Differences in osteoarthritis self-management support intervention outcomes according to race and health literacy

• Published in: Health education research 2013-06, Vol.28 (3), p.502-511
• Main Authors: Sperber, Nina R., Bosworth, Hayden B., Coffman, Cynthia J., Lindquist, Jennifer H., Oddone, Eugene Z., Weinberger, Morris, Allen, Kelli D.
• Format: Article
• Language: English
• Subjects: African Continental Ancestry Group; Continental Population Groups; Diseases; European Continental Ancestry Group; Female; Health Education; Health Literacy; Health technology assessment; Humans; Intervention; Literacy; Male; Measures (Individuals); Middle Aged; ORIGINAL ARTICLES; Osteoarthritis; Osteoarthritis - psychology; Osteoarthritis - therapy; Outcomes of Treatment; Pain; Pain Measurement; Patient Education as Topic - methods; Patients; Physical Mobility; Race; Racial Differences; Self Care - methods; Self Care - psychology; Self Efficacy; Self Management; Selfmanagement; Statistical Analysis; Student Behavior; Telecommunications; Whites
• ISSN: 0268-1153; 1465-3648
• DOI: 10.1093/her/cyt043

We explored whether the effects of a telephonebased 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 [AEMS2] 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.