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Identifying different typologies of experiences and coping strategies in men with rheumatoid arthritis: a Q-methodology study
  1. Caroline A Flurey1,
  2. Sarah Hewlett1,
  3. Karen Rodham2,
  4. Alan White3,
  5. Robert Noddings4,
  6. John R Kirwan5
  1. 1Universtiy of the West of England, Bristol, UK
  2. 2Staffordshire University, Stoke-on-Trent, UK
  3. 3Leeds Beckett University, Leeds, UK
  4. 4University Hospitals Bristol NHS Trust, Bristol, UK
  5. 5University of Bristol, Bristol, UK
  1. Correspondence to Dr Caroline Flurey; Caroline2.Flurey{at}


Objective To identify typologies of experiences and coping strategies of men with rheumatoid arthritis (RA).

Design Q-methodology (a qualitative and quantitative approach to grouping people according to their subjective opinion). Men with RA sorted 64 statements relating to their experience of living with RA according to level of agreement across a normal distribution grid. Data were examined using Q-factor analysis.

Setting Rheumatology outpatient departments in the UK.

Participants 30 of 65 invited men with RA participated in this study (46%).

Results All participants ranked highly the need to be well informed about their medication and the importance of keeping a positive attitude. 2 factors describing the experiences and coping strategies of male patients living with RA were identified: factor A: ‘acknowledge, accept and adapt’ (n=14) take a proactive approach to managing the impact of RA and find different ways of doing things; while factor B: ‘trying to match up to a macho ideal’ (n=8) are determined to continue with their pre-RA lives, and therefore push themselves to carry on even if this causes them pain. They are frustrated and angry due to the impact of RA but they internalise this rather than directing it at others.

Conclusions While some men adapt to their RA by renegotiating their masculine identity, others struggle to relinquish their traditional masculine roles. Further research is needed to identify whether the finding that there are 2 distinct groups of men with RA can be generalised, and if so whether the differences can be explained by clinical, social or psychological factors, which may inform different therapeutic approaches.

  • Q-methodology
  • Men's health
  • Masculinity
  • Coping
  • Self-management
  • Rheumatoid Arthritis

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  • Contributors All authors were involved in the design and planning of the study. CAF prepared the statements for participants to sort, which were reviewed and revised by SH, JRK, KR, AW and RN until all were satisfied. CAF and local research nurses invited patients to participate. CAF conducted the Q-methodology study and the post-study interviews. CAF conducted the initial Q-methodology analysis, then all authors participated equally in deciding on the most appropriate factor solution and the qualitative interpretation of the chosen solution. CAF led the writing of the manuscript with guidance and input from SH, JRK, KR, AW and RN. All authors read and approved the final manuscript.

  • Funding This work was supported by Arthritis Research UK (grant number 20210).

  • Competing interests None declared.

  • Ethics approval Dyfed Pows NHS Research Ethics Committee (reference number 14/WA/0101).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Raw data from individual participants’ Q-sort scores are available on request by emailing CAF:

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