Health-related impact on quality of life and coping strategies for chikungunya: A qualitative study in Curaçao

Introduction: Chikungunya is an emerging public health problem in tropical and subtropical regions, due to ongoing transmission and its incapacitating acute disease phase, and chronic sequelae. The disease is responsible for a major impact on Health Related Quality of Life (HRQoL), which may last several years. To our knowledge, this study is the first qualitative examination of HRQoL and coping strategies of chikungunya-infected individuals. Methods: Qualitative research methods consisted of 20 in-depth interviews and seven Focus Group Discussions (FGDs), n = 50. Analysis was based on the principles of the grounded theory. Results: Different impacts on HRQoL were reported. The physical and emotional domains of the HRQoL were mainly affected by chikungunya, while social and individual financial consequences were limited. Individual financial impact was limited through the universal health care program of Curaçao. Long-term lingering musculoskeletal and other manifestations caused significant pain and limited mobility. Hence, participants experienced dependency, impairment of normal daily life activities, moodiness, hopelessness, a change of identity, and insecurity about their future. The unpredictable nature and consequences of chikungunya gave rise to various coping strategies. Problem-focused coping styles led to higher uptake of medical care and were linked to more negative impact of HRQoL, whereas emotional coping strategies focusing on acceptance of the situation were linked to less uptake of medical care and more positive impact on HRQoL. Conclusions: This study provides an in-depth understanding of acute and long-term HRQoL impact of chikungunya. The results can better inform health promotion policies and interventions. Messages to the public should focus on promoting healthy and efficient coping strategies, in order to prevent additional stress in affected individuals. Author summary: Chikungunya is a disease caused by a virus, which is transmitted by mosquitoes. During the past years, major outbreaks of chikungunya have occurred in the Americas. Normally, chikungunya presents with an acute, fever-like disease. After acute disease, many people develop chronic disease manifestations, which are mainly characterized by joint pain. In this study, we examined the impact of chikungunya on quality of life and how people coped with these consequences. The results of this study show that people infected with chikungunya reported long-term pain and limitation of mobility. Consequently, impairment of normal daily life activities and several emotions were experienced; for example dependency, moodiness, and insecurity about their livelihood and their future. People narrated visiting a doctor and using treatment to cope with these consequences. However, the participants who accepted their chronic ‘diseased’ condition could better cope with the consequences of chikungunya than the participants who could not accept their chronic condition. The latter group kept searching for new treatments and frequently consulted doctors. It is important that doctors and health authorities are aware of these results, because this will aid them to improve care and promote better coping strategies of people affected by chikungunya.