Abstract/Summary

Background: Peripheral neuropathy is a neurological disorder characterised by pain, numbness, or tingling due to nerve damage. It can be caused by a number of conditions, including vitamin deficiency, immune system diseases, viral infections and diabetes. Peripheral neuropathy is one of the main health issues in Kuwait, which affects a large proportion of people therefore their treatment journey needs to be explored. Aim: The thesis aims to explore the experiences of people living with peripheral neuropathy. The systematic review study aimed to explore the experiences of people living with peripheral neuropathy by carrying out qualitative research on the existing literature. The aim of the process map study was to examine the patient journey of people living with peripheral neuropathy in Kuwait. Finally, the interview study aimed to explore the experiences of people living with peripheral neuropathy in Kuwait concerning both coping and management strategies. Methodology: The methodology of this study was based on foundational elements of sociological research: the epistemological means employed was theoretical constructionism, and hence the methodology selected was phenomenology, the theoretical perspective governing which was based on interpretivism. Constructionism was chosen as it describes the knowledge gained or "constructed" through individual perceptions and social awareness which was very relevant to the perceptions of people living with peripheral neuropathy. Phenomenology was selected as the qualitative approach because it highlights the essence of individual experiences, which is the main focus of the present study. Interpretivism, an approach that seeks to define meanings for each situation was apt as this thesis was culturally derived from residents of Kuwait living with peripheral neuropathy. Methods: The thesis consisted of three studies exploring people’s experience living with peripheral neuropathy. The first study was a systematic review which involved searching through three electronic databases for qualitative studies exploring the experiences of people living with peripheral neuropathy. The quality of studies was appraised using the Critical Appraisal Skills Programme (CASP), and then thematic synthesis was conducted to identify themes in the findings. The second study was a process map study. The study involved the participation of 25 individuals living with peripheral neuropathy in an exploratory study in Kuwait using semi-structured interviews that were approximately 45min to an hour in duration. Following the completion of the interviews, all were transcribed, translated into English and coded using NVivo 12 software. Four of the 25 patient journeys were comprehensively mapped out, and the four journeys were then compared and condensed into a single process map. Finally, the remaining 21 interviews were also reviewed against the single process map to ensure the final map signified all patient journeys and helped to discover various themes in the data. The final study involved the use of the same dataset included in the process map study and generated from the semi-structured interviews with the 25 participants selected from a Kuwaiti neurology hospital. The data was used to gain an in-depth insight into the experiences of people living with peripheral neuropathy in Kuwait. The transcripts were analysed using thematic analysis to identify themes and subthemes. Results: For the first study in the thesis, twenty-three studies were selected for the systematic literature review. Qualitative methods were employed for each study and included the use of focus groups and interviews. The use of qualitative methods allowed the examination of the various experiences of individuals living with peripheral neuropathy. Moreover, all of the 23 studies were assessed for the quality of their data. The main themes identified were: is the body sick or the mind; the relationship between the patient and the healthcare professional; and positive aspects of living with peripheral neuropathy “Is the body sick or the mind?” and “the relationship between the patient and the healthcare professional” were the first two themes, which supported previous themes reported in the literature. The final theme; positive aspects of peripheral neuropathy, emerged as a new theme following the systematic analysis of the data collated in the thesis. The second study which generated the process map found that individual patients reported similar healthcare pathways and faced numerous difficulties concerning their condition. These difficulties included lack of psychological support, administrative issues and inadequate medical care. The process map identified similarities between Kuwait and the UK regarding the pharmacological treatment of the condition, with the exception of the availability of some medications. The final study in the thesis identified three major themes from interviews with people living with peripheral neuropathy in Kuwait. The themes identified included: treatment beliefs such as the efficacy of treatments and searching for alternate treatments. Additional themes also covered barriers to the management of pain, such as side effects of the medication, the individual’s relationship with healthcare professionals and lack of information and access to healthcare. The third theme was the impact on the quality of life, which refers to the effect it, has on an individual’s work, their social standing, psychological consequences and physical consequences. Conclusion: The first study was a systematic review, which highlighted a connection between the body and mind, which has an impact on people’s lives, along with the potential positive aspects that emerge. There is a need for healthcare professionals to support people living with peripheral neuropathy to improve their quality of life. Such support could include encouraging self-management as well as pharmacological treatment. For the second study in the thesis, the process map study was conceived and conducted to understand the healthcare journey of people living with peripheral neuropathy in Kuwait, as this was identified as a gap in the literature. The process map highlighted a need for an integrated referral approach, the use of technology for electronic medical recording and report transmission, alongside education on self-management, coping mechanisms and treatment options for people living with peripheral neuropathy. Since the process map identified that the patient journey of people living with peripheral neuropathy in Kuwait was different to that in Western countries, there was a need to explore the patient experience in this cultural context and tailor recommendations relevant to Kuwait. The final study was identified treatment beliefs, barriers to pain management and the impact on the quality of life as necessary to people living with peripheral neuropathy in Kuwait. To improve quality of life; information and support on the condition to promote coping strategies should be adopted. Overall, the thesis concluded that there is scope to improve the current management of peripheral neuropathy in Kuwait, with a focus on patient-centred care.