Most participants in these focus groups had heard the message that losing weight would help their knee arthritis, and they believed that being overweight could increase susceptibility to health problems. However, the majority did not actively try to control their weight, citing a variety of reasons (e.g., unsupportive family members, difficulty changing habits, and an unwillingness to give up few remaining pleasures, such as food). In addition, African-American women believed that current weight guidelines were based on Caucasian models and were not applicable to them.
Those who tried to lose weight did it mostly for other health problems, such as diabetes, a disease “which tends to get people’s attention and makes them inclined to make dietary changes, at least temporarily,” said Dr. Brady. They did it to generically improve their overall health, not specifically for their knee pain.
Asked what would motivate them to lose 11 pounds, respondents ranked money, feeling better, looking good, and competition as their prime motivators. “Health is not a platform that we can build weight-loss strategies on,” concluded Dr. Brady. “Arthritis-specific messages are unlikely to motivate people.”
Paradoxical Beliefs and Effective Motivators
The focus groups revealed that patients’ views of their condition were often paradoxical. For instance, she said, “patients do believe arthritis is serious, but they don’t think theirs is serious.” Although pain could be a motivator to seek help or take an action, often patients reported that their arthritis (or pain caused by it) was not yet “bad enough” for them to take action. For clinicians, Dr. Brady suggested some possible strategies for communicating with their patients about self-management activities:
- Work with patients one-on-one to identify their individual motivators;
- Try approaching the concept of self-management through their other co-morbidities;
- Emphasize that engaging in exercise and learning about self-management may not only bring pain relief and allow them to move more easily, but will also help them to retain independence; and
- When recommending exercise, give specifics and urge an incremental approach, such as elevating the heart rate in 10-minute intervals.
“Arthritis doesn’t get their attention until it interferes with what they want to do,” said Dr. Brady, but, based on this focus group work, patients still value their doctors’ recommendations, and often that can persuade them to participate in SME and exercise.
The CDC’s Arthritis Program is currently working to measure the burden of arthritis, strengthen the science base, and increase the awareness of effective interventions. “We know what we want people with arthritis to do—now we need to tailor our approaches to match their perceptions to help them (and us) succeed,” concluded Dr. Brady. More information on the public health interventions to reduce the burden of arthritis is available at www.cdc.gov/arthritis/intervention.
