INTRODUCTION
Chronic illness refers to those disease categories for which are incurable, to conditions that are ineradicable and usually progressive. Royer (1998) states that long-term chronic illness, be it physical or mental, is catastrophic. Even with advance treatment, chronic illness exists and will never go away. Royer cited that The Commission on Chronic Illness (1956:1) defines chronic illness as “all impairments or deviations from normal which have one or more of the following characteristics: are permanent, leave residual disability, are caused by non-reversible pathological alteration, require special training of the patient for rehabilitation, and/or may be expected to require a long period of supervision, observation or care.” The torment of physical pain, discomfort, and the effects of the treatment procedures contribute to the burden being carried by the chronically ill as it triggers with the illness. As Royer (1998: 2) depicts, partially “the course of illness and treatment of a chronic illness is quite different from that of an acute illness.” Its course of illness is long and unpredictable, after it begins abruptly. Some basic examples of chronic illness are arthritis, diabetes, multiple sclerosis, stroke, cardiac incapacity, paraplegia, renal disease, some forms of cancer, progressive blindness, and osteoporosis.
This study particularly focuses on osteoporosis as it hopefully seeks if positive attitude has an advantage over negative attitude when it comes to coping with the chronic illness. This study also has the purpose to determine the extent and integration of osteoporosis knowledge. The researcher will evaluate the different attitude of women with chronic illness, and then analyzes the result to determine the right attitude on facing a serious chronic illness like osteoporosis. This cross-sectional study will cover two age groups of women with osteoporosis and aims to compare attitudes through questionnaires and interviews. In addition, since all chronic illness is similar in terms of its incurable nature, examples of attitude of women with the illness aside from osteoporosis will also be reviewed.
Generally, this study aims to evaluate and determine if a person with osteoporosis that has a positive attitude can do better with someone who handles the chronic condition in a negative way. Specifically, the study will try to answer the following queries:
1. What are the different attitudes and approaches of women with osteoporosis on their illness?
2. In what way does these attitudes differ from each other?
3. What are the factors that cause a woman with an osteoporosis to in a particular attitude?
4. Is attitude one of the factor that affects a successful coping of a woman with osteoporosis?
LITERATURE REVIEW
Cogswell and Weir (1973) states that although chronic diseases vary in course of disease and type of treatment, the whole array can be considered a single category on the basis of two similarities: the patient is an active participant in her or his medical care; and the goal of treatment is control, or management, since “recovery” at this stage of medical knowledge is usually impossible. With this approaches, it is imperative that the right attitude should be applied. But in some cases, people with chronic illness seem to give up easily wishing that their life would just end to stop the suffering. This attitude takes place because of the psychological and social factors that a chronic illness brings to a patient.
Women Today published a brief story of a woman struggling to fight a Chronic Fatigue Syndrome (CFS). Susan Martinuk (2003) had a blooming career until she was diagnosed with CFS. The illness causes permanent fatigue and a depressed immune system. Susan had a Type A personality and for a short period of time, she have managed to keep this attitude for her work and to maintain her identity. But with all the efforts, Susan admitted that when she couldn’t work effectively, her self-esteem crashed and depression soared. This changed Susan’s attitude as she blamed God for everything that have happened to her. Bearing this attitude caused her more suffering than to what CFS alone did to her. Then finally, she decided to turn to God and ask for His help. The decision brought her peace of mind and acceptance of her condition. “Each step that I have taken on my journey of reconciliation with God has brought some degree of physical healing,” Susan stated. “My battle with CFS is the hardest thing I’ve ever had to endure. And, although I didn’t recognize it at the time, it was the beginning of a life-changing journey with God. That journey has changed my priorities and taught me to place my hope in God’s power to accomplish things, rather than in my own talents and skills,” she continued.
In the case of Susan, like all the other cases, she faced difficulty accepting her condition. Royer (1998: 75) states that “the act of living itself is an adaptive process. By adulthood, everyone achieves a certain level of life adaptation, but chronic illness disrupts this achievement, because the additional burdens in dealing with the many problems of chronic illness diminish the capacity of individuals to respond in satisfactory ways.” Adaptation implies a balance between demands and expectations of a given situation and the capacities of an individual to respond to those demands. Failure to adapt, then, means that there is a discrepancy between demands and capabilities (Mechanic 1977). Royer (1998) continues that adaptation is influenced by multiple factors and manifested in various forms.
