Development of Resilience Among Rheumatoid Arthritis Patients: A Qualitative Study

Abstract

Objective Resilience, the ability to recover from and adapt successfully to stressful situations, is a valuable resource for patients who live with chronic conditions. This qualitative study examines the development of resilience among rheumatoid arthritis (RA) patients. We aimed to describe the resilience development process and to describe strategies used by patients to cultivate resilience. Methods Our approach combined ethnographic data collection and narrative analysis methods. Semistructured interviews were conducted with adult RA patients in the US. Interviewees were asked to discuss their experiences with diagnosis, living with RA, coping with challenges, treatment, and health care providers. The interviews were audiorecorded, transcribed, and analyzed to describe the stages of resilience development and to identify patients’ strategies for building/maintaining resilience. Results Eighteen patients were interviewed, ages 27–80 years and with RA duration of 5–41 years. Patient responses to challenging situations were grouped into 3 stages: 1) lacking capacity to handle the situation, 2) struggling but growing in capacity to handle the situation, and 3) attaining mastery. Patients used 10 strategies to cultivate resilience: perseverance, exchanging social support, pursuing valued activities, flexibility, positive reframing, acceptance, humor, avoiding threatening thoughts, equanimity, and maintaining a sense of control. Conclusion RA patients acquire resilience in a dynamic process of learning in response to new challenges. Patients use a combination of behavioral and emotion management strategies to cultivate resilience. Awareness of these strategies may benefit patients, health care providers, and researchers developing behavioral interventions and social support programs in the context of RA and other chronic diseases.

Living with arthritis: a “training camp” for coping with stressful events? A survey on resilience of arthritis patients following the COVID-19 pandemic

“…In this context, an even higher psychological distress may be expected in patients with chronic rheumatic diseases, fuelled by the patients' perception of increased susceptibility to infection arising from the vulnerability associated with the chronic condition itself, the use of immunosuppressive disease-modifying anti-rheumatic drugs (DMARDs) and the difficulty in attending routine visits. On the other side, as suggested by previous research, patients with autoimmune diseases may develop stronger resilience as an adaptive response to the chronicity of their condition [7,8] and be therefore equipped with more effective coping strategies to deal with an unexpected stressful experience such as the ongoing COVID-19 pandemic [9]. On the light of this background, we aimed to investigate the levels of resilience of patients affected by inflammatory arthritis living in Emilia Romagna, the third hardest-hit Italian region during the ongoing COVID-19 pandemic.…”

The experience of living with rheumatoid arthritis: A qualitative metasynthesis

“…Findings from 21 studies (Ahlmen et al., 2005; Bergström et al., 2019; Carr et al., 2003; Feldthusen, Bjork, Forsblad‐d'Elia, & Mannerkorpi, 2013; Flurey, Morris, Richards, Hughes, & Hewlett, 2014; Flurey et al., 2018; Iaquinta & Larrabee, 2004; Josefsson & Gard, 2010; Lack, Noddings, & Hewlett, 2011; Lempp, Scott, & Kingsley, 2006; Lyyra & Heikkinen, 2006; Nikolaus, Bode, Taal, & van de Laar, 2010; Orbai, Smith, Bartlett, De Leon, & Bingham, 2014; Oshotse, Zullig, Bosworth, Tu, & Lin, 2018; Ostlund et al., 2014; Plach, Stevens, & Moss, 2004; Repping‐Wuts, Uitterhoeve, van Riel, & van Achterberg, 2008; Shaw et al., 2020; Squire, 2012; Stamm et al., 2008; Sverker, Thyberg, Ostlund, Waltersson, & Thyberg, 2014) were considered for synthesis and are summarised in Table 1.…”

“…Differences in terms of relationships with healthcare systems were found between studies from the first retrieval (2000–2017) and those from the second retrieval (2018–2020). In fact, three out of four studies retrieved in the second period of research (Bergström et al., 2019; Oshotse et al., 2018; Shaw et al., 2020) pointed out a new interpretation of the relationship with the healthcare system. In fact, these authors proposed a different interpretation of the relationship between healthcare systems and patients with RA.…”

“…The authors reported that the care relationship itself (in terms of positive communication, support of patients' independence and control over the disease, etc.) is a treatment tool that can promote resilience and psychological well‐being (Shaw et al., 2020), self‐efficacy in terms of adaptation to the new life situation, adherence to treatment and independent adjustment of medication (Oshotse et al., 2018) and engagement of patients' significant others in the care process and everyday life activities (Bergström et al., 2019).…”

“…Shaw et al. (2020) highlighted that behavioural strategies (exchanging social support, flexibility, pursuing valued activities, etc.) and emotional regulation strategies (acceptance, equanimity, managing sense of control, etc.)…”