The P-A-I-N-S Typology of Health Literacy Perspectives among Filipino Chronic Non-malignant Pain Sufferers: A Q Methodology Study


Introduction: Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage (IASP). Acute pain is a positive experience that performs a survival function. However, when the pain becomes chronic, these first accounts are generally found wanting and are often replaced by more biomedical accounts of illness and cure. As a culturally-invested construct and a private sensation that cannot be reduced by objectification, this paper proposes to segment the health literacy perspectives in the eyes of the Filipino chronic non-malignant pain sufferer through the lens of the social constructionist theory. The intent is to explore the extent to which such domains require a rethinking of the healthcare professionals' approach to the management of Filipino patients with chronic pain.

Methodology: Q-methodology is the primary design used in this study. It combines the objectivity of quantitative approach with the essence of human experiences as explored in qualitative studies. The participants (P-sample) were 30 subjects gathered by a purposive sample of participants with chronic pain. They were asked to arrange 33 statements (Q-sample), derived from literature, in the Q-sort table based on their degree of agreement, which was then further explicated in the post-sort interviews. The results were then subjected to by-person factor analysis with Varimax rotation using the PQ method version 2.11.

Results and Discussion: This paper evolves the P-A-I-N-S Typology of Health Literacy Perspectives Among Filipino Chronic Pain Sufferers. The PASSIVE perspective resonates with mere acceptance and thoughts of self-efficacy but very minimal self-management behavior. The ACTIVE perspective reflects moderate self-efficacy and self-management skills moderated by acceptance of their chronic pain condition. The INFORMED perspective shows a tendency towards self-management behaviors to control their pain through the use of the internet. The NEGATIVE perspective (Profile B) shows a highly catastrophizing attitude towards their pain with minimal acceptance and self-efficacy skills. Their consensus statements revealed a SPIRITUAL stance that allows them to take on and bear their pains silently, yet allowing them to carry on with their activities of daily living, thus living through their chronic pain experience while fostering a balance between hope and resignation.

Conclusion: This typology of Filipino chronic pain patients according to specific health literacy domains of catastrophizing, acceptance, self-efficacy, and self-management contributes to knowledge about the continuum of care that should be afforded by these patients. A patient’s type should be considered as a dynamic starting point, so interventions can be instituted to move them from the catastrophizing to the self-management end of the spectrum.


Keywords: Filipino, Chronic Non-malignant Pain, Health Literacy, Q methodology

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