itsthiswholepicture,thiswell-being.patientsunderst.docVIP

“It’s this whole picture, this well-being.” Patients’ understanding of ‘feeling well’ with rheumatoid arthritis. Objectives The aim of this study was to explore the meaning of ‘feeling well’ for people with rheumatoid arthritis (RA). Methods In-depth interviews were conducted with 23 RA patients, purposively sampled for medication type, disease duration, disease activity, age, and gender. Data were analysed using Framework, emphasising participants’ personal context. Results Well-being was viewed as a broad concept, with ‘feeling well’ being the result of an on-going process to actively engage with a changing body, self and life. Four dimensions emerged: ‘Living in the body’, ‘Being in the mind’, ‘Adapting to illness’, and ‘Being in the world’. The physical impact of RA underpinned the global perception of well-being and was clearly described as linking to the experience of psychological well-being. Physical and psychological wellness was often affected by individual’s adaptation to RA and personal context (e.g. home environment, broader social attitudes). Discussion Well-being is a multi-dimensional concept that is meaningful to RA patients regardless of medication type and disease severity. Patients commonly illustrated a process of actively engaging in cognitive and behavioural adjustments to move towards wellness. Clinical practice and research must take account of the complexity of well-being in long term conditions, in order to fulfil patients’ expectations. Keywords Adaptation, Patient perspective, Qualitative, Rheumatoid arthritis, Well-being, Introduction Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease, causing swollen, painful joints, and characterised by fluctuating inflammatory activity.1 The long term prognosis is highly varied among individuals, and although an overall trend of progressive disability was previously reported,2 recent studies of aggressive early treatment with combination medications show th