Abstract
Purpose
The purpose of this study was to evaluate a self-care program for elders with osteoarthritis managed by primary health care workers, Community Health Practitioners (CHPs), in rural Korea.
Methods
The self-care program, consisting of 7 areas, was evaluated with a randomized experimental study for patients over age 60 with osteoarthritis in which 150 participants in the experimental group and 140 in the control group were compared. The self-care program was implemented for six weeks, 2 hours per week, at community health posts by CHPs. Data were collected using an interview questionnaire given by the CHPs and laboratory tests before and after the intervention for both groups. Propensity score matching analysis was done to test effectiveness after controlling for confounding variables.
Results
The intervention group showed a significant decrease in the number of painful joints (p<.001) and a significant increase in self-care ability (p<.05) compared to the control group.
Conclusion
Study results indicate that training and utilizing primary health care workers in rural areas is valuable in increasing the generalization and continuity of intervention programs. As arthritis should be managed life-long, CHP directed self-care programs are useful interventions for rural elders with arthritis to learn self-care management.
References
Ahmed A.., Perry G. J.., Fleg J. L.., Love T. E.., Goff D. C.., Kitzman D.W. 2006. Outcomes in ambulatory chronic systolic and diastolic heart failure: A propensity score analysis. American Heart Journal. 152:956–966. http://dx.doi.org/10.1016/j.ahj.2006.06.020.
Burgio L.., Lichstein K. L.., Nichols L.., Czaja S.., Gallagher-Thompson D.., Stevens A., et al2001. Judging outcomes in psychosocial interventions for dementia caregivers: The problem of treatment implementation. The Gerontologist. 41:481–489. http://dx.doi.org/10.1093/geront/41.4.481.
Centers for Disease Control and Prevention. 2010. Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation-United States, 2007-2009. Morbidity and Mortality Weekly Report, 59, 1261-1265. Retrieved May 12, 2012, from. http://www.cdc.gov/mmwr/PDF/wk/mm5939.pdf.
Centers for Disease Control and Prevention. 2011. Self-management education. Retrieved May 29, 2012, from. http://www.cdc.gov/arthritis/in-terventions/self_manage.htm.
Choi S.H. 2001. The effect of health promotion program on health of the clients with arthritis in primary health care center. Journal of Korean Academy of Community Health Nursing. 12:344–360.
Cohen, J. 1988. Statistical power analysis for the behavioral sciences. 2nd ed.New York: Psychology Press.
Cook C.., Pietrobon R.., Hegedus, E. 2007. Osteoarthritis and the impact on quality of life health indicators. Rheumatology International. 27:315–321. http://dx.doi.org/10.1007/s00296-006-0269-2.
Devos-Comby L.., Cronan T.., Roesch S.C. 2006. Do exercise and self-management interventions benefit patients with osteoarthritis of the knee? A metaanalytic review. The Journal of Rheumatology. 33:744–756.
Goeppinger J.., Armstrong B.., Schwartz T.., Ensley D.., Brady T.J. 2007. Self-management education for persons with arthritis: Managing comorbidity and eliminating health disparities. Arthritis Care & Research. 57:1081–1088. http://dx.doi.org/10.1002/art.22896.
Kim C. S.., Kim R.., Kim Y. J.., Park I. S.., Park M. H.., Park I.H. 2003. Effects of self-help program in daily living and self-care activities, flexibility, grip strength and depression in patients having chronic arthritis. The Journal of Rheumatology Health. 10:131–141.
Kim J.S. 2004. Satisfaction and need on primary health care services among rural people in community health practitioner’s post area. Unpublished master’s thesis. Chonnam National University;Gwangju:
Kim W. J.., Yoon S. N.., June K. J.., Kim S. Y.., Kim C. M.., Kim H. S., et al2010. Community health nursing. 8th ed.Paju: Soomoonsa.
Lee E. O.., Suh M. J.., Kim K. S.., Kang H. S.., Han S. S.., Lim N. Y., et al2002. The effect of self-help health promotion program for arthritis patients from year 1997-2000. The Journal of Rheumatology Health. 9:5–17.
Lee K. S.., Choi J. S.., Lee E. H.., Suh G. H.., So E. Y.., Choi S. H., et al2001. The effect of health promotion program for osteoarthritis patients at public health organization. The Journal of Rheumatology Health. 8:357–364.
Lee S. J.., Yoo J. S.., Shin M.., Park C. G.., Lee H. C.., Choi E.J. 2007. The use of propensity score matching for evaluation of the effects of nursing interventions. Journal of Korean Academy of Nursing Science. 37:414–421.
Lee T. W.., Ko I.S. 2002. Cost-benefit analysis on community health practitioner. Journal of Korean Academy of Nursing Science. 32:435–446.
Lorig K.., Seleznick M.., Lubeck D.., Ung E.., Chastain R. L.., Holman H.R. 1989. The beneficial outcomes of the arthritis self-management course are inadequately explained by behavior change. Arthritis and Rheumatism. 32:91–95. http://dx.doi.org/10.1002/anr.1780320116.
Ministry of Health and Welfare. 2010. Korea community health post statistics. Retrieved November 19, 2010, from. http://kosis.kr/abroad/abroad_01List.jsp.
