Self-Management of Chronic Pain by Elderly People Living in Rural Communities in North-eastern Thailand

Transcription

1 Self-Management of Chronic Pain by Elderly People Living in Rural Communities in North-eastern Thailand Ladawan Panpanit Ph.D candidate, Victoria University, Melbourne, Australia

2 Aims General aim To describe and understand the measures that elderly people, who live in rural communities in northeast Thailand, take to self-manage their chronic pain Specific aims To understand how chronic pain affects the general wellbeing of elderly people To examine the measures that the elderly people take to self-manage their chronic pain To identify the factors that moderate the way elderly people self-manage their chronic pain

3 Background Chronic pain is a common problem among elderly people Proper management of chronic pain is crucial to promote the general well-being (Katz, 2002) Rural North-eastern Thai elderly encounter limited resources for their management Understanding the way the elderly people selfmanage their pain will help better management

4 Sweden Spain Taiwan Background: Chronic pain is a common problem among elderly people Porportion of pain in elderly (%) Figure 1. Prevalence of chronic pain in other countries

5 Background: Chronic pain is a common problem among Thai elderly body & joint pain 43.9 Hypertension back pain 10.2 headache Most common symptoms in Thai elderly (%) Figure 2. Most common symptoms/illness in Thai elderly (Ageing Thai Organization Ministry of Public Health Thailand, 2006)

6 Background: Chronic pain in Thai elderly Headache Body&back joint body&joint back NH Com1 Com2 Figure 3. Prevalence of chronic pain in Thai elderly from different surveys.

7 Background (cont d) Chronic pain is a common problem among elderly people Proper management of chronic pain is crucial to promote the general well-being (Katz, 2002) Rural North-eastern Thai elderly encounter limited resources for their management Understanding the way the elderly people selfmanage their pain will help better management

8 Background (cont d) Limited resources for pain management: Income 40.8% of Thai elderly reported having insufficient incomes (Ageing Thai Organization Ministry of Public Health Thailand, 2006) Thai elderly living in rural communities were in a very precarious situation (Lloyd-Sherlock 2006) Rural North-eastern Thai have relatively low incomes compared to those in other rural parts of the country and to those in the urban North-eastern region (Benjakul, 2004)

9 Background (cont d) Limited resources for pain management: Limited access to health care services and low health status Low ratio of nurses and doctors to the general population in the rural Northeastern region (1:1,278 and 1: 7,251 compared to 1:289 and 1:767 in Bangkok Metropolis) (Ministry of Public Health Thailand, 2005) The proportion of North-eastern elderly who reported that their health status was good or very good was relatively low (31%), compared to those in central (35%), northern (38%), and southern (39%) parts of the country (Ageing Thai Organization Ministry of Public Health Thailand, 2006)

10 Background (cont d) Chronic pain is a common problem among elderly people. Proper management of chronic pain is crucial to promote the general well-being (Katz, 2002) Rural North-eastern Thai elderly encounter limited resources for their management. Understanding the way the elderly people selfmanage their pain will help better management

11 Design Qualitative research, using a grounded theory approach (Strauss & Corbin, 1990, 1998) Theory that was derived from data, systematically gathered and analysed through the research process (Strauss & Corbin, 1998, p. 12)

12 Participants and Recruitment A purposive sample (Patton, 2002) at the beginning of the study Inclusion criteria - Male or female Thai elderly, aged 60 years or over - Experiencing chronic pain for 6 months or longer - Living in the selected villages - Can communicate in conversational Thai or Northeastern Thai dialect. Thereafter, theoretical sampling was used

13 Participants and Recruitment 32 males and females aged 60 years or over who had suffered pain for at least 6 months at the time of commencing the data collection in July 2008

14 Setting Khon Kaen Roi-Et Maha Sarakham Thailand Map from Map from

15 Methods of data collection A triangulated approach to data collection (Denzin & Lincoln, 2005; Speziale & Carpenter, 2007) Three data collection methods: Questionnaires: A demographic data questionnaire Interviews: 32 In-depth, individual interviews 28 audio-recorded Observations: 8 observations Simultaneous data collection and analysis

16 Data analysis Quantitative data Questionnaire data: SPSS for Window to analyse descriptive statistics Qualitative data Interview data was transcribed verbatim translated into English The transcriptions were read and re-read Interview and observation data was analysed using constant comparative analysis

17 Data analysis cyclical three-step process of coding: - open coding - axial coding - selective coding Integration of theory: Category reduction selective sampling of the literature selective sampling of the data (McCann & Clark, 2003; Strauss & Corbin, 1998)

18 Preliminary findings Contextual factors Accessibility to pain relief treatments Accessibility to pain related information Availability of support Participant-provider-service circumstances

