Considerable research focuses on the negative impact of arthritis on work (A
W). This study adopted a broader perspective examining the interplay among arthritis, employment and personal life roles (A
A). Findings highlight that not only does arthritis affect work and personal life, but also these latter roles affect arthritis and one another. Moreover, negative and positive impacts emerged among role inter-relationships. Numerous personal and contextual factors potentially aggravated or ameliorated these role difficulties.
Inter-role relationships emphasized time pressures, the fit or congruence of behaviours across roles and perceptions of strain or stress. They also highlighted benefits of roles for health related to resources, support and psychological well-being. This is in keeping with existing models of work–family conflict and quality that acknowledges the consequences engaging in one role has for other roles [15
]. It is also similar to emerging literature that finds balancing arthritis, work and personal life stressful [13
]. This study adds to the literature by examining the intersection of diverse roles among people with arthritis and by examining positive aspects of role interplay.
Time constraints fulfilling role demands (role overload) were frequent, and this was one way that work and personal roles negatively impacted caring for arthritis. Individuals were protective of their work, sometimes not taking time to care for their health. A consequence of this was that reports of fatigue were pervasive for those with IA and OA. Ultimately, many respondents could not sustain involvement in all roles and reported role loss in their personal lives, especially in socializing and leisure. Future research needs to examine role overload and personal life role loss as potential early warning indicators of employment difficulties that might result in changes to work, including forgoing employment.
Role conflict focused almost exclusively on difficulties that arthritis created in other roles. Pain, fatigue, symptom unpredictability and disability interfered with work and personal roles. A wide range of self-management behaviours and job accommodations had the potential to improve the person–job fit and mitigate role conflict. Although the general workplace literature emphasizes the importance of person–organization fit, much of this research has examined the congruence between a worker’s attitudes or personality and the organization’s culture [32
]. Our study finds additional dimensions are relevant. Namely, health conditions such as arthritis have an intermittent and unpredictable course, and symptoms and disability can undermine the person–organization fit. This may be exacerbated by unwillingness to disclose arthritis or utilize job accommodations until absolutely necessary. Yet, delaying accommodations may have consequences for work and put employment retention at risk [34
]. Person–organization fit will be of increasing importance as the workforce ages and individuals in their prime earning years develop chronic conditions, particularly OA.
Role strain created by balancing multiple roles was common. Role stress has been linked to numerous negative outcomes in the role conflict literature [11
]. It points to the need for increased attention to stress and referral for management in occupational, vocational and community interventions. Recent intervention research in arthritis has been promising [36–38
]. However, this study highlights that, even among individuals who want to be responsible self-managers of their disease, the challenges of balancing multiple roles is daunting and many people report role loss and guilt that may undermine well-being.
Although stress was common, reports of the positive impact of work on arthritis on health were equally frequent. This positive influence of work has been largely ignored in arthritis. Employment provided resources; it was important to people’s identities and enabled them to be productive; it supported positive social interactions and provided opportunities for physical activity. Personal life roles also positively impacted arthritis, especially through support. These findings suggest new directions for outcome measurement. Current outcomes largely document varying degrees of negative impact and may misrepresent the inter-relationships among roles in employment. Additional attention is needed in assessing positive benefits of role interplay, such as role facilitation, balance and support [39
Limitations to this research should be recognized. Although the mixed diagnosis and employment status groups enriched the breadth and depth of the discussion, our sample was small and may not have captured all the role interplay experiences of individuals. The sample size and focus group methodology also made it difficult to examine some contextual factors that were not discussed explicitly in the groups. For example, facilitators did not ask about and participants did not spontaneously comment upon gender, age or education as influencing role interplay, although these have been found to be important in work–family research. Moreover, discussing the interplay among roles and teasing out cause and effect relationships was not always easy to articulate. Additional research developing new measures and examining changes in role conflict and balance longitudinally is needed.
Nevertheless, this study underscores the importance of examining inter-relationships among multiple roles to better understand living and working with arthritis. Role conflict and overload may act as early warning indicators of workplace difficulties that could significantly change employment outcomes. Measurement of positive and negative role interplay might aid in early identification of individuals most at risk and inform intervention efforts to remain working.