Men's Experiences of Rheumatoid Arthritis: An Inductive Thematic Analysis

RESEARCH ARTICLE

Men’s Experiences of Rheumatoid Arthritis: An InductiveThematic AnalysisSarah Lack1 DClinPsych, Bristol Doctorate in Clinical Psychology, Robert Noddings2 PRP &Sarah Hewlett3* PhD, MA, RN, arc Professor of Rheumatology Nursing

1Plymouth University, Plymouth, UK2Bristol Royal Infirmary, Bristol, UK3University of the West of England, Bristol, UK

Abstract

Objectives. There is a lack of evidence for understanding the clinical needs of men with rheumatoid arthritis (RA).

This study investigated the psychosocial experience of this group, to inform clinical practice and generate further

research.

Methods. Twelve adult male patients with RA were interviewed once. Interview data were analysed using an

inductive thematic analysis procedure. Categories and themes were validated by a second researcher and a male RA

patient research partner.

Results. Four themes were generated: loss of power and control; use of power and control; adjustment; influencing

factors (age, pain, medication, relationships and health staff communication). Loss of power and control left

participants vulnerable to low mood. Participants asserted power and control over RA by adopting a problem‐

solving stance in order to continue with ordinary life. An accepting attitude characterized the adjustment theme

where men respected their bodies’ limits. The final theme consisted of factors which influenced these three themes.

Discussion. These data suggest that when RA results in loss of personal power and control, patients experience

distress, which they may not express to their clinicians. Findings indicate directions for further research

investigating the possibility that men and women may have differing clinical needs. Copyright © 2011 John Wiley &

Sons, Ltd.

Keywords

Coping; gender; rheumatoid arthritis

*Correspondence

Professor Sarah Hewlett, Academic Rheumatology, Bristol Royal Infirmary, Bristol, BS2 8HW, UK.

Email: [email protected]

Published online 1 March 2011 in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/msc.203

Introduction

Rheumatoid arthritis (RA) is an autoimmune disease

resulting in chronic and destructive joint inflammation.

Despite recent advances in medical treatment for RA,

including anti‐tumour necrosis factor drugs, the

experience of RA still involves living with symptoms

such as joint pain and fatigue (National Institute for

Health and Clinical Excellence, 2007). The psychosocial

implications of these symptoms are similar to those of

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other chronic illnesses: reduced ability to work, carry

out physical tasks and maintain social roles and

relationships, and increased risk of depression (Lempp

et al., 2006). The biopsychosocial model currently

dominates RA research (Cieza and Stucki, 2005; Walker

et al., 2004). Additionally, a ‘biographical disruption’ of

assumptions, behaviours and self‐concept has been

widely applied in the sociology of chronic illnesses such

as RA (Bury, 1982). Most recently, such biographical

concepts have been adapted to be seen within the

Musculoskelet. Care 9 (2011) 102–112 © 2011 John Wiley & Sons, Ltd.

Lack et al. Men’s Experiences of RA

context of the symptoms experienced and adjustment

processes, including different types of normalization

of symptoms and illness (Sanderson et al., 2011).

RA is three times more common in women and

there appears to be a less severe course in men

(Forslind et al., 2007). Qualitative research methods

are appropriate for exploring the subjective experience

of RA, and a literature search for these (Medline, Web

of Science, PsychInfo, the National Research Register

databases, 1980–2010) revealed a strong focus on

women’s experiences of RA and an absence of studies

on men, perhaps reflecting the greater clinical demand

to date. Studies of women with RA often suggest that

new ways of fulfilling role responsibilities and

prioritizing activities can reduce depression (Plach

et al., 2004; Shaul, 1995). Age also affects the prevalence

and severity of depression among women with chronic

illnesses (such as RA or heart disease): older women are

more likely to experience the physical limitations of

chronic illness as consistent with the ageing process,

and therefore report fewer depressive symptoms than

younger women (Plach et al., 2003, 2005).

While investigations into the biopsychosocial factors

in coping with RA tend to assume no gender

differences or to focus only on women, women report

higher levels of depression and more severe physical

symptoms, and health professionals rate women as

more disabled than men (Mann and Dieppe, 2006;

Newth and Delongis, 2004).

