Abstract
BackgroundThere is little prior research on the burden of arthritis in the developing world. We sought to document how patients with advanced arthritis living in the Dominican Republic are affected by and cope with their disease.MethodsWe conducted semi-structured, one-to-one interviews with economically disadvantaged Dominican patients with advanced knee and/or hip arthritis in the Dominican Republic. The interviews, conducted in Spanish, followed a moderator's guide that included topics such as the patients' understanding of disease etiology, their support networks, and their coping mechanisms. The interviews were audiotaped, transcribed verbatim in Spanish, and systematically analyzed using content analysis. We assessed agreement in coding between two investigators.Results18 patients were interviewed (mean age 60 years, median age 62 years, 72% women, 100% response rate). Patients invoked religious and environmental theories of disease etiology, stating that their illness had been caused by God's will or through contact with water. While all patients experienced pain and functional limitation, the social effects of arthritis were gender-specific: women noted interference with homemaking and churchgoing activities, while men experienced disruption with occupational roles. The coping strategies used by patients appeared to reflect their beliefs about disease causation and included prayer and avoidance of water.ConclusionsPatients' explanatory models of arthritis influenced the psychosocial effects of the disease and coping mechanisms used. Given the increasing reach of global health programs, understanding these culturally influenced perceptions of disease will be crucial in successfully treating chronic diseases in the developing world.
Highlights
There is little prior research on the burden of arthritis in the developing world
The objective of this study is to examine the illness experience of arthritis, including disease perceptions, physical and psychosocial effects of disease, and coping strategies of economically disadvantaged patients with advanced arthritis in the Dominican Republic, a society in which resources are scant, belief systems about disease differ from those of Western cultures, and gender roles are rigidly delineated [16]
While all citizens are covered by a public healthcare system, only basic healthcare needs are included in this plan and advanced treatments such as total joint replacements are generally not accessible to the poor
Summary
There is little prior research on the burden of arthritis in the developing world. We sought to document how patients with advanced arthritis living in the Dominican Republic are affected by and cope with their disease. Arthritis is a leading cause of pain, functional limitation and disability worldwide [1,2,3]. Little is known about the burden of arthritis in developing-world settings. A substantial body of research has illuminated ways in which patients in developed countries are affected by arthritis. Osteoarthritis (OA) and rheumatoid arthritis (RA) often lead to physical limitations and depression [4,5,6,7]. Women with OA tend to report more severe pain and functional limitation as compared to men with advanced disease [8].
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