AB1684-PARE I WANT TO TALK ABOUT MY MENTAL HEALTH, BUT…: THE TE WHARE TAPA WHA MODEL
Authors: Y. El Mabrouk, A. Ben Ammou, S. Akremi, A. Ben Abid, M. Ben Salah
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Te Whare tapa wha was developed in 1984 by Sir Mason Durie. This model describes hauora (health and wellbeing) as a wharenui (meeting house): a house of four walls. Each wall represents a dimension of our health, and our connection to the whenua (land) forms the foundation. When one or more of these walls are out of balance, our hauora (wellbeing) is impacted. We need these different dimensions to be in balance for strength and stability. By nurturing and strengthening each of these areas, we can support our holistic health and wellbeing. <h3>Objectives:</h3> The aim of our study was to explore prevailing prespectives concerning coping among patients suffering of low back pain stigma and so to identify potential determinants of these beliefs. <h3>Methods:</h3> Participants were adults with chronic low back pain who completed questionnaires assessing chronic pain stigma: The Internalized Stigma of Chronic Pain Scale (ISCP), hospital anxiety and depression scale (HAD), opioid use, pain and disability. <b>The ISCP</b> is a 21 item scale which measures stigma associated with chronic pain. Each item is answered on a 4-point Likert scale (alienation, discrimination experience, social withdrawal, stigma resistance). The study used a cross-sectional, <b>sequential explanatory mixed methods design</b>. Participants ranked 20 opinion statements: <b>Q-sort</b> about strategies for coping with the chronic pain stigma on an agreement scale. A by-person factor analysis identified common patterns in the rankings. These patterns represent the different viewpoints among the patients. Data from interviews, in which they explained their ranking, was used to further interpret the viewpoints. All data was collected after patient consent and was analyzed using the SPSS statistical package. <h3>Results:</h3> Sixty patients were selected for the study, with a sex ratio (M/ F) of 1.4. Their average age was 56 [20-70]. In our series, greater stigma was experienced by those who used more opioids (p=0.01) and had fibromyalgia (p=0.002). Stigma was associated with depression and functional disability (p=0.03, p= 0.001 respectively). Qualitative results supported quantitative findings, with four viewpoints on how to deal with chronic pain stigma, based on the Te Whare Tapa Wha model of health (mental and emotional, spiritual, physical, social). At least 2 participants were significantly associated with each factor (p&lt;0.05). 1)« Increase relaxation and mindfulness activities » 2)« Manage your stress » 3)« Join a support group » 4)« Stigma doesn't just come from others. Don't let stigma create self-doubt and shame: Positive thinking is a powerful tool». A strong association was found between stigma scores and emotion-focused coping strategy (p=0.001). A significant association was found between spiritual coping strategies and mental health problems. <h3>Conclusion:</h3> In our series, several factors may contribute to chronic pain-related stigma such as opioid abuse and fibromyalgia. This study demonstrates the negative influence of stigma on mental health and functional ability. We identified 4 viewpoints on coping with chronic pain stigma. In fact, we have noticed that these patients believe in the Te Whare Tapa Wha model of health. This study presents a novel integrated model of coping with chronic pain stigma, which may be used to develop interventions. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>