Living with rheumatoid arthritis : the coping, control and knowledge
This study was designed to investigate psychological factors involved in the adjustment to Rheumatoid Arthritis (RA). In particular, the study examined perceptions of control over daily symptoms, knowledge of RA and the use of coping strategies, and looked at how these factors related to emotional adjustment, clinical disease activity and subjective physical functioning in RA outpatients. The study also aimed to determine aspects of RA which patients perceived as most stressful. The main study was cross-sectional and designed in two parts. The first part was a quantitative design in which 50 participants completed questionnaires to assess perceptions of RA stressors; health locus of control beliefs over RA symptoms; levels of RA-related knowledge; coping strategies used; emotional adjustment and physical functioning. An objective measure of disease activity was also taken. The second part was a qualitative design consisting of semi-structured interviews with 14 participants, exploring perceptions of stress, control, knowledge, coping and adjustment. Quantitative data were statistically analysed and compared with previous research findings. Qualitative data were transcribed into predefined themes and compared with the quantitative data. Results showed that participants consistently rated fatigue and disability as the most stressful aspects of RA. Participants reported more symptoms of anxiety than depression and used a wide range of coping strategies. Quantitative data suggested that participants perceived high levels of chance control over their daily RA symptoms, however, qualitative findings did not support this view. Participants knew most about RA-related issues that were directly relevant to them. Significant associations were found between coping strategies and psychological outcome, particularly for positive affect. Associations were also found between maladaptive coping and positive physical adjustment and between adaptive coping and negative physical adjustment. Adaptive coping strategies were associated with `internal' and `doctor' locus of control and increased knowledge. Few associations were found between outcome and either control or knowledge. Regression analyses found coping strategies to account for some of the variance in outcome variables, particularly positive affect. The implications for clinical practice were considered. Methodological limitations of the study and implications for future research were also discussed.