The impact of rheumatoid arthritis on the homemaker

Few current studies of the effects of chronic conditions on social functioning examine the effects of disease on the role of homemaker. A major problem confronting researchers in this area is the difficulty in operationalizing dysfunction in social roles other than work roles. In this study we have developed a measure of homemaker functioning based on conceptualizing the homemaker role on two dimensions: the instrumental functions associated with meeting the physical needs of the household and the nurturant dimension concerned with meeting the expressive needs of the household. We used our measure of homemaker functioning to study the effects of rheumatoid arthritis on 142 women, whether employed outside the home or not, between the ages of 21 and 65, all living with husband and/or children at the time of disease onset. The disease significantly limited both instrumental and nurturing functions associated with managing a household. The more strenuous instrumental functions were more likely to be limited, although women in our study experienced serious limitations in nurturant role functions, as well. Limitations in functioning along the nurturant dimension were surprisingly high and previously undocumented. Comparisons between women employed outside the home and those not employed found few differences between the groups in social functioning on either dimension of the homemaker role. Employed women were somewhat less physically disabled than the unemployed, but both groups of homemakers continued to assume major responsibility for homemaking. Assessing functioning in social roles other than work, and functioning in nurturant as well as instrumental areas, is especially important in evaluating the effects on women of a chronic disease such as rheumatoid arthritis.