Self-management education for persons with arthritis: Managing comorbidity and eliminating health disparities.
OBJECTIVE
To compare short-term and long-term effectiveness of the Arthritis Self-Help Course (ASHC) and the Chronic Disease Self-Management Program (CDSMP) for persons with arthritis concerning health care use, health-related quality of life, health behaviors, and arthritis self-efficacy.


METHODS
Forty-eight workshops were randomized to the ASHC (n = 26) or CDSMP (n = 22). A total of 416 individuals, including 365 African Americans, participated. The mean age for each group was 64 years, mean years of education was 11.7, mean number of chronic conditions was 4, and 75-80% of participants in each group were female. Multivariate statistical tests were used to assess effectiveness within and between programs for all workshop participants and African Americans.


RESULTS
At 4 months all ASHC participants including African Americans, had significant improvements (P <or= 0.05) in self-efficacy, stretching and strengthening exercises, aerobic exercises, and general health. All CDSMP participants had statistically significant improvements in self-efficacy, disability, pain, and general health. African American CDSMP participants showed statistically significant improvements in general health. Trends toward improvement (P = 0.051-0.100) were shown in 5 variables among African American CDSMP participants and in 4 variables among all CDSMP participants. Statistically significant differences between the 2 programs at 4 months were seen in pain and disability in both groups. The CDSMP produced stronger results. Significant results at 1 year within and between programs were minimal for both groups.


CONCLUSIONS
When populations with arthritis and multiple comorbid conditions are targeted, the CDSMP may be most cost effective.
University of North Carolina at Chapel Hill, Schools of Nursing and Public Health, Chapel Hill, NC 27599-7460, USA. jgoeppin@email.unc.edu
Jean
J
Goeppinger
Brian
B
Armstrong
Todd
T
Schwartz
Donald
D
Ensley
Teresa J
TJ
Brady
D001741:Black or African American; D000368:Aged; D001168:Arthritis / Q000150:complications* / Q000451:nursing* / Q000503:physiopathology; D015897:Comorbidity; D005260:Female; D015438:Health Behavior; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic / Q000379:methods*; D011380:Programmed Instructions as Topic; D011788:Quality of Life; D012648:Self Care; D020377:Self Efficacy; D013997:Time Factors