Background
Methods
Q-Methodology
Materials
Statements (Q-set)
Q-sort grids and statement cards
Participants
Methods
Analysis
Factor extraction and rotation
Factor interpretation
Results
Presentation of results
ID | Dis Dur (yrs) | HAQ | Pt Global | Med | In Flare? | Daily life factor | Daily life factor load | Flare factor | Flare factor load |
---|---|---|---|---|---|---|---|---|---|
P1
| 7 | 1.38 | 2.2 | Biologic | No | A | 0.48 | X | 0.86 |
P2
| 36 | 2.38 | 6.7 | NSAIDs | No | A | 0.70 | Did not load | - |
P3
| 23 | 2.63 | 2.6 | Biologic | Yes | A | 0.55 | X | 0.70 |
P4
| 16 | 2.63 | 2.3 | Biologic | No | A | 0.52 | X | 0.89 |
P5
| 32 | 2.25 | 2.6 | Steroids | No | A | 0.51 | Did not complete | - |
P6
| 31 | 1.50 | 4.0 | Biologic | No | A | 0.59 | X | 0.62 |
P7
| 14 | 1.38 | 1.5 | Biologic | No | A | 0.52 | Did not complete | - |
P8
| Unknown | 0.00 | 0.5 | Biologic DMARDs | No | B | 0.70 | X | 0.86 |
P9
| 40 | 2.25 | 6.9 | DMARDs | No | B | -0.50 | Y | -0.72 |
P10
| 27 | 0.50 | 4.3 | DMARDs | No | B | -0.46 | X | 0.78 |
P11
| 4 | 1.63 | 4.7 | DMARDs Steroids | No | B | -0.70 | X | 0.58 |
P12
| 2 | 2.00 | 5.4 | Biologic DMARDs | No | B | -0.54 | X | 0.57 |
P13
| 5 | 0.63 | 6.7 | DMARDs | Yes | B | -0.46 | Y | -0.63 |
P14
| 25 | 2.13 | 5.5 | Biologic Steroids | No | B | -0.54 | X | 0.60 |
P15
| 2 | 0.75 | 7.9 | Steroids | No | B | -0.85 | X | 0.76 |
P16
| 17 | 2.14 | 1.0 | Biologic DMARDs | No | B | -0.42 | Did not load | - |
P17
| 9 | 0.38 | 1.2 | Biologic | Yes | C | -0.52 | X | 0.90 |
P18
| 6 | 0.00 | 0.3 | Steroids | No | C | -0.42 | Y | -0.71 |
P19
| 1 | 0.125 | 1.3 | DMARDs | No | C | -0.67 | Did not load | - |
P20
| 16 | 0.88 | 3.4 | Biologic | No | C | -0.44 | X | 0.78 |
P21
| 30 | 0.62 | 2.3 | No medication | No | C | -0.63 | Y | -0.60 |
P22
| 3 | 0.00 | 1.9 | DMARDs | No | C | -0.48 | Did not load | - |
P23
| 4 | 1.25 | 1.5 | Biologic | No | C | -0.59 | X | 0.67 |
P24
| 20 | 2.50 | 5.0 | DMARDs | No | Did not complete | - | X | 0.81 |
P25
| 30 | 0.88 | 0.3 | Biologic | No | Did not load | - | X | 0.55 |
P26
| 12 | 0.75 | 2.0 | DMARDs | No | Did not load | - | X | 0.76 |
P27
| 18 | 1.57 | 3.6 | DMARDs | Yes | Did not load | - | Y | -0.70 |
P28
| 13 | 2.30 | 5.0 | DMARDs | Yes | Did not load | - | Y | -0.59 |
P29
| 4 | 3.00 | 2.0 | DMARDs Steroids | No | Did not load | - | Did not load | - |
P30
| 11 | 1.13 | 1.7 | DMARDs | No | Did not load | - | Did not load | - |
P31
| 14 | 0.75 | 1.5 | DMARDs | No | Did not load | - | Did not load | - |
Overall mean (SD)
|
15.7 (11.3)
|
1.4 (0.9)
|
3.2 (2.1)
|
Factor | Eigenvalue | % variance explained | Gender | Age (yrs) | Dis Dur (yrs) | HAQ | Pt Global | Summary |
---|---|---|---|---|---|---|---|---|
Daily life study (n = 30)
| n/a | n/a | 73.3% f | 54.6 (11.8) | 15.2 (11.3) | 1.3 (0.9) | 3.2 (2.2) | |
26.7% m | ||||||||
Daily Life Factor A (n = 7)
| 3.29 | 11% | 85.7% f | 61.7 (10.3) | 22.7 (10.8) | 2.0 (0.6) | 3.1 (0.7) | Patients ‘take active control’, they use effective self-management strategies, which they have developed through experience, they have become experts in managing their RA and they know what works for them. They take a practical approach to managing their RA, using preventative rather than crisis management techniques. They are predominantly female, older, with longer disease duration and more disabled. |
14.3% m | ||||||||
Daily Life Factor B (n = 9)
| 3.97 | 13% | 25.0% f | 54.9 (7.1) | 15.3 (14.3) | 1.3 (0.9) | 4.8 (2.5) | |
75.0% m | ||||||||
Factor B- (n = 8)
