title: Differences in osteoarthritis self-management support intervention outcomes according to race and health literacy.
abstract: We explored whether the effects of a telephone-based osteoarthritis (OA) self-management support intervention differed by race and health literacy. Participants included 515 veterans with hip and/or knee OA. Linear mixed models assessed differential effects of the intervention compared with health education (HE) and usual care (UC) on pain (Arthritis Impact Measurement Scales-2 [AIMS2] and Visual Analogue Scale), function (AIMS2 mobility and walking/bending), affect (AIMS2) and arthritis self-efficacy by: (i) race (white/non-white), (ii) health literacy (high/low) and (iii) race by health literacy. AIMS2 mobility improved more among non-whites than whites in the intervention compared with HE and UC (P = 0.02 and 0.008). AIMS2 pain improved more among participants with low than high literacy in the intervention compared with HE (P = 0.05). However, we found a differential effect of the intervention on AIMS2 pain compared with UC according to the combination of race and health literacy (P = 0.05); non-whites with low literacy in the intervention had the greatest improvement in pain. This telephone-based OA intervention may be particularly beneficial for patients with OA who are racial/ethnic minorities and have low health literacy. These results warrant further research designed specifically to assess whether this type of intervention can reduce OA disparities.
authors.affiliation: Health Services Research and Development Service, Durham VA Medical Center, Durham, NC, USA. nina.sperber@duke.edu
authors.forename: Nina R
authors.initials: NR
authors.lastname: Sperber
authors.forename: Hayden B
authors.initials: HB
authors.lastname: Bosworth
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Coffman
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Lindquist
authors.forename: Eugene Z
authors.initials: EZ
authors.lastname: Oddone
authors.forename: Morris
authors.initials: M
authors.lastname: Weinberger
authors.forename: Kelli D
authors.initials: KD
authors.lastname: Allen
mesh_terms: D044383:Black People; D005260:Female; D057220:Health Literacy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000523:psychology / Q000628:therapy*; D010147:Pain Measurement; D010353:Patient Education as Topic / Q000379:methods*; D044469:Racial Groups; D012648:Self Care / Q000379:methods / Q000523:psychology; D020377:Self Efficacy; D044465:White People