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Original Article
Evaluation of a Community Health Practitioner Self-care Program for Rural Korean Patients with Osteoarthritis
Chung Yul Lee1, Yoon Hee Cho2
Journal of Korean Academy of Nursing 2012;42(7):965-973.
DOI: https://doi.org/10.4040/jkan.2012.42.7.965
Published online: December 12, 2012

1College of Nursing, Institute of Health Services Research, Yonsei University, Seoul, Korea

2College of Nursing, Eulji University, Seongnam, Korea

1College of Nursing, Institute of Health Services Research, Yonsei University, Seoul, Korea

2College of Nursing, Eulji University, Seongnam, Korea

Address reprint requests to : Cho, Yoon Hee College of Nursing, Eulji University, 212 Yangji-dong, Sujeong-gu, Seongnam 461-250, Korea Tel: +82-31-740-7405 Fax: +82-31-740-7359 E-mail: c7y6h@eulji.ac.kr
• Received: June 14, 2012   • Revised: July 6, 2012   • Accepted: November 13, 2012

Copyright © 2012 Korean Society of Nursing Science

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    The purpose of this study was to evaluate a self-care program for elders with osteoarthritis managed by primary health care workers, Community Health Practitioners (CHPs), in rural Korea.
  • Methods
    The self-care program, consisting of 7 areas, was evaluated with a randomized experimental study for patients over age 60 with osteoarthritis in which 150 participants in the experimental group and 140 in the control group were compared. The self-care program was implemented for six weeks, 2 hours per week, at community health posts by CHPs. Data were collected using an interview questionnaire given by the CHPs and laboratory tests before and after the intervention for both groups. Propensity score matching analysis was done to test effectiveness after controlling for confounding variables.
  • Results
    The intervention group showed a significant decrease in the number of painful joints (p<.001) and a significant increase in self-care ability (p<.05) compared to the control group.
  • Conclusion
    Study results indicate that training and utilizing primary health care workers in rural areas is valuable in increasing the generalization and continuity of intervention programs. As arthritis should be managed life-long, CHP directed self-care programs are useful interventions for rural elders with arthritis to learn self-care management.
  • Keywords: Osteoarthritis; Self care; Program evaluation; Propensity score
Table 1.
Contents of the SCP
Weeks Contents
1st 1. Overview of arthritis
2. Everyday exercise for arthritis
2nd Pain control by medication
1. Pain management
2. Principle of medication use
3. Pain control medication use
4. Anti-inflammatory medication
3rd Pain control by other methods
1. Cold massage
2. Hot massage
3. Joint massage
4. Knee joint massage
5. Hand joint massage
6. Other physical therapy
7. Environment support for pain control
8. Healthy life style for arthritis management
4th Obesity control
1. Definition of obesity
2. Effects of obesity on health
3. Causes of obesity
4. Obesity management: Healthy eating exercise
5th Dietary management
1. Principle of diet
2. Good diet for arthritis
3. Diet to avoid if arthritic
4. Supplementary diet for arthritis
6th Stress management
1. Relaxation therapy
2. Effective communication
3. Checklist for my communication skills
4. Checklist for my listening skills

SCP=Self-care program.

