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postgraduate thesis: Determinants of resilience in patients with rheumatic disorders
Title | Determinants of resilience in patients with rheumatic disorders |
---|---|
Authors | |
Advisors | Advisor(s):Chung, KF |
Issue Date | 2012 |
Publisher | The University of Hong Kong (Pokfulam, Hong Kong) |
Citation | Young, M. [楊敏智]. (2012). Determinants of resilience in patients with rheumatic disorders. (Thesis). University of Hong Kong, Pokfulam, Hong Kong SAR. Retrieved from http://dx.doi.org/10.5353/th_b4786965 |
Abstract | Introduction
Rheumatic disease is an autoimmune disorder with an unpredictable course of
exacerbation and remission. There is no known cure for the disease at the moment.
The patients’ conditions may progressively deteriorate despite intensive therapies, and
runs an erratic course with the possibility of disfiguration and alteration in body
image. Pain, disabilities and psychological distress are common. Rheumatic patients
may respond differently to the same level of pain and physical symptoms. The
understanding of the needs of rheumatic patients and how they successfully manage
the disease and optimize psychological adjustment can help develop effective
psychosocial interventions.
Aims
The aims of the study are (1) to identify the needs of rheumatic patients and
perceptions of their disease, (2) to develop a conceptual framework for psychological
adjustment, and (3) to identify factors associated with resilience in rheumatic patients.
Methods
The present study consisted of two phases. The first phase was a focus group
interview, aiming to understand the patients’ feelings and to design a questionnaire.
The second phase was a prospective questionnaire survey that includes a baseline
study and a six-month follow-up study. Patients were recruited from support groups in
Hong Kong. The baseline questionnaire was self-administrated, and the follow-up
questionnaire was administrated by telephone interview. The self-regulation model
was chosen as the basis for the conceptual framework for psychological adjustment.
The questionnaire included demographics, illness representation, coping efforts,
appraisal of coping efforts, sense of coherence, quality of care, functional disability,
and health-related quality of life. The outcome measures were functional and
psychological health, change in adjustment, and positive and negative resilience.
Results
Having a good and caring doctor, more information on the disease, and public
understanding of the disease were the needs of rheumatic patients. The patients
perceived that the disease was chronic, cyclical, and had poor consequences. They
perceived that the disease caused great pain, stress, depression and anxiety, and
affected their daily activities, appearance, and relationship with family and friends.
Poor adjustment was associated with chronic and cyclical timeline, and poor
perception of personal and treatment control. The analysis of resilience shows that
positive perception of treatment control and disease consequence, correct
understanding of disease causes, and high sense of own value and importance to the
society, were protective. While those who lacked family support and blamed
themselves or their families to be the cause of disease, were vulnerable.
Discussion and conclusions
The present study lends support to the validity of self-regulation model in
psychological adjustment to disease, but coping efforts could only partially mediate
the relationship of illness representation to appraisal of coping efforts, implying that
the coping style might not sufficiently capture the underlying differences in individual
coping styles. An effective psychosocial intervention can be developed based on the
factors associated with better adjustment and resilience, and targeted at non-working
older patients with rheumatoid arthritis. Last but not least, support from the
community, and public understanding of the disease are important for rheumatic
patients. |
Degree | Doctor of Philosophy |
Subject | Rheumatism - Patients - Rehabilitation. Adjustment (Psychology) |
Dept/Program | Psychiatry |
Persistent Identifier | http://hdl.handle.net/10722/161525 |
HKU Library Item ID | b4786965 |
DC Field | Value | Language |
---|---|---|
dc.contributor.advisor | Chung, KF | - |
dc.contributor.author | Young, Man-chi. | - |
dc.contributor.author | 楊敏智. | - |
dc.date.issued | 2012 | - |
dc.identifier.citation | Young, M. [楊敏智]. (2012). Determinants of resilience in patients with rheumatic disorders. (Thesis). University of Hong Kong, Pokfulam, Hong Kong SAR. Retrieved from http://dx.doi.org/10.5353/th_b4786965 | - |
dc.identifier.uri | http://hdl.handle.net/10722/161525 | - |
dc.description.abstract | Introduction Rheumatic disease is an autoimmune disorder with an unpredictable course of exacerbation and remission. There is no known cure for the disease at the moment. The patients’ conditions may progressively deteriorate despite intensive therapies, and runs an erratic course with the possibility of disfiguration and alteration in body image. Pain, disabilities and psychological distress are common. Rheumatic patients may respond differently to the same level of pain and physical symptoms. The understanding of the needs of rheumatic patients and how they successfully manage the disease and optimize psychological adjustment can help develop effective psychosocial interventions. Aims The aims of the study are (1) to identify the needs of rheumatic patients and perceptions of their disease, (2) to develop a conceptual framework for psychological adjustment, and (3) to identify factors associated with resilience in rheumatic patients. Methods The present study consisted of two phases. The first phase was a focus group interview, aiming to understand the patients’ feelings and to design a questionnaire. The second phase was a prospective questionnaire survey that includes a baseline study and a six-month follow-up study. Patients were recruited from support groups in Hong Kong. The baseline questionnaire was self-administrated, and the follow-up questionnaire was administrated by telephone interview. The self-regulation model was chosen as the basis for the conceptual framework for psychological adjustment. The questionnaire included demographics, illness representation, coping efforts, appraisal of coping efforts, sense of coherence, quality of care, functional disability, and health-related quality of life. The outcome measures were functional and psychological health, change in adjustment, and positive and negative resilience. Results Having a good and caring doctor, more information on the disease, and public understanding of the disease were the needs of rheumatic patients. The patients perceived that the disease was chronic, cyclical, and had poor consequences. They perceived that the disease caused great pain, stress, depression and anxiety, and affected their daily activities, appearance, and relationship with family and friends. Poor adjustment was associated with chronic and cyclical timeline, and poor perception of personal and treatment control. The analysis of resilience shows that positive perception of treatment control and disease consequence, correct understanding of disease causes, and high sense of own value and importance to the society, were protective. While those who lacked family support and blamed themselves or their families to be the cause of disease, were vulnerable. Discussion and conclusions The present study lends support to the validity of self-regulation model in psychological adjustment to disease, but coping efforts could only partially mediate the relationship of illness representation to appraisal of coping efforts, implying that the coping style might not sufficiently capture the underlying differences in individual coping styles. An effective psychosocial intervention can be developed based on the factors associated with better adjustment and resilience, and targeted at non-working older patients with rheumatoid arthritis. Last but not least, support from the community, and public understanding of the disease are important for rheumatic patients. | - |
dc.language | eng | - |
dc.publisher | The University of Hong Kong (Pokfulam, Hong Kong) | - |
dc.relation.ispartof | HKU Theses Online (HKUTO) | - |
dc.rights | The author retains all proprietary rights, (such as patent rights) and the right to use in future works. | - |
dc.rights | This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. | - |
dc.source.uri | http://hub.hku.hk/bib/B47869653 | - |
dc.subject.lcsh | Rheumatism - Patients - Rehabilitation. | - |
dc.subject.lcsh | Adjustment (Psychology) | - |
dc.title | Determinants of resilience in patients with rheumatic disorders | - |
dc.type | PG_Thesis | - |
dc.identifier.hkul | b4786965 | - |
dc.description.thesisname | Doctor of Philosophy | - |
dc.description.thesislevel | Doctoral | - |
dc.description.thesisdiscipline | Psychiatry | - |
dc.description.nature | published_or_final_version | - |
dc.identifier.doi | 10.5353/th_b4786965 | - |
dc.date.hkucongregation | 2012 | - |
dc.identifier.mmsid | 991033516189703414 | - |