Background Heterogeneity in adaptation to arthritis can partly be explained by difficulties with attaining goals in several domains of life. Pursuing goals is important for wellbeing, but when goals become threatened or unattainable this may lead to dissatisfaction and depressive symptoms. Goal management strategies are ways to minimize the perceived distance between the actual and preferred situation with regard to personal goals. Previous cross-sectional research related higher levels of goal management strategies to lower levels of distress and higher levels of wellbeing1. Studies focusing on change over time in goal management and its relation with adaptation are lacking.
Objectives To examine the natural course of adaptation to polyarthritis, patterns of goal management and their interrelations longitudinally.
Methods A questionnaire study with three measurements over a year time was employed. Changes over time were analysed with ANOVAs. Cluster analysis was used to identify subgroups with different patterns of goal management (goal maintenance, goal adjustment, goal disengagement and goal reengagement) at baseline. Longitudinal relationships between the subgroups and adaptation (depression, anxiety, purpose in life, positive affect, and social participation) were analysed using generalized estimating equations analyses.
Results Participants were 331 patients with polyarthritis (61% women, 29% working, mean age 62 years, mean disease duration 14 years, 58% Rheumatoid Arthritis). The course of adaptation remained stable over time. Three patterns were identified; “Moderate engagement” (44%), “Broad goal management repertoire” (35%), and “Holding on” (21%). “Holding on” included high goal maintenance and low levels of the other strategies. The “Holding on” pattern was identified as the most unfavourable in terms of successful adaptation; patients with this pattern had the highest levels of anxiety and depression and the lowest levels on positive adaptation outcomes. “Moderate engagement” included high goal disengagement, average goal reengagement and low levels of both other strategies. Patients scored significantly lower on depression and anxiety and had more purpose in life compared to the “Holding on” cluster. “Broad goal management repertoire” included high levels of goal maintenance, goal adjustment and goal reengagement and average goal disengagement. Patients with the “Broad goal management repertoire” pattern had the highest level of successful adaptation; they scored significantly lower on depression and anxiety and higher on the positive adaptation outcomes compared to both other clusters. Over time, stable differences in levels of adaptation were found between the patterns.
Conclusions This study was the first that revealed patterns of several goal management strategies and their relationship to adaptation. Patients who were able to use a variety of strategies revealed clearly better coping with the challenges and difficulties associated with a chronic disease. Psychosocial support for arthritis patients with difficulties in adaptation should focus on the flexible use of different ways to deal with threatened goals.
Arends RY, Bode C, Taal E and Van de Laar MAFJ (2013). The role of goal management for successful adaptation to arthritis. Patient Educ Couns 93(1): 130-138
Disclosure of Interest None declared
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.