Table 2.
Characteristics of Participants
Variables Categories Total (N=290)
 Exp. (n=150)
 Cont. (n=140)
 χ2 or t p
n (%) or M±SD n (%) or M±SD n (%) or M±SD
Demographic characteristics
Gender Female 264 (91.0) 139 (92.7) 125 (89.3) 0.64 .423
Male 26 (9.0) 11 (7.3) 15 (10.7)
Age (year) 65.70±8.98 63.61±8.70 67.94±8.76 4.22 <.001
Education No formal education 93 (32.6) 46 (31.7) 47 (33.6) 0.47 .791
Elementary school 134 (47.0) 71 (49.0) 63 (45.0)
≥Middle school 58 (20.4) 28 (19.3) 30 (21.4)
Marital status Married 198 (68.5) 111 (74.5) 87 (62.1) 4.55 .033
Widowed 91 (31.5) 38 (25.5) 53 (37.9)
Religion Yes 184 (63.4) 102 (68.0) 82 (58.6) 2.38 .123
No 106 (36.6) 48 (32.0) 58 (41.4)
Economic status High 101 (38.3) 66 (45.8) 35 (29.2) 7.01 .008
Low 163 (61.7) 78 (54.2) 85 (70.8)
Health-related characteristics
Perceived health status Poor 143 (49.3) 60 (40.0) 83 (59.3) 10.88 .004
Moderate 113 (39.0) 70 (46.7) 43 (30.7)
Good 34 (11.7) 20 (13.3) 14 (10.0)
Systolic blood pressure (mmHg) 123.08±15.11 119.25±13.76 127.19±15.44 4.63 <.001
Fasting blood sugar level (mg/dL) 122.89±29.02 119.15±30.45 126.89±26.94 2.29 .023
BMI (kg/m2) 24.49±3.03 24.43±3.35 24.54±2.65 0.31 .761
Osteoarthritis-related characteristics
Period of illness (year) 6.38±5.96 6.83±5.80 5.91±6.12 2.32 .188
Family history Yes 81 (27.9) 58 (38.7) 23 (16.4) 16.70 <.001
No 209 (72.1) 92 (61.3) 117 (83.6)
Medication Yes 250 (86.2) 122 (81.3) 128 (91.4) 5.39 .020
No 40 (13.8) 28 (18.7) 12 (8.6)
OP history Yes 21 (7.2) 12 (8.0) 9 (6.4) 0.15 .695
No 269 (92.8) 138 (92.0) 131 (93.6)
Admission history Yes 29 (10.0) 16 (10.7) 13 (9.3) 0.04 .845
No 261 (90.0) 134 (89.3) 127 (90.7)
Previous education about osteoarthritis Yes 45 (15.5) 32 (21.3) 13 (9.3) 7.13 .008
No 245 (84.5) 118 (78.7) 127 (90.7)

Exp.=Experimental group; Cont.=Control group; BMI=Body mass index; OP=Operation.

Table 3.
The relationship between baseline characteristics and dependent variables
Variables Categories Number of painful joints
 Level of osteoarthritis management skill
M±SD t or F or r p M±SD t or F or r p
Gender Female 4.04±3.53 −3.43 .001 60.39±14.71 1.68 .104
Male 2.88±1.31 66.62±18.32
Age (year) .15 .010 −0.08 .170
Education No formal educationa 3.84±3.25 0.33 .721 61.00±14.90 10.89 <.001*
Elementary schoolb 3.90±3.03 57.97±13.09 (c>a,b)
≥Middle schoolc 4.28±4.47 68.69±17.31
Marital status Married 4.31±3.51 −2.97 .003 58.72±14.44 3.86 <.001
Bereavement 3.11±3.05 66.08±15.30
Economic status High 5.27±4.34 −4.12 <.001 61.84±18.17 −1.24 .217
Low 3.29±2.63 59.29±12.53
Perceived Poora 4.04±3.41 3.06 .048* 60.00±13.64 4.93 .008*
health status Moderateb 3.46±2.93 (c>a,b) 59.88±16.19 (c>a,b)
Goodc 5.06±4.51 68.50±15.78
Systolic blood pressure .02 .789 −0.19 .001
Fasting blood sugar level −.05 .394 0.06 .277
Family history Yes 3.69±3.13 −0.76 .450 56.52±14.07 −3.26 .001
No 4.03±3.51 62.67±15.21
Medication Yes 4.04±3.48 1.27 .205 61.32±14.89 0.96 .343
No 3.30±2.84 58.65±16.58
Previous education Yes 3.40±4.08 1.15 .253 66.64±16.22 −2.60 .012
about osteoarthritis No 4.03±3.27 59.90±14.72
Experimental group Post-Pre 1.22±2.65 2.83 .005 9.87±11.67 −2.42 .016
Control group Post-Pre 0.39±2.21 6.16±14.20

*Tukey test.

Table 4.
PSM Analysis for Factors related to the Differences between Pretest and Posttest
Variables Number of painful joints
 Level of osteoarthritis management skill
Exp. (mean/%) Cont. (mean/%) χ2 or t p Exp. (mean/%) Cont. (mean/%) χ2 or t p
Dependent variable −2.04 −0.37 −7.00 <.001 10.03 6.69 2.28 .024
Gender (female) 92.1 86.4 0.78 .376 92.1 92.0 0.001 .961
Age (year) 65.44 63.66 1.62 .106 63.69 64.66 −0.90 .371
Education (no formal education) 32.4 31.8 0.003 .959 32.8 36.0 0.09 .691
Marital status (married) 75.5 68.2 0.54 .462 75.7 60.0 2.68 .128
Economic status (high) 44.6 36.4 0.52 .469 45.0 24.0 3.84 .060
Perceived health status (poor) 38.8 54.5 1.93 .164 39.3 52.0 1.42 .298
Systolic blood pressure 120.51 118.54 1.16 .247 118.59 119.55 −0.55 .583
Fasting blood sugar level 125.44 117.85 2.38 .018 117.96 120.11 −0.73 .468
Family history (yes) 38.1 18.2 3.30 .069 37.9 20.1 2.97 .104
Medication (yes) 82.7 90.9 0.94 .333 82.9 84.0 0.02 .891
Previous education about osteoarthritis (yes) 22.3 13.6 0.86 .355 22.1 16.0 0.48 .496

Exp.=Experimental group; Cont.=Control group; PSM=propensity score matching.

