Chronic low back pain and the construction of illness identities in women from Kuwait

Abstract

Chronic low back pain (CLBP) has been identified as a prominent health problem and a major cause of disability. Recent research has focussed on providing a better understanding of subjective experiences of people with CLBP; however, emphasis continues to be geared towards the physical restrictions associated with CLBP. There is a scarcity of literature that considers the relation between self and identity, and people‟s experiences with CLBP. Moreover, studies have concentrated on the experiences of people in Western contexts; to date, no studies have been carried out in Middle Eastern sociocultural contexts including Kuwait. Finally, there is a deficiency of studies that focus on the particularity of the experiences of women with CLBP and the impact on identity. This is the first study that investigates how women with CLBP construct illness identities in Kuwait. This study adopted a constructivist grounded theory methodology using dimensional analysis. In line with the grounded theory (GT) approach, data collection and analysis took place concurrently. A longitudinal study design was adopted. Semi-structured interviews were used to investigate women‟s perspectives on their experiences with CLBP in relation to their socio-political and cultural context. Eleven women were recruited from three musculoskeletal outpatient clinics in Kuwait. Initially, five women were purposively sampled. A follow up interview was conducted with four of those women one year after the initial interview to investigate any changes in their experiences. Subsequently, six women were theoretically sampled with the aim of comparing the influence of age, educational level, marital status, socioeconomic status and time on women‟s illness experiences. The findings of this study offer the first explanatory theory of the construction of illness identities of women with CLBP in Kuwait. Women‟s identities can be seen as part of a continuum from oppressed at one end to liberated at the other. Salience of oppressed identities was associated with periods of exacerbation of CLBP and passive coping behaviours. Appearance of liberated identities was accompanied with episodes of remission of CLBP and active coping approaches. Changes in women‟s social circumstances, thoughts and feelings over time were related to changes in the identities they portrayed, and changes in their manifestation of CLBP and illness experiences. The substantive theory developed through this study has implications for clinical practice, education and research, and may inform physiotherapy professional development activities in Kuwait.

Date of Award	2015
Original language	English
Awarding Institution	University of Brighton
Supervisor	Kay Aranda (Supervisor) & Nicola Petty (Supervisor)