The treatment strategies of arthritis sufferers

This paper describes and analyses the reasons for variation in the treatment strategies used by arthritis sufferers. The research was undertaken among 103 people from the Australian city of Perth. Qualitative data was obtained from a clinical sample of 27 and, on the basis of that, an interview schedule was constructed and administered to a survey sample of 76 self-reported arthritis sufferers. Data collected included comprehensive case histories, knowledge and beliefs about arthritis, types of practitioners consulted and treatments used and a range of demographic and socioeconomic variables. On the basis of analysis, four basic treatment strategies were discerned. Named after their most salient characteristics and ranging from least to most inclusive these were 'general practitioner and/or self care', 'medical and paramedical care', 'medical and alternative care' and use of 'all sources of care'. The most important determinants of treatment strategy were characteristics of disease--severity, mode of onset and period since onset. The longer the period since onset, the wider the range of treatments utilized. When onset occured at a relatively young age when progression was rapid, the more frequently alternative services and treatments were employed. Disease characteristics were followed in importance by socioeconomic factors. Use of the less inclusive strategies was related to social class; with working class people relying primarily on 'general practitioner and/or self care' and middle class people using 'medical and paramedical care'. However, when onset and progression were rapid, the disease was severe and the person relatively young socioeconomic factors were of lesser importance and people from all classes made use of the more inclusive strategies. The relationship between people's knowledge and beliefs about arthritis was not as strong as those between treatment strategies and the other variables examined. In part, knowledge and belief were built up in the course of seeking treatment rather than determining its choice. The results of the study emphasize the importance of the combination of disease characteristics and social structural factors in shaping people's response to illness.