Background/Purpose:  In rheumatoid arthritis (RA), early diagnosis and treatment are essential to better outcomes. Many people defer seeking help or treatment for reasons that are currently not well accounted for, but often seem to be related to decisions concerning work. This study aims to understand the contextual factors that influence patients’ decisions in the early stages of RA when dealing with concerns about their health and employment. Contextual factors are factors that mediate or moderate the effect of an intervention (e.g., a work disability prevention program) on outcomes (e.g., the patient’s decision to continue working).

Methods: We conducted a secondary data analysis from 2 qualitative studies[1]^,[2]Participants were eligible if they were diagnosed with RA within the 12 months prior. The interview questions focused on how RA affected the daily lives of participants. In the first study we conducted 1 in-depth interview per participant, in the second study another set of participants were interviewed 3 times over a 1-year period. In the current analysis, transcripts were examined for participant experiences of the impacts of their health on employment, and the impacts of their employment on health. We used the constant comparison method, a theme-based, iterative, qualitative approach that foregrounds the experience of the participants. The analysis was done by one researcher, in consultation with researchers who previously worked with the dataset.

Results:  A total of 48 interview transcripts from our two previous studies were examined. Most participants were women (91%) and roughly half (55%) were from rural or remote areas. We found that many participants continued to work despite pain and fatigue, and even if they had alternatives to working for their livelihood. In these instances people seemed to act counter to a “health first” logic. Physical limits and financial concerns were often the catalyst for work-related decisions, however, many participants deferred making a decision until one of these factors became so overwhelming that they were forced to act upon them. In situations where decisions had not been dominated by physical or financial necessity, factors that often influenced decision-making were related to a sense of attachment to work that included: love of occupation, sense of responsibility, the commitment to being a hard worker, and occupation defining identity. We broadly described these factors as “work ethic.”

Conclusion:  Our findings suggested that while physical limits and financial necessity were important contributors to patients’ decisions about work, these decisions might also be influenced by work ethic. Participants revealed the preference to stay at work despite difficulties with their health and challenges related to their work, suggesting that non-medical life-course factors could be as influential as physical or financial factors in one’s decision about employment. Further research is needed to understand the interplay of these contextual factors in the effectiveness of interventions on patient decision-making.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/understanding-contextual-factors-that-influence-decisions-related-to-health-and-work-among-people-with-recently-diagnosed-rheumatoid-arthritis/