“Individuals are not passive organisms; their responses to particular situations are conditioned by the success or failure of their past experiences, among other factors. Furthermore, adaptation takes place at an uneven pace within multiple spheres of life” (Royer, 1998: 76)
This explanation can be linked to what Susan have experienced as she reflected her past experiences and assessed it with the situation she was in. Normally, Susan had the difficulty of adopting the conditions of the sickness. Royer (1998) continues that adaptation is evaluated from many perspectives by different sets of criteria. Ill persons themselves, health care providers, family, friends, employers, and funding agencies each have different sets of priorities and criteria for measuring different sets of role expectations. Susan’s turned her priority to God, and this has helped her adopt with the illness.
Dimond and Jones (1983) point out at least three major characteristics of illness that are critical to the long-term adaptive responses of the chronically ill person. These characteristics are: the type of onset and expected course of the illness, the nature and extent of limitation, and the type and extent of changes in physical appearance and bodily functions. Susan had the negative attitude at the early start of her illness because it wasn’t her expected course, or what would happen. She assumed that she could still handle her job despite the hindrance of the illness. The moment she realized that the illness was starting to affect her work, frustration started to kick in that eventually led to depression. However, realizing her limitations, she decided to have a priority and that has been to have a closer bond with God.
Weinert (1999) of the Montana State University, College of Nursing states the hardship of coping up with chronic illness. She also states that living with chronic illness requires “work” or the expenditure of energy to maintain health and emotional stability, and the need for social support is an imperative. Information and reassurance should also be intensified. Weinert (1999) concluded research has demonstrated that social support has a positive influence on the experience of dealing with illness.
Siddel (1997) states that loss issues appear to be a significant factor for adults younger than age 65 coping with chronic illness, regardless of the specific disease process or etiology. Zemzars (1984: 44) indicated that the one characteristic common to all chronic illnesses is that the person “can never fully return to his or her pre-illness state of heath. Thus the experience of a loss ensues”. This loss of health can be devastating, regardless of the individual’s particular situation. The attitude of an individual with a chronic illness, therefore, can be based to the amount of loss that he or she acquired. If the individual has a meaningful career about to be destroyed by the illness, the devastation level would be higher than that of a chronically ill individual who is already retired.
Pollin (1994) cited eight fears of a person with a chronic illness: loss of control, loss of self-image, loss of dependency, stigma, abandonment, expression of anger, isolation, and death. In addition, Lapham and Ehrhart (1986) cited increased depression, anxiety, alienation, abandonment, withdrawal from intimate or previously satisfying relationships, and emotional ambivalence as potential reactions. This list is not comprehensive, nor is it dependent on any prescribed set of circumstances. These fears and conditions result in the deterioration of the patient’s self-esteem just like what happened to Susan. She feared of losing her self-image that resulted in the acquisition of negative attitudes. In relation to how Susan countered this, Siddel (1997) states that people dealing with loss issues relative to chronic must navigate an emotionally charged battlefield, but on the other hand, Hymovich and Hagopian (1992: 3) observed that “chronic conditions present a challenge to overcome: to incorporate living with an illness into one’s lifestyle”. This positive reframing of hardship into growth builds on the intrinsic strength and coping abilities of some individuals. However, it may not be a possible restructuring of thought for others.
Coping is one of the stages that a chronically ill person treads. Lazarus and Folkman (1984) describe coping as cognitive and behavioral attempts to deal with psychological stress. Basically, there are many ways to cope with chronic illness, but in the case of Susan, religion or religious beliefs have been used. This tool has been successful for Susan in terms of changing her attitude towards her condition. To most people, participating in religious activities or adhering in religious beliefs are ways to recover from a slump of attitude due to unprecedented crises like chronic illness. Crose, et al (2002) cited that in a study conducted by Rosen (1982), approximately 40% of the respondents over the age of 65 years used religion as a coping behavior. He further cited that Conway (1985-1986) reported similar findings in a study of women’s responses to stressful medical problems. The effect of religious beliefs on coping has been measured in the context of serious illness. In addition, Holt and Dellman-Jenkins (1992) discussed the impact of religion on issues of morale and well-being. They noted several studies that suggested that individuals with intrinsic or extrinsic religiosity, or both, were less lonely, more positive about their lives, and perceived greater social support than individuals who do not express religiosity.
