The beneficial outcomes of the arthritis self‐management course are not adequately explained by behavior change

Abstract

Evaluation of the Arthritis Self-ManagementCourse revealed significant positive changes in the practice of behaviors that were taught and in health outcomes. However, utilizing a variety of statistical techniques, we were able to demonstrate only weak associations between changes in behavior and changes in health status. This suggests the need to examine the mechanisms by which health education affects heaMh status.As do other persons who have chronic and disabling illnesses, the person who has arthritis plays a potentially significant role in the management of his or her health care. This role includes using techniques for maintaining mobility and strength, engaging in practices that reduce pain, and balancing the beneficial and adverse effects of medication. If the patient's role is to emerge fully, it is necessary that he or she gain new understanding about chronic illness and skills for coping with the effects. The purpose of the Arthritis Self-Management Course (ASMC) was to assist patients in attaining such understanding and skills.The underlying assumptions of those who developed the ASMC hold that enhanced knowledge and adoption of specific self-management behaviors will lead to improved functional outcomes. The ASMC, as originally tested in a randomized trial of 190 people with arthritis, was successful: Knowledge about arthritis was increased, taught behaviors were adopted, and pain was diminished by approximately 20%. No significant improvement in the average degree of disability was observed, but there was no deterioration. The effects persisted without reinforcement, albeit with some decay, for as long as 20 months, which was the longest time interval studied (1). We describe here the results of an inquiry into mechanisms of the effects of the ASMC. The first part of the report presents ASMC outcomes for 707 people, including the original 190 participants in the initial study. The second part describes the associations between participants' adoption of taught behaviors and improved health outcomes. The data reveal only weak correlations between the two.The weak associations of behavior change with health outcomes, which run counter to the usual perception of a direct progression from health education intervention to specified behavior change to improved health outcome, raise potentially important questions concerning the sources of benefit from health education. PATIENTS AND METHODSPublic service announcements in newspapers, on radio, and on television in the San Francisco Bay area were used to recruit 854 persons with arthritis. A physician's consent form confirming the patient's diagnosis was part of the application process.Upon completion of the application, all subjects were classified by the site at which they chose to take

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