Living With Arthritis: A Case Study - WordPress.com · Living With Arthritis: A Case Study 2015 screener survey asked questions about the type of arthritis, the severity, and the

Living With Arthritis: A Case Study Analysis of the

Arthritic Phenomena and Emotion

www.DiscoveryReserachGroup.com (800) 678-3748

[email protected]

Discovery Research Group

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Living With Arthritis: A Case Study 2015

Project Scope Introduction: For those who suffer with arthritis, the pain they feel extends well beyond the physical characteristics of

the disease. Arthritis impacts people on an emotional level that is just as impactful as the physical condition. Because

the pain of arthritis is both physical and emotional, those wishing to effectively communicate the benefits of any

treatment regimen must demonstrate an understanding not only of the physical impact of arthritis, but also the

associated emotional impact.

Primary Objective: The primary objective of this research project was to develop an understanding of the emotions

associated with arthritis and the phenomena, or experience, of having the arthritic condition. This understanding will

then be used for the purpose of creating an effective advertising message for the use of a drug designed to treat the

symptoms associated with arthritis. This message must communicate a deep level of emotional understanding in order

to effectively communicate to arthritis sufferers that the company understands them or in essence “feels their pain.” It

is anticipated that if those who suffer from arthritis feel understood they will be more open and willing to try the drug

being advertised as a replacement for their current solution.

Project Approach Focusing on the emotional aspects associated with arthritis, this study was grounded in phenomenology – the way

individuals ascribe meaning to things and then relate that meaning to their experience. In other words, arthritis

sufferers all share similar experiences with regard to joint pain, but the meaning they ascribe to this experience is

unique and subjective. This subjective meaning results in a variation of emotions among those that suffer from arthritis.

It is these subjective emotions that this study aims to identify and examine by looking at the crucial properties and

structures of the emotional experience.

The Centers for Disease Control and Prevention define Arthritis as the word to describe “more than 100 rheumatic

diseases and conditions that affect joints, the tissues which surround the joint and other connective tissue. The pattern,

severity and location of symptoms can vary depending on the specific form of the disease. Typically, rheumatic

conditions are characterized by pain and stiffness in and around one or more joints. The symptoms can develop

gradually or suddenly. Certain rheumatic conditions can also involve the immune system and various internal organs of

the body.” Sufferers of arthritis describe their condition very differently using very different words and terms. The aim

of this report is to understand this meaning.

Although no two suffers of arthritis share the exact same physical experience, those chosen to participate in the study all

indicated that their arthritic pain was moderate to severe when not taking any medication. This similarity between

participants was designed to reduce, as much as possible, the influence that the severity of pain had on emotion.

Methodology: A semi-structured in-depth interviewing method was employed. A total of 14 open-ended questions

were asked of each participant. Ten of the 14 questions were considered core to the objectives of the study and are

analyzed in detail in this report.

Recruiting: Participants were recruited via an email blast to members of an online panel. Respondents to the email

invitation were required to complete a screener survey in order to determine their eligibility to participate. The


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screener survey asked questions about the type of arthritis, the severity, and the respondent’s ability to easily use a

computer with a webcam, as the interviews were to take place online. Of the 34 that participated in the survey, a total

of nine were selected and interviewed. Participants were incentivized to participate with a $25 honorarium.

Participants with osteoarthritis and participants with rheumatoid arthritis were selected for the study.

Interviews: All nine interviews took place online via webcam in order to allow the sharing of visuals and facilitate the

communication of non-verbal emotion.

Plutchik’s Structure of Emotion: Core to the objectives of the study is Plutchik’s Structure of Emotion. The role of

emotion in the decision making process is the primary reason the identification of emotions are so important to any

organization wishing to promote its product or service. The majority of cognitive research indicates that decisions are

based primarily on emotion rather than rational thinking or logic. Logic is used as a means of justification, but it is

emotion that drives the decision making process, often on a subconscious level. As indicated in the objectives, an

understanding of the emotions associated with arthritis will allow the development of an effective advertising campaign

that uses emotion to communicate a level of

understanding, which in turn will facilitate influence.

In this figure, Plutchik’s structure arranges 32

emotions in such a way that their relationships are

connected. There are eight core emotions identified

in the first ring away from the center: joy, trust, fear,

surprise, sadness, disgust, anger, and anticipation.

Each of these core emotions varies in its intensity, for

example, rage is a more intense form of anger, and

annoyance a less intense form of anger. The eight

emotions located on the outside of the rings are

combinations of the more basic emotions. For

example, love is constructed through the combination

of joy and trust.

