Self-Management Education Class Attendance and Health Care Provider Counseling for Physical Activity Among Adults with Arthritis — United States, 2019

Arthritis is a highly prevalent and disabling condition among U.S. adults (1); arthritis-attributable functional limitations and severe joint pain affect many aspects of health and quality of life (2). Self-management education (self-management) and physical activity can reduce pain and improve the health status and quality of life of adults with arthritis; however, in 2014, only 11.4% and 61.0% of arthritis patients reported engaging in each, respectively. To assess self-reported self-management class attendance and health care provider physical activity counseling among adults with doctor-diagnosed arthritis, CDC analyzed 2019 Behavioral Risk Factor Surveillance System (BRFSS) data. In 2019, an age-standardized state median of one in six (16.2%) adults with arthritis reported ever attending a self-management class, and 69.3% reported ever receiving health care provider counselling to be physically active. Prevalences of both differed by state and sociodemographic characteristics; decreased with lower educational attainment, joint pain severity, and urbanicity; and were lower in men than in women. Health care providers can play an important role in promoting self-management class attendance and physical activity by counseling arthritis patients about their benefits and referring patients to evidence-based programs (3).

BRFSS is an annual, cross-sectional, state-based telephone survey conducted among the noninstitutionalized U.S. population aged ≥18 years.* In 2019, the median combined landline and cellular survey response rate for 49 states^† and the District of Columbia (DC) was 49.4% (range = 37.3%–73.1%).^§ Participants were identified as having arthritis if they responded “yes” to the question, “Have you ever been told by a doctor or other health care professional that you have arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?”^¶ Among 135,862 adults with arthritis, self-management class attendance was defined by an affirmative response to the question, “Have you ever taken an educational course or class to teach you how to manage problems related to your arthritis or joint symptoms?” Respondents with arthritis were classified as having received health care provider counseling for physical activity if they answered “yes” to the question, “Has a doctor or other health professional ever suggested physical activity or exercise to help your arthritis or joint symptoms?”

Among adults with arthritis in 49 states and DC, state-specific unadjusted and age-standardized** prevalences (with 95% confidence intervals [CIs]) were calculated for self-management class attendance or having received health care provider counseling (counseling) to be physically active. Differences in the prevalences of these two outcomes by selected characteristics were assessed in age-adjusted^†† logistic regression models that included age as a categorical covariate. All analyses accounted for BRFSS’s complex sampling design and sampling weights, based on iterative proportional fitting, were applied to make state-specific estimates representative of each state.^§§ Analyses were conducted using SAS (version 9.4; SAS Institute) and SUDAAN (version 11.0; RTI International). This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.^¶¶

In 2019, among 49 states and DC, a median of 23.6% of respondents reported having arthritis. Among adults with arthritis, the median age-standardized prevalence of reported self-management class attendance was 16.2% (range = 9.8% [DC] to 24.9% [Hawaii]) (Table 1). Age-adjusted prevalence reflected lower self-management class attendance among men (15.4%) than among women (17.0%), among non-Hispanic White (15.6%) or Hispanic (17.0%) persons than among non-Hispanic Asian (20.9%), American Indian or Alaska Native (21.9%), or other or multiple race (21.2%) persons, and among those never married (15.0%) or a member of an unmarried couple (15.8%) than among those married (16.0%) or divorced, separated, or widowed (17.3%) (Table 2). Age-adjusted prevalence increased with higher educational attainment, urbanicity, federal poverty level, and joint pain severity. Groups with prevalences of self-management class attendance of <15.0% included persons with a high school education or less (12.8%); those employed (14.8%), unemployed (13.4%), or a student or homemaker (12.8%); those residing in micropolitan (14.5%) or rural areas (14.7%); those who were inactive in the last 30 days (12.9%); and those with no to mild joint pain (13.6%). No differences in prevalence by sexual orientation or body mass index were observed.