One qualitative study exploring men’s identity

dilemmas compared interview data from chronically

ill men and women with conditions such as heart

disease, kidney disease, arthritis, diabetes and multiple

sclerosis (Charmaz, 1994). Results suggested that in

order to cope, men behaved in ways which embodied

characteristics from hegemonic masculinities, such as a

problem‐solving stance, bravery and an emphasis on

power and autonomy. When chronic illness hindered

such enactments of masculinities, this increased the

risk of severe depression; grief over loss of physical

ability turned into long‐term depression when men

could no longer carry out their most valued physical

actions (Charmaz, 1994).

Masculinities

Masculinities and femininities are the ways that men

and women position their gender identities, often

through behaviour. Gender identities are fluid, multiple


and flexible, depending on background, class, sexual

orientation and social change; men and women may

embody and exhibit both masculinities and femininities

(Connell, 1995). Hegemonic masculinity is a term

which describes society’s currently ‘most honoured’way

of being a man. For example, it is argued that, in

Western culture at least, the dominant discourse of what

it is to be masculine is ‘tough, independent, unemo-

tional, physically competent, mentally strong and

aggressive’ (Connell, 1995). Hegemonic masculinity

theory is relevant in health research for understanding

how men may counteract feelings of powerlessness in

the face of chronic illness, or develop strategies for

coping by utilizing masculine characteristics (Connell

and Messerschmidt, 2005).

Concepts of coping and adjustment

Literature on coping with chronic illness often defines

coping within the cognitive appraisal theory of stress,

where coping includes problem‐focused strategies for

taking action to deal with a stressor and emotion‐

focused strategies for managing the emotions evoked

by a stressor (Lazarus and Folkman, 1984). Coping

theory has been criticized for implying that an

endpoint is reached, contrary to evidence that living

with illness involves a transitional process of adjust-

ment, continually influenced by patients’ ever‐changing

disease and life circumstances (Brennan, 2001).

To date, our understanding of men’s psychosocial

experience of RA is based on studies which assume no

gender difference or which focus only on women. There

is no evidence for which psychosocial interventions may

aid men in coping with RA or howmen cope with RA in

everyday life. Research into the experience of daily

events and fatigue in adults with RA has revealed gender

differences, but whether masculinities influence how

men cope with and adjust to RA has not yet been

explored (Davis et al., 2010.) The current study aimed to

address these questions, to extend current knowledge of

men’s psychosocial experiences of RA and to reveal

implications for clinical practice.

Methods

Subjects

Qualitative data were gathered in single, semi‐structured

interviews (mean time of one hour) with 12 adult men

with RA who were patients of one rheumatology unit.

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Table 1. Demographic data of 12 male patients with RA

Participant Gender Age (years) Disease duration (years) Relationship status Occupation

A M 78 7 Married Director

B M 46 20 Married Director

C M 63 36 Married Manager

D M 67 55 Married Sales

E M 59 1.5 Married Health

F M 55 10–15 Widowed Entertainment

G M 56 35 In a relationship Director

H M 38 2 Married Manager

I M 60 8 Married Academic

J M 64 7 Married Transport

K M 61 4 Divorced Construction

L M 47 10 Married + young children Transport

Men’s Experiences of RA Lack et al.

Participants were purposefully selected to obtain a range

of age, disease duration, disability, treatment type,

employment and marital status (Table 1). Recruitment

packs containing an introductory letter, participant

information sheet, reply‐slip and pre‐paid reply enve-

lope were sent to 18 male patients currently attending

clinics. Six patients did not wish to participate.

Recruitment ended when no new themes were identified

in analysis, corresponding with recent research into data

saturation (Guest et al., 2006).

Procedures

Interviews were conducted in clinical or research

rooms at a hospital rheumatology department. Partici-

pants were asked open‐ended questions to encourage

them to recount in detail their subjective experience of

living with RA (Table 2). Interview questions were

generated from previous qualitative research exploring

the impact of chronic illness and refined after

Table 2. Interview schedule

1. Can you tell me a little bit about yourself?

2. What was life like before you had RA?

3. What did it feel like when you found out you had RA?

4. What, if anything, has changed since RA?

5. Do you perceive yourself to have any outward, physical signs of RA?

6. If RA was a person, what sort of relationship do you have with that

person?

