For example, few of the focus group participants used the term manage when they described living with arthritis, said Dr. Brady. “They tolerate it, cope with it, deal with it, ignore it, or medicate it—the idea of managing their arthritis is a foreign thought.” In general, these group members reported they do not search out patient education. “Patients expect those recommendations from the healthcare system, but we’re not doing a good job of making people aware of these programs—and recommending them,” she said. When SME programs were described to participants, they indicated agreement with key program elements. In general, they preferred terms such as workshop and self-management to self-help or self-care; wanted to learn from someone who had a chronic condition; liked to hear stories about those who had benefited from the SME programs; and thought six weeks was a realistic timeframe for a class, although a two- to two-and-a-half-hour class seemed too long.
Trouble with Exercise
Perceptions about physical activity were assessed in the development of two separate communications campaigns, the first in 2000–2003 and the second in 2007–2008. Most participants were aware of the “Be physically active” public health message and reported that they were physically active. Further probing, however, revealed that by active, people actually meant that they were busy and not necessarily engaging in regular exercise programs, such as aerobic conditioning.
The word exercise conjures associations, said Dr. Brady, of young people in spandex outfits, having to sweat, and heavy exertion. These associations can be negative to some people. Other barriers to engaging in exercise included lack of time, competing priorities, fatigue, and arthritis-specific barriers, such as pain and fear of making their arthritis worse. Most were told by their doctors to exercise, but didn’t receive specifics; this was corroborated in interviews with primary care physicians. Arthritis Foundation–sponsored structured exercise programs (which teach safe techniques for exercising with arthritis) were virtually invisible to the target population.
Control Weight
The Arthritis Program tested public health messages about weight control in two broad overview research projects and a specific project in 2005 using a total of six focus groups in Anaheim, Calif.; Milwaukee; and Philadelphia. The latter included Caucasians, African Americans, and Hispanics, ages 45–70, who were overweight or obese. Participants were included if they reported knee pain and a doctor’s diagnosis of arthritis or had chronic joint symptoms. Some populations, particularly Hispanics, may not have access to care, said Dr. Brady, so it was important to include those with chronic joint symptoms who did not report a physician diagnosis.
