THE IMPORTANCE OF PSYCHOLOGICAL WELL-BEING DETERMINANTS IN EDUCATING PATIENTS WITH ANKYLOSING SPONDYLITIS

Introduction: The diagnosis of ankylosing spondylitis (AS), the actual chronic course of the disease and its treatments are associated with important physical, psychological and social implications which imply a significant reduction in patients' quality of life. To this end, with a view to an effective educational intervention for these patients, promoting effective adherence to therapy and rehabilitation programmes, it is critical to identify socio-demographic and clinical context variables which may influence Psychological Well-Being (PWB) in people with AS. This was the main aim of this study. Methods: Thus, we conducted a cross-sectional, descriptive-correlational and quantitative study with a non-probabilistic sample of 51 patients with ankylosing spondylitis. They were mostly male (70.59%) aged between 19 and 79 years (M=47.00, SD= 14.14). The research protocol included measuring instruments which have been assessed and validated for the Portuguese population and all of which with considerable psychometric qualities, namely: the Family Functioning Scale (Smilkstein, Ashworth & Montano, 1982); the MOS 36-item Short-Form Health Survey (Ware & Sherbourne, 1992); the PWBS-Psychological Well-Being Scale (Ryff, 1989); BASFI-Bath Ankylosing Spondylitis Functional Index (Calin et al., 1994); and BASDAI-Bath Ankylosing Spondylitis Disease Activity Index (Garrett et al., 1994). Results: The Psychological Well-Being evidenced by respondents is mostly perceived as high (47.1%). It is generally higher in males in all its dimensions, with the exception of objective dimensions of life and positive relationships with others. On the other hand, the dimensions personal autonomy and growth showed highest levels of PWB. Other variables also had a statistically significant effect on PWB, namely: (i) older subjects are less able to establish positive relations with others (p<0.05); (ii) those integrated into more highly functional families show higher levels of PWB; (Iii) those who have been diagnosed with the disease the longest express lower dominion of their environment (p<0.05), are less able to establish positive relationships with others (p<0.01) and have a worse overall PWB score (p<0.05); (iv) those who have no symptoms manifest a greater capacity to establish positive relationships with others (p<0.01); (v) those who engage in physical exercise and a rehabilitation programme generally have higher PWB rates; (vi) and, finally, the respondents who manifest worse QOL, greater impairment associated with the disease's activity and worse functioning capacity, to show a more negative perception of PWB in general. Conclusions: The evidence presented here highlights the importance of critical reflection with the person with AS with regards to certain measures which, according to our results, we think are appropriate and beneficial for effective support of their psychological well-being. In another context, we believe it is essential to consider the variables that showed as predictors of psychological wellbeing in the planning and implementation of educational programmes in the field of health education, among patients with ankylosing spondylitis.