A narrative approach to explore grief experiences and treatment adherence in people with chronic pain after participation in a pain-management program: a 6-year follow-up study

Figures & data

Figure 1 Schematic overview of the qualitative mixed-methods design, to reveal and compare changes. The left pathway illustrates the core component of the project (QUAL data from the written reports). The right pathway illustrates the supplemental components of the project (qual data from the images). The point of interface is the position at which the core and the supplemental components meet. The “results narrative” refers to the write-up of the core-component findings with the addition of the results of the supplemental components.

Table 1 Analysis of the written narratives

Selection of subtext	Content categories	Picture of the content universe
Grief caused lack of energy and fatigue	Past life experiences indicate many losses and grief	Progress and an ongoing struggle towards a reintegrated body and a meaningful life
Frustration and despair because of lack of understanding of the body and lack of self
My pain, invisible to others, caused many problems, chaos, and reduced self-esteem
Lack of energy, lack of self and meaning in life
The pain has stolen from me the roles of mother, wife, friend, and work colleague
My quality of life is best if I can conserve energy	Present life experiences of the situation indicate movement toward acceptance and adaptation
I still become tired and sorry, but it is not grief
I am aware that I cannot be as social as before
My focus is now on positive aspects and playing an active role
My view of life tells me that I am unique and valuable; acceptance and frequent use of tools
I am positive, aware of my own responsibilities, and I know that I must work with me all my life	Awareness of their own potential, and future plans are optimistic, but realistic
My plans correspond to my present life and are much better than before
I must change my attitude to myself away from my life as it was before, and work with acceptance
I can do more myself, and am aware of my potential
I must be realistic and make the best of it

Notes: Examples of how the stories were analyzed to identify important subtext, content categories, and picture of the content universe, paying attention to commonalities, differences, and areas of emphasis.

Table 2 Analysis of the pain drawings

P	Production	Image	“Audiencing”
1	Naïve, colored, instrumental, several illustrations, A4 format	First aid kit, arrows, boxing glove, weight, tools, handlebar	A battle with ups and downs to find control and balance; different tools are needed
2	Naïve, simple, black pencil, few illustrations, A4 format	Sun shining on a tree, raining? A broken, nearly invisible flower on the ground; the shadow from the tree falls on it?	The self as a broken flower, small compared with the mighty tree, which receives most of the sunlight; contradictions, the good life in growth
3	Abstract and concrete body chart, colored, streamlined, circles and lines illustrate the content, A4 format	The body with separate parts, head, thorax and arms, abdomen, and legs	Body–mind separation, different intensities of pain, feelings, and thoughts fill the separate parts of the body. Does not work as an entity
4	Naïve, colored, several illustrations, supplemented with written text, A4 format	Three people, a woman with a bleeding heart and tears, another carrying a child, a person surrounded by people with intertwined arms; mountains, a heart with black strikes through it, sun and a road where hope is written in the lower part	Grief and emotions are illustrated and contrasted with a future filled with hope
5	Naïve, very detailed, colored, chest of drawers, title, A4 format	Five open drawers; on the bottom, only small black animals are crawling; in the next drawers, fewer and fewer animals are found together with flowers, sunshine, palms, tunnel opening with a candle, music, and many hearts on top	Movements. Adaptation process. The pain is always present, although love, music, sun, and palms may reduce its presence

Notes: Three aspects of the visual analysis of images are illustrated. The first deals with how and when the image was made (production). The second is related to the story that is described (the image itself). The third is the response of the viewers (“audiencing”).

Abbreviation: P, participant.