| n/a | n/a | 37.5% f | 55.5 (7.3) | 15.3 (14.3) | 1.5 (0.8) | 5.3 (2.1) | These patients, mainly men, seem to prioritise their physical symptoms, reporting negative thoughts and emotions associated with their RA, and they cannot find self-management or coping strategies that work for them. They may therefore be experiencing a sense of hopelessness about their lives with RA. Despite having less disability than patients in Factor A, these patients seem to be in a ‘constant struggle’ with their RA. |
62.5% m | ||||||||
Factor B + (n = 1)
| n/a | n/a | Male | 50.0 (n/a) | Not known | 0.0 (n/a) | 0.5 (n/a) | |
Daily Life Factor C (n = 7)
| 2.67 | 9% | 100% f | 42.4 (11.2) | 9.9 (10.2) | 0.5 (0.5) | 1.7 (1.0) | These patients, all female and younger on average than the patients in Factors A and B seem to ‘put RA in its place’ by prioritising their responsibilities above their RA. These patients have lower average HAQ and patient global scores than the other two daily life Factors, which may be the reason that they seem to experience less impact of their RA, but it may also be due to assigning less importance to their RA as a coping strategy. |
0% m | ||||||||
Flare Help-Seeking study (n = 29)
| n/a | n/a | 72.4% f | 54.6 (11.8) | 15.2 (11.3) | 1.3 (0.9) | 3.2 (2.2) | |
27.6 m | ||||||||
Help-Seeking Factor X (n = 16)
| 10.18 | 35% | 68.8% f | 54.8 (9.6) | 15.2 (10.4) | 1.4 (0.8) | 3.3 (2.1) | These patients will not wait to seek help when they are in an RA flare. They make a ‘definite decision’ that their symptoms constitute a flare and that the medical team are there to help them. |
31.2% m | ||||||||
Help-Seeking Factor Y (n = 6)
| 4.58 | 16% | 66.7% f | 50.5 (15.4) | 18.7 (13.9) | 1.2 (1.0) | 4.1 (2.6) | These patients will wait to seek help for their RA flares, whilst going through a period of ‘cautious indecision’. These patients are indecisive as to whether their flare needs medical help as they hope it will go away on its own and are cautious of seeking help due to worries about wasting the medical team’s time and beliefs they should manage alone. |
33.3% m |
Factor scores | ||||
---|---|---|---|---|
Living with RA day by day means… | Factor A+ | Factor B+ | Factor B- | Factor C- |
D1: I sometimes have to cancel plans due to my RA
| 0 | 0 | 0 | 1 |
D2: Being more spontaneous with life | -1 | +3 | -3 | +1 |
D3: Struggling to do certain things | +1 | -2 | +2 | 0 |
D4: Choosing my clothes according to how easy they will be to put on and take off | +1 | +2 | -2 | -4 |
D5: I am unable to predict how bad my symptoms will be each day | -1 | -3 | +3 | +1 |
D6: Taking longer to get things done than I think it should | +2 | -2 | +2 | -2 |
D7: Finding different ways of doing the things I want to | +4 | 0 | 0 | +2 |
D8: Giving myself permission to leave a task half finished
| +1 | 0 | 0 | -1 |
D9: Using tools or devices to aid me in daily tasks | +3 | +1 | -1 | -5 |
D10: Finding a balance between asking for help and remaining independent | +2 | -1 | +1 | 0 |
D11: Doing what I want to do regardless of the consequences | -3 | +2 | -2 | -1 |
D12: Choosing to prioritise pleasurable activities against chores | 0 | +2 | -2 | -2 |
D13: Not letting my RA get me down | +3 | +3 | -3 | +4 |
D14: Relying on support from my family/friends/others | 0 | 0 | 0 | -3 |
D15: Talking to other people with RA who are similar to me helps
| -1 | +1 | -1 | -1 |
D16: Using alternative medicines/therapies to manage my RA symptoms | -4 | +3 | -3 | 0 |
D17: Distracting myself from my symptoms | +2 | +1 | -1 | 0 |
D18: Trying not to eat certain foods | -4 | +4 | -4 | -3 |