Siddel (1997) states that the developmental stage of the individual plays a major role in how he or she views chronic illness. She cited that chronic illness, particularly if it strikes the late 30’s to 50’s age group, is likely to bring about fears of dying or a fear of early aging. It adds to the frustration of the midlife crisis and leaves many new responsibilities” (Adderley & Levine, 1986: 111). It adds up to frustrations as being in the mid-life means having many responsibilities, and because of the chronic illness, these responsibilities might not be met. As in other stages in life, a crisis such as chronic illness may reawaken struggles and conflicts of earlier periods (Adderley & Levine, 1986). Concurrently struggling with unresolved issues of earlier life stages while dealing with care tasks necessitated by a chronic illness is often a difficult task.
Research Method
This will be a cross-sectional study of two age groups of women: middle aged and postmenopausal. Women with osteoporosis will be interviewed to evaluate the effects of their attitude on their chronic condition. The cross-sectional study will be used to be able to conduct an in-depth analysis of the respondent’s attitude. Results will be based on the answers of the respondents, observation of the researcher, and the available literature about the topic.
The Ipsative-Clustering Model will be applied in this study for behavior depends in part on patterns of attitudes and beliefs. The model define a model for the structure of attitude data for people who are in different groups or clusters which allows for individual, ipsative effects (a respondent having a personal average or modal score across a number of variables), and for ipsative amplitude effects of narrow to wide response patterns (standard deviation around a mean or modal deviation). Cluster analysis is a general set of methodological tools for estimating groups of similar objects. Similarity is usually based on resemblance coefficients derived from an object’s attributes (Romesburg, 1979, 1990). Applications of cluster analysis to recreation have evaluated people (objects) on attributes such as participation rates (Romsa, 1973; Ditton et al., 1975), or motivations for engaging in an activity (Hautaloma & Brown, 1978; Manfredo & Larson, 1993). The cluster analysis involves five steps. The first step is constructing a data matrix. The second step involves transforming the data. Step three involves a coefficient measuring the resemblance as a similarity, or dissimilarity, distance between each pair of objects is calculated, resulting in a resemblance matrix. A variety of resemblance coefficients are available. Step four involves selecting a clustering method (e.g., UMPGA – Unweighted pair-group method using arithmetic averages) that may result in a tree giving the estimated resemblance among objects from which clusters are identified (Aldenderfer & Blashfield, 1984, Chapter 3; Romesburg, 1990, Chapter 9). Finally, Step five examines the goodness of fit of the resemblance coefficients to the estimated clusters. This framework would be helpful in evaluating the attitude of women who have osteoporosis.
Conclusion
There are many factors that affect the attitude of a chronically ill woman. It is evident, based on the examples that positive attitude may help a person with osteoporosis or any chronic illness make the condition better. Royer (1998: 145) states that the basic difference between chronic sufferers and relatively healthy people is merely that the former have additional burdens; they must learn to live with their incurable illness, their ever-present and sometimes unpredictable symptoms, and often with their special, costly, and difficult treatment regimens. As a result, the illness becomes the central focus of chronically ill persons’ lives. But even with this condition, some chronically ill individuals have learned to cope with their illness and lived like normal people. The question is to determine the role of attitude in their coping capability, which is the aim of this study. Women with osteoporosis will answer the questions using the cross-sectional study approach and the ipsetive-clustering model. This is study is significant to osteoporosis education for women as it will reveal the best attitude to adhere in facing a crisis like chronic illnesses. Royer (1998: 157) states that people with chronic illness were not easily able to accept and learn to live with the limitations imposed by the illness and go on with their lives, not so much because of the medical aspects of the illness, but because of all the social and psychological problems created by the ongoing illness experience. This study will determine if attitude can make the difference.
