“We had decided to perform this study among first-degree relatives of those already diagnosed with RA,” says Dr. Sparks. “First off, they are at increased RA risk, probably due to both shared genetics and environmental exposures. Second, we felt they would be motivated to participate because they were familiar with RA and would be amenable to prevention strategies.”
The interventions were chosen based on research into what are important risks in RA development. These included smoking, fish omega-3 fatty acid intake, poor dental health behaviors and being overweight or obese. With the exception of the fish and omega-3 fatty acids, all of these behaviors increase risk.
The primary outcome was readiness for change. This was based on the transtheoretical model for behavior change levels measured using validated contemplation ladder scales. An increase in motivation to improve any risk behaviors (smoking, diet, exercise or dental hygiene) was found when there was an increase in any of the corresponding ladder scores when compared with baseline, at six weeks and six months after the intervention.
PRE-RA Increased Ladder Scores
Those randomized to receive PRE-RA (either alone or with the health educator) were more likely to increase their ladder scores over post-intervention assessments than those randomized to the general RA education arm (RR 1.23, 95% confidence interval [CI] 1.01–1.51).
By six months, 63.9% of those receiving PRE-RA and 50.0% of the comparison group increased their motivation to improve behaviors (age-adjusted difference 15.8%, 95% CI 2.8–28.8%). When compared with nonpersonalized education, more PRE-RA participants increased fish intake (45.0% vs. 22.1%; P=0.005), brushed more often (40.7% vs. 22.9%; P=0.01), flossed with increased frequency (55.7% vs. 34.8%; P=0.004) and quit smoking (62.5% vs. 0.0% among 11 smokers; P=0.18).
Those in the PRE-RA Plus group were more likely to report increased tooth brushing (P=0.025), flossing (P=0.010) and fish consumption (P=0.009) at six months compared with the comparison arm. There were no statistically significant differences in behavior changes between the two PRE-RA arms suggesting that the Web-based PRE-RA tool by itself could be a powerful tool if widely implemented.
Motivated to Change Following Education
“What we found is that, overall, people are motivated to change those behaviors once they were educated about them using this novel, personalized RA risk calculator,” says Dr. Sparks. “Just the act of giving this RA risk calculator to first-degree relatives made them want to change those behaviors more than those that were receiving standard care in the comparison arm.”
