UBC Theses and Dissertations

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UBC Theses and Dissertations

What are womxn thinking? Understanding perinatal management of rheumatoid arthritis using a feminist epidemiological framework Rebić, Nevena


INTRODUCTION: Despite recent guidelines for managing rheumatoid arthritis (RA) in pregnancy, high rates of discontinuing medications compatible with pregnancy during the first trimester among patients may suggest a translation gap of emerging clinical knowledge. This thesis aims to provide an understanding of how female patients with RA engage in making medication and reproductive decisions. OBJECTIVES: To understand the perspectives and experiences related to pregnancy and early parenting among female patients with RA and healthcare providers involved in their care (Part 1); and to understand how female patients with RA form decisions related to having children, pregnancy, and medication use (Part 2). METHODS: Part 1: I conducted a systematic review and thematic synthesis of literature about pregnancy and early parenting amongst female patients with inflammatory arthritis, including RA, and their healthcare providers. Part 2: I employed a constructivist grounded theory design and used semi-structured interviews to explore medication and reproductive decision-making in the context of living with RA among a purposive sample of participants. Data collection and analysis were iterative, employed theoretical sampling, and peer debriefing, and culminated in a theoretical model. RESULTS: Part 1: I identified 5 analytical themes among patients – making reproductive and family building decisions; experiencing pregnancy and parenting; navigating caregiving with chronic disease; seeking information and resources for pregnancy planning; and interacting with healthcare providers – and 3 additional analytical themes among providers – providing reproductive health care; interacting with patients; and coordinating patient care with other providers. Part 2: Participants dynamically engaged in four decision-making processes: using medications, having children, planning pregnancy, and parenting. These processes were complexly influenced by their intersecting identities and contextual factors within their decision-making environment, particularly attitudes towards health and medications, disease onset and severity, familial support system, and healthcare provider relationship. CONCLUSION: This thesis provides insight into how patients make reproductive decisions in the context of managing RA with particular emphasis on the patient identity and care experiences. A patient-centred care approach is suggested to support female patients with RA in making better reproductive and medication choices aligning with their individual desires, needs, and values.

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