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        Evaluation of a Community Health Practitioner Self-care Program for Rural Korean Patients with Osteoarthritis
        J Korean Acad Nurs. 2012;42(7):965-973.   Published online December 12, 2012
        DOI: https://doi.org/10.4040/jkan.2012.42.7.965
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      Evaluation of a Community Health Practitioner Self-care Program for Rural Korean Patients with Osteoarthritis
      Evaluation of a Community Health Practitioner Self-care Program for Rural Korean Patients with Osteoarthritis
      Weeks Contents
      1st 1. Overview of arthritis
      2. Everyday exercise for arthritis
      2nd Pain control by medication
      1. Pain management
      2. Principle of medication use
      3. Pain control medication use
      4. Anti-inflammatory medication
      3rd Pain control by other methods
      1. Cold massage
      2. Hot massage
      3. Joint massage
      4. Knee joint massage
      5. Hand joint massage
      6. Other physical therapy
      7. Environment support for pain control
      8. Healthy life style for arthritis management
      4th Obesity control
      1. Definition of obesity
      2. Effects of obesity on health
      3. Causes of obesity
      4. Obesity management: Healthy eating exercise
      5th Dietary management
      1. Principle of diet
      2. Good diet for arthritis
      3. Diet to avoid if arthritic
      4. Supplementary diet for arthritis
      6th Stress management
      1. Relaxation therapy
      2. Effective communication
      3. Checklist for my communication skills
      4. Checklist for my listening skills
      Variables Categories Total (N=290)
      		 Exp. (n=150)
      		 Cont. (n=140)
      		 χ2 or t p
      n (%) or M±SD n (%) or M±SD n (%) or M±SD
      Demographic characteristics
      Gender Female 264 (91.0) 139 (92.7) 125 (89.3) 0.64 .423
      Male 26 (9.0) 11 (7.3) 15 (10.7)
      Age (year) 65.70±8.98 63.61±8.70 67.94±8.76 4.22 <.001
      Education No formal education 93 (32.6) 46 (31.7) 47 (33.6) 0.47 .791
      Elementary school 134 (47.0) 71 (49.0) 63 (45.0)
      ≥Middle school 58 (20.4) 28 (19.3) 30 (21.4)
      Marital status Married 198 (68.5) 111 (74.5) 87 (62.1) 4.55 .033
      Widowed 91 (31.5) 38 (25.5) 53 (37.9)
      Religion Yes 184 (63.4) 102 (68.0) 82 (58.6) 2.38 .123
      No 106 (36.6) 48 (32.0) 58 (41.4)
      Economic status High 101 (38.3) 66 (45.8) 35 (29.2) 7.01 .008
      Low 163 (61.7) 78 (54.2) 85 (70.8)
      Health-related characteristics
      Perceived health status Poor 143 (49.3) 60 (40.0) 83 (59.3) 10.88 .004
      Moderate 113 (39.0) 70 (46.7) 43 (30.7)
      Good 34 (11.7) 20 (13.3) 14 (10.0)
      Systolic blood pressure (mmHg) 123.08±15.11 119.25±13.76 127.19±15.44 4.63 <.001
      Fasting blood sugar level (mg/dL) 122.89±29.02 119.15±30.45 126.89±26.94 2.29 .023
      BMI (kg/m2) 24.49±3.03 24.43±3.35 24.54±2.65 0.31 .761
      Osteoarthritis-related characteristics
      Period of illness (year) 6.38±5.96 6.83±5.80 5.91±6.12 2.32 .188
      Family history Yes 81 (27.9) 58 (38.7) 23 (16.4) 16.70 <.001
      No 209 (72.1) 92 (61.3) 117 (83.6)
      Medication Yes 250 (86.2) 122 (81.3) 128 (91.4) 5.39 .020
      No 40 (13.8) 28 (18.7) 12 (8.6)
      OP history Yes 21 (7.2) 12 (8.0) 9 (6.4) 0.15 .695
