https://orcid.org/0000-0003-4199-6302
ABSTRACT
A healthy lifestyle should be recommended to all patients with inflammatory arthritis due to the increased risk for cardiovascular diseases. Healthcare professionals (HPs) are essential in supporting patients to achieve healthy lifestyle habits and are expected to follow international and national lifestyle management guidelines. Despite this, few studies have studied HPs’ perceptions of working on lifestyle management.
Aim
To explore HPs’ perceptions of working on lifestyle management for patients with early rheumatoid arthritis (RA).
Methods
In this qualitative study, individual interviews were conducted with 20 HPs. Qualitative content analysis was used, and three categories and six subcategories were identified.
Results
HPs’ perceptions of working on lifestyle management for patients with early RA revealed a need for commitment from different levels. This included commitment from healthcare managers and organizations prioritizing work on lifestyle management and providing competence development for HPs. Commitment within the team regarding coordination of interdisciplinary teamwork and development of a structured lifestyle management approach, and commitment to involving patients in lifestyle management, by facilitating patient engagement and a person-centred approach.
Conclusions
HPs’ perceptions of working on lifestyle management for patients with early RA revealed that commitment from healthcare managers, organizations, and the interdisciplinary team was essential to facilitate collaboration, patient involvement, and a person-centred approach.
Introduction
Non-communicable diseases are the leading cause of death and threaten global health, often resulting from unhealthy lifestyle habits (World Health Organization, Citation2021, Citation2022). Therefore, lifestyle management has become more important in healthcare, especially for patients with chronic diseases such as rheumatoid arthritis (RA) (Agca et al., Citation2017). RA is a chronic inflammatory systemic disease affecting the joints with swelling, stiffness, and pain. Increased fatigue is common, and the disease can involve various organ systems, resulting in significant disabilities, reduced work capacity, and reduced quality of life (Smolen et al., Citation2016). Patients with RA also have an increased risk of developing cardiovascular disease, and mortality from RA is elevated compared to that in the general population (Agca et al., Citation2017; Smolen et al., Citation2016). A combination of adequate pharmacological treatment and healthy lifestyle habits has been reported to improve symptoms and quality of life for those with RA (Agca et al., Citation2017; Hulander et al., Citation2021; Verhoeven et al., Citation2016).
Unhealthy lifestyle habits, such as tobacco consumption, lack of physical activity, and poor dietary habits, are associated with an increased risk of cardiovascular diseases in patients with inflammatory arthritis, especially RA (Agca et al., Citation2017). Previous research also shows that people who smoke are more likely to develop RA, and that smokers with RA have a more severe disease course (Deane et al., Citation2017; Gwinnutt et al., Citation2020) and inferior effects from drug treatment (de Hair et al., Citation2018; Gwinnutt et al., Citation2020). Research regarding alcohol consumption in patients with RA is not unequivocal (Humphreys et al., Citation2017). While it is known that alcohol can interact with anti-rheumatic drugs (Burmester & Pope, Citation2017), harmful drinking is associated with injuries and health consequences (WHO). More recent studies in patients with RA have reported that alcohol consumption can be associated with lower disease activity and higher health-related quality of life (Alfredsson et al., Citation2023; Turk et al., Citation2021). Physical activity can contribute to increased self-esteem, reduced pain, relief of symptoms of depression, and improved sleep quality in patients with RA (Verhoeven et al., Citation2016). There is also some evidence that physical activity and diet may have anti-inflammatory effects, which is why these lifestyle habits are relevant in patients with RA (Vadell et al., Citation2020; Verhoeven et al., Citation2016). In a previous Scandinavian study, every other patient with RA reported two or more unhealthy lifestyle factors (Karstensen et al., Citation2022), which is two to three times higher than in the general population in Sweden (The National Board of Health and Welfare, Citation2018). Still, only half of the patients with established RA in another Scandinavian study recalled discussing lifestyle habits with any HP in the preceding five years (Malm et al., Citation2019). In a previous study in primary healthcare, 77% of the HPs reported that they would like to work more with lifestyle management, and 79% considered lifestyle management important, but expressed several barriers for lifestyle management. Registered nurses were more likely than physicians to use clinical practice guidelines to support lifestyle management (Kardakis et al., Citation2018).