19 Preliminary findings Accessibility to pain relief treatments Western-oriented medicines Traditional medicines Over-the-counter medications Other choices

20 Preliminary findings Accessibility to pain related information Health care personnel Other sources

21 Preliminary findings Availability of support Family members Relatives Community Health care staff The Thai government

22 Preliminary findings Participant-provider-service circumstances Relationships with the providers Satisfaction with public and private services

23 Process of chronic pain self-management Making sense of pain Exploring the treatments and resources to self-manage chronic pain Integrating the treatments in everyday life Identifying the most suitable treatments Incorporating the treatments into life - Asking question - Making causal assumptions & Predicting prognosis - Identifying pain related influences - Gathering pain management information - Responding to pain management information - Accessing pain management resources - Using trial and error - Assessing the treatments - Appraising the practitioners - Achieving realistic goals - Minimising the adverse effects of the treatments - Adjusting roles - Preserving health - Managing other symptoms

24 Process of chronic pain self-management Making sense of pain Exploring the treatments and resources to self-manage chronic pain Integrating the treatments in everyday life Identifying the most suitable treatments Incorporating the treatments into life - Pain experiences - Pain related belief systems - Priority given to chronic pain - Other people s concerns - Low health literacy - Reflective thinking skills - Information and resource seeking skills - Elderly people s self-care ability - Availability of support - Beliefs about the causes of illness and preferences for specific treatments - Availability of support - Numbers of people living with

25 Preliminary findings Categories Making sense of pain Exploring the treatments and resources to self-manage chronic pain Integrating the treatments in everyday life Sub-categories Identifying the most suitable treatments Integrating the treatments into life Context of categories - pain experiences - pain related belief systems - Priority given to chronic pain - Other people s concerns - Low health literacy - Reflective thinking skills - Information and resource seeking skills -Elderly people s self-care ability - Availability of support - Beliefs about the causes of illness and preferences for specific treatments - Availability of support - Numbers of people living with the elderly people Strategies - Asking question - Making causal assumptions and predicting prognosis - Identifying pain related influences - Gathering pain management information - Responding to pain management Information - Accessing pain management resources - Using trial and error - Assessing the treatments - Appraising the practitioners - Achieving realistic goals - Minimising the adverse effects of the treatments - Adjusting roles - Preserving health - Managing other symptoms

26 Special thanks Supervisors Professor Terence McCann Victoria university, Australia Associated Professor Wanapa Sritanyarat Khon Kaen University, Thailand Scholarships Endeavour Postgraduate Awards, Australia All participants and their families

27 Thank you

28 References Ageing Thai Organization Ministry of Public Health Thailand. (2006). The survey and study of health status of elderly in 4 regions of Thailand. Bangkok: Ageing Thai Organization Minister of Health Thailand Ageing Thai Organization Ministry of Public Health Thailand. (2007). Health of Thai elderly. Retrieved 3 October, 2007, from Assantachai, P., & Maranetra, N. (2003). Nationwide survey of the health status and quality of life of elderly Thais attending clubs for the elderly. Journal of Medical Association Thailand, 86(10), Benjakul, S. (2004). Equity of Health Care Utilization by the Elderly Population in Thailand during the Periods of the Economic Bubble and after the Economic Crisis:Human Security and Health Policy Options. Japan: Graduate School of Media and Governance, Keio University. Blay SL, Andreoli SB, Dewey ME, & Gastal FL. (2007). Co-occurence of chronic physical pain and psychiatric morbidity in a community sample of older people. International journal of geriatric psychiatry 22(9), Blyth, F. M., Marchb, L. M., Brnabicc, A. J. M., Jormd, L. R., Williamsond, M., & Cousins, M. J. (2001). Chronic pain in Australia: a prevalence study. Pain, 89(2-3),

29 References Catala, E., Reig, E., Artes, M., Aliaga, L., Lopez, J. S., & Segu, J. L. (2002). Prevalence of pain in Spanish population: Telephone survey in 5000 homes. 2002;6: European Journal of Pain, 6(2), Dellaroza MS, Pimenta CA, & Matsuo T. (2007). Prevalence and characterization of chronic pain among the elderly living in the community. Cadernos De Saude Publica, 23(5), Denzin, N. K., & Lincoln, Y. S. (2005). The SAGE handbook of qualitative research (3 rd ed.). Thousand Oaks: Sage. Eriksen, J., Jensen, M. K., Sjøgren, P., Ekholm, O., & Rasmussen, N. K. (2003). Epidemiology of chronic non-malignant pain in Denmark. Pain, 106(3), 221 Institute for Population and Social Research Mahidol University Thailand. (2007). Thai Population Mahidol Population Gazette, 16, 1-2. International Association for the Study of Pain. (2007, 2007). Global Year Against Pain. Retrieved 1 October, 2007, from /HTMLDisplay.cfm&ContentID=2760

