Arthritis

Completed Projects Comparisons of Outcomes North Carolina

Comparisons of the Outcomes of the Arthritis Self Help Course (ASHC) and the Chronic Disease Self Management Program (CDSMP) Among People with Arthritis

Funding Number

S2233-22\23 (UNC)

Project Description

The arthritis-specific Arthritis Self Help Course (ASHC) and the more generic Chronic Disease Self Management Program (CDSMP) teach generalizable skills for managing arthritis and other chronic diseases. In some locations it may be more feasible to combine efforts and offer the generic course rather than the arthritis-specific program. However anecdotal evidence has questioned whether people with arthritis obtain as much benefit from the more generic course as they do the arthritis-specific course. The primary purpose of this research study was to examine the effectiveness and acceptability of the ASHC and the CDSMP among people with arthritis. The North Carolina project focused primarily on African Americans from 12 eastern North Carolina counties; rural African Americans had not been included in previous studies of these two interventions. The results of this research project will be used to guide arthritis program recommendations on the use of ASHC and CDSMP to improve the quality of life for people with arthritis.

Key Findings

Effectiveness

Four months after participation in the programs, both ASHC and CDSMP produced significant improvements in self-efficacy, aerobic exercise, stretching and strengthening exercises, and self-reported health. CDSMP also produced significant improvements in cognitive symptom management, health distress, disability, and pain. At 12-month follow-up, none of these improvements were maintained in either group.
While no changes in health care utilization were significant at 4-month follow-up, at 12-month follow-up, CDSMP participants showed a significant decrease in physician visits when compared to ASHC participants.
Investigators concluded that generic chronic disease self management programming may be more cost effective than disease specific programming among persons with substantial comorbidities.

Acceptability

Pre-testing determined that modest changes were needed in both programs to make them culturally appropriate. With permission of Stanford Patent Education Research Center modifications were made to address cultural barriers to healthy eating, decreases in fat and salt, communication with health care professionals, faith and spirituality, and mutual help.
Community coordinators were essential to reach 365 African Americans with arthritis. The community coordinator role was more time intensive than the workshop leader role.
Males were hard to recruit; most successful strategies involved working through their wives. This may have been a reflection of traditional gender roles among older African American couples.

Abstracts, Publications, Presentations

Goeppinger J, Armstrong B, Schwartz T, Ensley D, Brady, TJ. Self management education for persons with arthritis: Managing co-morbidities and eliminating health disparities. Arthritis Rheum 2007;57(6):1081–1088.

Goeppinger, J., Barnwell, S., and Ensley, D. (2005, November). Effectiveness of disease self-management education for African Americans with arthritis. Paper presented at the annual meeting of American College of Rheumatology and Arthritis and Rheumatology Health Professionals. San Diego, CA.

Fisher, S. (2005, October). Implementing culturally acceptable disease self-management education with African American communities. Paper presented at the workshop, Conducting Culturally Competent Research, sponsored by Center for Innovation in Health Disparities Research. Chapel Hill, NC.

Goeppinger, J. (2004, November). Arthritis self-management: Partnering with rural African-American communities. Paper presented at The Science of Self Management in Chronic Disease Work Group Meeting, The National Institute of Nursing Research, The National Institutes of Health, Bethesda, MD.

Goeppinger, J. (2004, October). Arthritis self-management education: From effectiveness to acceptability (via partnering). Paper presented at the American College of Rheumatology Pre-Conference (Economic, Social and Psychological Impact of Arthritis). San Antonio, TX.