Although the range of human emotion extends well

beyond what is represented in Plutchik’s structure,

the organization that is provided allows for the

identification of those emotions that have the

strongest impact on the decision making process.

Qualitative Research Caveat: Because only nine individuals with arthritis were interviewed this research is classified as

qualitative. As such it is exploratory in nature and the findings are not projectable. Although some of the findings are

supplemented with quantitative-based text analysis, the overall results are meant to be used as guidance in the

decision-making process rather than as empirical evidence of facts.

Text Analysis: To provide some additional insight and supplement the findings, the transcripts from the focus group

were analyzed using Discovery Research Groups text analytics capabilities.


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Question-by-Question Analysis Warm-up Questions: Participants were warmed up with three initial questions designed to give the interviewer a

background on the interviewee and create a comfortable atmosphere for the core questions. Because the warm-up

questions were not central to the objectives, no analysis is provided here. The warm-up questions were:

Q1: Where do you suffer from arthritis?

Q2: When did you first determine that you had arthritis?

Q3: How did you come to that determination/realization?

Core Questions: Per the objectives of the study, the core questions addressed the emotional feelings associated with

arthritis and attempted to derive a deeper understanding of these emotions by looking into how people who suffer from

arthritis experience everyday life.

Q4: What were some of the initial feelings that you experienced when you first realized that you had arthritis? While participants expressed a number of negative emotions, two of the most common were shock/surprise and sadness. Shock was especially evident in younger participants who did not think they were old enough to have arthritis. For some, these feelings of shock were accompanied by feelings of fear. Although arthritis is known to be a relatively painful condition, their fear of physical pain was not expressed in a straightforward manner by the research participants. The sadness and depression they experienced when first realizing they had arthritis was the result of the fear and realization that arthritis would “limit” their activity and ability to do what they want rather than an overall fear of pain. http://youtu.be/WYfHkQCUqp8 Q5: Do you still feel the same way or have your feelings changed over time? In what way? As time has gone on, feelings of fear were found to give way to feelings of acceptance. Participants soon came to a realization that arthritis was just part of their life and they simply accepted the fact.

“I guess you just accept it. You do what you can to get along with it.”

“Not as surprised anymore. Just in a different stage of acceptance.”

“How have my feelings evolved? I would say acceptance. It means that, you know, this is my life now. You know, to experience arthritis.”

Aside from feelings of acceptance, some participants indicated that they felt a desire to learn more about their situation and as a result they have conducted research on their condition. This has also helped them move away from feelings of fear.

“I've done some research on my own, because you have a limited time frame at the doctor's office. He suggested for me to Google things online. I have for research. So I'm not as fearful, or frustrated, or confused.”

“Just a little bit more at ease with it. More interested in doing research and finding out as much as possible…Just

http://youtu.be/WYfHkQCUqp8


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doing research on medication that's available as well as non-prescription med therapies that could be possible.” Q6: If you could use one word to describe the emotion associated with your arthritic pain what would it be? Can you

give me two more?

Five out of nine participants chose “frustration” as the emotion they associate with arthritis. This would seem to echo what was learned in question number four where it was discovered that the physical aspect of pain isn’t as big a concern as the fact that the pain limits their ability to do certain activities. The frustration stems more from what they are unable to experience because of pain, rather than the active experience of the pain itself. Anger was the second most common emotion expressed, with three indicating that they felt angry. When probed for additional information as to the origin or direction of their anger, they each indicated that the anger they felt stems from their inability to do what they want. In essence, the anger they feel is most likely a more intense form of their frustration. Other words expressed include: depressing, damper, worrying (2), anxious, fear (2), limited, depression (2), acceptance, annoyed, sadness, distraction, uncomfortable (2), hindrance and drag. http://youtu.be/jwre6r9O6v0

http://youtu.be/jwre6r9O6v0


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Q7: This picture is called Plutchik’s structure of emotion. Which of the emotions listed here best represents how you

feel when you think about the fact that you have arthritis?

Unlike the previous question, which allowed participants the freedom to express any emotion that came to mind, this question focused on identifying specific emotions from Plutchik’s structure. With frustration not an option, the focus turned to acceptance. In fact, seven out of nine indicated that acceptance was a primary emotion. This underscores what was learned in question five about acceptance being a primary sentiment. As stated earlier, there are eight core emotions, with emotions of lesser intensity than the core emotion located to the outside and emotions of greater intensity than the core emotion located toward the center. In this case, the core emotion related to acceptance, at a higher level of intensity, is trust. Trust is something that is typically directional in nature. In other words, we trust people or brands. In this case the participants appear to trust themselves. Participants indicated throughout the interview that they understand their situation and felt confident in their ability to manage it.


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Distraction was uncovered as a second key emotion. When pressed as to what the respondents meant by distraction, most indicated that they chose that emotion because their arthritis was something that is “always there.” It is ever present and is something that they are constantly thinking about when doing or considering doing any type of activity. This sentiment also coincides with another key emotion, annoyance. Participants described what they meant by annoyance in a similar way to distraction. http://youtu.be/CPeCEDQC1ss Q8: How does having arthritis affect your life? Does it change anything you do and how you do it? As pointed out in the previous question, the distracting part of arthritis is that it impacts the decision making process. The ever-present pain dictates what they will or won’t do and how they are going to do it. It limits.

“I'm not sure what it's going to do for that day for me. It can alter my day completely.”

“You're limited on your energy, how much you can get done in a day. Because it's either take more pills or you're hurt. That's what it comes down to.”

“It is something that is on my mind daily, and something that I think about. If I need to move something heavy or move a box, it does enter my mind. ‘Should I do this?’ or ‘Should I not do it?’ and that's where the annoyed thing comes into play. It's just something that's on my mind that I have to think about.”

“I have to think during my day so I don't do the same thing for a long period of time. When I’m cooking my dinner, I have to be sure I give myself resting periods. I have to do something, then stop. I have to sit down. I have to do something else. I just can't stand for long periods of time, so I have to manage it by being flexible in my day, and my day all the time.”

“I have to think for myself, but I have to think of what the aftermath would be if I don't listen to it. I guess the inner voice of arthritis saying ‘hey you're going to wake up all worse than you did today if you do this and this and that.’”

Q9: Do you feel like you control your arthritis, or does your arthritis control you? What makes you say that? A total of five indicated that they felt like they were in control of their arthritis. However, each were quick to point out that even though they felt like they had control, this control was a result of them taking medication or actively managing their daily activity.

“At this point I control it. It hasn't stopped me from doing anything. I just do things differently.”

“Probably, at this point I control it. Because I know what I have to do to make it not hurt during the day.”

“I'm actually in control of it. Simply because I know the moments when I feel like the pain is starting to intensify, I know I can limit the activities, things that I am doing.”

The control these individual feel is likely rooted in how they choose to see the situation. Even while “in control,” the arthritis is forcing them to make a decision to limit or change their activity, or pay a price for not doing so. It would appear that those who say they are in control have chosen an optimistic perspective, while those who say that the arthritis is in control of them have chosen a more pessimistic perspective.

http://youtu.be/CPeCEDQC1ss


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Q10: Now I want you to describe for me, as best you can, what your arthritic pain is like. In doing so I would encourage you say things such as “it feels like,” and be as descriptive as possible. Tell me what it is like to have arthritis. Two general types of pain were described by the participants. The first is a sharp stabbing pain, like “pins and needles” or even a knife. The second is more of a constant nagging, throbbing, annoying pain that is always there. A couple of participants went on to say that this constant annoying pain not only affected them physically, but that constantly fighting it drained them mentally as well. http://youtu.be/RivgLSh-C_U Q11: Take a look at this picture of 14 different types of weather. Which type of weather best illustrates the way your arthritis makes you feel? Why is that?

Most participants chose a “mixed” type of weather condition. The storminess to represent the fact that their arthritis is always there, that it is a negative thing, the lightning to represent the pain, and the sun to represent either days that aren’t so bad or an optimistic view that they have of the future.

http://youtu.be/RivgLSh-C_U


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“I'm going to go with nine because, I'm trying to do something about it, I'm trying to be happy, trying to fix it, but

then it's always there. You got the clouds and the lightning, it's stabbing me. And I'm trying to fight it, I'm trying to fight with it, that's how I see it with the sun. So it's a battle between me and the arthritis.”

“Number seven. I guess it's kind of a metaphor of life of arthritis. The raindrops portray how I am that I have this. They're annoying and distracting. The sun above the clouds shows me that I can manage it, and I can deal with it. The sun comes shining through.”

“I would say nine, because I sometimes feel like it's stormy. And the feeling I get from that is, like, when is the storm going to be over? But then, also the sun peeking, I'm optimistic that if I'm doing everything correctly, I'm going to feel better.”

Q12: Pretend that you are forecasting the future of your arthritis, the way a weather man would forecast the weather, what is the weather forecast for your arthritis? In other words, which type of weather best illustrates the way you believe your arthritis will make you feel in the future?