In the updated CVD risk management recommendations from the European Alliance of Associations for Rheumatology (EULAR), healthy lifestyle behaviours are emphasized together with cardiovascular risk assessment for patients with inflammatory arthritis. Accordingly, HPs working in rheumatology care play an essential role in informing, motivating, and supporting patients in need of behavioural change to prevent diseases and promote health.
Evidence of how HPs can support patients with early RA to maintain or achieve a healthy lifestyle is scarce, and to the best of our knowledge, no previous qualitative studies have explored HPs’ perceptions of working with patients on lifestyle management in rheumatology care. Therefore, knowledge of how HPs perceive their current work regarding lifestyle management in early RA will offer insights for structured improvements. The present study is an explorative part of a larger project with the goal of developing a structured, coordinated, and person-centred interdisciplinary lifestyle management programme.
Aim
The aim of this study was to explore HPs’ perceptions of working on lifestyle management for patients with early RA.
Method
Design
The study has an exploratory design with manifest qualitative content analysis to better understand HPs´ perceptions of working with patients on lifestyle management. An inductive approach with a low interpretation level was used (Lindgren et al., Citation2020). The study has been reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) 32-item checklist (Tong et al., Citation2007).
Setting
The study was conducted in a specialist rheumatology clinic in Sweden. The clinic has a “tight control” regimen with frequent visits to a rheumatologist and a rheumatology nurse for patients with newly diagnosed RA. All patients are also invited to meet with a physiotherapist and an occupational therapist early in the disease course. Contact with a social worker, and follow-up team visits are scheduled for patients if needed. Lifestyle management is expected to be included in the regular visits. National and rheumatology-specific guidelines support HPs work with lifestyle management in rheumatology care (The National Board of Health and Welfare, Citation2018; Swedish Society for Rheumatology, Citation2022). Both focus on preventing and treating unhealthy lifestyle habits regarding tobacco, alcohol, physical activity, and dietary habits. Tailored guidance to facilitate and support patients’ behavioural change can be offered (Kardakis et al., Citation2018).
Participants
The participants in the study were HPs working at a specialist rheumatology clinic with experience working with lifestyle management in patients with early RA. A purposeful sample was used to obtain variation in professions and years of professional rheumatology care experience. A total of 22 HPs were invited to participate in the study by researchers at the clinic, and 20 accepted; 17 women and three men aged 35–67 years. The participants had between two and 44 years of professional experience in rheumatology care and represented rheumatologists, registered nurses, assistant nurses, physiotherapists, occupational therapists, and social workers (see ). Information power modelling indicates that a study with a specific aim, specificity of participant experiences, quality of dialogue, and explorative analysis requires a lower number of participants (Malterud et al., Citation2016). Since the aim of this study was specific, and the data comprised in-depth interviews conducted with participants with extensive experience of the phenomenon under study, 20 participants were expected to be sufficient.
Table 1. Demographic data for the HPs.
Data collection
Data collection was conducted from June to July 2021. The interview guide contained main questions with accompanying follow-up questions. The interview questions focused on perceptions of working on lifestyle management, for example: “How do you work with lifestyle management (tobacco, alcohol, physical activity, dietary habits) in patients with RA?”. The interviews were semi-structured and conducted by authors IL and AB, with documented experience in qualitative methods and rheumatology and no previous relationship with the participants in the study. Because of the ongoing COVID-19 pandemic, the interviews were conducted by telephone or video call, and the dialogue was recorded and transcribed verbatim. Each interview lasted about an hour, and the total interview time was 18 hours and 37 minutes.
