title: Patient disease perceptions and coping strategies for arthritis in a developing nation: a qualitative study.
abstract: BACKGROUND
  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.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  18 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.
  
  
  CONCLUSIONS
  Patients' 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.
authors: Orthopedic and Arthritis Center for Outcomes Research, Brigham and Woman's Hospital, Boston, MA 02115, USA. Nina_Niu@hms.harvard.edu
authors: Nina N
authors: NN
authors: Niu
authors: Aileen M
authors: AM
authors: Davis
authors: Laura M
authors: LM
authors: Bogart
authors: Thomas S
authors: TS
authors: Thornhill
authors: Luis Alcantara
authors: LA
authors: Abreu
authors: Roya
authors: R
authors: Ghazinouri
authors: Jeffrey N
authors: JN
authors: Katz
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001168:Arthritis / Q000523:psychology*; D001294:Attitude to Health; D017281:Cost of Illness; D003906:Developing Countries; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010465:Perception; D011788:Quality of Life; D055815:Young Adult