Optimism is the primary theme when looking toward the future. Most are optimistic that their arthritis will get better with six participants forecasting a move toward calmer or sunnier weather in the future (as illustrated by the blue/grey


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lines) and three indicating a change of some sort, but not necessarily a positive one (as illustrated by the red lines). When asked for the reason for their optimism, most indicated that they believe that advances in medicine will lead to a cure of some sort or that the things they are doing to manage their arthritis will lead to its improvement. http://youtu.be/i7lGN5sKZaM Q13: Are there things you would like to do that you are not able to do because of your arthritis? Aside from participants mentioning specific activities that they once enjoyed doing without the hindrance or pain of arthritis, some mentioned a social downside that they experienced. They either felt like they were letting other people down that they were with, or that other people simply didn’t understand their situation.

“It's interesting the way other people react with you, because I don't show any outward signs, you know. I don't

have any marks on my skin. I don't have my arm in a sling. People don't really realize you have a problem. So they think, ‘Well can't you do this?’ or ‘Why can't you do that?’ Until I have to realize that they just don't know. They can't see my leg in a cast, so they don't know why it's hard for me to walk, or why I walk around so slowly.”

“When I would travel or go to the parks or whatever, I would be able to walk all day long, continuously, and I can't do that… the people I'm with can go on and on and on. I'm frustrated, because I have to stop and I'm sure it frustrates them, without saying it, because they have to stop for me.”

“I'd like to be more outgoing, as far as, with my teenagers, you know, do more sports with them, or not just play like tossing the ball, playing football, being a little more involved.”

Q14: What do you typically do to manage your pain each day? All indicated that they take some sort of medication to help with the pain. Over the counter medicine such as Advil and Aleve were common. Others have prescription medicine that they take. Some stated that in addition to taking pain medication they exercise and take vitamins.

Text Analysis Word Cloud Additional insight was gathered by transcribing all of the text from the interviews and then examining the frequency of word occurrence among participants. The word cloud below is a simple but effective way to accomplish this. Some common words such as “the” have been removed as well as some words that were used excessively by participants that, upon review, weren’t considered important to the analysis, specifically “know,” “like,” and “just.”

http://youtu.be/i7lGN5sKZaM


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“Feel” is one of the key words that stands out. Participants use the word to describe how the pain feels and how they feel emotionally. Because “feel” is descriptive, the use of the word in marketing efforts may be important to establishing a level of understanding and empathy.

Another dominate word, “something” was often found when participants weren’t able to completely express their feelings or in forward looking statements about the future as in “is something else going to happen?” or “there has to be something more that I can do.” The use of the word “something” was also sometimes used along with the word “think.”

Along with “something” and “think,” “get” was also used as a forward looking word as in “is the pain going to get worse?” The dominate word “going” was used frequently in conjunction with “get.”

The word “things” was used primarily to describe things the participant wishes they could do but can’t anymore, or things that they have difficulty doing.

Distraction, annoyance, acceptance, frustrated, and anger are the top emotional words used most frequently. This supports what has been learned throughout the analysis.

Colocation Analysis

Similar to word cloud analysis is colocation analysis. Co-location analysis takes a look at the words surrounding a specific word in order to identify any patterns or word relationships that may have not been fully discovered during the initial analysis.

Five key words were analyzed using colocation analysis: shock/surprise, anger, frustration, acceptance, and sadness. Common words, transitional words, unrelated nouns, and other unrelated words were not included so as to focus on emotional words, adjectives and descriptive words.


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In the charts below, the first level is the key word, the second level consists of the words co-located most frequently adjacent to the keyword. The third level consists of words that are also co-located adjacent to the keyword, but not as frequently as the second level words.

One of the more interesting findings is the co-location of the word “annoyance” to three of the four key words: anger, frustration, and acceptance. It’s also interesting to note that while anger and frustration are similar emotions, acceptance isn’t. However, its relationship to acceptance is strong. Not only is annoyance a key emotion, but it is a key driver of other emotions.

Apprehension is another emotion that is tied into anger, frustration, and acceptance. Its relationship isn’t as strong as annoyance, but it appears to be a driver of these emotions as well. The apprehension expressed by participants was primarily felt because of the uncertainty or fear that they had regarding the future or a solution for their arthritis.

Anger is another key word that is found throughout. It is related to both frustration and acceptance. As with annoyance, anger appears to give way to acceptance.

Acceptance also shows up as a third level key word to both anger and frustration. It is also a level two keyword to shock/surprise. While acceptance is not a strong driver of other emotions like annoyance, it is one of the most universal emotions among arthritis sufferers.