7. Has RA changed the way important people in your life view or treat

you?

8. Can you describe any goals, hopes or wishes for the future you have?

104

consultation with a male RA patient research partner

(PRP) (Hewlett et al, 2006). With the aim of collecting

data that might reveal information about masculine

identities and coping strategies, follow‐up and experi-

ence questions such as ‘Can you tell me a little more

about that?’ and ‘What was that like for you?’ were also

asked (Crossley, 2000).

Data analysis

Interviews were audio‐recorded, transcribed verbatim,

including all the interviewer’s interjections, and made

anonymous. Interview data were analysed using the

inductive thematic analysis procedure, appropriate for

investigating a diversity and range of experiences, as

described by Braun and Clarke (2006). A realist

approach was adopted, whereby patients’ experiences

were taken at face value; it was assumed that patients

were reporting the truth about their subjective

experiences (Hayes, 2000). The researcher engaged in

reflective note‐taking during all stages of the study, in

order to record and acknowledge any effect of possible

researcher bias or society’s discourses on data collec-

tion and analysis. Transcripts were read, re‐read and

coded line‐by‐line. Ideas which recurred across the

entire dataset or which represented an important idea

in relation to the research questions were identified as

categories. As each new category was identified,

previous transcripts were re‐examined for relevant

material. The analysis was exhaustive, in that 72% of

the data were allocated to at least one category. A

second researcher validated 66% of the categories from

analysing two randomly selected transcripts (18% of



the data). Finally, data were systematically reviewed to

ensure that a label, definition and exhaustive set of data

to support each category were identified. A third,

independent researcher and the male PRP validated

the groupings of categories and themes in their

structural hierarchy.

Ethical approval

Independent ethical approval from the North Somerset

and South Bristol Research Ethics Committee and

written consent from participants were obtained.

Results

Analysis of the 12 interview transcripts resulted in 44

categories, naturally grouped into four themes: i) Loss

of power and control, ii) use of power and control,

iii) adjustment and iv) factors which influenced sense of

power and control or adjustment (contact the authors

for a full list of categories). The themes are shown in

Figure 1, accompanied by categories selected according

to their clinical relevance and supported by data from at

least 25% of participants.

InfluencingFactors

Adjustment

Use of power and control

Medication Response offrom wife friends/family

Living with RA is about problem-solving Practical solutions help me stay in control I am mentally strong Understanding my RA helps me stay in control RA is not in charge of me RA will not defeat me I hide my symptoms It is easier to accept my limitations as due to old age than to RA

I have learnt to live withArthritis is part of who IIt is important to learn yI accept the limitations bI am positive about lifeRA has had some positiv

Understanding

Figure 1 The four themes of men’s experiences of RA and relevant ca


Loss of power and control

This theme typically revealed men’s emotional distress

as a result of loss of physical ability and strength:

‘I flew off the handle ’cause I couldn’t do it. I can’t

help it – I just get so irritable. I know I can do it,

but I can’t, you know?’ (Patient K)

and

‘I’d pick up a nine gallon barrel of beer and walk

up a flight of 15 stairs and not worry about it. But

going from that to not being able to pick up a cup

of tea… Well, you’re thinking, “What the hell?!”

You feel totally useless’ (Patient L).

Some men described their depressive thoughts and

symptoms as a result of RA:

‘I’m at the lowest point I’ve ever been in my life. I

was confident before… I just don’t want to see

Loss of power and

control

Diseaseprogress

It is terrible to lose physical ability

RA ruined my life

RA forced me to give up/change my job

Before I got RA I led an active life

I have lost some social roles

I have lost my social life

It is humiliating when RA takes away your independence

I hate it if RA makes me look or feel weak

I do not like how RA has changed my appearance

RA is in charge of me

RA has limited my life choices and goals

RA am

our limits rought by RA

e effects on my life

Communication Pain from health staff

tegories

105


anyone these days. And talking about myself now, it

feels like I could burst into tears at any moment. I

feel like a right let‐down’ (Patient H).

