power E, Dass-Brailsford P, Schelbert KB, Giller E, et al. Trauma-informed medical care: patient response to a primary care provider communication training. J Loss Trauma. 2016;21(2):147–59.

Gundacker C, Barry C, Laurent E, Sieracki R. A scoping review of trauma-informed curricula for primary care providers. Fam Med. 2021;53(10):843–56.

Lewis N, Bierce A, Feder G, Macleod J, Turner K, Zammit S et al. Trauma-informed approaches in primary healthcare and community mental healthcare: a mixed methods systematic review of system change interventions (TAPCARE study). 2022.

Hamberger LK, Barry C, Franco Z. Implementing trauma-informed care in primary medical settings: evidence-based rationale and approaches. J Aggress Maltreatment Trauma. 2019;28(4):425–44.

Veritas Health Innovation. Covidence systematic review software. Melbourne, Australia: Veritas Health Innovation; 2023.

Lumivero. NVivo (Version 14) 2020 [Available from: NVivo (Version 14).

Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol. 2008;8(1):1–10.

Critical Appraisal Skills Programme. CASP Qualitative Checklist 2018 [ https://casp-uk.net/images/checklist/documents/CASP-Qualitative-Studies-Checklist/CASP-Qualitative-Checklist-2018_fillable_form.pdf

Bergman AA, Hamilton AB, Chrystal JG, Bean-Mayberry BA, Yano EM. Primary care providers’ perspectives on Providing Care to women veterans with histories of sexual trauma. Women’s Health Issues. 2019;29(4):325–32.

Brooks M, Barclay L, Hooker C. Trauma-informed care in general practice:‘Findings from a women’s health centre evaluation’. Australian J Gen Pract. 2018;47(6):370–5.

Cullen P, Mackean T, Worner F, Wellington C, Longbottom H, Coombes J, et al. Trauma and violence informed care through decolonising interagency partnerships: a complexity case study of Waminda’s model of systemic decolonisation. Int J Environ Res Public Health. 2020;17(20):7363.

Browne AJ, Varcoe C, Lavoie J, Smye V, Wong ST, Krause M, et al. Enhancing health care equity with indigenous populations: evidence-based strategies from an ethnographic study. BMC Health Serv Res. 2016;16:1–17.

Hiratsuka VY, Moore L, Dillard DA, Avey JP, Dirks LG, Beach B, et al. Development of a screening and brief intervention process for symptoms of psychological trauma among primary care patients of two American Indian and Alaska native health systems. J Behav Health Serv Res. 2017;44:224–41.

Browne AJ, Varcoe C, Ford-Gilboe M, Nadine Wathen C, Smye V, Jackson BE, et al. Disruption as opportunity: impacts of an organizational health equity intervention in primary care clinics. Int J Equity Health. 2018;17:1–16.

Chung JY, Frank L, Subramanian A, Galen S, Leonhard S, Green BL. A qualitative evaluation of barriers to care for trauma-related mental health problems among low-income minorities in primary care. J Nerv Ment Dis. 2012;200(5):438.

Levine S, Varcoe C, Browne AJ. We went as a team closer to the truth: impacts of interprofessional education on trauma-and violence-informed care for staff in primary care settings. J Interprof Care. 2021;35(1):46–54.

Castellanos S, Cooke A, Koenders S, Joshi N, Miaskowski C, Kushel M, et al. Accounting for the interplay of interpersonal and structural trauma in the treatment of chronic non-cancer pain, opioid use disorder, and mental health in urban safety-net primary care clinics. SSM-Mental Health. 2023;4:100243.

Matthew A, Moffitt C, Huth-Bocks A, Ronis S, Gabriel M, Burkhart K. Establishing trauma-informed primary care: qualitative Guidance from patients and Staff in an Urban Healthcare Clinic. Children. 2022;9(5):616.

Green BL, Kaltman S, Frank L, Glennie M, Subramanian A, Fritts-Wilson M, et al. Primary care providers’ experiences with trauma patients: a qualitative study. Psychol Trauma: Theory Res Pract Policy. 2011;3(1):37.

van den Berk-Clark C, Gallamore R, Barnes J, Oberle A, Meyer D, Schneider FD. Identifying and overcoming barriers to trauma screening in the primary care setting. Families Syst Health: J Collaborative Family Healthc. 2021;39(2):177–87.

Rønneberg M, Mjølstad BP, Hvas L, Getz L. Perceptions of the medical relevance of patientsstories of painful and adverse life experiences: a focus group study among Norwegian General practitioners. Int J Qualitative Stud Health Well-being. 2022;17(1):2108560.

Reeves E. A synthesis of the literature on trauma-informed care. Issues Ment Health Nurs. 2015;36(9):698–709.

