Coping and Resilience in Chinese Couples with Connective Tissue Diseases: A Culturally Informed Qualitative Explanation

Xingfeng Cai,* Shu Xu,* Chen Dong, Zhifeng Gu Department of Rheumatology, Affiliated Hospital of Nantong University, Nantong University, Nantong, People’s Republic of China*These authors contributed equally to this workCorrespondence: Chen Dong, Department of Rheumatology, Affiliated Hospital of Nantong University, Nantong University, Nantong, People’s Republic of China, Email [email protected] Zhifeng Gu, Department of Rheumatology, Affiliated Hospital of Nantong University, Nantong University, Nantong, People’s Republic of China, Email [email protected]: Connective tissue diseases (CTDs) predominantly affect women, creating complex self-care and psychosocial demands that extend to their spouses. Yet, how couple-level interactions shape outcomes—or how nurses can harness dyadic resources in care—remains poorly understood. This study aims to explain and deeply understand how couples co-construct resilience in managing CTDs, thereby elucidating the interactional mechanisms underlying the previously observed null effect of partner coping.Patients and Methods: A descriptive qualitative study was conducted and reported following the COREQ guidelines. Twelve couples (comprising women with CTDs and their husbands) were purposively sampled. Semi-structured joint interviews, lasting 60– 90 minutes, were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis in NVivo 14. To ensure credibility, member checking and dual-coder consensus were employed.Results: Three themes emerged: (1) emotional resonance from disease shock, involving shared disbelief, role imbalance, and contagion; (2) an evolution in dyadic coping from joint avoidance to a division of labor and finally to embodied support; and (3) the joint construction of resilience through meaning-making, trust-building rituals, and humorous future re-imagining. However, well-intentioned support was found to subvert patient autonomy, providing a key explanation for the null effect of positive dyadic coping observed in quantitative studies.Conclusion: Resilience is a dynamic, dyadic construct, co-constructed in moment-to-moment interactions. This necessitates viewing the couple, not the individual, as the essential unit of care in CTDs management. Interventions must therefore be designed to preserve patient autonomy while cultivating authentic emotional disclosure and collaborative problem-solving.Plain Language Summary: Using joint interviews with 12 Chinese couples in which the wife lived with systemic lupus, rheumatoid arthritis or systemic sclerosis, this qualitative study uncovered how marital interaction shaped resilience. Through reflexive thematic analysis we found that (1) shared shock and emotional contagion initially intensified dyadic distress, (2) couples evolved task-oriented coping that occasionally slipped into protective over-control, silencing the patient, and (3) dyads who sustained co-constructed narratives, micro-rituals and collaborative humor transformed illness into a communal “we-experience”, strengthening joint resilience. The findings foreground the couple—rather than the individual patient—as the minimal unit of care and emphasize preserving patient agency within authentic dyadic dialogue.Keywords: connective-tissue diseases, dyadic coping, resilience, couple interaction, clinical nursing, qualitative research