Elsinga Jelte, Grobusch Martin P, Tami Adriana, Gerstenbluth Izzy, Bailey Ajay
University of Groningen, University Medical Center Groningen, Department of Medical Microbiology, Groningen, The Netherlands.
Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
PLoS Negl Trop Dis. 2017 Oct 9;11(10):e0005987. doi: 10.1371/journal.pntd.0005987. eCollection 2017 Oct.
Chikungunya is an emerging public health problem in tropical and subtropical regions, due to ongoing transmission and its incapacitating acute disease phase, and chronic sequelae. The disease is responsible for a major impact on Health Related Quality of Life (HRQoL), which may last several years. To our knowledge, this study is the first qualitative examination of HRQoL and coping strategies of chikungunya-infected individuals.
Qualitative research methods consisted of 20 in-depth interviews and seven Focus Group Discussions (FGDs), n = 50. Analysis was based on the principles of the grounded theory.
Different impacts on HRQoL were reported. The physical and emotional domains of the HRQoL were mainly affected by chikungunya, while social and individual financial consequences were limited. Individual financial impact was limited through the universal health care program of Curaçao. Long-term lingering musculoskeletal and other manifestations caused significant pain and limited mobility. Hence, participants experienced dependency, impairment of normal daily life activities, moodiness, hopelessness, a change of identity, and insecurity about their future. The unpredictable nature and consequences of chikungunya gave rise to various coping strategies. Problem-focused coping styles led to higher uptake of medical care and were linked to more negative impact of HRQoL, whereas emotional coping strategies focusing on acceptance of the situation were linked to less uptake of medical care and more positive impact on HRQoL.
This study provides an in-depth understanding of acute and long-term HRQoL impact of chikungunya. The results can better inform health promotion policies and interventions. Messages to the public should focus on promoting healthy and efficient coping strategies, in order to prevent additional stress in affected individuals.
由于持续传播以及其使人丧失能力的急性期疾病和慢性后遗症，基孔肯雅热在热带和亚热带地区已成为一个新出现的公共卫生问题。该疾病对健康相关生活质量（HRQoL）产生重大影响，且这种影响可能持续数年。据我们所知，本研究是对基孔肯雅热感染个体的健康相关生活质量和应对策略的首次定性研究。
定性研究方法包括20次深入访谈和7次焦点小组讨论（FGD），共50人。分析基于扎根理论原则。
报告了对健康相关生活质量的不同影响。健康相关生活质量的身体和情感领域主要受基孔肯雅热影响，而社会和个人经济后果有限。通过库拉索岛的全民医疗保健计划，个人经济影响得到了限制。长期存在的肌肉骨骼及其他症状导致了严重疼痛和行动受限。因此，参与者经历了依赖、正常日常生活活动受损、情绪多变、绝望、身份改变以及对未来的不安全感。基孔肯雅热的不可预测性及其后果引发了各种应对策略。以问题为导向的应对方式导致更多地寻求医疗护理，并且与健康相关生活质量的更负面影响相关联，而专注于接受现状的情感应对策略与较少寻求医疗护理以及对健康相关生活质量的更积极影响相关联。
本研究深入了解了基孔肯雅热对急性和长期健康相关生活质量的影响。研究结果可为健康促进政策和干预措施提供更好的参考依据。向公众传达的信息应侧重于推广健康有效的应对策略，以防止受影响个体产生额外压力。
