TY - JOUR
T1 - Renegotiating dimensions of the self
T2 - A systematic review and qualitative evidence synthesis of the lived experience of self-managing rheumatoid arthritis
AU - Donnelly, Susie
AU - Manning, Molly
AU - Mannan, Hasheem
AU - Wilson, Anthony G.
AU - Kroll, Thilo
N1 - Publisher Copyright:
© 2020 The Authors. Health Expectations published by John Wiley & Sons Ltd
PY - 2020/12
Y1 - 2020/12
N2 - Background: As chronic illnesses, such as rheumatoid arthritis (RA), place an increased burden on health-care systems, the ability of individuals to self-manage these diseases is crucial. Objective: To identify and synthesize the lived experience of self-management described by adults living with RA. Design: A systematic search of five electronic databases (MEDLINE, CINAHL, EMBASE, PsycINFO and ASSIA) was undertaken to identify relevant studies. Data were extracted and quality-assessed using CASP guidelines. A meta-synthesis was conducted based on Thomas and Harden's thematic synthesis approach. Results: The search identified 8423 publications. After removing duplicates, 6527 records remained of which 32 studies met the inclusion criteria. Quality of studies was moderate to high, yet a considerable lack of reflection on researcher bias was evident. Our analysis identified 28 dimensions of self-management RA across six domains: (a) cognitive-emotional, (b) behavioural, (c) social, (d) environmental, (e) physical and (f) technological. Cognitive-emotional experiences dominated the analysis. Renegotiating ‘the self’ (self-concept, self-esteem, self-efficacy) was a key focus of self-management among individuals with RA. Conclusion: Our findings highlight the focus of ‘the self’ as a central concern in the self-management of RA. Standardized self-management programmes may primarily focus on disease management and daily functioning. However, we suggest that personal biographies and circumstances should move to the fore of self-management support. Registration: PROSPERO International Prospective Register of Systematic Reviews 2018: CRD42018100450. Patient or Public Contribution: Patient and public involvement was not explicit in this review. However, three authors provided a patient perspective on the self-management of arthritis and autoimmune disease.
AB - Background: As chronic illnesses, such as rheumatoid arthritis (RA), place an increased burden on health-care systems, the ability of individuals to self-manage these diseases is crucial. Objective: To identify and synthesize the lived experience of self-management described by adults living with RA. Design: A systematic search of five electronic databases (MEDLINE, CINAHL, EMBASE, PsycINFO and ASSIA) was undertaken to identify relevant studies. Data were extracted and quality-assessed using CASP guidelines. A meta-synthesis was conducted based on Thomas and Harden's thematic synthesis approach. Results: The search identified 8423 publications. After removing duplicates, 6527 records remained of which 32 studies met the inclusion criteria. Quality of studies was moderate to high, yet a considerable lack of reflection on researcher bias was evident. Our analysis identified 28 dimensions of self-management RA across six domains: (a) cognitive-emotional, (b) behavioural, (c) social, (d) environmental, (e) physical and (f) technological. Cognitive-emotional experiences dominated the analysis. Renegotiating ‘the self’ (self-concept, self-esteem, self-efficacy) was a key focus of self-management among individuals with RA. Conclusion: Our findings highlight the focus of ‘the self’ as a central concern in the self-management of RA. Standardized self-management programmes may primarily focus on disease management and daily functioning. However, we suggest that personal biographies and circumstances should move to the fore of self-management support. Registration: PROSPERO International Prospective Register of Systematic Reviews 2018: CRD42018100450. Patient or Public Contribution: Patient and public involvement was not explicit in this review. However, three authors provided a patient perspective on the self-management of arthritis and autoimmune disease.
KW - lived experience
KW - meta-synthesis
KW - qualitative evidence synthesis
KW - rheumatoid arthritis
KW - self-management
KW - systematic review
UR - http://www.scopus.com/inward/record.url?scp=85090019882&partnerID=8YFLogxK
U2 - 10.1111/hex.13122
DO - 10.1111/hex.13122
M3 - Review article
C2 - 32869404
AN - SCOPUS:85090019882
SN - 1369-6513
VL - 23
SP - 1388
EP - 1411
JO - Health Expectations
JF - Health Expectations
IS - 6
ER -