Transformation of meaning perspectives in clients with rheumatoid arthritis

Article type
Authors
Jehanne Dubouloz C, Laporte D, Hall M, Hall B
Abstract
Background: Transformative learning, originally studied by Mezirow in adult education [1], involves changing the fundamental personal feelings, values and beliefs known as meaning perspectives, through which persons view themselves and the world. It is a precursor to sustainable behaviour change when the change challenges previously held meaning perspectives. In the health field, there is growing recognition of the importance of meaning perspectives on health behaviours leading to successful therapeutic outcomes, particularly in the physical rehabilitation of chronic illnesses such as rheumatoid arthritis. Such illnesses disrupt the occupational balance between work, leisure, self-care and rest/sleep, that supports the clients successful occupational performance and personal well-being, and requires the adoption of new behaviours to adapt to and minimize the chronic condition.

Objectives: The purpose of this study is to examine the process of transformation of personal beliefs, values, feelings and knowledge (meaning perspectives) underlying occupational change and performance in a small group of clients with rheumatoid arthritis.

Methods: This qualitative study employed a grounded theory design [2,3] commonly used to explore processes and generate theories.With this design data was collected and analyzed concurrently using: 1) a theoretical sample of five adult home-based occupational therapy clients diagnosed with rheumatoid arthritis , 2) data collection through 28 individual semi-structured interviews using an interview guide focusing on participants meaning perspectives in four areas of occupation during their rehabilitation, and 3) data analysis with the Constant Comparison Method using three data coding phases (open, axial and selective), and the computer software program ATLAS/ti [4], to systematically conceptualize, categorize and interpret data.

Results: The study identified meaning perspectives, barriers, and transformations related to the modification of occupational balance. It explored the development of a substantive theory on the meaning perspective transformation process in rehabilitation clients with rheumatoid arthritis.

Conclusions: This study provided new qualitative evidence that meaning perspective transformation does occur in clients with rheumatoid arthritis during their period of rehabilitation, as part of an inner process of rehabilitation. This suggests that clients experiencing change based difficulties with the self-management of their condition , would benefit if therapists understood the transformative process and helped them to explore their meaning perspectives as an integral part of the rehabilitation program. Such a practice could contribute to the development of improved physical rehabilitation intervention plans for clients with rhuematoid arthritis.

Acknowledgements: This study, funded by the Canadian Occupation Therapy Foundation and The Arthritis Society, was made possible with the collaboration of the Consultation and Rehabilitation Service of the Arthritis Society for Eastern Ontario, and of the participants who generously shared their time, life experiences and reflections.

References: 1. Mezirow J. Transformative dimensions of adult learning. San Francisco: Jossey-Bass; 1991. 2. Glaser BG, Strauss AL. Discovery of grounded theory: Strategies for qualitative research. New-York: Aldine; 1967. 3. Strauss A, Corbin J. Basics of qualitative research. San Fransisco: Sage; 1990. 4. Muhr T. ATLAS/ti: Visual qualitative data analysis management model building in education research and business (Release 4.1). Berlin: Scientific Software Development; 1997.