Data analysis
Data analysis was performed using inductive manifest qualitative content analysis by searching for similarities, differences, and patterns in the data described in categories and subcategories (Graneheim & Lundman, Citation2004; Graneheim et al., Citation2017). The qualitative content analysis was characterized by a non-linear process involving de-contextualization and re-contextualization (Lindgren et al., Citation2020). The transcribed interviews were thoroughly read several times. A total of 667 meaning units were identified, condensed, abstracted, and coded. Similarities and differences were identified from the codes and sorted into six subcategories. For example, the codes “routines” and “guidelines” were sorted into the subcategory “structured lifestyle management approach”. The six subcategories were categorized into three main categories, representing the interviews’ overall content. For example, the subcategories “coordination of interdisciplinary teamwork in lifestyle management” and “structured lifestyle management approach” were grouped into the category “commitment within the team”. The first author (KDH) and the last author (IL), with no previously established relationship with the participants, interpreted the analysis via ongoing discussions in the research group. The research group represented the interdisciplinary team and included rheumatologists, physiotherapists, and registered nurses with experiences in rheumatology care and qualitative methods.
Ethical considerations
The Swedish Ethics Review Authority approved the study (no. 2020–01599, 2021–00941). The study followed the Declaration of Helsinki (WMA, Citation2013), and was guided by the ethical principles of autonomy, beneficence, non-malfeasance, and justice (Swedish Research Council, Citation2017). All participants received oral and written information about the purpose of the study. They were informed that all personal data would be handled confidentially, that participation was voluntary, and that they had the right to terminate their participation in the study at any time during the study without stating a reason. All HPs gave written consent to participate in the study. In summary, the study fulfilled the requirements for ethical research: information, consent, confidentiality, and safety of participants (Swedish Research Council, Citation2017).
Results
HPs working on lifestyle management for patients with early RA emphasized the importance of commitment from healthcare managers and organizations, the team, and involving patients (). Commitment from healthcare managers and organizations included prioritizing the work with healthy lifestyle habits and supporting competence development among HPs in lifestyle management. Commitment within the team was seen as crucial, given the daily collaboration between professionals with coordination of interdisciplinary teamwork and a structured lifestyle management approach. Commitment to involving patients was perceived as essential in facilitating patient engagement and providing person-centred lifestyle management.
Table 2. Overview of categories and subcategories that describe HPs’ perceptions of working on lifestyle management for patients with early RA.
Commitment from healthcare managers and organizations
According to HPs, commitment from healthcare managers and organizations was essential to lifestyle management. The preconditions for HPs to prioritize work on lifestyle management, and competence development for HPs, were requested to be put into place at an organizational level.
Prioritisation of work on lifestyle management
The HPs perceived that lifestyle management needs to be initiated by the organization to be prioritized. This requires support and commitment from healthcare managers and organizations, giving HPs the opportunity to prioritize lifestyle management in the clinical visits. According to HPs, lifestyle management was not prioritized to the extent they preferred.
But I would not say that it is something our managers might be leading on, or that I hear medical colleagues talk so much about, that lifestyle habits are important … I can’t say that I feel that it permeates our work now on all levels. I don’t think so. (Participant no 1)
Decisions about incorporating lifestyle management in clinical visits were expressed to be made by organizations, not individual HPs. The HPs described lack of resources as a reason for low prioritization of work on lifestyle management with patients. Some HPs expressed that they had limited time to discuss lifestyle habits with patients when lifestyle management was not the primary purpose of their visit. In addition, follow-up discussions on lifestyle habits were not always possible, even though the HPs wanted to offer regular follow-ups.
So, the idea is that they should have some form of follow-up after 1 year. But then we have to have more resources because in the current situation we do not have time for that. (Participant no. 4)
The HPs perceived that the team’s strategies to prioritize work on lifestyle management differed. The HPs’ focus on lifestyle management sometimes depended on personal interests, patients’ most acute or risky lifestyle habits, or patients’ motivation for change. This context-dependency was described as entailing unequal care. According to the HPs, healthcare managers and organizations should have a clear structure to support them in prioritizing work on lifestyle management to avoid this kind of unequal care.