Most participants were forced to give up work or to

change jobs

‘I loved that job. But it got too much for me… and

they said they thought it was time to call it a day’

(Patient E).

Being unemployed or unable to fulfil other roles with

social status signified loss of power for men:

‘I’m not as much of a man as I was. Because I’m

not out there earning my own money’ (Patient L)

and

‘As a cricket captain, you have to be able to play

cricket, don’t you? So I had to give that up’

(Patient D).

RA can make men feel weak:

‘Someone said, “Are you alright? You’re walking in

a funny way”, and my hips were bad and I was

feeling really weak and pretty pathetic’ (Patient F).

Furthermore, appearing weak was a humiliating

experience for men:

‘I was up there in the car trying to get out for about

10 minutes and I just couldn’t move. And this chap

came up and said, “Do you want a hand?” And I

said, “No, I’ll be alright”, and I felt a right idiot’

(Patient K).

This led some to avoid social contact:

‘I couldn’t bear it if anyone saw me where I can’t

walk or I can’t get up’ (Patient H).

Loss of independence due to RA was also experienced

as humiliating:

‘Sometimes the wife had to put me socks on! Like I

said, I wouldn’t wish it on nobody’ (Patient J).

Appearance concerns due to RA also exposed partici-

pants to feelings of weakness:

106

‘Most of the time I’d have me hands in the pocket

or under the table. I don’t want to advertise the

fact. I don’t want people’s sympathy’ (Patient D).

One participant with a rigidity in his right hand would

not shake hands at a business meeting:

‘We needed to have a hard conversation and so the

last thing I wanted was to feel weak by spearing the

guy in the hand and having to apologise to him in

the first two seconds’ (Patient B).

Many participants felt that RA controlled them at

times:

‘I wanna do it. The mind is willing and wanting to

do it. But it’s the body that’s not allowing me to’

(Patient L).

Asking for help was associated with relinquishing

control:

‘It’s only recently that I’ve said to people, “Oh,

would you just do that for me?” In the past I’ve

always struggled with that – it shows you’ve given

in’ (Patient C).

RA influenced men’s life choices, such as whether or

not to have children:

‘…to be honest, to a certain extent, whether I pass

the arthritis on… I’m not sure whether that had a

bearing on it or not but I’ve never really had the

thought of having a family’ (Patient G)

and

‘I’ve never ever felt well enough to have kids! … I

felt too ill, I couldn’t have looked after anyone else’

(Patient H).

Additionally, some men’s life goals could not be

fulfilled due to RA:

‘I can’t emigrate to Australia because I’ve got

arthritis’ (Patient G)

and

‘I planned to do the re‐wiring [in the new house]

myself… That was going to be my stamp on the



house… But I just couldn’t do it, which was

gutting’ (Patient H).

The significance of these losses was highlighted when

participants reminisced about their former lifestyles:

‘I had two jobs which I did and sleep was for

wimps! I was fit. As a postman, I ran. I never

walked, I ran’ (Patient C)

and competencies:

‘I knew sort of 99% about everything in the firm. If

someone didn’t turn up through illness and I

couldn’t get anyone else, I’d go in and fill in the

gap’ (Patient D).


A second theme portrays how participants used

masculinity to ‘be a man’ about dealing with RA:

‘I’ve never ever lost a day of work due to

arthritis… I have never ever got up in the morning

and said, “I can’t go to work today”, because of

arthritis’ (Patient C).

Most participants also believed that mental strength

helped them:

‘You need resilience and robustness’ (Patient B)

and

‘I thought to myself, “No, you gotta get over it!”’

(Patient J).

Similarly, many participants used fighting talk such as,

‘I’m not gonna let it beat me’ (Patient A)

to claim that RA would not defeat them. These

participants also seemed to blame any limitations on

their age rather than on RA:

‘I do have a lot of aches and pains, but as does

almost everyone over the age of 60… I’m physically

a lot less active than I was, but I think that is

possibly an age thing’ (Patient I).


