Exploring the power of stories as a means to promote physical activity for people with arthritis

Physical activity (PA) is widely known to have therapeutic potential, particularly for people with chronic conditions such as arthritis. Regular PA is commonly prescribed to

manage arthritis, yet often people with arthritis experience inactive lifestyles, exacerbating the condition and lessening quality of life. Thus, identifying effective strategies for PA promotion is imperative for this population. Despite stories being promising in changing health behaviours, there is limited research on PA. To address this, the overarching aim of this thesis was to explore how stories can be used as a means to promote PA for people with arthritis.

This thesis and the studies within are driven by an interpretivist paradigm that is underpinned by ontological relativism and epistemological constructionism. The main part of this thesis is comprised of five chapters. The first chapter (chapter 3) includes a review of the current use of public-facing narratives used by UK health charities to promote PA. Findings from the review indicate that although PA narratives are utilised, the use of narratives is inconsistent and often incomplete. For chapters 4 and 5, life-story interviews were conducted with 21 people with arthritis (6 male, 15 female) aged between 24 and 79 years (M = 57.7 years), yielding over 35 hours of data. Two data analysis methods were used, a) thematic analysis, and b) structural and dialogical narrative analysis. In chapter 4, 3 themes were presented: making sense of arthritis, adapting and enjoying exercise, and exercise as medicine. The conclusions from this chapter were that people with arthritis might benefit from supporting adaptation to illness more generally as opposed to an exclusive exercise focus. Chapter 5 aimed to explore the stories of arthritis and the role exercise plays in structuring these stories. Stories went from good to bad, as participants told stories of arthritis as contamination. Exercise functioned to change the structure of their stories to a more stable or positive (bad to good) plot. Based on chapters 3-5, I developed a protocol and produced two narrative-based PA promotional videos, each focusing on one participant’s story of PA with arthritis (presented in chapter 6). The final empirical chapter (chapter 7) evaluates the narrative quality and practical utility of the videos, using a focus group method involving 9 health care professionals and 20 people with arthritis. The findings indicated that the narrative videos have the potential to provide hope, educate, and ‘nudge’ people with arthritis to be active.

Overall, this thesis reveals the intricacies of coping with the disruption of arthritis and highlights the importance of PA and stories when navigating this process. There is value in using stories to promote PA, but the narrative must balance theory with realistic, relatable, and emotive content. In practice, a narrative should not be a ‘one-size fits all’ approach, nor should a narrative be used as a standalone tool but instead be targeted to the individual based on their personal characteristics (e.g., diagnosis, PA history, gender, age) and be provided alongside support and information. The conclusions arising from this thesis do not pitch narrative as a new, miracle solution to all behaviour change problems, instead, it is proposed that narratives can provide support through times of disruption and bridge the gap between information and steps to action.