University of Twente Student Theses


Fatigue in rheumatoid arthritis (RA): the role of illness perceptions and coping : a qualitative study

Thieler, I. (2015) Fatigue in rheumatoid arthritis (RA): the role of illness perceptions and coping : a qualitative study.

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Abstract:Introduction: Besides pain, patients with rheumatoid arthritis (RA) commonly experience fatigue as a symptom. Remarkably, individual differences in felt severity/impact of fatigue exist among RA patients. Therefore the aim of this study was to further increase our understanding of differences between more and less tired RA patients by investigating the relationship between illness perceptions (incl. self-efficacy beliefs), coping and perceived severity/impact of RA fatigue. Method: 14 patients participated in the study. By use of semi-structured in-depth interviews, information about coping and illness perceptions was gathered. The severity/impact of RA fatigue was measured with the BRAF-MDQ. An interpretative phenomenological analysis approach was used to generate a mixed top-down and bottom-up coding scheme. The data was analyzed according to this scheme in ATLASti. Next, based on the median of the total score of the BRAF-MDQ the patients were split into two groups (more/less tired). Group-trends in the data were identified by comparing the interviews of each group for similarities and differences in illness perceptions and coping behavior. Results: The two groups differed in their cognitive representation of fatigue. Both of them reported a great number and variety of physical symptoms. In contrast to less tired patients, more tired patients also reported more and various emotional symptoms, tended to distinguish between different types of fatigue and tended to perceive more and severe consequences. Moreover, they mostly held chronic timeline and causal beliefs, while those of the less tired patients tended to be episodic. Interestingly, both groups had strong self-efficacy beliefs but the more tired group frequently experienced an actual lack of control due to their fatigue. Both groups had a broad repertoire of coping strategies. However, the more tired group was more rigid, delayed, and context-independent in the application of coping strategies, and had a general preference for repressing symptoms associated with fatigue. Their appraisal of repression as effective seemed to be due to non-health related reasons. Two of the more tired patients represented special cases, in a sense that they were tired despite a tendency towards adaptive coping. Discussion: Findings of the analysis point towards the importance of psychological factors when it comes to RA fatigue. Concerning the successful adaption to fatigue, the findings suggest that it is the dynamic interplay between illness perceptions and coping behavior, which is important. This puts forth the advice of taking into account RA patient’s illness perceptions as well as coping behavior when developing interventions for fatigue. The developed heuristical model can serve as a source for hypothesis for future research. In addition, future research should examine the adaptability/maladaptability of coping behavior and the role of RA patients´ self-concepts with reference to individual differences in felt severity/impact of fatigue.
Item Type:Essay (Bachelor)
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:77 psychology
Programme:Psychology BSc (56604)
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