D19: I am cautious of gaining weight and putting extra stress on my joints | -1 | 0 | 0 | +3 |
D20: Exercising as much as I can | +1 | +5 | -5 | +2 |
D21: Making small adjustments to my day or activities constantly because of my RA | +5 | -1 | +1 | 0 |
D22: Taking my medication exactly as prescribed | +3 | +1 | -1 | +2 |
D23: Planning rest time into my week | +2 | +1 | -1 | -3 |
D24: Feeling lucky in comparison to other people | -1 | +2 | -2 | +5 |
D25: I have periods of being completely symptom free | -3 | +4 | -4 | -2 |
D26: Dealing with the severity of my symptoms going up and down | +1 | 0 | 0 | +1 |
D27: Getting frustrated due to my RA | -2 | -3 | +3 | +2 |
D28: Feeling guilty about holding others back due to my RA | -2 | -1 | +1 | -4 |
D29: Feeling that my body has let me down | -2 | -1 | +1 | 0 |
D30: Trying to forget that I have RA | 0 | +1 | -1 | +3 |
D31: Worrying because of my RA | -2 | -3 | +3 | 0 |
D32: Repetitive tasks make my RA symptoms worse | 0 | -2 | +2 | -1 |
D33: Being determined not to allow my RA to interfere with my responsibilities | +4 | 0 | 0 | +4 |
D34: Being angry because of my RA | -5 | -5 | +5 | -2 |
D35: Experiencing unexplainable fatigue/exhaustion daily | +1 | -4 | +4 | +3 |
D36: Experiencing pain daily | 0 | -4 | +4 | +1 |
D37: Experiencing swelling daily | -1 | -1 | +1 | -1 |
D38: Experiencing stiffness daily | 0 | -2 | +2 | +1 |
D39: Struggling to explain to family and friends what life is like for me | -3 | -1 | +1 | -1 |
Factor scores | ||
---|---|---|
When I am in an RA flare.... | Factor X | Factor Y- |
F1: I feel the flare will last until I seek medical help | 0 | -3 |
F2: I will contact the medical team as soon as possible | +1 | -3 |
F3: I am reluctant to seek medical help as I worry about wasting the rheumatology team’s time | -3 | 0 |
F4: I am more reluctant to seek medical help when I think I’ve caused the flare
| -1 | -2 |
F5: I am reluctant to seek medical help as I don’t think the Dr can do anything to help | -3 | -1 |
F6: I am reluctant to seek medical help as I hope it’ll go away on its own | -1 | +4 |
F7: I avoid seeking medical help as I don’t like taking drugs
| -2 | -2 |
F8: I seek help from the medical team once flare starts to affect my quality of life too much | +4 | +1 |
F9: I know I don’t have to manage my flare alone | +2 | +1 |
F10: Easy access to the medical team is part of my decision to seek help for my flare | +1 | 0 |
F11: A loved one tells me I ought to seek medical help | 0 | +2 |
F12: I don’t like admitting that I need to ask for help | -1 | +2 |
F13: I am reluctant to seek medical help as I don’t get on well with my rheumatology team
| -4 | -4 |
F14: I manage my symptoms until the flare stops | 0 | +1 |
F15: I seek help from the medical team as I worry about long term damage to my joints | +1 | -1 |
F16: I seek help from the medical team when the pain becomes too intense
| +3 | +3 |
F17: I wait until my next scheduled appointment with the rheumatologist before seeking help | -2 | -1 |
F18: I am reluctant to seek medical help as I don’t want to waste my own time | -2 | 0 |
F19: I seek help from the medical team when I know my flare needs to be controlled by new medication | +2 | -2 |
F20: I control my flare symptoms with medication before contacting the medical team
| 0 | 0 |
F21: I seek help from the medical team when my symptoms become uncontrollable
| +3 | +3 |
F22: I seek help from the medical team when the flare has gone on longer than I expected
| +2 | +2 |
F23: I wait until I have more than one flare symptom before seeking medical help
| 0 | 0 |