Preferences for arthritis interventions: identifying similarities and differences among African Americans and whites with osteoarthritis.

Arthritis is the leading cause of disability in the United States (1) with osteoarthritis (OA) being the most common type. OA often results in pain, disability and poor psychological well-being. Arthritis interventions (e.g., coping, self-management, exercise) have been shown through randomized controlled trials to be effective ways to manage OA symptoms (2–5). Effective interventions include, but are not limited to the Arthritis Foundation Aquatics Program (6), the Arthritis Self-Management Program (ASMP), (7–9), Walk-with-Ease (4), and psychological interventions for symptom management (10). Such interventions have been shown to decrease pain, depression, medical visits, disability, discomfort, medical expenses, and to increase relaxation, quality of life, self-efficacy, functional ability, self-care behavior, and knowledge about arthritis (2,10). However, the positive effect is only true for the populations the interventions reach. Research consistently highlights the lack of inclusion and lack of participation of Blacks in health related research and clinical trials (11–13). Similar problems have been found with arthritis behavioral intervention programs and research. The majority of arthritis intervention studies have been conducted with predominantly White populations without any special attention to minorities (e.g., examining effectiveness, recruitment and retention, social or structural needs, preferences or expectations; 2,5,10). The paucity of studies focused on Blacks in arthritis interventions emphasizes the need to understand present challenges (e.g., preferences of the individual, social determinants, healthcare delivery system structure) that may serve as a barrier to the inclusion of Blacks in arthritis interventions particularly when considering the potential impact of the lack of inclusion on health outcomes. Culture related barriers are a factor that deserves some attention in this field. Race is a multi-dimensional social construct that provides an overarching category for individuals who may have shared norms, values, experiences, and histories that may uniquely contribute either proximally or distally to the lack of inclusion in healthcare options of this type (14,15). Exploring how race differences in preferences and barriers might contribute to the lack of inclusion of Blacks in arthritis interventions is an important topic. In addition, designing effective interventions that can be successfully implemented and disseminated among Blacks with arthritis is predicated on understanding the potential influence of the cultural aspect of race. Recent research has acknowledged that the lack of inclusion of minorities in arthritis intervention research is problematic. Researchers have begun to make an effort to address this gap in the literature by including Blacks in studies of the ASMP (16,17) and other community-based arthritis interventions (18), adapting the materials to become more culturally sensitive (16,18), including Black intervention leaders and coordinators, and by working with African-American community-based organizations (e.g., churches, sororities; 16–18). However, in these studies the process of modifying the materials and delivery of the program for cultural sensitivity were not described in detail (16,17), and the effectiveness, satisfaction, or acceptability of the strategies amongst Blacks were not reported (18). Moreover, 17% of the participants (N=458) in the study conducted by Goeppinger et al. (17) were Black, and Altpeter et al. (18) reported that 19% of a combined sample (N=1,517) from four community-based arthritis interventions were Black; however, analyses specific to Blacks were not presented. To our knowledge only one study to date has examined the acceptability or the effectiveness of an arthritis intervention (i.e., ASMP) among Blacks (16). Without randomized controlled trials for arthritis interventions including and reporting findings on minorities (e.g., Blacks) the question remains as to whether arthritis interventions are appealing, acceptable, feasible, or effective in racial/ethnic minority populations. Therefore the purpose of this research was to determine if there were racial differences or similarities in barriers to participating in arthritis interventions or in preferences of arthritis intervention content, structure, and delivery. Past research has examined the needs of patients with arthritis, however samples included predominately White participants, and analyses did not examine race differences (19,20). While limited work using needs assessments have been conducted in the area of arthritis and arthritis disparities, utilizing needs assessments to evaluate the care needs of a target population is not a novel concept (21,22). Researchers have used needs assessments to gather information on health service needs and cultural diversity in other contexts [e.g., health service needs for Latino youth (21) and end of life care needs for African Americans (22)], and to use this information to make interventions appropriate for diverse individuals. Our project addressed the following research questions: 1) Are there race differences in barriers to arthritis interventions between Blacks and Whites with OA, and 2) Are there race differences in intervention preferences (i.e., content, structure, and delivery) between Blacks and Whites with OA? Based on previous literature (12,13,23,24), it was hypothesized that there would be significant race differences in barriers to participation in arthritis interventions. Black participants were predicted to be more likely to report that lack of trust in the healthcare system, family responsibilities, cost, and transportation were barriers to participating in arthritis interventions. Due to the lack of an extensive previous literature on issues of preferences for arthritis interventions, racial differences in the other issues were explored without hypotheses.