Literacy in Arthritis Public Deposited

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Last Modified
  • March 20, 2019
Creator
  • Bhat, Anita
    • Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
Abstract
  • Literacy in Arthritis Purpose: To evaluate the association between literacy, measured by Rapid Estimate of Adult Literacy in Medicine (REALM) and arthritis health outcomes in a cross-sectional and longitudinal study. Further, to evaluate the effect of literacy and psychosocial variables on arthritis health outcomes in the longitudinal study. Methods: REALM was administered to 447 participants in two community-based randomized controlled trials of life style interventions designed for sedentary adults with arthritis, People with Arthritis Can Exercise (PACE) (an 8-week exercise program) and Active Living Every Day (ALED) (a 20-week physical activity behavioral modification intervention). These studies were sufficiently similar to allow combining the two data sets to examine associations of literacy with health outcomes measured at baseline and at the end of the intervention, the Health Assessment Questionnaire (HAQ), and arthritis symptoms pain, fatigue, and stiffness Visual Analogue Scales (VAS). Descriptive statistics were conducted. Bivariate and multivariate analyses were done. Longitudinal model had 391 participants. Helplessness was measured using the Rheumatology Attitudes Index (RAI) and outcome expectation for exercise (OEE) was measured by OEE. Results: Amid 447 individuals, 89 (20%) had REALM score below 61, which indicates a reading level of 8th grade or less. Individuals with low literacy did not have worse arthritis health outcomes than individuals with adequate literacy. Descriptive statistics of the longitudinal model were similar to the cross-sectional model. Disability after intervention was not predicted by helplessness, literacy or OEE in adjusted models. Pain, fatigue and stiffness after the intervention were all significantly predicted by helplessness at various magnitudes in adjusted models, but OEE and literacy were not significant predictors. Conclusion: One in five of our patient population had low literacy. Participants with low literacy did not have worse arthritis health outcomes than individuals with adequate literacy. When literacy, helplessness and OEE were examined as predictors of arthritis outcomes in lifestyle intervention trials; neither literacy, nor psychosocial variables predicted disability. However, helplessness predicted symptoms of pain, fatigue and stiffness.
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  • In Copyright
Advisor
  • DeWalt, Darren
  • Callahan, Leigh
  • Zimmer, Catherine
  • Fried, Bruce
  • Paul, John
  • Rozier, R. Gary
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2008
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