title: Are illness perception and coping style associated with the delay between symptom onset and the first general practitioner consultation in early rheumatoid arthritis management? An exploratory study within the CareRA trial.
abstract: OBJECTIVE
  Persons who are later diagnosed with early rheumatoid arthritis (ERA) often delay their first contact with a health professional after symptom onset. Besides initial symptoms, psychosocial characteristics of individuals may influence their help-seeking behaviour. We explored the role of disease characteristics, illness perception, and coping in patient-related delay before treatment initiation in recently diagnosed patients with ERA.
  
  
  METHODS
  This exploratory, cross-sectional study included 112 patients with ERA from the Care for early RA (CareRA) trial for whom complete data on patient-related delay, coping, and illness perception were available. In addition to baseline sociodemographic and clinical data, the patients' psychosocial profiles were assessed with the Utrecht Coping List (UCL) and the revised Illness Perception Questionnaire (IPQ-R). Correlations were measured by Spearman's rho. Using regression analyses, we weighted the association of variables with patient-related delay.
  
  
  RESULTS
  Patient-related delay was positively correlated with perceptions of causality including psychological attributions (r = 0.301, p = 0.001), risk factors (r = 0.189, p = 0.045), immunity (r = 0.261, p = 0.005), and passive coping (r = 0.222, p = 0.018). It was negatively correlated with the 28 swollen joint count (SJC28; r = -0.194, p = 0.040), perceptions of treatment control (r = -0.271, p = 0.004), and illness coherence (r = -0.208, p = 0.028). Clinical and psychosocial variables explained 15% and 18%, respectively, of the variability in patient-related delay.
  
  
  CONCLUSIONS
  Aside from a lower SJC, a longer patient-related delay was correlated with a passive coping style, a strong conviction of symptom causality, poor expected treatment control, and a feeling of limited illness coherence. Psychosocial aspects influence individuals' help-seeking behaviour and are worth considering when aiming for a reduction in ERA treatment delay.
authors.affiliation: a Skeletal Biology and Engineering Research Centre, KU Leuven Department of Development and Regeneration , University of Leuven , Belgium.|b Department of Rheumatology , University Hospitals Leuven , Belgium.|c Centre for Health Services and Nursing Research, KU Leuven Department of Public Health and Primary Care , University of Leuven , Belgium.
authors.forename: K
authors.initials: K
authors.lastname: Van der Elst
authors.affiliation: a Skeletal Biology and Engineering Research Centre, KU Leuven Department of Development and Regeneration , University of Leuven , Belgium.
authors.forename: D
authors.initials: D
authors.lastname: De Cock
authors.affiliation: c Centre for Health Services and Nursing Research, KU Leuven Department of Public Health and Primary Care , University of Leuven , Belgium.
authors.forename: E
authors.initials: E
authors.lastname: Vecoven
authors.affiliation: a Skeletal Biology and Engineering Research Centre, KU Leuven Department of Development and Regeneration , University of Leuven , Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Arat
authors.affiliation: a Skeletal Biology and Engineering Research Centre, KU Leuven Department of Development and Regeneration , University of Leuven , Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Meyfroidt
authors.affiliation: b Department of Rheumatology , University Hospitals Leuven , Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Joly
authors.affiliation: c Centre for Health Services and Nursing Research, KU Leuven Department of Public Health and Primary Care , University of Leuven , Belgium.|d Institute of Health and Care Sciences , University of Gothenburg , Sweden.|e The Heart Centre , Copenhagen University Hospital , Denmark.
authors.forename: P
authors.initials: P
authors.lastname: Moons
authors.affiliation: a Skeletal Biology and Engineering Research Centre, KU Leuven Department of Development and Regeneration , University of Leuven , Belgium.|b Department of Rheumatology , University Hospitals Leuven , Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Verschueren
authors.affiliation: a Skeletal Biology and Engineering Research Centre, KU Leuven Department of Development and Regeneration , University of Leuven , Belgium.|b Department of Rheumatology , University Hospitals Leuven , Belgium.
authors.forename: R
authors.initials: R
authors.lastname: Westhovens
authors.lastname: CareRA Study Group
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000523:psychology; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D005260:Female; D058006:General Practice; D000066505:Help-Seeking Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology; D010465:Perception; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors