title: An exploration of patients’ experiences, coping strategies and management of peripheral neuropathy in Kuwait
Creators: name: Alkandari, Maryam Ibrahim
Publisher: name: University of Reading
Year: 2020

description: Background: Peripheral neuropathy is a neurological disorder characterised by pain, 
numbness, or tingling due to nerve damage. It can be caused by a number of conditions, 
including vitamin deficiency, immune system diseases, viral infections and diabetes. 
Peripheral neuropathy is one of the main health issues in Kuwait, which affects a large 
proportion of people therefore their treatment journey needs to be explored. 
Aim: The thesis aims to explore the experiences of people living with peripheral 
neuropathy. The systematic review study aimed to explore the experiences of people 
living with peripheral neuropathy by carrying out qualitative research on the existing 
literature. The aim of the process map study was to examine the patient journey of 
people living with peripheral neuropathy in Kuwait. Finally, the interview study aimed
to explore the experiences of people living with peripheral neuropathy in Kuwait 
concerning both coping and management strategies.
Methodology: The methodology of this study was based on foundational elements of 
sociological research: the epistemological means employed was theoretical 
constructionism, and hence the methodology selected was phenomenology, the 
theoretical perspective governing which was based on interpretivism. Constructionism 
was chosen as it describes the knowledge gained or "constructed" through individual 
perceptions and social awareness which was very relevant to the perceptions of people 
living with peripheral neuropathy. Phenomenology was selected as the qualitative 
approach because it highlights the essence of individual experiences, which is the main 
focus of the present study. Interpretivism, an approach that seeks to define meanings for 
each situation was apt as this thesis was culturally derived from residents of Kuwait 
living with peripheral neuropathy. 
Methods: The thesis consisted of three studies exploring people’s experience living 
with peripheral neuropathy. The first study was a systematic review which involved 
searching through three electronic databases for qualitative studies exploring the 
experiences of people living with peripheral neuropathy. The quality of studies was 
appraised using the Critical Appraisal Skills Programme (CASP), and then thematic
synthesis was conducted to identify themes in the findings. The second study was a 
process map study. The study involved the participation of 25 individuals living with 
peripheral neuropathy in an exploratory study in Kuwait using semi-structured 
interviews that were approximately 45min to an hour in duration. Following the 
completion of the interviews, all were transcribed, translated into English and coded 
using NVivo 12 software. Four of the 25 patient journeys were comprehensively 
mapped out, and the four journeys were then compared and condensed into a single 
process map. Finally, the remaining 21 interviews were also reviewed against the single 
process map to ensure the final map signified all patient journeys and helped to 
discover various themes in the data. The final study involved the use of the same 
dataset included in the process map study and generated from the semi-structured 
interviews with the 25 participants selected from a Kuwaiti neurology hospital. The 
data was used to gain an in-depth insight into the experiences of people living with 
peripheral neuropathy in Kuwait. The transcripts were analysed using thematic analysis 
to identify themes and subthemes.
Results: For the first study in the thesis, twenty-three studies were selected for the 
systematic literature review. Qualitative methods were employed for each study and 
included the use of focus groups and interviews. The use of qualitative methods 
allowed the examination of the various experiences of individuals living with peripheral 
neuropathy. Moreover, all of the 23 studies were assessed for the quality of their data.
The main themes identified were: is the body sick or the mind; the relationship between 
the patient and the healthcare professional; and positive aspects of living with 
peripheral neuropathy “Is the body sick or the mind?” and “the relationship between the 
patient and the healthcare professional” were the first two themes, which supported 
previous themes reported in the literature. The final theme; positive aspects of 
peripheral neuropathy, emerged as a new theme following the systematic analysis of the 
data collated in the thesis. The second study which generated the process map found 
that individual patients reported similar healthcare pathways and faced numerous
difficulties concerning their condition. These difficulties included lack of psychological 
support, administrative issues and inadequate medical care. The process map identified 
similarities between Kuwait and the UK regarding the pharmacological treatment of the condition, with the exception of the availability of some medications. The final study in 
the thesis identified three major themes from interviews with people living with 
peripheral neuropathy in Kuwait. The themes identified included: treatment beliefs such 
as the efficacy of treatments and searching for alternate treatments. Additional themes 
also covered barriers to the management of pain, such as side effects of the medication, 
the individual’s relationship with healthcare professionals and lack of information and 
access to healthcare. The third theme was the impact on the quality of life, which refers 
to the effect it, has on an individual’s work, their social standing, psychological 
consequences and physical consequences.
Conclusion: The first study was a systematic review, which highlighted a connection 
between the body and mind, which has an impact on people’s lives, along with the 
potential positive aspects that emerge. There is a need for healthcare professionals to 
support people living with peripheral neuropathy to improve their quality of life. Such 
support could include encouraging self-management as well as pharmacological 
treatment. For the second study in the thesis, the process map study was conceived and 
conducted to understand the healthcare journey of people living with peripheral 
neuropathy in Kuwait, as this was identified as a gap in the literature. The process map 
highlighted a need for an integrated referral approach, the use of technology for 
electronic medical recording and report transmission, alongside education on self-management, coping mechanisms and treatment options for people living with 
peripheral neuropathy. Since the process map identified that the patient journey of 
people living with peripheral neuropathy in Kuwait was different to that in Western 
countries, there was a need to explore the patient experience in this cultural context and 
tailor recommendations relevant to Kuwait. The final study was identified treatment 
beliefs, barriers to pain management and the impact on the quality of life as necessary 
to people living with peripheral neuropathy in Kuwait. To improve quality of life; 
information and support on the condition to promote coping strategies should be 
adopted. Overall, the thesis concluded that there is scope to improve the current 
management of peripheral neuropathy in Kuwait, with a focus on patient-centred care.