Ministry of Health and Welfare. 2011. December. Korea health statistics 2010: Korea National Health and Nutrition Examination Survey (KN-HANES V-1). 2005. Seoul: Author.
Moon O.R. 2007. April. The value of medicines in an aging society-based on survey results. Paper presented at the spring seminar of Medicine & Society Forum, Seoul.
Nuñez D. E.., Keller C.., Ananian C.D. 2009. A review of the efficacy of the self-management model on health outcomes in community-residing older adults with arthritis. Worldviews on Evidence-Based Nursing. 6:130–148. http://dx.doi.org/10.1111/j.1741-6787.2009.00157.x.
Oh Y.H. 2003. A study to improve financial accounting system of community health posts in Korea. Health and Welfare Policy Forum. 79:66–76.
Osborne R. H.., Wilson T.., Lorig K. R.., McColl G.J. 2007. Does self-management lead to sustainable health benefits in people with arthritis? A 2-year transition study of 452 Australians. The Journal of Rheu-matoloy. 34:1112–1117.
Park S.H. 2010. Comparison of community health post and clinic on knowledge and service quality for hypertension clients. Unpublished master’s thesis. Yonsei University;Seoul:
Qin R.., Titler M. G.., Shever L. L.., Kim, T. 2008. Estimating effects of nursing intervention via propensity score analysis. Nursing Research. 57:444–452. http://dx.doi.org/10.1097/NNR.0b013e31818c66f6.
Rosenbaum P. R.., Rubin D.B. 1983. The central role of the propensity score in observational studies for causal effects. Biometrika. 70:41–55. http://dx.doi.org/10.1093/biomet/70.1.41.
Rubin D. B.., Thomas, N. 2000. Combining propensity score matching with additional adjustment for prognostic covariates. Journal of American Statistical Association. 95:573–585. http://dx.doi.org/10.1080/01621459.2000.10474233.
The Korean Rheumatology Health Professionals Society. 1999. Self-help health promotion program for arthritis patients. Retrieved May 29, 2012, from. http://plaza1.snu.ac.kr/-rheumato/ieindex.htm.
World Health Organization. 1978. Declaration of Alma-Ata, international conference on primary health care. Alma-Ata, USSR. 6–12. Retrieved March 3, 2012, from. http://www.who.int/publications/almaata_decla-ration_en.pdf.
Yip Y. B.., Sit J. W.., Fung K. K.., Wong D. Y.., Chong S. Y.., Chung L. H., et al2007. Effects of a self-management arthritis programme with an added exercise component for osteoarthritis knee: Randomized controlled trial. Journal of Advanced Nursing. 59:20–28. http://dx.doi.org/10.1111/j.1365-2648.2007.04292.x.
Table 1.
Table 2.
Table 3.
Variables | Categories |
Number of painful joints |
Level of osteoarthritis management skill |
||||
---|---|---|---|---|---|---|---|
M±SD | t or F or r | p | M±SD | t or F or r | p | ||
Gender | Female | 4.04±3.53 | −3.43 | .001 | 60.39±14.71 | 1.68 | .104 |
Male | 2.88±1.31 | 66.62±18.32 | |||||
Age (year) | .15 | .010 | −0.08 | .170 | |||
Education | No formal educationa | 3.84±3.25 | 0.33 | .721 | 61.00±14.90 | 10.89 | <.001* |
Elementary schoolb | 3.90±3.03 | 57.97±13.09 | (c>a,b) | ||||
≥Middle schoolc | 4.28±4.47 | 68.69±17.31 | |||||
Marital status | Married | 4.31±3.51 | −2.97 | .003 | 58.72±14.44 | 3.86 | <.001 |
Bereavement | 3.11±3.05 | 66.08±15.30 | |||||
Economic status | High | 5.27±4.34 | −4.12 | <.001 | 61.84±18.17 | −1.24 | .217 |
Low | 3.29±2.63 | 59.29±12.53 | |||||
Perceived | Poora | 4.04±3.41 | 3.06 | .048* | 60.00±13.64 | 4.93 | .008* |
health status | Moderateb | 3.46±2.93 | (c>a,b) | 59.88±16.19 | (c>a,b) | ||
Goodc | 5.06±4.51 | 68.50±15.78 | |||||
Systolic blood pressure | .02 | .789 | −0.19 | .001 | |||
Fasting blood sugar level | −.05 | .394 | 0.06 | .277 | |||
Family history | Yes | 3.69±3.13 | −0.76 | .450 | 56.52±14.07 | −3.26 | .001 |
No | 4.03±3.51 | 62.67±15.21 | |||||
Medication | Yes | 4.04±3.48 | 1.27 | .205 | 61.32±14.89 | 0.96 | .343 |
No | 3.30±2.84 | 58.65±16.58 | |||||
Previous education | Yes | 3.40±4.08 | 1.15 | .253 | 66.64±16.22 | −2.60 | .012 |
about osteoarthritis | No | 4.03±3.27 | 59.90±14.72 | ||||
Experimental group | Post-Pre | 1.22±2.65 | 2.83 | .005 | 9.87±11.67 | −2.42 | .016 |
Control group | Post-Pre | 0.39±2.21 | 6.16±14.20 |