Adaptive coping with rheumatoid arthritis: the transforming nature of response shift.
OBJECTIVE
Qualitative investigations of patients' perspectives of coping can offer insights into a wide array of adaptive coping patterns selectively used to deal with illness-related challenges. The purpose of this qualitative study was to examine adaptive coping patterns reported by a sample of women with rheumatoid arthritis (RA).


METHODS
Using thematic analysis, interviews from 19 participants were analysed until theoretical saturation was achieved. The interviews were coded, with narrative excerpts collated within each code, sorted by codes into potential themes, and then collated within identified themes. These themes were then further defined, providing specific adaptive coping strategies for each major theme.


RESULTS
Major themes included accepting role limitations, reclaiming control, reframing their situation, and bolstering courage. Women described accepting more realistic performance standards, accepting their limitations and dependence on others, and altering their basis of self-worth. They reclaimed control of their lives by changing priorities, pacing themselves, being flexible, delegating to others, and setting appropriate boundaries. Reframing their situation enabled them to change their perspective, minimize threats from RA, re-prioritize their values, and find meaning and positive changes associated with their suffering. To bolster courage, they turned to a variety of sources for encouragement, including confidence from past successes, inspiring role models, and social support.


CONCLUSIONS
The data reflect adaptive strategies similar to response shift processes. A link between response shift processes and higher levels of perceived control is discussed.
Sinclair
Vaughn G
VG
Vanderbilt University School of Nursing, Nashville, TN 37240, USA. vaughn.sinclair@vanderbilt.edu
Blackburn
Donna S
DS
D000223:Adaptation, Psychological; D000328:Adult; D001172:Arthritis, Rheumatoid / Q000523:psychology* / Q000628:therapy; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy; D015331:Cohort Studies; D005260:Female; D015438:Health Behavior; D006801:Humans; D008875:Middle Aged; D036301:Qualitative Research; D012649:Self Concept; D012803:Sick Role; D016896:Treatment Outcome; D055815:Young Adult