369 Swimming against the current: a meta-ethnography examining living with arthritis and being employed

Abstract

IntroductionArthritis and related rheumatic conditions are common causes of work disability in Canada and the United States, with job loss ranging between 37%–60% within the first 10 years of diagnosis. As diagnosis commonly occurs between the ages of 30–60 years, the symptoms of pain, limited mobility, and fatigue can seriously disrupt and hinder work lives. While research has examined disability and work loss among persons with arthritis (PwA), little is known about what they do to maintain employment. Our goal was to understand how PwA experience employment and to use this information to build a model describing what they need to sustain employment.MethodsWe searched published studies on arthritis and employment from six electronic databases (1980–2017) and bibliographical reviews using a combination of keywords related to arthritis, employment, and qualitative research. Our search yielded 748 articles, and after applying the inclusion criteria, 17 studies remained. Two reviewers independently reviewed, critically appraised, and extracted concepts from each study in chronological order.ResultUsing a meta-ethnographic process, we identified seven themes highlighting the common issues experienced by PwA. Using these themes, we developed a process model that illustrates how individual factors (i.e., physical symptoms, self-awareness, meaning of work) influence work-sustainability strategies that are initially privately managed (i.e., personal adjustments, medical treatment, family support); however, when symptoms become too difficult to conceal, individuals will disclose their condition to their employer so that they can draw upon additional work-sustainability strategies (i.e., work accommodations, supervisor and co-worker support, insurers). Individuals engage in these strategies to maintain a ‘non-ill’ identity and remain in their current job for as long as possible.DiscussionOur findings will help rehabilitation specialists, employers, and researchers understand what PwA may need to sustain meaningful employment outcomes. Implications to workplace policies and practices are discussed.