title: The Use of Avoidance, Adjustment, Interaction and Acceptance Strategies to Handle Participation Restrictions Among Swedish Men with Early Rheumatoid Arthritis.
abstract: Living with a chronic disease means learning to live under new circumstances and involves a continuous adaptation to new ways of living. There is increasing knowledge about how people cope with stressful life events and adapt to new life situations. Approximately a third of patients diagnosed with rheumatoid arthritis (RA) are men; however, few studies have described the needs and experiences of men living with RA. The aim of the present study was to explore men's strategies for handling challenges related to participation in everyday life.
  
  
  
  The present study was associated with the prospective Swedish multicentre early arthritis project (given the Swedish acronym TIRA), which, in 2006-2009, included patients with early RA, contemporarily treated, with a mean disease duration of three years. From this cohort, 25 men, aged 20-63 years, were recruited consecutively. Data were collected in individual interviews, using the critical incident technique. The strategies for dealing with the challenges of RA in everyday life were analysed and categorized using content analysis.
  
  
  
  Men with RA described four types of strategy for dealing with participation restrictions in everyday life: (i) Adjustment strategies - adjust behaviour, movements, medication, equipment and clothing to find new ways to conduct tasks or activities; (ii) Avoidance strategies - avoid activities, movements, social contacts and sometimes medication; (iii) Interaction strategies - say no, ask for help and work together to handle participation restrictions; and (iv) Acceptance strategies - learn to accept RA, with the pain, the slower work pace and the extended time needed.
  
  
  
  According to men's lived experiences, a combination of strategies was used to deal with RA, depending on the situation and the experienced restriction. The results provided an understanding of how men with RA manage their disease, to reduce physical, social and emotional challenges. This knowledge may be used further to develop multi-professional interventions and patient education tailored to men with RA.
authors.affiliation: Division of Social Work, School of Health, Care and Social Welfare, Mälardalen University, Sweden.
authors.forename: Gunnel
authors.initials: G
authors.lastname: Östlund
authors.affiliation: Department of Rheumatology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Thyberg
authors.affiliation: Department of Activity and Health, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Valtersson
authors.affiliation: Department of Rheumatology and Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
authors.forename: Mathilda
authors.initials: M
authors.lastname: Björk
authors.affiliation: Department of Activity and Health, Department of Rehabilitation Medicine and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.|Department of Social and Welfare Studies, Social Work, Linköping University, Linköping, Sweden.
authors.forename: Sverker
authors.initials: S
authors.lastname: Annette
mesh_terms: D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000328:Adult; D001172:Arthritis, Rheumatoid / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012917:Social Adjustment; D055815:Young Adult
keywords: Male adaptation; chronic illness; coping; patient perspective