Background Research on coping with RA reflects the preponderance of women with the condition (70%). In other long term conditions research suggests men need their own health strategy.
Objectives To explore the experiences and coping styles of men with RA.
Methods Using Q-methodology (a qualitative and quantitative approach to grouping people according to subjective opinion) men with RA sorted 64 statements (generated in previous qualitative interviews) across a constrained distribution in ranked order of agreement and took part in interviews about their rationale for sorting the statements. Groups of patients with similar sort patterns (“factors”) were identified using centroid factor analysis with varimax rotation.
Results Thirty patients took part: mean age 64yrs (SD10.3); median (IQR) disease duration 5yrs (2-13); HAQ 0.75 (0.16-1.84); 67% DMARDs, 17% biologics. All patients ranked highly the importance of keeping themselves informed about their RA, especially regarding their medication. In the factor analysis a participant loading of ≥±0.32 reached significance at p<0.01 and 2 patient groupings explained 34% of the study variance and included 22 participants. Five of the patients' views were represented across both factors (confounded).
Factor A: Acknowledge, accept and adapt: “It is far easier to cope with it if you accept it”. These 14 patients acknowledge their limitations due to RA, but will not allow this to impact on their lives. They manage the impact of RA by adapting their activities to suit their RA and taking a flexible approach to life. Their ability to control other aspects of their lives (e.g. being in a job that allows autonomy) enables them to accept the loss of control that RA brings. They are therefore more willing to accept help from other people and will talk to people about their RA. Their mean (SD) age was 67yrs (10.1); median (IQR) disease duration 5yrs (2-13); HAQ 0.78 (0.25-1.50); 86% DMARDs, 7% biologics.
Factor B: Trying to match up to a macho ideal: “Men don't cry, you know this don't you?” These 8 patients feel angry and frustrated because of the limitations imposed by RA on their ability to continue their “normal” (pre-RA) life. They feel guilty about the impact this has on friends and family. This leads to internalised anger expressed both physically (pushing themselves to finish tasks, leading to more pain); and emotionally (self-criticism). These patients will not accept help from others, especially not strangers; and are not interested in talking to either friends, other men with RA or their medical team about their emotional well-being. Their mean (SD) age was 62yrs (12.3); median (IQR) disease duration 5yrs (5-22); HAQ 1.59 (0.84-2.25); 38% taking DMARDS, 50% biologics.
Conclusions Some men accept and adapt to RA, through negotiating loss of control. However, others fight the impact of RA, leading to further pain and internalised anger. As in other conditions, these male patients seem to be employing coping strategies not addressed by current interventions. Thus, a substantial proportion of male patients may have different support needs to women. Greater understanding of the potentially different needs of men is necessary to improve communication and inform the design of supportive interventions.
Disclosure of Interest C. Flurey Grant/research support from: Arthritis Research UK, S. Hewlett: None declared, K. Rodham: None declared, A. White: None declared, R. Noddings: None declared, J. Kirwan: None declared