A qualitative study of work participation in early rheumatoid arthritis

Aims: This article details a qualitative study aiming to explore the impact of rheumatoid arthritis (RA) on participation in paid work during the first two years after diagnosis. Methods: In-depth semi-structured interviews using the Model of Human Occupation Worker Role Interview were used to explore the impact of a diagnosis of RA on the participant's lived experience, the meaning of work from the participant's point of view, and whether there was any change in perception or attitude towards work and work ability since diagnosis. Qualitative methods were felt to be appropriate to capture the lived experience of participation and engagement in work. Interviews were conducted on entry to the study and were repeated at six-month follow-up. Transcripts from the interviews were subjected to interpretative phenomenological analysis. Findings: Ten individuals with RA in paid employment participated in the study. The mean age was 38 years. The mean duration from diagnosis was 14.2 months. Participants identified work-specific changes and external lifestyle alterations made early in the disease trajectory to support maintenance of the worker role. The personal meaning of work and the importance of the worker role in shaping self-identity emerged as an important factor in determining work participation. Qualitative factors influenced the type and extent of changes made to work and determined the impact of RA on work. These findings suggest that from early in the disease course RA influences the individual's normal lifestyle and work participation. Conclusions: Qualitative assessment of work participation demonstrated that paid work was affected in the early phase of RA. Work intervention needs to shift to encompass such factors which influence maintenance of the worker role.