Jean Goeppinger

Mail-delivered arthritis self-management tool kit: A randomized trial and longitudinal followup†

OBJECTIVE To determine the effectiveness of an intervention Tool Kit of arthritis self-management materials to be sent once through the mail, and to describe the populations reached. METHODS Spanish speakers (n = 335), non-Hispanic English-speaking African Americans (n = 156), and other non-Hispanic English speakers (n = 404) were recruited separately and randomized within each of the 3 ethnic/racial categories to immediately receive the intervention Tool Kit (n = 458) or to a 4-month wait-list control status (n = 463). At the end of 4 months, controls were sent the Tool Kit. All subjects were followed in a longitudinal study for 9 months. Self-administered measures included health status, health behavior, arthritis self-efficacy, medical care utilization, and demographic variables. Using analyses of covariance and t-tests, analyses were conducted for all participants and for Spanish- and English-language groups. RESULTS At 4 months, comparing all intervention subjects with randomized wait-list controls, there were significant (P < 0.01) benefits in all outcomes except medical care utilization and self-rated health. The results were maintained at 9 months compared with baseline. On average, the Tool Kit reached persons ages 50-56 years with 12-15 years of schooling. There were few differences between English- and Spanish-language participants in either the effectiveness or reach variables. CONCLUSION A mailed Arthritis Self-Management Tool Kit proved effective in improving health status, health behavior, and self-efficacy variables for up to 9 months. It also reached younger persons in both English- and Spanish-language groups and Spanish speakers with higher education levels than previous studies of the small-group Arthritis Self-Management Program.

Interventions to reduce the impact of chronic disease: community-based arthritis patient education.

Systematic development and testing of the efficacy of educational interventions to improve functioning, prevent disability, and reduce the impact of chronic disease has been limited, perhaps because many chronic diseases disable, do not kill, and because they are managed largely within home, work, and community environments and not within the medical care system. Until recently, these factors contributed to a paucity of arthritis educational interventions. But since the impetus provided by the establishment of the Multipurpose Arthritis Centers Program of the NIH (1977), a number of arthritis patient education programs have been established and evaluated. This chapter summarizes findings from community-based arthritis patient education studies conducted between 1980 and 1995, critiques the methods of these studies, and provides guidance for state-of-the-art community-based intervention research aimed at reducing the individual and social impact of arthritis and other chronic diseases.

Process Evaluation Assessing Re-Invention of Community-Based Interventions

Although complete program evaluation includes assessment of the program implementation process as well as examination of impact and outcome variables, such process evaluation does not always occur. Duringfield implementation programs may be changed, or reinvented, by those adopting the innovation. A case study of the A rthritis Self-Care Project, a rural community-based intervention study, demonstrates the importance of process evaluation in determining the actual independent variable. Instances of reinvention uncovered by theArthritis Self-Care Project are explored, and suggestions are provided for dealing with the reinvention inevitable in field research.

The Albrecht Nursing Model for Home Healthcare: Predictors of Satisfaction with a Self-care Intervention Program

Satisfaction with a self-care intervention program was evaluated through this quantitative study of arthritis clients at home. The results indicate that the clients were highly satisfied with the intervention. In this era of consumer satisfaction with their care, nurse administrators knowledge of which interventions are satisfying is important for staff development and case management in the community.

Dissertation Abstracts: Changes and Continuities in Domiciliary Family Arrangements and Kin Interaction Patterns: A Study of Selected Urban Im migrants

Although the family has been the subject of much study, the social history of the family in Western Europe and North America has remained relatively unexplored. Speculations about relationships between kinship systems and types of economy have not been systematically pursued. The present research describes some of these relationships by examining changes and continuities in: (1) the domiciliary arrangements of families, and (2) the interaction patterns among kin of individuals who have migrated from a rural, agricultural setting to an industrialized American city. The Transylvanian Saxon community was chosen as the research population. Informants were selected purposively from this community to fulfill sampling criteria. Fifty-one individual informants and seventeen informants from two family lines were interviewed. A questionnaire and an interview guide were used. The data from such documents as parish records, city directories, and Heimatbilcher (Saxon village histories) were used to validate the data generated by interviewing. Both changes and continuities in domiciliary family arrangements and kin interaction patterns were demonstrated. Domi-