Barriers and reinforcing factors to self-management behaviour in rheumatoid arthritis patients: A qualitative study

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The aim of the present study was to explore the view of rheumatoid arthritis (RA) patients about the barriers and reinforcing factors in practising self-management behaviour (SMB).


This was a qualitative study based on directed content analysis of in-depth semi-structured interviews with 30 patients. The participants were selected using a purposeful sampling approach. The interviews continued until data saturation was reached. The study was conducted over 6 months in 2014–2015 at the Rheumatology Clinic of Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.


Three main themes and 14 subthemes were extracted. The main themes included behavioural barriers, environmental barriers and reinforcing factors. The subthemes included lack of awareness; poor physician–patient relationship; lack of motivation; negative attitude and willingness; lack of time; cost; housing conditions and in-home equipment; negative social effects; social support; consequences of SMB; and comparing yourself with others.


Behavioural and environmental barriers, as well as social support and outcomes of SMB were the most important barriers and reinforcing factors of SMB. Therefore, considering these factors in patients may help in designing programmes that attempt to reduce barriers and increase reinforcing factors, which ultimately result in higher levels of SMB and quality of life among patients.

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