O. Wiegman

Health status, adherence with health recommendations, self-efficacy and social support in patients with rheumatoid arthritis

A study was performed in 86 patients with rheumatoid arthritis (RA) to assess their health problems, the problems they experience in adhering to health recommendations and the relationships of these problems with self-efficacy and social support. Feeling dependent, disability and pain were the most important health related problems. The results showed self-efficacy to be related to the subjective experience of health status as measured by DUTCH-AIMS. Social emotional support was not related to health status, and contrary to what we expected social instrumental support was positively related to health status. The majority of the patients (55%) experienced adherence problems with health recommendations. These problems were not related to functional incapacity, pain or other aspects of health status but to the patients self-efficacy expectations about coping with arthritis. Our conclusion is that to improve the self-management of disability and pain and adherence to health recommendations, patient education should be aimed at strengthening self-efficacy expectations in which social emotional support might be a motivating factor.

Effects of patient education on compliance with basic treatment regimens and health in recent onset active rheumatoid arthritis

OBJECTIVES To determine the effects of patient education on compliance and on health in patients with active, recent onset rheumatoid arthritis (RA). METHODS A randomised, controlled, assessor blinded, one year trial. The experimental group followed an education programme. All patients started on sulphasalazine therapy. Compliance with sulphasalazine was measured by pill counting. Compliance rates with regimens of physical exercise, endurance activities, and energy conservation were measured by questionnaires. Compliance with prescriptions of joint protection was scored using a test for joint protection performance. Health was measured by a Disease Activity Score (function of erythrocyte sedimentation rate, Ritchie score, and number of swollen joints), C reactive protein, Dutch-AIMS scores, and M-HAQ scores, range of motion of shoulder, elbow, and knee joints. Parameters were scored at baseline and after three, six, and 12 months. RESULTS Sixty of 65 patients gave informed consent, five of them withdrew from follow up. Compliance with sulphasalazine exceeded 80% with no differences between groups. Compliance with physical exercise (at three months), energy conservation (at three and at 12 months), and joint protection (at three months) improved significantly more in the experimental group. The improvements of health were not different in the groups. CONCLUSION Compliance with sulphasalazine among patients with active, recent onset RA is high, whether formal patient education is followed or not. Compliance with physical exercise, energy conservation, and joint protection was increased by patient education. Formal patient education did not improve health status.

Patient education and self-management in the rheumatic diseases: a self-efficacy approach

As stated in the standards for arthritis patient education recently developed by a task force of the National Arthritis Advisory Board in the United States (1,2), patient education can improve the lives of patients with rheumatic diseases. Patients need a formal body of knowledge and skills in order to manage the disease on a day-to-day basis. These standards give the following definition of patient education:

Risk-appraisal, outcome and self-efficacy expectancies: Cognitive factors in preventive behaviour related to cancer

Health education often attempts to influence or persuade through risk-appraisal of impending danger or harm. Risk: appraisal implies cognitive processes concerning the severity of the threatening event and the probability of its occurrence. In two studies we investigated whether risk factors could adequately predict preventive behaviour with respect to cancer. The tint study concerned the health belief model. the second study the protection motivation theory. Protection motivation theory includes the health belief factors but also self-efficacy expectancy. The most important finding is that risk-appraisal does not predict preventive behaviour adequately: outcome expectancy and self-efficacy expectancy should be included in the prediction of preventive behaviour. In general, our findings suggest the superiority of the protection motivation theory to the health belief model in predicting preventive behaviour with respect to cancer.

Gender-specific reactions to environmental hazards in the Netherlands

In this study differences in appraisal, feelings of insecurity, and ways of coping were assessed between men and women, and related to their level of formal education. The sample consisted of 513 men and women who responded to a mailed questionnaire dealing with the hazards of living in an estate with soil pollution, near a chemical plant, or in the vicinity of a planned site for the storage of radioactive waste. The results show that women assess the hazards as more unacceptable and threatening, and report more feelings of insecurity than men. A number of possible explanations is reviewed.