      No 269 (92.8) 138 (92.0) 131 (93.6)
      Admission history Yes 29 (10.0) 16 (10.7) 13 (9.3) 0.04 .845
      No 261 (90.0) 134 (89.3) 127 (90.7)
      Previous education about osteoarthritis Yes 45 (15.5) 32 (21.3) 13 (9.3) 7.13 .008
      No 245 (84.5) 118 (78.7) 127 (90.7)
      Variables Categories Number of painful joints
      		 Level of osteoarthritis management skill
      M±SD t or F or r p M±SD t or F or r p
      Gender Female 4.04±3.53 −3.43 .001 60.39±14.71 1.68 .104
      Male 2.88±1.31 66.62±18.32
      Age (year) .15 .010 −0.08 .170
      Education No formal educationa 3.84±3.25 0.33 .721 61.00±14.90 10.89 <.001*
      Elementary schoolb 3.90±3.03 57.97±13.09 (c>a,b)
      ≥Middle schoolc 4.28±4.47 68.69±17.31
      Marital status Married 4.31±3.51 −2.97 .003 58.72±14.44 3.86 <.001
      Bereavement 3.11±3.05 66.08±15.30
      Economic status High 5.27±4.34 −4.12 <.001 61.84±18.17 −1.24 .217
      Low 3.29±2.63 59.29±12.53
      Perceived Poora 4.04±3.41 3.06 .048* 60.00±13.64 4.93 .008*
      health status Moderateb 3.46±2.93 (c>a,b) 59.88±16.19 (c>a,b)
      Goodc 5.06±4.51 68.50±15.78
      Systolic blood pressure .02 .789 −0.19 .001
      Fasting blood sugar level −.05 .394 0.06 .277
      Family history Yes 3.69±3.13 −0.76 .450 56.52±14.07 −3.26 .001
      No 4.03±3.51 62.67±15.21
      Medication Yes 4.04±3.48 1.27 .205 61.32±14.89 0.96 .343
      No 3.30±2.84 58.65±16.58
      Previous education Yes 3.40±4.08 1.15 .253 66.64±16.22 −2.60 .012
      about osteoarthritis No 4.03±3.27 59.90±14.72
      Experimental group Post-Pre 1.22±2.65 2.83 .005 9.87±11.67 −2.42 .016
      Control group Post-Pre 0.39±2.21 6.16±14.20
      Variables Number of painful joints
      		 Level of osteoarthritis management skill
      Exp. (mean/%) Cont. (mean/%) χ2 or t p Exp. (mean/%) Cont. (mean/%) χ2 or t p
      Dependent variable −2.04 −0.37 −7.00 <.001 10.03 6.69 2.28 .024
      Gender (female) 92.1 86.4 0.78 .376 92.1 92.0 0.001 .961
      Age (year) 65.44 63.66 1.62 .106 63.69 64.66 −0.90 .371
      Education (no formal education) 32.4 31.8 0.003 .959 32.8 36.0 0.09 .691
      Marital status (married) 75.5 68.2 0.54 .462 75.7 60.0 2.68 .128
      Economic status (high) 44.6 36.4 0.52 .469 45.0 24.0 3.84 .060
      Perceived health status (poor) 38.8 54.5 1.93 .164 39.3 52.0 1.42 .298
      Systolic blood pressure 120.51 118.54 1.16 .247 118.59 119.55 −0.55 .583
      Fasting blood sugar level 125.44 117.85 2.38 .018 117.96 120.11 −0.73 .468
      Family history (yes) 38.1 18.2 3.30 .069 37.9 20.1 2.97 .104
      Medication (yes) 82.7 90.9 0.94 .333 82.9 84.0 0.02 .891
      Previous education about osteoarthritis (yes) 22.3 13.6 0.86 .355 22.1 16.0 0.48 .496
      Table 1. Contents of the SCP

      SCP=Self-care program.

      Table 2. Characteristics of Participants

      Exp.=Experimental group; Cont.=Control group; BMI=Body mass index; OP=Operation.

      Table 3. The relationship between baseline characteristics and dependent variables

      Tukey test.

      Table 4. PSM Analysis for Factors related to the Differences between Pretest and Posttest

      Exp.=Experimental group; Cont.=Control group; PSM=propensity score matching.

      Table 1.

      Table 2.

      Table 3.

      Table 4.

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