Shock/Suprise

Definitely

Research Think

Acceptance

Stage Possible

Anger

Annoyance

Feel Acceptance

Sadness

Worry Apprehension

Frustration

Annoyance

Distraction Acceptance

Anger

Fearful

Distraction

Apprehension

Acceptance

Distraction

Anger Apprehension

Annoyance

Submission


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Conclusions An Emotional Path There appears to be a general path that people follow when they come to a realization that they have arthritis. While everyone is different, a typical emotional path likely flows from shock/surprise to frustration and anger. The frustration and anger never go away but anger diminishes somewhat with time as the emotion of acceptance becomes larger. Frustration and acceptance then become the two most dominant emotions. With acceptance, the “I guess I just have to live with this” mentality dominates.

In order to further verify the dominance of the emotional acceptance, Discovery Research Group utilized its text and social media data analytics capabilities to collect and analyze a sample of approximately 10,000 comments about arthritis. Sources analyzed include Twitter, Facebook, forums, blogs, and Google+. From this analysis it was learned that comments related to acceptance were expressed nearly four times as often as those related to frustration. The Loss is More Painful than the Pain Participants discussed the physical pain they experienced when asked directly about it, but it is the emotional suffering that appears to be the most painful. As stated in the introduction, phenomenology is the study of how individuals subjectively ascribe meaning to things, and then relate that meaning to their experience. For most participants acceptance is the most common emotion they assign to their experience with arthritis. To them acceptance means living with continual frustration over not being able to fully do the things they want. It is the physical pain that holds them back, but it is the emotional loss that then creates feelings of frustration, anger and sadness. Acceptance Fosters Optimism In spite of feelings of frustration, anger and sadness, most are optimistic when looking toward the future and feel that their situation will eventually get better, either through their own efforts or that of medical science. This optimism was verified by turning again to social media analytics. This time the same 10,000 comments discussed earlier were analyzed with regard to the amount of content related to each of the eight core emotions. A total of 20% of all comments related to the eight core emotions were found to be associated with optimism through the core emotion of anticipation.

Always There, Always Changing The physical nature of arthritis creates a never-ending reminder that it is always there. Although it never goes away, each participant indicated that some days were better than others. This was a result of both their physical and emotional state. The exercise with the various forms of weather attests to this mixed bag of emotions that arthritis sufferers experience. As a result, it appears that those who suffer from arthritis have their emotions driven at least in part by the perception they ascribe to their situation each day. The frustration they feel from not being able to do something they want triggers feelings of anger and sadness. The desire they feel to do the things they want triggers feelings of hope and optimism. What is Arthritis? Those who suffer from arthritis face physical discomfort and limitations associated with the condition, but the phenomenological meaning they ascribe to their situation is an emotional one consisting primarily of anger, frustration, and acceptance. These emotions are driven principally by the constant annoyance that they feel by not being able to do what they want to do without pain. Shock, surprise and fear are initial emotions that eventually diminish, and optimism

SHOCK ANGER & FRUSTRATION ACCEPTANCE

ACCEPTANCE OPTIMISM


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provides the desperate hope they are seeking. When you really evaluate what it means to be arthritic, there are obviously the symptoms of the “disease,” but the condition of “arthritis” comes to take on much more meaning than the symptoms. It comes to mean limitation, which generates anger and frustration, and then finally acceptance and eventually control and optimism for the future. For the arthritis sufferer, the faster the sufferer moves through the path to acceptance and optimism, the more improved their life situation becomes.

Recommendations As stated earlier, the most effective advertising campaigns make use of emotion. This emotion is then lightly backed up with a few data points or “facts” in order to provide rational justification for an emotional decision. What we’ve found is that arthritis sufferers feel better, are more optimistic and are more active, when they are in control of the disease and accept its role in their lives. When arthritis sufferers are given control, they live well. When they aren’t given control, their lives look gloomy. To that end, the creative direction of the advertising message to arthritis sufferers should therefor take the following path:

Communicate that the company understands the arthritis sufferer by opening with a message related to the frustration and anger arthritis sufferers experience such as not being able to do what they love, slowing family and loved ones down, etc.

This message would then communicate that the sufferer has simply come to accept arthritis and this situation as part of their life.

The message should then appeal to the optimism they can have for the future by showing the new drug as the solution they have been waiting for and provides them with the control they long for. It will be important to emphasize the “waiting for” message as they are already engaged in managing their pain through other “solutions.”

Finally, limited facts and data are presented at the end to provide proof of the drugs effectiveness. While a message that a drug is available to treat the symptoms of arthritis is nothing new, the emphasis on the emotions associated with arthritis should help connect with arthritis sufferers by communicating a sense of understanding that they may not have felt before.

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Living With Arthritis: A Case Study - WordPress.com · Living With Arthritis: A Case Study 2015 screener survey asked questions about the type of arthritis, the severity, and the