“It’s becoming the centre of everything” – a qualitative study using Patient Journey Mapping to examine the impact of social factors on healthcare interactions and disease outcomes for people living with rheumatoid arthritis

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ID: 332048
2026
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Abstract
Abstract Objectives Disadvantageous socioeconomic status (SES) is associated with poorer disease outcomes for people living with rheumatoid arthritis (RA). We aimed to determine how people living with both RA and socioeconomic disadvantage navigate the healthcare system. In particular, we aimed to determine how their SES influences their interactions with the healthcare system, and, how it modifies the care they receive, to influence health outcomes. Methods This was a qualitative study utilising patient journey mapping techniques. In-depth, semi-structured interviews were conducted by two interviewers. Interview transcripts were coded and reflexive thematic analysis (TA) was undertaken through sequential rounds of theme generation until thematic consensus was achieved. Themes were synthesised and interpreted using the Cumulative complexity (CC) model and Candidacy Framework (CF). Results Following purposeful sampling, 42 individuals met inclusion criteria, and interviews were ultimately arranged with 8 individuals (50% female, median age 58.5 (IQR 56–66.5)). Interviews lasted mean 88.5 minutes (SD 13.6). Most participants were unemployed and receiving social benefits. Six key themes were identified: the challenges of acknowledging and attributing symptoms, building health literacy, maintaining effective relationships with healthcare staff, managing treatment challenges, living with trauma, and, adapting to chronic illness. Conclusion Individuals with low SES have unique experiences of RA care, influencing all aspects of their RA health journey. Using the CC and CF, the themes identified in this study highlight actionable strategies to improve care pathways to better support individuals living with greater cumulative complexity and disadvantage.
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Authors Oscar Kenneth Russell, Angela Elisabeth Brown, Carlee Deanne Ruediger, Rachel J Black, Catherine Hill, Elizabeth A Hoon
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Journal Rheumatology Advances in Practice
Year 2026
DOI
10.1093/rap/rkag121
URL
https://doi.org/10.1093/rap/rkag121
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