Group Education for Rheumatoid Arthritis Patients

This article reviews the effectiveness of group education programs in improving the knowledge, behavior, and health status of patients with rheumatoid arthritis (RA) and evaluates to what extent various programs fulfill certain criteria for educational self-management programs. Thirty-one studies are reviewed: in 12, patients with various rheumatic diseases including RA were included, and in 19, only RA patients were studied. Group education increased the knowledge of the participants, which was maintained over long intervals. Beneficial behavioral effects were found in mixed populations but less often found in RA patients. Group education often improved physical health status both in mixed and in RA populations, but seldom led to improved psychosocial health status. In general, the beneficial effects of group education were found more often in mixed populations than in strictly RA patients. Further investigations must examine which mechanisms make educational interventions effective and determine the types of interventions or combinations of interventions that are effective. Effects of group education on health status are almost never maintained over long intervals. More research is needed to develop strategies for maintaining and enhancing early gains from group education.

Problematic and positive support in relation to depression in people with rheumatoid arthritis

This study focuses on the associations of both positive and problematic aspects of social support with depression in patients with rheumatoid arthritis. In a hierarchical multiple regression analysis we found that stressors such as functional limitations and pain are strongly related to depression. Positive and problematic support each explain an additional significant portion of the variance in depression. More positive support is associated with fewer feelings of depression and more problematic support is associated with more feelings of depression. An interaction effect between positive and problematic social support indicates that the negative aspects of problematic support may be partly diminished by positive support (buffering effect). Patients receiving more problematic support and less positive support experience the most feelings of depression.

Compliance in Rheumatoid Arthritis and the Role of Formal Patient Education

OBJECTIVE This study was performed to determine the compliance with the basic treatments for rheumatoid arthritis (RA; medication, physical therapy, and ergonomic measures), to study psychological factors that influence compliance in light of the social learning theory, to learn whether patient education positively influences compliance and health, and to find an approach to patient education that improves compliance. METHODS A MEDLINE search of the English language literature was performed. RESULTS Few studies have dealt with compliance in RA patients; levels of adherence are generally low. According to the social learning theory, human function involves a continuous interaction between behavior, personal factors, and external environment. Self-efficacy is a personal factor that refers to the belief in ones capabilities and opportunities for being compliant with treatment advice. Patient education may improve ergonomic performance and compliance with physical exercise programs. CONCLUSIONS Compliance with medication was infrequently studied. Whether improved compliance leads to better health status could not be determined. Compliance with RA treatments are generally low. Systematic study of the effect of patient education on treatment and health is warranted. Self-efficacy enhancing techniques in patient education may improve compliance.

Psychosocial aspects of rheumatic diseases: Introduction

This special issue of Patient Education and Counseling deals with psychosocial and patient-educational aspects of rheumatic diseases, comprising more than 100 chronic diseases with complaints involving the joints and/or connective tissues. The most prevalent forms of rheumatic diseases are osteoarthritis, rheumatoid arthritis (RA), ankylosing spondylitis and libromyalgia. The causes of many rheumatic conditions are unknown, and these diseases cannot be prevented or completely cured. However, due to the proportional increase of the ageing population, the number of patients with rheumatic diseases is growing rapidly (Fielts and Yelin, 1989).

Newspaper Coverage of Hazards and the Reactions of Readers

,For most hazardous events, information is likely to come neither from personal experience nor from other interpersonal sources but, rather, from the symbolic environment of the mass media. In several studies a direct link between mass media reporting of hazards and the perception and reaction of the public is presumed. Combs and Slovicl for example, correlated the frequency with which 41 causes of death were reported in two newspapers with people’s estimates of the frequency of these same causes of death. Moderately high positive correlations were found even when the actual frequency of death associated with these causes was held constant. In 1981 Mazur2 formulated his Coverage-Attitude Hypothesis in which was stated that ‘the rise in reaction against a scientific technology appears to coincide with a rise in quantity of media coverage, suggesting that media attention tends to elicit a conservative public bias’. In an analysis of mass media coverage of Three