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Postgraduate Thesis: Determinants of resilience in patients with rheumatic disorders
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TitleDeterminants of resilience in patients with rheumatic disorders
 
AuthorsYoung, Man-chi.
楊敏智.
 
Issue Date2012
 
PublisherThe University of Hong Kong (Pokfulam, Hong Kong)
 
AbstractIntroduction 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.
 
AdvisorsChung, KF
 
DegreeDoctor of Philosophy
 
SubjectRheumatism - Patients - Rehabilitation.
Adjustment (Psychology)
 
Dept/ProgramPsychiatry
 
DC FieldValue
dc.contributor.advisorChung, KF
 
dc.contributor.authorYoung, Man-chi.
 
dc.contributor.author楊敏智.
 
dc.date.hkucongregation2012
 
dc.date.issued2012
 
dc.description.abstractIntroduction 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.description.naturepublished_or_final_version
 
dc.description.thesisdisciplinePsychiatry
 
dc.description.thesisleveldoctoral
 
dc.description.thesisnameDoctor of Philosophy
 
dc.identifier.hkulb4786965
 
dc.languageeng
 
dc.publisherThe University of Hong Kong (Pokfulam, Hong Kong)
 
dc.relation.ispartofHKU Theses Online (HKUTO)
 
dc.rightsThe author retains all proprietary rights, (such as patent rights) and the right to use in future works.
 
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License
 
dc.source.urihttp://hub.hku.hk/bib/B47869653
 
dc.subject.lcshRheumatism - Patients - Rehabilitation.
 
dc.subject.lcshAdjustment (Psychology)
 
dc.titleDeterminants of resilience in patients with rheumatic disorders
 
dc.typePG_Thesis
 
<?xml encoding="utf-8" version="1.0"?>
<item><contributor.advisor>Chung, KF</contributor.advisor>
<contributor.author>Young, Man-chi.</contributor.author>
<contributor.author>&#26954;&#25935;&#26234;.</contributor.author>
<date.issued>2012</date.issued>
<description.abstract>&#65279;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&#8217; 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&#8217; 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.</description.abstract>
<language>eng</language>
<publisher>The University of Hong Kong (Pokfulam, Hong Kong)</publisher>
<relation.ispartof>HKU Theses Online (HKUTO)</relation.ispartof>
<rights>The author retains all proprietary rights, (such as patent rights) and the right to use in future works.</rights>
<rights>Creative Commons: Attribution 3.0 Hong Kong License</rights>
<source.uri>http://hub.hku.hk/bib/B47869653</source.uri>
<subject.lcsh>Rheumatism - Patients - Rehabilitation.</subject.lcsh>
<subject.lcsh>Adjustment (Psychology)</subject.lcsh>
<title>Determinants of resilience in patients with rheumatic disorders</title>
<type>PG_Thesis</type>
<identifier.hkul>b4786965</identifier.hkul>
<description.thesisname>Doctor of Philosophy</description.thesisname>
<description.thesislevel>doctoral</description.thesislevel>
<description.thesisdiscipline>Psychiatry</description.thesisdiscipline>
<description.nature>published_or_final_version</description.nature>
<date.hkucongregation>2012</date.hkucongregation>
<bitstream.url>http://hub.hku.hk/bitstream/10722/161525/1/FullText.pdf</bitstream.url>
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