You have to talk to the patients and see what they are motivated to change. You should try to get as much benefit as you can with as little effort as possible. For example, if they think it’s easy to stop drinking alcohol or reduce that behaviour, then maybe this is the lifestyle habit to start with. If it seems that it is extremely difficult to quit smoking, then it may not be the first thing to do, even if it is the biggest risk factor.(Participant no.10)
Competence development in lifestyle management
According to the HPs, competence development in lifestyle management, initiated by healthcare managers at an organizational level, would be valuable for both patients and HPs. HPs requested that competence development should focus on developing interpersonal skills regarding lifestyle management and improving theoretical knowledge of local, national, and international guidelines.
To be able to explain something clearly to someone else, you have to have pretty good knowledge yourself. To be able to break it down and convey it easily. (Participant no.1)
A deeper theoretical knowledge of some lifestyle habits was seen as desirable, especially competencies to discuss dietary habits with patients, and to coach them on how to change these. However, HPs perceived that competence development in lifestyle management was only possible when other assignments allowed time for knowledge acquisition.
Our manager has said, “You can set aside, whatever it may be, an hour a week” or something like that. But it is hard. It’s not always that easy to apply. (Participant no. 5)
Commitment within the team
Commitment within the team in terms of coordination of interdisciplinary teamwork and utilizing profession-specific expertise was seen as crucial for working on lifestyle management for patients with early RA. The adoption of a structured lifestyle management approach was also identified as an essential prerequisite.
Coordination of interdisciplinary teamwork in lifestyle management
According to HPs, optimally constituted interdisciplinary teams possess knowledge of each other’s professions and treatments, collaborate closely, and share common goals with the patients. Such teamwork was carried out at varying levels due to unstructured working methods, lack of cooperation, or time, according to HPs. The HPs highlighted the value of being able to refer patients to a local health unit that specialized in lifestyle habits. It was also put forward that a specific team within the clinic specialized in lifestyle habits could have been desirable. Coordinated interdisciplinary teamwork was seen as necessary to clarify responsibilities and expectations in the team. HPs conveyed that the overall picture of lifestyle management and responsibilities for different professions was somewhat unclear. However, they also perceived that patients usually had the opportunity to discuss lifestyle habits with someone within the team.
Everyone should know what the other colleague is saying about what… That we know who takes which ball, so no one ends up in the middle, and everyone should be able to know a little about everything. (Participant no.1)
A recurring proposal from the HPs was that team members should try to increase their competence and cooperation regarding lifestyle management by learning from each other and each profession’s specific competencies. HPs also stated that continuity regarding information about lifestyle habits was important and that it was valuable that all professions repeated the importance of achieving or maintaining healthy lifestyle habits to the patients.
I think we are all important in the healthcare chain. If several of us talk about the same thing, I think we probably reach the patient better. That’s how people work. The more people who mention the same thing, the more valuable you think that the information is. Then the chances are greater that they will follow your advice. We are all important. From the receptionist who says that this is a non-smoking hospital or take the stairs instead of the elevator to the [attending rheumatologist] who meets the patient. (Participant no. 8)
HPs perceived that they focused on different lifestyle habits according to their discipline and in relation to each profession’s responsibilities and specific knowledge. The HPs with the most profound knowledge of each lifestyle habit tended to discuss the subject with the patient.
A lifestyle habit that is the obvious one that we always work with in every single patient meeting is physical activity. It feels like a matter of course … and it is, as always, included in the patient conversation. (Participant no. 11)
According to the HPs, some lifestyle habits were more challenging than others to discuss with patients. Physical activity, diet, and tobacco were often perceived as manageable to discuss, while discussions about alcohol consumption were perceived as stigmatized. Lack of evidence was another reason why specific lifestyle habits did not receive as much focus in the conversation. One example was that HPs found it hard to give recommendations regarding specific diets in relation to RA because the evidence was deficient, even though some patients requested this information. On the other hand, HPs described that dietary advice was given in relation to excess weight, obesity, or cardiovascular disease.
