The Marginalised Women and Their Pathways to Arthritis Care in Kashmir, India: A Grounded Theory Study.

Background: Rheumatoid Arthritis (RA) is a chronic musculoskeletal disorder that is a leading cause of disability worldwide, with early diagnosis and pharmacological treatment being critical to alleviate disease progression. However, the marginalised populations face significant barriers in accessing timely medical care, which contributes to functional impairment, and reduced quality of life (QoL). Despite this, little is understood about how intersecting marginalities influence access to musculoskeletal care, particularly in low-resource settings.

Purpose: To explore care-seeking pathways, underlying factors, and access constraints among the socioeconomically marginalised women living with RA in rural Kashmir.

Methods: Constructivist grounded theory approach of Cathy Charmaz was employed to obtain an in-depth comprehension of the phenomenon under study. Purposive and theoretical sampling strategies were employed to recruit 18 women diagnosed with RA from rural Kashmir. Data were collected through semi-structured interviews and analysed using the constant comparative method, which is well viewed to be the hallmark of the grounded theory approach.

Findings: Participants sought care from a pluralistic healthcare system involving a variety of untrained, and trained providers, and kept on changing from one provider to another without any restrictive access protocols. Their care-seeking trajectories usually began with self-medication, home-based remedies, traditional healers, spiritual intervention and local medicates. Conventional medical care was considered as the last resort, undertaken following a prolonged delay, and only when all other options proved ineffective. These care-seeking choices were largely influenced by illness/treatment perception, cultural norms, accessibility, affordability and organizational dynamics.

Conclusion: The delayed transition to formal healthcare highlights the need for strengthening health(care) awareness, affordability, and rural health infrastructure to ensure timely, equitable and culturally sensitive care for the vulnerable.