Journal List > J Korean Acad Nurs > v.42(7) > 1002882

Lee and Cho: Evaluation of a Community Health Practitioner Self-care Program for Rural Korean Patients with Osteoarthritis

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

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Table 1.
Contents of the SCP
Weeks Contents
1st 1. Overview of arthritis
2. Everyday exercise for arthritis
2nd Pain control by medication
1. Pain management
2. Principle of medication use
3. Pain control medication use
4. Anti-inflammatory medication
3rd Pain control by other methods
1. Cold massage
2. Hot massage
3. Joint massage
4. Knee joint massage
5. Hand joint massage
6. Other physical therapy
7. Environment support for pain control
8. Healthy life style for arthritis management
4th Obesity control
1. Definition of obesity
2. Effects of obesity on health
3. Causes of obesity
4. Obesity management: Healthy eating exercise
5th Dietary management
1. Principle of diet
2. Good diet for arthritis
3. Diet to avoid if arthritic
4. Supplementary diet for arthritis
6th Stress management
1. Relaxation therapy
2. Effective communication
3. Checklist for my communication skills
4. Checklist for my listening skills

SCP=Self-care program.

Table 2.
Characteristics of Participants
Variables Categories Total (N=290)
Exp. (n=150)
Cont. (n=140)
χ2 or t p
n (%) or M±SD n (%) or M±SD n (%) or M±SD
Demographic characteristics
Gender Female 264 (91.0) 139 (92.7) 125 (89.3) 0.64 .423
Male 26 (9.0) 11 (7.3) 15 (10.7)
Age (year) 65.70±8.98 63.61±8.70 67.94±8.76 4.22 <.001
Education No formal education 93 (32.6) 46 (31.7) 47 (33.6) 0.47 .791
Elementary school 134 (47.0) 71 (49.0) 63 (45.0)
≥Middle school 58 (20.4) 28 (19.3) 30 (21.4)
Marital status Married 198 (68.5) 111 (74.5) 87 (62.1) 4.55 .033
Widowed 91 (31.5) 38 (25.5) 53 (37.9)
Religion Yes 184 (63.4) 102 (68.0) 82 (58.6) 2.38 .123
No 106 (36.6) 48 (32.0) 58 (41.4)
Economic status High 101 (38.3) 66 (45.8) 35 (29.2) 7.01 .008
Low 163 (61.7) 78 (54.2) 85 (70.8)
Health-related characteristics
Perceived health status Poor 143 (49.3) 60 (40.0) 83 (59.3) 10.88 .004
Moderate 113 (39.0) 70 (46.7) 43 (30.7)
Good 34 (11.7) 20 (13.3) 14 (10.0)
Systolic blood pressure (mmHg) 123.08±15.11 119.25±13.76 127.19±15.44 4.63 <.001
Fasting blood sugar level (mg/dL) 122.89±29.02 119.15±30.45 126.89±26.94 2.29 .023
BMI (kg/m2) 24.49±3.03 24.43±3.35 24.54±2.65 0.31 .761
Osteoarthritis-related characteristics
Period of illness (year) 6.38±5.96 6.83±5.80 5.91±6.12 2.32 .188
Family history Yes 81 (27.9) 58 (38.7) 23 (16.4) 16.70 <.001
No 209 (72.1) 92 (61.3) 117 (83.6)
Medication Yes 250 (86.2) 122 (81.3) 128 (91.4) 5.39 .020
No 40 (13.8) 28 (18.7) 12 (8.6)
OP history Yes 21 (7.2) 12 (8.0) 9 (6.4) 0.15 .695
No 269 (92.8) 138 (92.0) 131 (93.6)
Admission history Yes 29 (10.0) 16 (10.7) 13 (9.3) 0.04 .845
No 261 (90.0) 134 (89.3) 127 (90.7)
Previous education about osteoarthritis Yes 45 (15.5) 32 (21.3) 13 (9.3) 7.13 .008
No 245 (84.5) 118 (78.7) 127 (90.7)

Exp.=Experimental group; Cont.=Control group; BMI=Body mass index; OP=Operation.

Table 3.
The relationship between baseline characteristics and dependent variables
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

* Tukey test.

Table 4.
PSM Analysis for Factors related to the Differences between Pretest and Posttest
Variables Number of painful joints
Level of osteoarthritis management skill
Exp. (mean/%) Cont. (mean/%) χ2 or t p Exp. (mean/%) Cont. (mean/%) χ2 or t p
Dependent variable −2.04 −0.37 −7.00 <.001 10.03 6.69 2.28 .024
Gender (female) 92.1 86.4 0.78 .376 92.1 92.0 0.001 .961
Age (year) 65.44 63.66 1.62 .106 63.69 64.66 −0.90 .371
Education (no formal education) 32.4 31.8 0.003 .959 32.8 36.0 0.09 .691
Marital status (married) 75.5 68.2 0.54 .462 75.7 60.0 2.68 .128
Economic status (high) 44.6 36.4 0.52 .469 45.0 24.0 3.84 .060
Perceived health status (poor) 38.8 54.5 1.93 .164 39.3 52.0 1.42 .298
Systolic blood pressure 120.51 118.54 1.16 .247 118.59 119.55 −0.55 .583
Fasting blood sugar level 125.44 117.85 2.38 .018 117.96 120.11 −0.73 .468
Family history (yes) 38.1 18.2 3.30 .069 37.9 20.1 2.97 .104
Medication (yes) 82.7 90.9 0.94 .333 82.9 84.0 0.02 .891
Previous education about osteoarthritis (yes) 22.3 13.6 0.86 .355 22.1 16.0 0.48 .496

Exp.=Experimental group; Cont.=Control group; PSM=propensity score matching.

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