Among adults with arthritis who reported having received counseling to be physically active, the median age-standardized prevalence was 69.3% (range = 59.9% [North Dakota] to 75.8% [Alaska]) (Table 1). The age-specific percentage of adults with arthritis who reported receipt of counseling was lowest among those aged 18–44 years (Table 2). Age-adjusted reporting of receipt of counseling was less prevalent among those physically inactive (66.5%) in the last 30 days than among those active (73.1%), among non-Hispanic American Indian or Alaska Native (67.8%) or non-Hispanic White (69.2%) persons than among Hispanic (75.3%), or non-Hispanic Asian or Black persons (75.1% and 76.0%, respectively), and among those employed (67.7%) or unemployed (69.6%) than among those who were retired (72.6%) or unable to work or disabled (73.6%). Prevalence of receiving counseling increased with increasing education, urbanicity, body mass index, and joint pain severity. Groups among which <67.0% had received counseling were men (65.3%), those residing in rural areas (66.0%), those who were inactive in the last 30 days (66.5%), those who were underweight or healthy weight (66.9%), and those who had no to mild joint pain (66.3%). Prevalence of receiving physical activity counseling was similar across federal poverty level, marital status, and sexual orientation categories. No clear regional patterns in the unadjusted and age-standardized prevalence of either self-management class attendance or counseling to be physically active were noted.

Corresponding author: Lindsey M. Duca, 404-498-2798, pgz5@cdc.gov.

¹Epidemic Intelligence Service, CDC; ²Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC; ³Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee.

References

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Abbreviations: CI = confidence interval; Est. = estimated; NA = not applicable.
* Estimates were age-standardized to the 2000 Projected U.S. Population aged ≥18 years using three age groups: 18−44, 45–64, and ≥65 years. https://www.cdc.gov/nchs/data/statnt/statnt20.pdf
^† Respondents were classified as attending a self-management education course if they answered “yes” to the question, “Have you ever taken an education course or class to teach you how to manage problems related to your arthritis or joint symptoms?”
^§ Respondents were classified as receiving health care provider counseling to be physically active if they answered “yes” to the question, “Has a doctor or other health professional ever suggested physical activity or exercise to help your arthritis or joint symptoms?”
^¶ Respondents were classified as having arthritis if they responded “yes” to the question, “Have you ever been told by a doctor or other health care professional that you have arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?”
** In 2019, New Jersey did not collect enough data to meet the minimum requirement for inclusion in the Behavioral Risk Factor Surveillance System public-use data set.
^†† Estimated number represents the weighted estimated number of adults with arthritis who reported the outcome of interest (e.g., health care provider counseling to be physically active and self-management education class attendance) rounded to the nearest thousand.
^§§ Median calculated for 49 states and the District of Columbia.

Abbreviations: CI = confidence interval; FPL = federal poverty level; NH = non-Hispanic.
* Except for the age groups category and the unadjusted overall variables, age-adjusted estimates were generated in weighted logistic regression models that included age as a categorical covariate using the following cut points: 18−44, 45−64, and ≥65 years.
^† Respondents were classified as attending a self-management education course if they responded “yes” to the question, “Have you ever taken an education course or class to teach you how to manage problems related to your arthritis or joint symptoms?”
^§ Respondents were classified as receiving health care provider counseling to be physically active if they responded “yes” to the question, “Has a doctor or other health professional ever suggested physical activity or exercise to help your arthritis or joint symptoms?”
^¶ Respondents were classified as having arthritis if they responded “yes” to the question, “Have you ever been told by a doctor or other health care professional that you have arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?”
** In 2019, New Jersey did not collect sufficient data to meet the minimum requirement for inclusion in the Behavioral Risk Factor Surveillance System public-use data set.
^†† Age-specific estimates.
^§§ Federal poverty level is the ratio of total family income to federal poverty guideline per family size.
^¶¶ Urban-rural status was categorized using the National Center for Health Statistics 2013 Urban-Rural Classification Scheme for Counties. https://www.cdc.gov/nchs/data/series/sr_02/sr02_166.pdf
*** Sexual orientation was asked in 30 states (Alaska, Arizona, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Louisiana, Maryland, Minnesota, Mississippi, Montana, New York, North Carolina, Ohio, Oklahoma, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, and Wisconsin).
^††† Physical activity was defined using the question, “During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?”
^§§§ For the question, “On a scale of 0 to 10 where 0 is no pain or aching and 10 is pain or aching as bad as it can be, during the past 30 days, how bad was your joint pain on average,” an answer of 0−4 was defined as none or mild, an answer of 5−6 was defined as moderate, and an answer of 7−10 was defined as severe.