There are a lot of patients asking, “How does diet affect my rheumatic disease?” I usually feel that I have no very clear answer to give. Because the evidence that is available is quite scattered …So I usually do not go into any big reasoning but explain that, unfortunately, I do not have a lot of knowledge about it. (Participant no. 3)
Structured lifestyle management approach
A more structured approach to lifestyle management was desirable, according to the HPs. They described that the current work concerning lifestyle management did not follow a specific structure or routine. More specifically, developing working methods into structured documentation and communication about lifestyle management was seen as essential.
I think it would be great if we could have a more systematic teamwork that follows patients in their disease development, which I think we are missing. (Participant no. 3)
Perceptions of local intervention models and checklists varied. Some HPs described local models and checklists as valuable, while others felt that such tools would be ineffective. Some HPs were not aware of checklists already available.
A checklist of things to bring up on the first visit. We could be much clearer with that so that it´s not so personal. (Participant no.1)
Commitment to involving patients
Commitment from HPs to involve patients in lifestyle management was identified as essential. Strategies seen as valuable to improve patients’ ability to achieve healthy lifestyle habits were facilitating patient engagement and providing a person-centred lifestyle management approach.
Facilitating patient engagement in lifestyle management
The HPs expressed that it was important to facilitate patients’ engagement in lifestyle management. Helpful strategies were to motivate and empower patients to manage their lifestyle habits.
If the patient in our conversation gets a feeling that they themselves can influence how their future will be, then I feel that there is a motivation that can be strengthened. It is very individual where the patient is when I meet him. It feels like the most important thing is to give space and mirroring the feeling that I actually can influence my situation in different ways and that lifestyle habits are an important part. (Participant no. 12)
In their work on lifestyle management, HPs found motivational interviewing and mindfulness as practical approaches to involve patients.
I love motivational interviewing. I think it’s excellent. I really buy that concept straight off and try to think about it. Start at the right end and start where you should. (Participant no. 16)
Commitment from HPs to involving patients in lifestyle management and facilitating patient engagement was described as having developed more in recent years.
We are much closer to lifestyle habits today, with activity in everyday life … Today, it is much more to motivate patients to become involved and find the patients’ strategies. That’s a huge difference. This way of working is much more fun, and it becomes much more patient-centred. (Participant no. 12)
Person-centred lifestyle management
The HPs expressed a need for improvement concerning patients’ knowledge about the impact of lifestyle habits on RA. A recurring conclusion was that information about healthy lifestyle habits should be individualized, and convey a sense that patients have the power to influence their health. HPs also highlighted the importance of seeing each patient’s individual needs and resources when motivating them to engage in lifestyle management. According to the HPs, person-centred lifestyle management should be given at an early stage in the disease to facilitate motivation.
The fact that it is person-centred, individualised, and tailored—the patient needs that. We will provide patients with person-centred care—they need it. It’s so obvious to us. (Participant no. 11)
The HPs perceived shared decision-making as fundamental in person-centred lifestyle management and that patients’ commitment and participation were essential for behavioural change. Motivation and empowerment were expressed as vital elements of shared decision-making.
If you, together [with the patient], reach an agreement on a small change to be made. To be responsive to what they want and meet them on it … It’s about coaxing and meeting and taking one step at a time. Coaxing and coaxing, and meeting them where they are and proceed from there… (Participant no.2)
Discussion
This study indicated that commitment from healthcare managers, organizations, interdisciplinary teams, and patients is essential in the work on lifestyle management in patients with early RA. HPs expressed that healthcare managers and organizations needed to provide preconditions for HPs to prioritize work on lifestyle management and support for competence development in lifestyle management. Commitment within the team was considered valuable, including coordination of interdisciplinary teamwork and a structured lifestyle management approach. Another important aspect was the commitment from the team to involve patients in lifestyle management by facilitating patient engagement and using a person-centred approach early in the disease course. The need for support and commitment from different levels is congruent with the theoretical framework of person-centred care. Person-centred care includes several domains, including prerequisites, environment, processes, and outcomes (McCormack & McCance, Citation2006, Citation2016). Prerequisites for lifestyle management in the present study related to HPs’ competence, responsibility, and commitment to the work. The significance of the care environment was highlighted by the need for commitment from healthcare managers and organizations to act as a foundation for HPs to assist patients in achieving healthy lifestyle habits. The HPs perceived it essential to utilize an approach including professional expertise, coordinated interdisciplinary teamwork, and a care process focusing on structured, person-centred care in work on lifestyle management. These findings will be further elaborated below by the headings; the foundation, the approach, and the care process.