A problem‐solving stance was depicted in this theme as

a means for staying in control:

‘Everything can be done if it’s thought about’

(Patient D)

and if nothing else:

‘…you can sublet the worry to somebody else,

that’s how you manage a company, isn’t it? So I

manage the house like that’ (Patient A).

Understanding their RA helped participants stay in

control:

‘I know my limits and some days are better than

others so I know whether I can keep going or not’

(Patient G).

However, the admissions that RA imposes such limits

somewhat undermined men’s demonstration of power

and control over RA. This was illustrated when

participants described hiding their symptoms in order

not to ‘lose face’:

‘I don’t know what’s preferable – them thinking

I’m in a bad mood or them knowing that I’m

suffering’ (Patient D).

Adjustment

A theme of adjustment was characterized by a more

reflective and accepting attitude in men’s descriptions

of RA:

‘I’ve learnt that I really only have about three

hours in the day to get anything done’ (Patient

I)‘You’ve definitely got to listen to your body…

don’t push it, just listen’ (Patient L)‘You’re not

going to get rid of it so you’ve gotta learn to live

with it. You’ve got to accept your condition’

(Patient D).

A few participants felt that RA was:

‘part of what I am’ (Patient B)

or

‘a way of life for me’ (Patient C).

107


Many more explained how they were engaged in an

ever‐changing process of :

‘…reacting and adapting. There are some days

where I can do certain things more easily than

other days’ (Patient F).

Men gave positive statements about life with RA and

explicitly referred to their emotions:

‘How you judge how good a life you’ve had is

about what makes you happy, really. I’m happy

with what I have’ (Patient G).

RA had benefited one man’s whole life:

‘I’m quite glad I got it… it stopped me doing things

which were unhealthy… I mean it is bad for you to

work 110 hour weeks… so I’m always quite glad

that I had to stop… it made me become, in the best

sense, introspective and reflective’ (Patient B).

Influencing factors

The final theme represents six factors reported by

participants to influence their experience of RA: the

effect of medication; the level of pain experienced;

perceived understanding from partner; the response of

family and friends; communication from health staff;

and progression of RA due to age. Medication could

have dramatic effects:

‘…after my first injection… I was doing things I

hadn’t done for three or four years and it was quite

emotional actually’ (Patient F)

and negligible effects:

‘I didn’t really notice any change… But being used

to just living with the pain all the time, you just

forget’ (Patient H).

Unsurprisingly, pain was usually associated with less

ability to cope:

‘It’s just miserable, you feel tired and it’s painful…

You’re in the pit and the sides are steep and slippy’

(Patient C).

Participants’ ability to deal with their RA depended on

understanding from their partners, families and

108

friends. Messages received from health staff were also

important:

‘The doctor was very good… he understood. That’s

important. Me members of family don’t under-

stand. He praised me up!’ (Patient D)

or conversely:

‘They kept putting me in a wheelchair… It just

seemed out of proportion because I could walk

around fine… Before that I never really worried

about whether I would end up in a wheelchair or

not’ (Patient G).

Progression of RAwith age was a concern for somemen:

‘My father’s got rheumatoid arthritis and he’s in a

wheelchair and I just felt like I was going to go

down that road’ (Patient E).

Discussion

Summary of main findings

These data suggested that RA influenced masculinities

by threatening participants’ sense of power and control

over their own lives, leaving them vulnerable to low

mood. However, participants also mobilized their

masculinities (their sense of power and control), as a

means of coping with RA by using problem‐solving

strategies. Finally, participants seemed to depart from

their masculinities as part of the adjustment process,

characterized by an acceptance of RA. Participants

in this study felt simultaneously in control of,

controlled by and accepting of RA, depending on

the context and the current influencing factors,

including age, the level of pain experienced, the impact

of medication, the quality of current relationships and

the response of health professionals.

Contrary to general beliefs in coping literature that

men adopt mainly problem‐solving strategies, this

study suggests that men’s experiences of RA include

both practical and emotional issues, depending on

external and internal influences.

