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Factors Associated With Factors Associated With Utilization of Arthritis SelfUtilization of Arthritis Self--Help Programs in MichiganHelp Programs in Michigan
Peter DeGuirePeter DeGuire11, Emily Somers, Emily Somers22, , Steven SpringerSteven Springer11 and Judith Lylesand Judith Lyles11
11 Arthritis Program, MI Dept of Community HealthArthritis Program, MI Dept of Community Health22 Dept of Rheumatology, University of MichiganDept of Rheumatology, University of Michigan
ObjectivesObjectives
To identify groups of people with arthritis To identify groups of people with arthritis who have been less likely to participate in who have been less likely to participate in arthritis selfarthritis self--management programs management programs ((actualactual use)use)
To characterize groups who reported a To characterize groups who reported a relatively higher degree of interest in relatively higher degree of interest in using these programs (using these programs (potentialpotential use)use)
To compare groups based on use and To compare groups based on use and interest to identify service opportunities. interest to identify service opportunities.
MethodsMethods
Two statewide randomTwo statewide random--digit dialed telephone digit dialed telephone surveys of Englishsurveys of English--speaking, nonspeaking, non--institutionalized institutionalized adults (age 18 & over) in 2005:adults (age 18 & over) in 2005:
•• Michigan Behavioral Risk Factor Survey (MBRFS) Michigan Behavioral Risk Factor Survey (MBRFS) 12,136 completed interviews12,136 completed interviews
•• Michigan Diabetes, Arthritis & Osteoporosis Survey Michigan Diabetes, Arthritis & Osteoporosis Survey (MDAOS) 2,656 completed interviews (MDAOS) 2,656 completed interviews -- oversampledoversampledage 45+, Africanage 45+, African--Americans and HispanicsAmericans and Hispanics
Used same survey organization for data collection Used same survey organization for data collection and similar sample design for each survey.and similar sample design for each survey.
Confidence intervals were calculated and tests of Confidence intervals were calculated and tests of significance were performed using SUDAAN significance were performed using SUDAAN (Release 9.0.1) to account for the complex sample (Release 9.0.1) to account for the complex sample design.design.
Persons with doctorPersons with doctor--diagnosed arthritisdiagnosed arthritis (DDA)(DDA)
(In both surveys)(In both surveys) Responded “Yes” Responded “Yes” to “Have you ever been told by a to “Have you ever been told by a doctor or other health professional doctor or other health professional that you have some form of arthritis, that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or rheumatoid arthritis, gout, lupus, or fibromyalgiafibromyalgia?”?”
Prevalence (%) of Dr-Diagnosed Arthritis By Survey (MDAOS & MBRFS), Michigan Adults, 2005
31.5 30.9
0
5
10
15
20
25
30
35
40
Perc
ent
2005 MDAOS 2005 MBRFS
Prevalence of Dr-Diagnosed Arthritis by Age and Survey (MDAOS & MBRFS), Michigan Adults, 2005
0
10
20
30
40
50
60
70
80
18-24 25-34 35-44 45-54 55-64 65-74 75+Age
Perc
ent
2005 MDAOS 2005 MBRFS
Prevalence of Dr-Diagnosed Arthritis by Gender and Survey (MDAOS & MBRFS), Michigan Adults, 2005
35.0
27.7
35.2
26.3
0
5
10
15
20
25
30
35
40
45
Male Female
Perc
ent
2005 MDAOS 2005 MBRFS
Prevalence of Dr-Diagnosed Arthritis by Race-Ethnicity and Survey (MDAOS & MBRFS), Michigan Adults, 2005
14.6
29.326.2
33.7
21.5
30.029.931.4
0
5
10
15
20
25
30
35
40
45
50
White-NH Black-NH Other-NH Hispanic
Perc
ent
2005 MDAOS 2005 MBRFS
Arthritis selfArthritis self--help program help program use/participationuse/participation
Responded “Yes” to “Have you ever Responded “Yes” to “Have you ever taken an educational course or class taken an educational course or class to teach you how to manage to teach you how to manage problems related to your arthritis or problems related to your arthritis or joint symptoms?”joint symptoms?”
(Source: MI BRFSS, 2005)(Source: MI BRFSS, 2005)
InterestInterest in arthritis in arthritis selfself--help coursehelp course
Responded “Yes” to third question below:Responded “Yes” to third question below:
“Now I’m going to ask you about treatments for “Now I’m going to ask you about treatments for arthritis that were not provided by a physician. If arthritis that were not provided by a physician. If any of these were any of these were available near where you live near where you live or work, would you go to:or work, would you go to:
Warm water exercise class (Y/N?)Warm water exercise class (Y/N?)An arthritis support group (Y/N?)An arthritis support group (Y/N?)Classes on arthritis and how to manage it (Y/N)Classes on arthritis and how to manage it (Y/N)Yoga classes for arthritis (Y/N?)Yoga classes for arthritis (Y/N?)Tai chi for arthritis (Y/N?)Tai chi for arthritis (Y/N?)Other (specify) (Y/N?)”Other (specify) (Y/N?)”