The foundation
The results showed that healthcare managers and organizations play an essential role in HPs’ work on lifestyle management and that prioritizing and creating a supportive structure based on recommended guidelines was seen as a necessary foundation for lifestyle management in early RA. However, the HPs in this study highlighted that lack of structure, resources, and time was challenging and prevented them from developing their competence and prioritizing the work on lifestyle management, as recommended (Agca et al., Citation2017; Gwinnutt et al., Citation2020; The National Board of Health and Welfare, Citation2018; Swedish Society for Rheumatology, Citation2022). This is in line with previous research in which HPs in primary care described how lack of resources, organizational structure, and support were barriers to implementing clinical practice guidelines for lifestyle management (Kardakis et al., Citation2018). The national guidelines for prevention and treatment of unhealthy lifestyle habits confirm that governmental agencies and organizations in the healthcare sector need to become more actively involved in strengthening work on lifestyle management (The National Board of Health and Welfare, Citation2018).
The approach
An elaborate lifestyle management structure was found as a practical approach to strengthening interdisciplinary teamwork. Commitment within the team, coordination of interdisciplinary teamwork, and a structured lifestyle management approach were identified as essential by the HPs. Several studies support that an interdisciplinary team collaborating towards shared goals is necessary to achieve positive outcomes (Burmester et al., Citation2020; Wade, Citation2020; Zangi et al., Citation2015). The HPs in the present study also emphasized that collaboration between and within the professions was a vital part of the work on lifestyle management to achieve a person-centred approach. This corresponds to previous research, showing the need for interdisciplinary teams to consider patients’ needs and preferences (Burmester et al., Citation2020; Lahiri et al., Citation2022; Zangi et al., Citation2015) and that the approach with interdisciplinary teamwork is the key element in the care environment and care process domains (McCormack & McCance, Citation2006, Citation2016).
The care process
The commitment to involving patients in lifestyle management and the clinical encounter between patients and HPs are essential in the care processes. The HPs emphasized that person-centred lifestyle management should consider each person’s needs and resources, which is in line with previous research demonstrating that effective interventions should be tailored to the patient’s needs (Agca et al., Citation2017; Gwinnutt et al., Citation2020; Wade, Citation2020). Seeing the person behind the patient, listening to the patient’s story, and letting the patient be involved in their healthcare are the fundamental components of person-centred care (Ekman et al., Citation2011, Citation2021; McCormack & McCance, Citation2006, Citation2016). HPs expressed that patient engagement, motivation, and empowerment were vital elements in the care process of person-centred lifestyle management. This follows the EULAR recommendations to facilitate patients’ involvement in care processes and that healthy lifestyle habits can improve patients’ health and quality of life (Gwinnutt et al., Citation2020; Marques et al., Citation2021).
Clinical implications
The results indicate that rheumatology care needs to prioritize and optimize lifestyle management. Healthcare managers and organizations can facilitate and strengthen lifestyle management in the clinical setting by providing more structured conditions and allocating time and opportunities for competence development. Overall, a structured interdisciplinary team creates added value when each profession contributes its expertise to patients in order to succeed in lifestyle management and should be based on a person-centred approach.