Relation to theories

Participants in this study revealed their masculinities

when describing their experiences of RA which



challenged or highlighted their sense of power and

control. Participants often framed RA as a problem

requiring problem‐focused strategies (Patient A hired a

gardener when such work was no longer possible for

him) or emotion‐focused strategies (for Patient J, the

thought of wanting to be strong for his much‐loved

grandchildren distracted him from his negative

thoughts). This approach maps clearly onto stress

appraisal coping theory. Masculinities seemed to be

utilized when participants wanted to hide their RA

symptoms to maintain the appearance of physical

strength or to prove their mental strength. They

attributed RA symptoms to old age in an attempt to

legitimize physical weakness. Such responses to their

condition correspond with previous masculinity re-

search and literature on men with chronic illness

which stresses that personal power and control have a

high value for men (Connell, 1995; Connell and

Messerschmidt, 2005).

The six factors specifically identified by participants

to influence their ability to cope with or adjust to RA

reflect previous RA coping literature which has

suggested that patients’ disease status, use of social

support and perception of how well their RA was being

medically managed correlates with mood and adjust-

ment (Curtis et al., 2004). Future clinical practice may

benefit from research comparing men’s and women’s

response to RA, access to treatment and experience of

helpful and unhelpful aspects of spousal relationships

or social support.

Clinical implications

Challenging some participants’ purported power and

control over RA was the finding that all experienced

RA as highly distressing at some point. Feelings of

humiliation and worthlessness associated with phys-

ical incompetence and lack of control were described,

threatening participants’ masculinities. Similarly, in a

previous study, men denied that testicular cancer

affected their masculinities but simultaneously

expressed concern that cancer could lead to unem-

ployment and therefore loss of status, financial

income, power and control: all key issues in terms

of masculinity (Moynihan, 1998). According to

cognitive behavioural therapy, beliefs which corre-

spond to this type of behaviour such as ‘emotional

expression should be avoided’ present obstacles for

coping (Moorey, 2002).


The participants’ affinity with hegemonic masculi-

nities gave rise to further clinical implications. Such

ideals may inhibit male patients from disclosing the

psychological impact of RA and encourage behaviour

which signals that they do not need support.

Healthcare professionals may collude with these ideals;

staff may omit to ask men about the negative impact of

RA or may ask in a way which assumes no difficulties,

in order to avoid acknowledging a man’s difficulty in

coping. Therefore, to provide equal access to services

for men and women with RA, health professionals

should not expect men to live up to hegemonic

masculinities. Health education and promotion mate-

rials should be worded to challenge the idea that asking

for support signifies weakness. This requires sensitivity

when men’s inexpressiveness is a way of maintaining

control; expecting men to express themselves ‘like

women’ could add to men’s distress.

Participants’ descriptions of adjusting to RA

signified an attitude of acceptance and ‘dropping the

fight’. In adjusting, some men found an approach to

living with RA which seemed to lack concerns about

masculinity. It may indicate that a psychological

intervention such as acceptance and commitment

therapy, which uses behaviour change strategies to

increase psychological flexibility, could benefit men

who feel disempowered by RA (Hayes et al., 1999).

Relation to literature on women

The current study illustrates processes which may

account for claims made in previous research that men

may be more vulnerable than women to isolation as a

result of chronic illness because they are less likely to

seek medical help when ill (Wuest, 2000). Participants

avoided actions which could evoke feelings of vulner-

ability, such as sharing their concerns with others or

revealing their physical disability.

Participants used words associated with depression,

such as ‘useless’ and ‘stuck’ to describe their feelings

about loss of social roles. According to feminist

literature, men are more likely to place a higher value

on their paid and other roles outside of the home and

less likely than women to seek peer support (Moynihan,

1998). Therefore, men who lose their employment or

other social roles may be more vulnerable to depression

than are women with similar losses. To explore this

claim and to highlight any gender difference in the

clinical need of patients with RA, a replication of this

109


study on women may be useful. However, the current

study indicates a use for research into the efficacy of

psychosocial interventions in chronic illness care and

supports an individualized approach to interventions,

where patients set their own goals based on their own

most valued roles and activities (Backman, 2006).

