Year

2008

Degree Name

Doctor of Public Health

Department

School of Health Sciences - Faculty of Health & Behavioural Sciences

Abstract

Osteoarthritis (OA) is one of the most frequent chronic diseases seen in older populations with increasing prevalence in China and worldwide. Arthritis Self Management is widely recognized as one of the strategies to reduce pain and functional disability. Over many years the role of social and psychological factors has been investigated for rheumatoid arthritis (RA), but not OA. This study was designed to examine the extent to which social factors and psychological factors influence self-management behaviour (SMB) and health outcomes in patients with OA in Shanghai, China.

Three broad research questions addressed were: (1) Do social factors and psychological factors influence self-management behaviours (SMB) in people with OA? (2) Do social factors and psychological factors influence OA outcomes? and (3) Does SMB influence OA outcomes?

A cohort of patients (n= 176) who had been provided training in the Arthritis Self-Management Program (ASMP) in Shanghai, China was examined at baseline and six months after to collect data on social factors, psychological factors, self-management behaviour and OA outcomes. A battery of instruments was used to collect data including the arthritis self-efficacy scale (ASES), geriatric depression scale (GDS), life orientation test (LOT), medical outcome study-social support survey (MOS-SSS) and Western Ontario and McMaster University Osteoarthritis Index (WOMAC), alongside a specifically designed scale: the osteoarthritis self-management behaviour scale.

The results of correlation analyses indicated that higher levels of emotional support and tangible support were associated with higher levels of exercise-related behaviour and passive activity. However, these relationships were not seen between social support at baseline and SMB at follow-up, indicating that the linkage of social support to SMB is only cross-sectional.

Higher levels of emotional support were associated with higher levels of pain, stiffness and functional disability. Increased positive social interaction was associated with increased pain and functional disability. Regression analyses indicated that emotional support is a significant predictor of all OA outcomes (pain, stiffness and functional disability), controlling all other variables.

Among the psychological variables examined, self-efficacy (SE) for pain and self-efficacy for other arthritis symptoms were associated with decreased pain, stiffness and functional disability. In the regression analysis of OA outcomes, SE for pain predicted pain at follow-up, while SE for other symptoms was the predictor of stiffness and functional disability at follow-up. When change in SE was measured, change in SE in pain consistently predicted change in pain, stiffness and functional disability.

Contrary to the findings from other studies, depressive symptoms were found to be associated with increased functional disability only, and had no significant relationship with other OA outcomes. No significant relationships were found between optimism with self-management behaviour and OA outcomes either.

Path analyses revealed the direct and indirect effects of social and psychological factors on OA outcomes. Emotional support had a direct effect on pain and stiffness, and an indirect effect on functional disability through SE for other symptoms. SE for pain had a direct effect on pain, and SE for other symptoms also had a direct effect on stiffness and functional disability. Neither direct nor indirect effects of depression were related to pain and functional disability. Depression had an indirect effect on stiffness through SE for other symptoms.

There was no relationship of SMB with OA outcomes, which concurs with other studies, of the poor link of SMB to health outcomes in chronic disease.

Overall the results of this research partially supported the hypotheses that social and psychological factors influenced self-management behaviours and health outcomes in patients with OA, suggesting that increased in emotional support and increased in confidence to cope with pain and other symptoms would have useful effects on self management behaviour and health outcomes in OA.

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