Exploring Protective Factors Against Adverse Childhood Experiences in Primary Care: A Systematic Review Based on Ungar's Socio-Ecological Resiliency Model

Abstract

Adverse childhood experiences (ACEs) profoundly impact physical and mental health throughout one's lifespan. While research reports on the assessment of ACEs in primary care (PC), less is known about protective factors – crucial for fostering resilience. Using Ungar’s Socio-ecological resilience model, this systematic review investigated how protective factors are assessed within PC screening for ACEs and their potential to influence patient/health outcomes. PubMed, PsycINFO, and CINAHL from database inception were searched up until September 30, 2022. The study included research without language or country restrictions. A comprehensive search strategy across multiple databases yielded 764 initial studies. Following duplicate removal and a two-stage review process with the inter-rater agreement (Cohen's κ = .583, .677), 27 articles met the inclusion criteria. Screened for ACEs, patients were also assessed for at least one protective factor. Studies varied widely in the specific protective factors that were measured. Based on Ungar’s model of resilience, individual factors such as relationships, identity, and power/control were frequently assessed, in addition to community/social factors such as cohesion, material resources, and social justice. Only two articles meaningfully addressed cultural adherence. These findings reveal potential gaps in understanding how certain protective factors may promote better biopsychosocial-spiritual health for patients in PC settings, especially within diverse cultural contexts. This review highlights the need for PC research to broaden its focus on a wider spectrum of protective factors, addressing their potential to mitigate the effects of ACEs. It underscores the importance of Ungar's Socio-ecological model for its comprehensiveness yet calls for more culturally sensitive assessment tools and interventions. Understanding which protective factors are most potent within PC settings could enable targeted support and optimize patient health outcomes.