Methodological considerations
Strengths and limitations are discussed using the qualitative concepts of credibility, dependability, confirmability, and transferability, to provide conditions for the reader to assess the study’s trustworthiness (Lincoln & Guba, Citation1985). Credibility refers to confidence in the truth of the data and the analysis and finding a sufficient number of participants with perceptions of the phenomenon to cover variations around content (Lincoln & Guba, Citation1985). The rich and detailed descriptions of all elements in the methodological process strengthened credibility. The data was rich in content and covered variations in experiences of the phenomenon, since the study is based on 20 interviews with HPs with care experience at a specialized rheumatology clinic, and since interdisciplinary researchers were involved in the data collection and analysis. Dependability refers to the stability of data over time (Lincoln & Guba, Citation1985). The dependability was strengthened since the interviews were based on an interview guide that ensured the same questions were asked to all participants, and two experienced qualitative researchers conducted the interviews. The researchers that interviewed the participants and analysed the data had no established relationship with the participants prior to the study’s commencement. The fact that there were two researchers conducting the interviews can be both a strength and a limitation, given that the researchers’ preconceptions can influence the interpretation of the participants’ narrative and, thus, the follow-up questions. But the researchers’ various professions also entailed a broader understanding and variation of the phenomenon. Confirmability refers to the neutrality of data (Lincoln & Guba, Citation1985), ensuring that the data represents the information provided by the participants and accurately reflects their voices. Quotes have been used to present the HPs’ own words and to show variations and similarities in the material, strengthening the study’s dependability. Transferability refers to whether the result can be transferred and applied to other environments or populations (Graneheim & Lundman, Citation2004; Graneheim et al., Citation2017). An appropriate selection of the HPs, to obtain a variation in professions and years of professional experience in rheumatology strengthened transferability. A limitation can be that all the participants were recruited from the same clinic.
Conclusion
In conclusion, commitment from healthcare managers and organizations to prioritize lifestyle management and facilitate competence development for HPs serve as a foundation for lifestyle management in patients with early RA. Commitment from the interdisciplinary team to coordinate the work on lifestyle management requires a structured approach that serves as the basis for the care process. The importance of involving and facilitating patient engagement as well as providing a person-centred approach was highlighted.
The results from this study reveal the complexity of the work on lifestyle management. Future studies are thus needed to explore how patients with early RA perceive lifestyle management.
Clinical message
The foundation of lifestyle management in early RA has to include commitment from healthcare managers and organizations prioritizing lifestyle management
The approach in lifestyle management requires commitment within the interdisciplinary team and structured lifestyle management
The care process should include commitment to involving patients and ensure a person-centred approach in lifestyle management
Acknowledgments
We thank the participants for generously sharing their perceptions.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Correction Statement
This article has been republished with minor changes. These changes do not impact the academic content of the article.
Additional information
Funding
Notes on contributors
Klara Drake Af Hagelsrum
Klara Drake af Hagelsrum (KDaH) is a Registered Nurse with a Master’s degree in Health and Lifestyle. She is at the beginning of her academic career in the health and lifestyle research field with a particular interest in physical activity and lifestyle behaviours.
Elisabeth Mogard
Elisabeth Mogard (EM) is a Physiotherapist and PhD, specialized in rheumatology. Her research focuses on patients with inflammatory arthritis and rehabilitation, with a special interest in physical activity, lifestyle behaviours, chronic pain, and fatigue. She has performed observational studies and participated in intervention studies.
Ann Bremander
Ann Bremander (AB) is a Physiotherapist and Professor. Her research focuses on rehabilitation, where physical activity and lifestyle are of special interest. She has performed observational studies as well as intervention studies, including the general population, adolescents, and people with chronic diseases.
Elisabet Lindqvist
Elisabet Lindqvist (EL) is a Medical Doctor and Associate professor in Rheumatology. Her research focuses on early Rheumatoid arthritis, Spondyloarthritis and rehabilitation, where functioning, pain and quality of life are of special interest. She has performed observational studies and participated in clinical trials.
Ingrid Larsson
Ingrid Larsson (IL) is a Registered Nurse, PhD, and Associate professor in Nursing. Her research focuses on person-centred care and patient participation within the field of health and lifestyle. She has performed qualitative studies as well as intervention studies, including children, adolescents, and adults, with chronic physical and mental health conditions.
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