References:
Adderley, I., and Levine, J. B. (1986). Maturity: Guiding future generations. In
E. V. Lapham & K. M. Shevlin (Eds.), The impact of chronic illness on psychosocial stages of human development. Washington, DC: National Center for Education in Maternal and Child Health. pp. 105-111
Aldenderfer, M. S., & Blashfield, R. K. (1984). Cluster analysis. Beverly Hills,
California: Sage Publications.
Cogswell B., and Weir, D. (1973). “A Role in Process: Development of Medical
Professionals’ Role in Long-Term Care of Chronically Diseased Patients”. Journal of Health and Human Behavior 5:95-106.
Commission on Chronic Illness. (1956). In Guides to Action on Chronic Illness,
ed. L. Mayo, 9-13, 35, 55. New York: National Health Council. p. 1
Conway, K. (1985-1986). Coping with the stress of medical problems among
Black and White elderly. International Journal of Aging and Human Development, 21, pp. 39-48.
Crose, R., Feldman, D., Gordon, P.A., Griffing, G., Schoen, E. and Shankar,
J. (2002). The role of religious beliefs in coping with chronic illness. Counseling and Values. Volume: 46. Issue: 3. COPYRIGHT 2002 American Counseling Association; COPYRIGHT 2002 Gale Group. pp. 160-162
Dimond M., and Jones, S. L. (1983). Chronic Illness Across the Life Span.
Norwalk, Connecticut: Appleton-Century Crofts.
Ditton, R. B., Goodale, T. L., & Johnsen, P. K. (1975). A cluster analysis of
activity, frequency and environmental variables to identify water based recreation types. Journal of Leisure Research. 7, pp. 282-295.
Hautaloma, J. E., & Brown, P.J. (1979). Attributes of the deer hunting
experience: A cluster analytic study, Journal of Leisure Research, 10, pp. 271-287.
Hymovich, D. P., & Hagopian, G. A. (1992). Chronic illness in children and
adults: A psychosocial approach. Philadelphia: W. B. Saunders.
Lapham, E. V., & Ehrhart, L. S. (1986). Young adulthood: Establishing intimacy.
In E. V. Lapham & K. M. Shevlin (Eds.), The impact of chronic illness on psychosocial stages of human development. Washington, DC: National Center for Education in Maternal and Child Health.
Lazarus, R. S., and Folkman, S. (1984). Stress, appraisal, and coping. New
York: Springer.
Royer, A. (1998). Life with Chronic Illness: Social and Psychological
Dimensions. Praeger Publishers, Westport, Connecticut. pp. 2, 75,
Manfredo, M.J., & Larson, R. A. (1993). Managing for wildlife viewing recreation
experiences: An application in Colorado. Wildlife Society Bulletin. 21, pp. 226-236.
Martinuk, S. (2003). Why Me? Women Today: Where Women Live (online).
Available at: www.womentodaymagazine.com [Accessed: 01/28/04]
Pollin, I. (1994). Taking charge: Overcoming the challenge of long-term illness.
New York: Random House.
Romesburg, H. C. (1979). Use of cluster analysis in leisure research. Journal of
Leisure Research, 11, pp. 144-153.
Romesburg, H. C. (1990). Cluster analysis for researchers. Malabar, Florida:
Robert E. Krieger Publishing Company.
Romsa, G. H. (1973). A method of deriving outdoor recreation activity packages.
Journal of Leisure Research. 5, pp. 34-46.
Rosen, C. C. (1982). Ethnic differences among impoverished rural elderly in use
of religion as a coping mechanism. Journal of Rural Community Psychology, 3, pp. 27-34.
Siddel, N.L. (1997). Adult adjustment to chronic illness: a review of the literature.
Health and Social Work. Volume: 22. Issue: COPYRIGHT 1997 National Association of Social Workers; COPYRIGHT 2002 Gale Group. p. 5
Weinert, C. (1999). Women to Women Project. Montana State University,
College of Nursing.
Zemzars, I. S. (1984). Adjustment to health loss: Implications for psychosocial
treatment. In S. E. Milligan (Ed.), Community health care for chronic physical illness: Issues and models. Cleveland: Case Western Reserve University. p. 44
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