Open Access Research article

Patient Disease Perceptions and Coping Strategies for Arthritis in a Developing Nation: A Qualitative Study

Nina N Niu1*, Aileen M Davis10789, Laura M Bogart45, Thomas S Thornhill1, Luis Alcantara Abreu6, Roya Ghazinouri3 and Jeffrey N Katz12

Author Affiliations

1 Orthopedic and Arthritis Center for Outcomes Research, Brigham and Woman's Hospital, 75 Francis Street BC-4-4016, Boston, 02115, USA

2 Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, 75 Francis Street, Boston, 02115, USA

3 Department of Physical Therapy, Brigham and Women's Hospital, Tower 2C 75 Francis Street, Boston, 02115, USA

4 Division of General Pediatrics, Children's Hospital Boston, 300 Longwood Avenue, Boston, 02115, USA

5 Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, 02115, USA

6 Department of Orthopedic Surgery, Hospital General de la Plaza de la Salud, Avenida Ortega y Gasset, Dominican Republic

7 Division of Healthcare and Outcomes Research, Toronto Western Research Institute, 399 Bathurst St. Toronto, Canada

8 Arthritis Community Research & Evaluation Unit, Toronto Western Research Institute, 399 Bathurst St., Toronto, Canada

9 Graduate Departments of Health Policy, Management and Evaluation and Rehabilitation Science, University of Toronto, 500 University Avenue, Toronto, Canada

10 Department of Physical Therapy, University of Toronto, 500 University Avenue, Toronto, Canada

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BMC Musculoskeletal Disorders 2011, 12:228  doi:10.1186/1471-2474-12-228

Published: 10 October 2011



There is little prior research on the burden of arthritis in the developing world. We sought to document how patients with advanced arthritis living in the Dominican Republic are affected by and cope with their disease.


We conducted semi-structured, one-to-one interviews with economically disadvantaged Dominican patients with advanced knee and/or hip arthritis in the Dominican Republic. The interviews, conducted in Spanish, followed a moderator's guide that included topics such as the patients' understanding of disease etiology, their support networks, and their coping mechanisms. The interviews were audiotaped, transcribed verbatim in Spanish, and systematically analyzed using content analysis. We assessed agreement in coding between two investigators.


18 patients were interviewed (mean age 60 years, median age 62 years, 72% women, 100% response rate). Patients invoked religious and environmental theories of disease etiology, stating that their illness had been caused by God's will or through contact with water. While all patients experienced pain and functional limitation, the social effects of arthritis were gender-specific: women noted interference with homemaking and churchgoing activities, while men experienced disruption with occupational roles. The coping strategies used by patients appeared to reflect their beliefs about disease causation and included prayer and avoidance of water.


Patients' explanatory models of arthritis influenced the psychosocial effects of the disease and coping mechanisms used. Given the increasing reach of global health programs, understanding these culturally influenced perceptions of disease will be crucial in successfully treating chronic diseases in the developing world.