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The relationship between healthcare workers' attachment styles and patient outcomes: a systematic review

Research output: Contribution to journalArticlepeer-review

Chizu Mimura, Ian J Norman

Original languageEnglish
Pages (from-to)332-343
Number of pages12
JournalInternational journal for quality in health care : journal of the International Society for Quality in Health Care / ISQua
Issue number5
Early online date21 Mar 2018
Accepted/In press15 Feb 2018
E-pub ahead of print21 Mar 2018
Published1 Jun 2018


King's Authors


Purpose: To examine whether attachment styles of healthcare workers influence the quality of their relationships with patients, or impact patients' health outcomes.

Data source: Literature database searches on the CINAHL, Cochrane Library, Embase, MEDLINE and PsyCinfo, and hand searching of reference lists of the retained articles.

Study selection: Original empirical studies reporting an analysis of the relationship of interest were selected for review.

Data extraction: Estimates of association between healthcare workers' attachment style and patients' health outcomes were extracted.

Results of data synthesis: Results from 13 studies were mixed in terms of which attachment styles related to patients' perceptions of care or health outcomes, and the evidence overall was of poor quality and methodologically heterogeneous. However, there is limited evidence that secure attachment styles of healthcare workers have little or a negative effect on patients' health outcomes or perceptions in the short term but in the long term have a more positive effect. Conversely, insecure styles tend to have a positive effect in the short term but little or a negative effect on long-term relationships. Studies which used self-report attachment measurements tended to report stronger associations with patients' outcome measurements than studies using the interviewer rated Adult Attachment Interview.

Conclusion: It is unclear whether or not there is a relationship between attachment style of health workers and patients' health outcomes. Further research using consistent data collection tools, especially in relation to the attachment measurement construct selected, and analysis methods across studies is required to draw recommendations for clinical practice.

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