30 References Jakobsson, U., Klevsgard, R., Westergren, A., & Ingalill Rahm Hallberg. (2003). Old People in Pain: A Comparative Study. Journal of Pain and Symptom Management, 26(1), Jitapunkul, S., & Bunnag, S. (1999). Ageing in Thailand. Family Planning and Population, 2(6), 1-3. Jitapunkul, S., & Chayovan, N. (2001, 10 May 2001). National Policies on Ageing in Thailand. Retrieved 11 September 2007, from Kreling MC, da Cruz DA, & Pimenta CA. (2006). Prevalence of chronic pain in adult workers. Revista Brasileira De Enfermagem 59(4), McCann, T., & Clark, E. (2003). Grounded theory in nursing research: Part 1- Methodology. Nurse Researcher, 11(2), Miró, J., Paredes, S., Rull, M., Queral, R., Miralles, R., Nieto, R., et al. (2007). Pain in older adults: A prevalence study in the Mediterranean region of Catalonia. European journal of pain, 11(1),

31 References Mujahid, G. (2006). Population Age ing in East and South-East Asia, : Implications for Elderly Care. Asia-Pacific Population Journal, 21(2), Nakorn, N., Mummeng, T., Osaka, H., Usawapak, V., & Donkrasin, B. (1993). An assessment of communities' health problems and felf needs in Khon Kaen Northeast, ThailandL a participatory action research. Khon Kaen: Khon Kaen University. National Statistical Office Thailand. (1990, April 1990). Population and Housing Census. Retrieved 19 September, 2007, from National Statistical Office Thailand. (2000, 2000). Population and Housing Census Retrieved 19 September, 2007, from /pop_e2000.htm Patton, M. Q. (2002). Qualitative research & evaluation methods (3 nd ed.). Thousand Oaks, CA: Sage Saastamoinena, P., Leino-Arjasb, P. i., Laaksonena, M., & Lahelma, E. (2005). Socioeconomic differences in the prevalence of acute, chronic and disabling chronic pain among ageing employees. Pain, 114, Katz, N. (2002). The Impact of Pain Management on Quality of Life. Journal of Pain and Symptom Management, 24(1), S38-S47.

32 Significance of the study help increase understanding of how elderly in rural communities self- manage chronic pain highlight helpful and unhelpful strategies that elderly people use to self- manage their pain provide valuable information for nurses and other health care workers to help elderly in rural communities to self-manage their chronic pain effectively provide further impetus for both qualitative and quantitative studies in chronic pain in rural communities or other settings Point out some considerations for policy in relation to health care services and other support for elderly in rural communities

33 Design: Grounded theory Seven key components (McCann & Clark, 2003) Theoretical sensitivity The ability to distinguish between less and more important data and obtain insight understanding into meaning of the data (Holloway & Wheeler, 2002). Theoretical sampling Sampling based on emerging concepts in order to explore variations among concepts (Strauss & Corbin, 1998). Constant comparative analysis Continuous comparison between new data and previous data where data collection and data analysis are undertaken simultaneously (McCann & Clark, 2003; Speziale & Carpenter, 2007). Coding and categorizing the data Coding : data are examined, conceptualized, reduced, elaborated, and related, to assign a name or a number Categorizing: identifying categories into a broader classification (Strauss & Corbin, 1998).

34 Design: Grounded theory Seven key components (McCann & Clark, 2003) Theoretical diagrams and memos as part of the analytical process Diagrams: visual tools representing relationships among categories (Schreiber, 2001). Memos: the researcher s written records (Strauss & Corbin, 1998). Literature as a source of data improving theoretical sensitivity; providing useful primary and/or secondary sources of data; providing questions, initial concepts and ideas for theoretical sampling; making comparisons; confirming the results; giving the basis for developing a general theory; and allowing for enhancing, verifying, and validating field knowledge (McCann & Clark, 2003; Strauss & Corbin, 1998). Integration of theory An ongoing process of interaction between the researcher and the data, to organize categories around a central category, from the first to the final steps of analysis (Strauss & Corbin, 1998).

35 Ethics approval Obtained from: Victoria University Human Research Ethics Committee, and The Ethical Review Committee for Research in Human Subjects, Ministry of Public Health, Nonthaburi, Thailand

36 The recruitment process Brief information about the study was given to potential participants by public health care centre staff, the formal leaders of each village, village health volunteers, informal village leaders. The researcher then gave a detailed explanation about the study to all potential participants and answered questions to their satisfaction. They was assured that participation was voluntary, and had as much time as they need to consider taking part in the study. They were able to ask questions throughout the study.