Measuring the Value of Program Adaptation: A Comparative Effectiveness Study of the Standard and a Culturally Adapted Version of the Arthritis Self-Help Program

Abstract

Background: Arthritis remains an important public health problem. Questions/Purposes: This study aims to determine the effects of an adapted (vs. the original) Arthritis Self-Help Program (ASHP) among older adults. Specifically, this study sought to determine (1) whether the adapted ASHP improved attendance, retention, and adherence with the use of self-management exercises, and (2) if the original ASHP's beneficial outcomes were maintained following program adaptation. Patient and Methods: Individuals age ≥60 with self-reported arthritis were recruited from eight New York City senior centers. Participants were assessed at baseline to assess their demographic and clinical status and at 6 and 24 weeks to ascertain study outcomes using validated measures. Results: Two-hundred-one participants (64 non-Hispanic African Americans, 86 Hispanics, and 51 non-Hispanic Whites) enrolled. Participants in the adapted (vs. original) ASHP had better average attendance in the six session program (4.7 vs. 3.2 classes attended, p<0.01) and program retention (93% vs. 74%, p<0.01). Adherence with use of the selfmanagement exercises (number of days using endurance, stretching, and relaxation exercises) was similar in both groups. Significant positive physical/psychosocial outcomes were documented in both the adapted and original program. Conclusion: The adapted ASHP improved program attendance and retention while maintaining improvements in physical and psychosocial functions. These results support future efforts to employ controlled designs to quantify the benefits of adapted evidence-based programs to ensure that adaptation maintains program effectiveness.

Evaluation of a community‐based hypertension self‐management model with general practitioners

“…The health‐related outcomes evaluated in the present study are similar to what has been investigated in other countries where disease management programs have been developed and evaluated, such as arthritis self‐management programs and positive self‐management programs for AIDS . These programs significantly improved behaviour, such as weekly exercise time and cognitive symptom management skills . In China, similarly, the CDSMP has been effective in improving patients' health service utilization and reducing adverse symptoms, and for different types of diseases.…”

“…[27][28][29][30] These programs significantly improved behaviour, such as weekly exercise time and cognitive symptom management skills. 31,32 In China, similarly, the CDSMP has been effective in improving patients' health service utilization and reducing adverse symptoms, and for different types of diseases. Further, the changes in health are enduring.…”

Help for Osteoarthritis Pain in African American Elders (HOPE)

“…b. Absence of cultural tailoring of standardized arthritis, chronic pain, and chronic disease self-management programs (Chen, Reid, Parker & Pillemer, 2013;Goeppinger et al, 2007;Mingo et al, 2013;Parker et al, 2012;Reid, Chen, Parker, Henderson, & Pillemer, 2014), a stronger preference for someone of their race to facilitate an OA self-management program (Mingo et al, 2013), and lack of evidence-based, culturally-congruent OA selfmanagement behaviors (Shengelia et al, 2013;Sperber et al, 2013).…”

“…Frequency. Several studies investigated the number of days spent exercising (Nour, Laforest, Gauvin, & Gignac, 2006;Parker et al, 2011;Reid et al, 2014). After participating in a chronic disease self-management program, post-intervention exercise behaviors increased in the number of days performing stretching, endurance training, and relaxation exercises in older AAs, CAs, and Hispanic Americans (Parker et al, 2011).…”

“…In Parker and colleagues' study (2011) Hispanic elders attended an average of 5.2 sessions, AAs 5 sessions, and CAs 4.9; their study was conducted in an inner-city which helps explain greater attendance by ethnic minorities. Completion rate for self-management education programs attended by ethnically diverse elders range from 61-91% (Parker et al, 2011;Reid et al, 2014;Sperber et al, 2013). Lack of interest, illness, death, lack of transportation are major reasons for attrition and drop-out of older adults in self-management programs (Parker et al, 2011).…”