E074 Self-care for rheumatoid arthritis during the COVID-19 pandemic: transferability of Canadian and UK experiences
Authors: Gavin James , Leese Jenny , Ramachandran Smruthi O , Therrien Stephanie , Backman Catherine , Ma Jasmin , Davidson Eileen , McQuitty Shanon , Hoens Alison M , Koehn Cheryl L , Adams Jo , Li Linda 
Published: April 2023

Abstract

Background/Aims
The COVID-19 pandemic posed unique challenges for people worldwide in self-caring for their rheumatoid arthritis (RA). COVID-19 also prompted global changes in public health (e.g., vaccination programs and mask wearing) and rheumatology services (e.g., integrating telehealth with in-person healthcare). To facilitate cross-country learning of how to support people with RA to self-care during and post-pandemic, better understanding of individuals’ experiences of self-care in the context of changes in public health and ‘integrated’ healthcare is needed. Our study aimed to explore transferability in experiences of public health measures and telehealth during COVID-19 among individuals with RA in Canada and the UK.

Methods
Between July and October 2022, online focus groups (90 mins) took place with participants living with RA in the UK. Participants were recruited via social media and professional networks (including Versus Arthritis). Each participant received a report ∼7days before each focus group, with a request to review in advance. The report contained preliminary findings identified through reflexive thematic analysis of interviews (30-70 mins) with thirty-nine participants with RA in British Columbia, Canada (26-86 years; 36 females) between December 2020 and 2021. Nine preliminary themes were identified across three topics: accessing telehealth and in-person healthcare; decision-making around COVID-19 vaccinations and public health measures; and renegotiating ‘the self’. The themes guided the focus groups, wherein UK participants shared their perspectives on each theme arising in the Canadian context. Audio-visual recordings were transcribed verbatim, and transcripts were de-identified. Ongoing directed content analysis of focus group data involves a collaborative approach with patient partners.

Results
Four focus groups involving thirteen participants (44-81 years;11 females) living across the UK were conducted. Participants had lived with RA for between 3-36 years. Canadian experiences typically resonated with UK participants, with some feeling a sense of unity and sadness that challenges were also experienced by others living with RA beyond their national context. Many UK participants supported preferences expressed by Canadian participants for a ‘hybrid’ healthcare approach to maximise benefits and minimise downsides of telehealth, and in-person consultations post-pandemic. Benefits (e.g., avoiding risk of COVID-19 transmission with telehealth) and disadvantages (e.g., lacking sensitivity/accuracy of in-person assessments) described by Canadian participants also resonated with UK-based participants. Many described how their decision-making on adopting public health measures to maintain their self-care was supported and/or undermined in their local context/community.

Conclusion
Our findings offer novel insights into the challenges and opportunities experienced by people with RA in their decision-making around public health measures and telehealth during a global pandemic. They also demonstrate some transferability of experiences between the UK and Canada. Insights may serve to inform decision-making for policy and programmes to support self-care (e.g., by integrating telehealth into routine rheumatology practice) across countries during and post-pandemic.
Disclosure
J. Gavin: None. J. Leese: None. S.O. Ramachandran: None. S. Therrien: None. C. Backman: None. J. Ma: None. E. Davidson: None. S. McQuitty: None. A.M. Hoens: None. C.L. Koehn: None. J. Adams: None. L. Li: None.