Control perceptions in patients with rheumatoid arthritis: the role of social support

Self-management support needs of patients with inflammatory arthritis and the content of self-management interventions: a scoping review

BACKGROUND

Self-management skills can empower a person to manage the physical, psychological, and social impact of a health condition. However, the components of self-management interventions differ widely between studies and interventions. By performing a scoping review, we aimed to describe patients' self-management needs and how health professionals (HPs) can provide effective self-management support to patients with inflammatory arthritis (IA).

OBJECTIVES

1) to identify the evidence for self-management support needs of patients with IA, and 2) to identify the content (theory/theoretical approach, mode of delivery, duration and frequency) of self-management interventions that target patients with IA.

METHODS

In May 2021, we performed a systematic literature search (from 2000 onward) in five databases (CINAHL (Ebsco), Cochrane Library, Embase (Ovid), Medline (Ovid) and PsycINFO (Ovid)) regarding self-management in patients with IA.

RESULTS

Out of 11,748 records identified, we included 31 articles describing patients' support needs and 33 articles describing the content of self-management interventions. Patients' support needs were sorted into six topics: 1) disease impact and the pharmacological treatment, 2) care continuity and relations with HPs, 3) the importance of non-pharmacological treatment, 4) the need for support from family and friends, 5) support needs related to work issues, and 6) contextual preferences for self-management support. The theory/theoretical approach, mode of delivery, duration and frequency varied widely and were often unclearly or insufficiently described. In addition, the self-management concept was scarcely - or not - defined in the included articles. The identified topics for support needs were compared with the described content in the included articles. Only a few self-management interventions focused on patients' need for support in relation to work, and to family and friends.

CONCLUSION

HPs provided self-management support to patients with IA in various ways, but there were gaps between the patients' support needs and the identified interventions. In developing self-management interventions, the self-management concept needs to be defined and a clear theory is required to support the development of the intervention. Future studies should seek to investigate various modes of delivery, frequency and duration, to develop effective interventions that meet patients' support needs.

Factors associated with perceived control and the relationship to quality of life in patients with heart failure

BACKGROUND AND PURPOSE

Health-related quality of life (HRQOL) is as important as survival to patients with heart failure (HF). Perceptions of loss of control are common in HF and negatively affect HRQOL. Knowledge of modifiable factors associated with perceived control could guide the development of interventions to improve perceived control and thus HRQOL. Accordingly, this study examined factors related to perceived control and the relationship between perceived control and HRQOL.

METHODS

Patients (N=232, mean age 61 ± 12, 67% male, 78% Caucasian) provided data on HRQOL (Minnesota Living with Heart Failure questionnaire), perceived control (Control Attitudes Scale-Revised), and factors possibly associated with perceived control (knowledge and barriers (Heart Failure Knowledge and Barriers to Adherence Scale), attitudes (Dietary Sodium Restriction Questionnaire), and social support (Multidimensional Scale of Perceived Social Support)). Patients also provided data on depressive symptoms, which were a covariate of HRQOL. Hierarchical multiple regression analysis was used to analyze the data.

RESULTS

Fewer barriers to following a low sodium diet, more positive attitudes toward following a low sodium diet, and better social support were related to higher perceived control (F=7.54, R(2)=0.17, p<0.001). Perceived control was independently associated with HRQOL, controlling for depressive symptoms, New York Heart Association functional class, age, gender, and all variables possibly associated with perceived control (F=29.67, R(2)=0.55, p<0.001).

CONCLUSIONS

Interventions targeting attitudes and barriers to a low sodium diet and social support may improve perceived control and, in turn, HRQOL.

Exploring the healthcare journey of patients with rheumatoid arthritis: a mapping project - implications for practice

OBJECTIVE

Consumers of healthcare can reveal important insights into the personal challenges they experience when negotiating their health needs. The National Rheumatoid Arthritis Society (NRAS) wanted to explore the experiences of those with rheumatoid arthritis (RA) in order to understand the impact on the individual and on healthcare resources and benchmark care against published standards and guidelines.

METHODS

A project was designed to explore the experiences of individuals with sero-positive RA who had been diagnosed for three years or less. Qualitative semi-structured interviews were used and combined with process mapping to explore the experiences of a purposeful sample of individuals with RA. The information generated was mapped and variances explored. Ethical approval was not required as the data were collected outside the National Health Service.

RESULTS

Twenty-two participants' stories were mapped. Fifty per cent of participants sought a medical opinion within three weeks of symptom onset and the majority received a disease-modifying anti-rheumatic drug within six months from first presenting symptoms. Work-related issues were highlighted by 13 participants, and seven of these experienced job losses directly attributed to their diagnosis.

CONCLUSIONS

This unique mapping approach used qualitative research and process mapping to compare patient experiences against recognized standards and guidelines. These twenty-two stories reveal important insights into the challenges experienced in negotiating these healthcare journeys and the impact upon the individual as a result of variances in standards of care received. The participants in this study were chiefly self-motivated, informed and articulate, and did not reflect the broad ethnic, social or cultural diversity in the UK. Limitations must also be considered in relation to perceptions and recall of participants over a three-year period, as these may have altered over time and illness experience.

The health and life experiences of mothers with rheumatoid arthritis: a phenomenological study

BACKGROUND

In our varied roles as health care professionals and researchers, many women with rheumatoid arthritis (RA) have commented to us about their feelings of inability to cope with everyday tasks, especially within their role as mothers.

AIMS

This study explored the health and life experiences of mothers with RA in order to increase knowledge about this group of women and inform health care professionals who provide them with support before and after becoming a mother.

METHODS

A phenomenological approach was adopted, and individual face-to-face semi-structured interviews were carried out with a sample of seven women, aged 21-41 years, who had lived with RA for 3-11 years and had one or more children under five years of age (total range of ages being 1-7 years). The data were analysed using Colaizzi's procedural steps.

RESULTS

The five major themes that emerged were inner strength, depression, labelling, failure, and pre- and post-natal education. Sub-themes included issues such as putting on a brave face, spirituality, guilt, burden, feeling 'robbed of motherhood', isolation, coping methods and lack of information.

CONCLUSIONS

This in-depth study informs health care professionals for their role as support provider for mothers with RA. Further research needs to be carried out to include multicultural experiences, which may or may not differ. As a step forward, we have implemented a local support group for mothers with RA, which will hopefully add benefit to existing rheumatology, midwifery and health visiting services.

A nurse-led rheumatology clinic's impact on empowering patients with rheumatoid arthritis: A qualitative study

The aim of this study was to describe a nurse-led rheumatology clinic's impact on empowering patients with rheumatoid arthritis (RA). Rheumatoid arthritis is a chronic, inflammatory disease that attacks many joints, causing considerable functional restrictions for patients. Consequently, these patients are dependent on a wide variety of health-care services. A descriptive, qualitative design inspired by phenomenography was chosen. The conceptions were collected through interviews with 16 strategically selected patients with RA. Three descriptive categories comprising eight conceptions emerged: teaching (gaining insight and receiving information), regular review (receiving security, realizing regularity, and achieving accessibility), and attention (getting a holistic assessment, receiving coordinated care, and getting sufficient time). A nurse-led rheumatology clinic can be a source for empowering patients with RA to adopt new stances to alternative actions and achieve a higher level of faith in their own abilities.