Approaches to osteoarthritis - A qualitative study among patients in a rural setting in Central Western India

Figures & data

Table 1. Characteristics of the participants (n = 24).

Pravara University Hospital/Primary Health Care Centers, n (%)	13 (54)/11 (46)
Gender, male/female, n (%)	9 (37.5)/15 (62.5)
Age, years, median (min-max range)	65 (49–85)
Language, English/Marathi, n (%)	2 (8)/22 (92)
Disease duration, years, median (min-max range)	3 (0–25)
Body Mass Index, n (%) Underweight [<18.5] Normal weight [18.5–24.9] Overweight [25–29.9] Obesity [≥30]	1 (4) 17 (71) 6 (25) 0 (0)
Marital status, single/married, n (%)	3(12.5)/21 (87.5)
Children at home, ≤5/>5, n (%)	13 (54)/11 (46)
Work status, part time/full time/not employed, n (%)	9 (37.5)/12 (50)/3 (12.5)
Education, university/high school/public school, n (%)	6 (25)/6 (25)/12 (50)
Activity limitation, VAS [0–10, none – complete], median (min-max range)	5.5 (1.6–8.9)
Perceived pain, VAS [0–10, none – worst imaginable], median (min-max range)	5.9 (3.2–8.5)

Table 2. Interview guide.

Opening question: “Tell me a little about your disease. How would you describe the impact of your present disease/symptoms a typical normal day at home, at work or another place”

Questions:

Can you tell me how you understand osteoarthritis (OA) – what is it?

Describe a situation or event that has had a significant impact on your life with OA.

Tell me something positive you have experienced with your symptoms/disease.

What about negative experiences with your symptoms/disease? How do you typically handle symptoms from your OA? Is there anything that makes your life with OA satisfying? What could be done to make your life with OA more satisfying? Describe a dialog or communication you have had about your symptoms/disease that has made an impact on you – either positive or negative. What advice about managing OA would you give to someone else – using your knowledge and experiences? What would your ideal life with OA look like, if you could make a wish? Tell me about your expectations for the future. Is there anything else you would like to add?

Table 3. Description of the data analysis.

Familiarization	To become familiar with and get an overview of the material, all of the transcribed interviews were read carefully by one of the authors (GJ).
Open coding and meaning units	Open coding was performed by writing manually notes and headings in the margins describing approaches to OA. Parts of the text (meaning units) containing elements related to the code through their content and/or context were then identified. The material was read through several times while open coding, and meaning units were identified to cover all aspects of the phenomenon. Open coding was performed iteratively for all interviews by one of the authors (GJ). To ensure coding consistency another author (ES) independently coded five of the interviews. The emerging codes and meaning units were discussed until agreement was reached between the researchers (GJ, ES).
Grouping codes	The codes were then moved/collected from the margins onto a manually created mind map structure. Codes representing similar meanings of approaches to OA were grouped together.
Creating categories and subcategories	The various codes were compared regarding differences and similarities. Codes with related meanings were manually grouped together in categories.
Refining and labeling	To increase trustworthiness, two of the authors (GJ, ES) repeatedly discussed and compared the emerging categories and subcategories with the content of the original interviews several times until negotiated consensus was reached. Discussions with the author used as the peer expert (CHO) were held continuously. The categories and subcategories were labeled by GJ and ES.
Quotes	Quotes from the interviews were chosen and are provided for illustration and trustworthiness.

Table 4. Examples of meaning units and codes underlying subcategories and categories.

Meaning unit	Code	Subcategory	Category
I feel very frustrated due to the knee pain. Unable to travel and, I can’t attend social activities.	Frustration and social loneliness	Negative psychosocial impact	Lack of power
I took hot water heating but it increased my pain. And as you advised – cold pack, but in the winter cold pack can aggravate my pain. So what to do?	Failing treatments	Doubts on treatments	Active ambivalence
I stopped myself in work as pain started, took a break and started again after getting some relief.	Ergonomics	Finding new solutions	Taking control
I ignore it. If I focus on pain the work cannot be completed. Since I am a farmer, it is compulsory for me to do farm work.	Ignorance	Work life and poverty	A constant struggle

Figure 1. Approaches to osteoarthritis among patients in a rural setting in central western India.