The impact of social support on the acceptance process among RA patients: a qualitative study

Acceptance is an important component of pain management, being associated with improved quality of life and lower levels of pain and depression. In enabling patients with chronic diseases to accept unpleasant consequences and to establish a new way of living, the support they receive from their social environment may play a decisive role. In this article, we identify the key sources and types of social support that are relevant for rheumatoid arthritis (RA) patients, and explore when and how those sources are important across the different stages of the acceptance process. We conducted a qualitative study involving 20 semi-structured interviews with RA patients in Switzerland. Analysis of the data followed the precepts of grounded theory. We found that, amid the complexity and variety of patients' struggles for acceptance, there were some common experiences or 'key moments' in which social support played an important role. While three sources of support - family, physicians and the external social context - are fundamental for RA patients, all three may inhibit as well as encourage acceptance, due to the invisible and unpredictable character of the disease. There is a pervasive risk either of underestimating patients' suffering or of over-supporting, both of which prevent patients accepting the disease and developing a new 'normal' life. We conclude that sources of social support need to find a middle way between scepticism and solicitousness.