title: Older American Indians' Perspectives on Health, Arthritis, and Physical Activity: Implications for Adapting Evidence-Based Interventions, Oregon, 2013.
abstract: Despite the high prevalence of arthritis and physical disability among older American Indians, few evidence-based interventions that improve arthritis self-management via physical activity have been adapted for use in this population. The purpose of this study was to identify beliefs about health, arthritis, and physical activity among older American Indians living in a rural area in Oregon to help select and adapt an arthritis self-management program.
  
  
  
  In partnership with a tribal health program, we conducted surveys, a focus group, and individual interviews with older American Indians with arthritis. Our sample comprised 6 focus group participants and 18 interviewees. The 24 participants were aged 48 to 82 years, of whom 67% were women. Forms B and C of the Multidimensional Health Locus of Control (MHLC) instrument, modified for arthritis, measured MHLC.
  
  
  
  The concepts of health, arthritis, and physical activity overlapped in that health was a holistic concept informed by cultural teachings that included living a healthy lifestyle, socializing, and being functionally independent. Arthritis inhibited health and healthy behaviors. Participants identified barriers such as unreliable transportation and recruiting challenges that would make existing interventions challenging to implement in this setting. The Doctor subscale had the highest MHLC (mean = 4.4 [standard deviation (SD), 1.0]), followed by the Internal subscale (3.9 [SD, 1.4]) and the Other People subscale (2.8 [SD, 1.1]).
  
  
  
  Existing evidence-based programs for arthritis should be adapted to address implementation factors, such as access to transportation, and incorporate cultural values that emphasize holistic wellness and social interconnectedness. Culturally sensitive programs that build on indigenous values and practices to promote active coping strategies for older American Indians with arthritis are needed.
authors.affiliation: The Australian Prevention Partnership Centre and the Menzies Centre for Health Policy; Charles Perkins Centre, D17; University of Sydney; Sydney, NSW, 2006 Australia. Email: kathleen.conte@sydney.edu.au.
authors.forename: Kathleen P
authors.initials: KP
authors.lastname: Conte
authors.affiliation: Montana State University, Bozeman, Montana.
authors.forename: Marc B
authors.initials: MB
authors.lastname: Schure
authors.affiliation: Western Carolina University, Cullowhee, North Carolina.
authors.forename: R Turner
authors.initials: RT
authors.lastname: Goins
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001168:Arthritis / Q000453:epidemiology / Q000523:psychology*; D001294:Attitude to Health; D054521:Cultural Competency; D055317:Evidence-Based Practice; D015444:Exercise; D005260:Female; D017144:Focus Groups; D015438:Health Behavior; D006303:Health Services, Indigenous; D006801:Humans; D007198:Indians, North American / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009922:Oregon; D015397:Program Evaluation; D012424:Rural Population; D012648:Self Care