Understanding Fatigue-Related Disability in Rheumatoid Arthritis and Ankylosing Spondylitis: The Importance of Daily Correlates.

OBJECTIVE: Fatigue is common among people with inflammatory arthritis but is hard to manage. The aim of this study was to investigate how daily fluctuations in psychological variables correspond with changes in fatigue-related disability in the daily lives of people with inflammatory arthritis and to identify factors to target in psychological interventions and routine clinical practice. METHODS: A cohort of 143 patients with rheumatoid arthritis (n = 97) or ankylosing spondylitis (n = 46) participated in a 10-day online diary study. Each evening participants completed a diary questionnaire assessing their fatigue, pain, fatigue-related disability, and 4 components of psychological flexibility (valued activity, mindfulness, cognitive fusion, and fatigue avoidance). RESULTS: On days when participants were more engaged in valued activities or more mindful, they reported less disability due to fatigue, even when controlling for levels of fatigue and pain that day. The daily psychological flexibility variables explained a total of 15.6% of the variance in daily fatigue-related disability. CONCLUSION: Psychological flexibility variables are directly associated with fatigue-related disability in the daily lives of inflammatory arthritis patients. Further research is needed to investigate whether interventions that target psychological flexibility are effective at reducing fatigue-related disability.

Maori Men's Experiences of Rehabilitation in the Moana House Therapeutic Community in Aotearoa/New Zealand: A Qualitative Enquiry.

In Aotearoa/New Zealand, culturally embedded rehabilitation programmes have been developed to reduce criminal offending among the indigenous Maori population. Currently, there is a lack of research investigating the experiences of these programmes from clients' perspectives. This study aimed to enhance understandings of the lived experiences of Maori men who were participating in a residential therapeutic community (TC) programme in Aotearoa/New Zealand. Semistructured interviews were conducted one-on-one by a psychology master's student who was a staff member at the TC and also of Maori descent. Seven Maori TC residents aged 22 to 48 were interviewed about life in a TC. Thematic analysis of the interview data yielded three themes: (a) "The importance of healing family relationships"; (b) "The relevance of Maori culture in rehabilitation"; (c) "Increased self-awareness." The findings highlight the significance of holistic approaches that emphasize culturally relevant approaches and the involvement of family members in the treatment of substance-use disorders and offending behaviour among indigenous populations.

Education Preferences of People With Gout: Exploring Differences Between Indigenous and Nonindigenous Peoples from Rural and Urban Locations.

OBJECTIVE: Gout typically responds well to medications, but adherence might be improved by education that meets individuals' needs in a way that is inclusive of their ethnicity and rurality. The aim of this study was to compare education preferences of Maori and New Zealand European (NZEuropean) individuals with gout, and of those living in rural or urban areas. METHODS: People with gout managed in primary care were recruited from 2 rural regions and 1 city within Aotearoa/New Zealand. Focus groups were held with 26 Maori and 42 NZEuropean participants (44 rural, 24 urban). Participants discussed education preferences for diet, medication, and ways of communicating. The nominal group technique was employed, whereby the group compiled a list of ideas and then participants individually ranked the 3 most important ideas for each topic. RESULTS: The most frequently prioritized ideas for the 3 topics were knowing one's own food triggers, knowing side effects of medications, and communicating via a general practitioner (GP) or specialist. More Maori participants prioritized natural remedies, easy to understand information, and communicating via television. More NZEuropean participants prioritized knowing the kinds of alcohol that trigger gout, communicating via GP/specialist, and receiving written information. More urban participants prioritized knowing to stay hydrated and medication doses as important information. CONCLUSION: Maori and NZEuropean individuals with gout report different understandings and education preferences around personal triggers of gout, treatment options, and ways of receiving information about gout. Further research is required to develop ethnicity-specific gout education resources internationally.

The importance of health(ism): A focus group study of lesbian, gay, bisexual, pansexual, queer and transgender individuals' understandings of health.

This study investigated understandings of health among lesbian, gay, bisexual, pansexual, queer and/or transgender people, who are under-represented in research. The study involved 12 focus groups in Aotearoa/New Zealand with 47 participants who identified as lesbian, gay, bisexual, pansexual, queer and/or transgender and responded to an advert inviting participants without chronic illnesses. Three themes were inductively formulated: health is important because education and protection efforts are seen as required to preserve health, health is seen as holistic, and contextual factors are seen as creating health risks. These findings provide insights into how lesbian, gay, bisexual, pansexual, queer and/or transgender people's understandings of health draw upon notions of healthism.

