Session Information
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Illness perceptions (IP) are the beliefs and expectations that an individual has about medical conditions. IP cluster around five coherent themes and provide a framework for patients to make sense of their symptoms, assess health risk, and direct action and coping. Positive IPs have been associated with higher adherence, better disease outcomes and wellbeing in several chronic diseases while addressing negative or incorrect perceptions has been shown to improve disease outcomes. We explored IP of Canadian and Nigerian RA patients.
Methods: Consecutive RA patients at two academic centers (Montreal and Lagos) completed the Illness Perception Questionnaire–Revised from 2013-14. Sociodemographic (age, sex, and education) and disease characteristics (duration, treatment, CDAI, HAQ) were obtained and compared with t-tests and chi-square, Spearman correlations were calculated between IPQ-R scales and CDAI levels and t-tests and ANOVA were used to compare IPQ scores between countries and across disease activity levels.
Results: 83 Canadian and 30 Nigerian patients completed the survey. While there were no significant differences in the age, sex and education or use of biologics between groups, African participants reported shorter disease duration and had higher CDAI and patient global scores (Table 1). In Canadians, Timeline-Cyclic, Consequences, and Treatment Control were associated with CDAI (rho’s=.28 to -.40; p<.05) whereas in Nigerians, Emotional Representations were moderately associated with CDAI (rho=.40; p<.05)(Table 2). Scores on Timeline – Chronic and Illness Coherence were significantly (p<.05) higher in Canadians whereas Treatment Control scores were significantly higher in Nigerians. Beliefs about causes of RA were similar in patients from both countries, although ‘chance’ or ‘other factors’ were cited by Nigerians.
Conclusion: Canadians were more likely to view their arthritis symptoms as coherent and chronic whereas Nigerians were more likely to view their RA as controllable through treatments but resulting in greater emotional distress. Understanding illness perceptions, beliefs about aetiology, and expectations about controllability may offer new insight into patient behaviors (e.g., adherence to treatment) that impact long-term outcomes.
|
Table 1. Characteristics of Participants in Canada and Nigeria |
|||
| Characteristic |
Canada |
Nigeria |
Sig |
|
N |
83 |
30 |
|
|
Age (yrs) |
|
|
.583 |
|
18-29 |
6 (7%) |
2 (7%) |
|
|
30-49 |
34 (45%) |
16 (53%) |
|
|
50-69 |
31 (37%) |
10 (33%) |
|
|
70+ |
12 (14%) |
2 (7%) |
|
|
Female (%) |
66 (80%) |
24 (83%) |
.705 |
|
Education (yrs) |
15 (4) |
16 (5) |
.607 |
|
RA duration (yr) |
|
|
.018 |
|
< 1 |
13 (16%) |
13 (43%) |
|
|
1-5 |
32 (39%) |
6 (20%) |
|
|
5-10 |
18 (22%) |
5 (17%) |
|
|
10+ |
20 (24%) |
6 (20%) |
|
|
Biologics (ever) |
23 (28%) |
4 (14%0 |
.117 |
|
HAQ |
.55 (.64) |
N/A |
|
|
Tender (28) |
3.5 (4.5) |
6.5 (7.4) |
.013 |
|
Swollen (28) |
2.3 (3.7) |
3.9 (5.8) |
.086 |
|
Patient Global |
2.7 (2.4) |
3.8 (2.3) |
.027 |
|
CDAI |
10.4 (10.2) |
17.4 (13.9) |
.005 |
|
Remission |
22 (27%) |
1 (3%) |
.017 |
|
Low |
29 (35%) |
11 (38%) |
|
|
Moderate |
22 (27%) |
8 (28%) |
|
|
High |
10 (14%) |
9 (31%) |
|
|
Values are mean ± SD unless otherwise indicated |
|
||
|
Table 2. Association of IPQ Scales with CDAI and mean scores by disease activity level. |
||||||||||||
|
IPQ-R Subscale (range) |
CDAI (rho) |
All |
Remission |
Low |
Moderate |
High |
||||||
|
CAN |
NIG |
CAN |
NIG |
CAN N=22 |
NIG N=1 |
CAN N=29 |
NIG N=11 |
CAN N=22 |
NIG N=11 |
CAN N=10 |
NIG N=9 |
|
|
Identity |
.08 |
.59 |
5 (2) |
7 (3) |
5 (3) |
— |
5 (3) |
5 (1) |
6 (2) |
4 (1) |
6 (2) |
9 (3) |
|
Timeline Chronic (6-30) |
.17 |
-.21 |
23 (5) |
14 (6)* |
22 (6) |
18 |
22 (6) |
14 (7) |
24 (4) |
15 (5) |
23 (5) |
12 (7) |
|
– Cyclical (4-20) |
.38 |
-.02 |
13 (3) |
12 (4) |
12 (4)a |
16 |
13 (4)a,b |
11 (4) |
14 (3)b |
12 (4) |
15 (2) b,c |
12 (3) |
|
Consequences (6-30) |
.28 |
.38 |
20 (5) |
21 (5) |
18 (5)a |
19 |
19 (5)a |
18 (5) |
20 (4)a,b |
23 (3) |
23 (4)b |
23 (5) |
|
Control – Treatment (5-25) |
-.40 |
.06 |
19 (3) |
21 (3)* |
20 (3)a |
14 |
18 (3)b |
21 (4) |
18 (3)b |
20 (2) |
18 (2)b |
22 (3) |
|
— Personal (6-30) |
-.13 |
.20 |
22 (4) |
22 (6) |
23 (4) |
18 |
21 (3) |
21 (5) |
21 (4) |
23 (4) |
22 (4) |
21 (8) |
|
Understanding of RA (5-25) |
-.09 |
-.17 |
18 (4) |
16 (5)* |
18 (5) |
11 |
18 (4) |
18 (5) |
18 (4) |
15 (4) |
16 (4) |
15 (6) |
|
Emotional Response (6-30) |
.15 |
.40 |
17 (6) |
19 (7)† |
15 (6) |
7 |
17 (5) |
16 (6)a |
16 (6) |
20 (7)a,b |
18 (6) |
22 (5)b |
|
*p<.05; †p=.07. Different superscripts indicate significant different groups using Duncan’s tests. |
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|
Table 3. Participant rankings of top three causes of RA by country. |
||
|
|
Canada |
Nigeria |
|
Risk Factors (genetics, diet, aging, smoking, previous medical care) |
40 (48%) |
12 (40%) |
|
Altered Immunity (germs/virus, pollution, changes in immunity) |
17 (21%) |
6 (20%) |
|
Psychological Factors (stress, negative emotions, overwork |
14 (17%) |
5 (17%) |
|
Don’t Know |
9 (11%) |
2 (7%) |
|
Accident / chance |
3 (4%) |
2 (7%) |
|
Other (spiritual, cold, drug reaction) |
— |
3 (10%) |
|
chi square .091 |
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To cite this abstract in AMA style:
Bartlett SJ, Adelowo O, Bazan Bardales MC, Colmegna I. Illness Perceptions in Rheumatoid Arthritis: A Comparison of Canadian and Nigerian Patients [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/illness-perceptions-in-rheumatoid-arthritis-a-comparison-of-canadian-and-nigerian-patients/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/illness-perceptions-in-rheumatoid-arthritis-a-comparison-of-canadian-and-nigerian-patients/