Strengths and limitations

Although participants were purposefully selected to

reflect a range of ages, disease durations and

medication types, the data may have been influenced

by cohort effects due to the sample being skewed

towards white British, married men in their 50s and

60s. The data reflected equal concern with masculinity

issues in older and younger participants but the study

was unable to explore any effect of lower social power

due to ethnic background or the different experiences

of single versus married men. Additionally, the effect of

class or wealth on the experience of RA was not

discussed. However, results still offered substantial

evidence of their difficulties relating to RA.

Strengths of the study include the validation of

categories and themes by independent researchers and

the PRP involvement, informing the interview schedule

and ideas for discussion. Suggestions made by the male

PRP were answered, within the aims of the study. All

participants were current patients of an NHS rheuma-

tology department and therefore it is likely that these

study findings are relevant to clinical settings in the UK.

Conclusion

The findings of this study indicate high levels of

distress experienced by the participants, linked to

perceived loss of personal power and control which

may have been undetected in routine clinical practice.

There is scope for further research into male and

female patients with RA to investigate whether gender

identities may result in patients hiding their symptoms

or vulnerabilities from clinicians and to what extent

this may influence the level of care they receive.

Masculinities and femininities are likely to be part of

how patients experience their illnesses, mobilize coping

strategies and embark on or be hindered in the process

of adjustment. Therefore, this study demonstrates that

issues of power and emotional distress may be

unspoken by men with RA but need to be elicited

and addressed in clinical practice. Further research is

110

required to identify helpful ways of supporting men’s

adjustment process.

Acknowledgements

We are grateful to all those patients who participated in

this research.

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111

Appendix 1The number of participants represented in each category, followed by the number of segments of text relatingto each category across the entire dataset is presented in brackets after each category below.

Loss of power and control

due to RA


to live with RA

Adjustment Influencing factors

It is terrible to have lost

physical ability and strength

due to RA (12; 54)

Living with RA is all about

problem‐solving (11; 39)

I have learnt to live

with RA (10; 43)

How well my

medication or

treatment works

(12; 43)

RA ruined my life (11; 35) I am mentally strong (9; 71) I accept the limitations

brought by RA (10; 35)

The level of pain

I have (5; 17)

RA forced me to give up work

or change my job (11; 27)

Understanding my RA helps

me stay in control (10; 31)

It is important to learn

your limits (10; 32)

Understanding from

my partner (11; 19)

It is frustrating and humiliating

when RA takes away your

independence (10; 38)

I hide my RA and the severity

of my symptoms from other

people (9; 32)

I am positive about

life (8; 35)

The response of my

family and friends

(10; 34)

I do not like how RA has

changed my appearance (10; 34)

My achievements show that

RA is not in charge of me

(7; 23)

RA has had some

positive effects on

my life (3; 17)

What health staff

communicate

with me (9; 19)

I hate it when RA makes me

feel or look weak (10; 24)

Practical solutions help

me stay in control (9; 22)

Arthritis is part of

who I am (3; 5)

The possible

progression of my

RA due to age (9; 21)

RA has limited my life choices

and goals (3; 9)

RA will not defeat me (8; 35)

I have lost some important

social roles due to RA (6; 12)

It is easier to accept my

limitations as due to old

age than due to RA (5; 8)

I have lost my social life due

to RA (6; 14)

RA will not change me or

my life (9; 26)

Before I got RA I led an active

life (8; 12)

I am not a patient (6; 19)

RA is in charge of me (7; 17) Living with RA means you

have to put extra effort into

everything you do (6; 15)

I can’t play sport any more

because of RA (5; 9)

Pushing myself to do regular

exercise helps to keep my RA

at bay (5; 12)

I am a patient (8;19) I have RA because of the way

I used to live my life (5; 10)

The reasons why I might

have got RA were beyond

my control (5; 6)

I have always been resilient

(9; 21)

RA has changed me (9; 16) I haven’t let RA stop me

playing sports completely (3; 3)

Due to RA I can’t take the

holidays or travel abroad the

way I’d planned to (3; 7)

It is sad that I can’t get down

on the floor to play with/look

after my children/grandchildren

(3; 4)


112 Musculoskelet. Care 9 (2011) 102–112 © 2011 John Wiley & Sons, Ltd.

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Men's Experiences of Rheumatoid Arthritis: An Inductive Thematic Analysis