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