Hegarty K, Tarzia L, Rees S, Fooks A, Forsdike K, Woodlock D et al. Women’s input into a trauma-informed systems model of care in health settings: the WITH study-final report. 2017. Report No.: 192537260X.

Tarzia L, Bohren MA, Cameron J, Garcia-Moreno C, O’Doherty L, Fiolet R, et al. Women’s experiences and expectations after disclosure of intimate partner abuse to a healthcare provider: a qualitative meta-synthesis. BMJ open. 2020;10(11):e041339.

Kyei-Onanjiri M, Cameron J, Hegarty K, Tarzia L. Women’s experiences and expectations of intimate partner abuse identification in healthcare settings: a qualitative evidence synthesis. BMJ open. 2022;12(7):e058582.

Cocksedge S, Greenfield R, Nugent GK, Chew-Graham C. Holding relationships in primary care: a qualitative exploration of doctors’ and patients’ perceptions. Br J Gen Pract. 2011;61(589):e484–91.

Kuruppu J, Humphreys C, McKibbin G, Hegarty K. Navigating the grey zone in the response to child abuse and neglect in primary healthcare settings. Child Youth Serv Rev. 2023;150:107029.

Temple-Smith M, Hammond J, Pyett P, Presswell N. Barriers to sexual history taking in general practice. Aus Fam Physician. 1996;25(9 Suppl 2):S71–4.

CAS   Google Scholar  

Lennox NG, Diggens J, Ugoni AM. The general practice care of people with intellectual disability: barriers and solutions. J Intellect Disabil Res. 1997;41(5):380–90.

Elisseou S, Puranam S, Nandi M. A novel, trauma-informed physical examination curriculum for first-year medical students. MedEdPORTAL. 2019;15:10799.

Kuruppu J, Humphreys C, McKibbin G, Hegarty K. Tensions in the therapeutic relationship: emotional labour in the response to child abuse and neglect in primary healthcare. BMC Prim care. 2022;23(1):48.

Woolhouse S, Brown JB, Thind A. Building through the grief: vicarious trauma in a group of inner-city family physicians. J Am Board Family Med. 2012;25(6):840–6.

Murray M, Murray L, Donnelly M. Systematic review of interventions to improve the psychological well-being of general practitioners. BMC Fam Pract. 2016;17(1):1–14.

Wathen CN, Varcoe C. Trauma- & Violence-Informed Care (TVIC): A Tool for Health & Social Service Organizations & Providers. London, Canada; 2021.

Royal Australian College of General Practitioners. Abuse and violence - Working with our patients in general practice (The White Book). 5th ed. East Melbourne: RACGP; 2022 [2024 May 26]. https://www.racgp.org.au/getattachment/4ab6102c-67d9-4440-9398-a3ae759164ef/Abuse-and-violence-Working-with-our-patients-in-general-practice.aspx

Download references

Acknowledgements

This research was supported by the Royal Australian College of General Practitioners with funding from the Australian Government under the Australian General Practice Training Program, as well as by the National Health and Medical Research Council (NHMRC) through the Centre for Research Excellence in Safer Families (grant number 1116690).

Author information

Authors and affiliations.

Department of General Practice and Primary Care, University of Melbourne, Melbourne, VIC, Australia

Eleanor Bulford, Surriya Baloch, Jennifer Neil & Kelsey Hegarty

Department of General Practice, Monash University, Melbourne, VIC, Australia

Jennifer Neil

The Royal Women’s Hospital, Melbourne, VIC, Australia

Kelsey Hegarty

You can also search for this author in PubMed   Google Scholar

Contributions

EB and KH conceived the study. EB, SB, and JN performed the search, screening, and data extraction, with any disagreements about study inclusion resolved through discussion with KH. EB conducted quality appraisal and data analysis; SB, JN, and KH contributed to the interpretation of data. EB drafted the manuscript and KH, SB, and JN reviewed and edited it. All authors have reviewed and approved the final manuscript.

Corresponding author

Correspondence to Eleanor Bulford .

Ethics declarations

Registration and protocol.

This review was not registered. A formal review protocol was not prepared.

Ethics approval and consent to participate

Not applicable.

Consent for publication

Competing interests.

The authors declare no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Bulford, E., Baloch, S., Neil, J. et al. Primary healthcare practitioners’ perspectives on trauma-informed primary care: a systematic review. BMC Prim. Care 25 , 336 (2024). https://doi.org/10.1186/s12875-024-02573-4

Download citation

Received : 21 December 2023

Accepted : 16 August 2024

Published : 12 September 2024

DOI : https://doi.org/10.1186/s12875-024-02573-4

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Domestic violence
• Trauma-informed care
• Primary healthcare
• General practice

BMC Primary Care

ISSN: 2731-4553

• General enquiries: [email protected]