Exploring meanings of illness causation among those severely affected by multiple sclerosis: a comparative qualitative study of Black Caribbean and White British people.
BACKGROUND
Illness attributions, particularly for those living with life limiting illnesses, are associated with emotional adjustment or psychological distress. Few studies have examined attributions among people severely affected by multiple sclerosis (PwMS), and specifically among from diverse communities. This study aimed to explore and compare the presence and construction of meanings among Black Caribbean and White British PwMS.


METHODS
Cross sectional qualitative interviews were conducted among Black Caribbean (BC) and White British (WB) PwMS with an EDSS of ≥6.0 (severe disease). Data were analysed using the framework approach.


RESULTS
15 BC and 15 WB PwMS were interviewed. Attributions were complex with most PwMS reporting multiple explanations. Uncertainty, represents the first theme surrounding the aetiology of MS where participants constantly rehearsed the "why me?" question in relation to their illness, a number expressing considerable frustration. The second theme, 'logical and scientific', was voiced more often by WB PwMS and accounts for a range of genetic/viral influences, stress, environmental and lifestyle factors. Third, the 'supernatural' illness attribution theme departs from a biomedical perspective and was reported often among BC PwMS. This theme included the sub-categories of tests of faith and divine punishment, a view although exclusive to BC participants but was sometimes in conflict with notions of modernity.


CONCLUSIONS
Our findings identify evidence of cross-cultural and intra-group diversity in relation to MS causation. A greater professional awareness of the processes used by PwMS from diverse communities to make sense of their situation will enable health care professionals to facilitate effective support for those in their care and channel relevant psychosocial resources to them. This requires heightened skills in communication and cultural competency.
King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, Bessemer Road, London, SE5 9PJ, UK. jonathan.koffman@kcl.ac.uk.
Jonathan
J
Koffman
King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, Bessemer Road, London, SE5 9PJ, UK. cassiegoddard558@hotmail.com.
Cassie
C
Goddard
King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, Bessemer Road, London, SE5 9PJ, UK. wei.gao@kcl.ac.uk.
Wei
W
Gao
King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, Bessemer Road, London, SE5 9PJ, UK. diana.m.jackson@kcl.ac.uk.
Diana
D
Jackson
Department of Neurology, King's College Hospital NHS Foundation Trust, SE5 9RS, London, UK. pauline.shaw@nhs.net.
Pauline
P
Shaw
King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, Bessemer Road, London, SE5 9PJ, UK. rachel.burman@nhs.net.
Rachel
R
Burman
King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, Bessemer Road, London, SE5 9PJ, UK. irene.higginson@kcl.ac.uk.
Irene J
IJ
Higginson
Department of Neurology, King's College Hospital NHS Foundation Trust, SE5 9RS, London, UK. esilber@doctors.org.uk.
Eli
E
Silber
D000328:Adult; D000368:Aged; D044383:Black People / Q000523:psychology*; D017691:Caribbean Region / Q000208:ethnology; D003430:Cross-Sectional Studies; D004777:Environment; D005006:Ethnicity / Q000523:psychology*; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D007407:Interviews as Topic; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000208:ethnology* / Q000523:psychology*; D012067:Religion; D012720:Severity of Illness Index; D006113:United Kingdom / Q000453:epidemiology; D044465:White People / Q000523:psychology*