Identifying the need for care in rheumatoid arthritis: A Candidacy 2.0 analysis of lived experiences

Abstract

This study explores how individuals with rheumatoid arthritis (RA) come to identify themselves as candidates for medical care, using the newly developed Candidacy 2.0 model. Candidacy 2.0 extends the original Candidacy Framework by emphasizing the role of the embodied intersectional relational self in healthcare access, providing a theoretical framework that transcends specific healthcare systems. Through semi-structured interviews with 33 individuals living with RA across six Canadian provinces, we examined how embodied experiences, social identities, and relational contexts shape initial recognition of care needs. Analysis revealed distinct 'tipping points' where symptom progression from single to multiple joints and unmanageable pain forced recognition of care needs. Age and gender identities created distinct barriers to care-seeking: younger individuals dismissed symptoms as affecting only older adults, while gendered expectations about caregiving delayed help-seeking among women. Professional identity emerged as particularly significant, offering knowledge advantages but sometimes hindering patient-centered care. Support networks proved crucial in symptom interpretation and help-seeking, with their importance highlighted by COVID-19-related disruptions. The study demonstrates how Candidacy 2.0's emphasis on embodied, intersectional, and relational aspects of healthcare access enhances understanding of help-seeking behaviors in chronic conditions. Findings suggest the need for targeted public health campaigns addressing age-related misconceptions, gender-sensitive clinical approaches, flexible care delivery models that accommodate support networks, and educational resources helping patients identify and act upon significant symptom changes.