(Source: MI DAOS, 2004(Source: MI DAOS, 2004--5)5)
Proposed AnalysisProposed Analysis
Prevalence of arthritis selfPrevalence of arthritis self--help program help program use/participationuse/participation by subby sub--groupsgroupsPrevalence of program Prevalence of program interestinterest by subby sub--groupsgroupsDifferences in program Differences in program useuse among groups among groups (e.g., age groups) (e.g., age groups) Differences in program Differences in program interestinterest among among groupsgroupsDifferences between Differences between useuse and and interestinterest for for particular groups (e.g., age 45particular groups (e.g., age 45--64)64)
ResultsResults
Arthritis SelfArthritis Self--Management ClassManagement Class
12.5% of all Michigan adults with doctor 12.5% of all Michigan adults with doctor diagnosed arthritis in 2005 reported that diagnosed arthritis in 2005 reported that they had taken an “educational course or they had taken an “educational course or class to teach them to manage problems class to teach them to manage problems related to their arthritis or other joint related to their arthritis or other joint symptoms.”symptoms.”
2005 BRFSS median for 18 states: 10.7% 2005 BRFSS median for 18 states: 10.7%
"If any of these were available near where you live or work, would you go to ... " (% saying "Yes" by program)
Michigan Adults With DDA, 2005
61.2
47.5
35.8
28.6
27.7
28.7
0 10 20 30 40 50 60 70
Other treatments
Arthritis support group
Tai chi classes
Yoga classes
Self-management classes
Warm water exercise
PercentSource: MDAOS
Self-Help Course Participation and Interest, Michigan Adults With DDA, 2005
47.5
12.5
0
10
20
30
40
50
60
Use Interest
Perc
ent
Source: MDAOSSource: MBRFS
Use and Interest in Arthritis Self-Help Course by Age, Michigan Adults With DDA, 2005
46.5
10.5
54.2
13.6
37.9
12.1
0
10
20
30
40
50
60
70
Use Interest
Perc
ent 18-44
45-6465+
2 v 3, p < .01
Source: MBRFS Source: MDAOS
Use and Interest in Arthritis Self-Help Course By Gender, Michigan Adults With DDA, 2005
45.4
10.1
49.0
14.2
0
10
20
30
40
50
60
Use Interest
Perc
ent
Male Female
p < .05
Source: MBRFS Source: MDAOS
Use and Interest in Arthritis Self-Help Course by Race-Ethnicity, Michigan Adult With DDA, 2005
11.0
43.6
78.0
21.2
53.5
10.8
48.8
18.4
0
10
20
30
40
50
60
70
80
90
Use Interest
Perc
ent White, Non-Hisp
Black, Non-HispOther, Non-HispHispanic
BN-H vs WN-H, p < .001BN-H vs ON-H, p < .01BN-H vs H, p < .05
WN-H vs BN-H, p < .05
Source: MBRFS Source: MDAOS
Use and Interest in Arthritis Self-Help Course by Education, Michigan Adults With DDA, 2005
59.7
6.9
49.8
12.2
46.6
13.6
43.0
13.9
0
10
20
30
40
50
60
70
80
Use Interest
Perc
ent
< HS
HS only
Some college
College grad1 vs 3, p < .051 vs 4, p < .05
Source: MDAOSSource: MBRFS
p for trend = .06
Use and Interest in Arthritis Self-Help Course by Income, Michigan Adults With DDA, 2005
54.8
14.0
38.5
11.8
40.6
11.9
39.5
9.7
0
10
20
30
40
50
60
70
Use Interest
Perc
ent <$35,000
$35,000-$49,999$50,000-$74,000$75,000+1 vs 4, p < .05
1 vs 2, p < .051 vs 3, p < .05
Source: MBRFS Source: MDAOS
SummarySummary
< $35K< $35K< $35K< $35K>> $75K$75KIncomeIncome
< HS< HS< HS< HSEducationEducation
BNBN--HHBNBN--HHWNWN--HHRaceRace--EthnicityEthnicity
MalesMalesGenderGender
4545--64644545--6464AgeAge
Higher GapHigher GapBetween Between Interest &Interest &UseUse
HigherHigherInterestInterest
LowerLowerUseUse
GroupGroupCharacCharac--teristicteristic
Source: MBRFS Source: MDAOS
SummarySummary
IncomeIncome
EducationEducation
RaceRace--EthnicityEthnicity
GenderGender
AgeAge
GroupGroupCharacCharac--teristicteristic
>> $75K$75K
< HS< HS
WNWN--HH
MalesMales
LowerLowerUseUse
< $35K< $35K
BNBN--HH
4545--6464
HigherHigherInterestInterest
< $35K< $35K
< HS< HS
BNBN--HH
4545--6464
Higher Higher GapGapBetween Between Interest &Interest &UseUse
< $35K< $35K
<HS<HS
BNBN--HHONON--HH
FemalesFemales
Higher Higher DisabilityDisability
Source: MBRFS Source: MDAOS Source: MBRFS
LimitationsLimitations
All data based on selfAll data based on self--reportsreportsUnable to identify specific types of selfUnable to identify specific types of self--management programs, e.g., AFSHP or management programs, e.g., AFSHP or CDSMPCDSMPUnable to differentiate among or make Unable to differentiate among or make inferences to specific types of arthritisinferences to specific types of arthritisDidn’t ascertain reason for nonDidn’t ascertain reason for non--use of or use of or nonnon--interest in classesinterest in classesSurvey biases due to nonSurvey biases due to non--response and response and nonnon--coveragecoverage
AcknowledgementsAcknowledgementsThis presentation was supported by Cooperative Agreement No. U58/CCU52826-01-05 from the U.S. Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC.
The authors are grateful to the following individuals The authors are grateful to the following individuals for their assistance:for their assistance:
Sarah LyonSarah Lyon--CalloCallo,,MI Dept of Community Health MI Dept of Community Health Drs. Julie Bolen and Terry BradyDrs. Julie Bolen and Terry Brady, US Centers for , US Centers for Disease Control & PreventionDisease Control & Prevention