A randomized controlled trial of a cognitive behavioural patient education intervention vs a traditional information leaflet to address the cardiovascular aspects of rheumatoid disease.

OBJECTIVES: Cardiovascular disease (CVD) is responsible for 50% of the excess mortality for patients with RA. This study aimed to evaluate a novel 8-week cognitive behavioural patient education intervention designed to effect behavioural change with regard to modifiable CVD risk factors in people with RA. METHODS: This was a non-blinded randomized controlled trial with a delayed intervention arm. Participants were randomly assigned to receive the cognitive behavioural education intervention or a control information leaflet at a ratio of 1:1. The primary outcome measure was patient's knowledge of CVD in RA; secondary measures were psychological measures relating to effecting behaviour change, actual behaviour changes and clinical risk factors. Data were collected at baseline, 2 and 6 months. RESULTS: A total of 110 participants consented (52 in the intervention group and 58 in the control group) to participate in the study. At 6 months, those in the intervention group had significantly higher knowledge scores (P < 0.001); improved behavioural intentions to increase exercise (P < 0.001), eat a low-fat diet (P = 0.01) and lose weight (P = 0.06); and lower mean diastolic blood pressure by 3.7 mmHg, whereas the control group's mean diastolic blood pressure increased by 0.8 mmHg. There was no difference between the groups on actual behaviours. CONCLUSIONS: Patient education has a significant role to play in CVD risk factor modification for patients with RA, and the detailed development of this programme probably contributed to its successful results. It is disappointing that behaviours, as we measured them, did not change. The challenge, as always, is how to translate behavioural intentions into action. Larger studies, powered specifically to look at behavioural changes, are required. Trial registration. National Institute for Health Research, UKCRN 4566.

First-time mothers' perspectives on relationships with and between midwives and doctors: insights from a qualitative study of giving birth in New Zealand.

OBJECTIVE: to explore the experience of giving birth for first-time New Zealand mothers. DESIGN: qualitative methodology was employed to obtain an in-depth insight into the birth experience using semi-structured interviews conducted face-to-face 11 days to 16 weeks (median 13.5 weeks) after giving birth were audio-recorded and transcribed verbatim. SETTING: the interviews were of a small group of New Zealand mothers. PARTICIPANTS: ten first-time mothers aged 24-38 years (median 31.5 years) participated. MEASUREMENTS: transcripts were analysed using a phenomenological form of thematic analysis. FINDINGS: a core theme was relationship issues. Two subthemes were delineated: lack of relationship between mothers and midwives and doctors; and the conflict between midwives and doctors. KEY CONCLUSIONS: personal, caring and co-operative relationships with all maternity care professionals were basic to New Zealand mothers feeling good about their birth experience. IMPLICATIONS FOR PRACTISE: relationships, with and between, all maternity care professionals merit further investigation in an effort to optimise birth satisfaction.

The suitability of yoga as a potential therapeutic intervention for rheumatoid arthritis: a focus group approach.

OBJECTIVES: The aim of this study was to explore the views of patients with rheumatoid arthritis (RA) regarding the suitability of yoga as a potential therapeutic intervention in the management of RA. METHODS: Twenty-two participants with RA were recruited from outpatient clinics at a regional hospital in New Zealand and divided into four focus groups. Heterogeneity between groups in terms of age, gender, duration of RA and functional ability provided opinions from a cross-section of RA patients. Transcripts were analysed using thematic analysis, with four themes predominating. RESULTS: Firstly, participants described their experience of symptoms related to their RA in three independent but linked categories of physical, mental and social well-being. Secondly, participants perceived the management of their RA to be prescriptive, medicalized and failing to address their wider health concerns. Thirdly, participants perceived yoga as a safe, adaptable therapy that may allow self-management of their RA. However, there was some concern that functional limitations may inhibit ability to practise the physical aspects of yoga. Fourthly, requirements for a yoga intervention that would be feasible for people with RA were presented by participants. CONCLUSIONS: Patients with RA perceive a disparity between their personal experience of living with RA and their current medical management. Yoga is perceived as a potential therapy to address this disparity. Based on opinions expressed by participants, future research regarding a yoga intervention as an adjunctive therapy for managing RA should meet patients' views on feasibility and test outcome measures reflecting the domains of physical, mental and social well-being.