Evaluation of a Self- Management Course Using the Health Education Impact Questionnaire Tiffany Gill Jing Wu Anne Taylor Report by Population Research and Outcome Studies, University of Adelaide for Arthritis SA
2011 This work is copyright. It may be reproduced and PROS, the School of Medicine at The University of Adelaide welcomes requests for permission to reproduce in the whole or in part for, study or training purposes subject to the inclusion of an acknowledgment of the source and no commercial use or sale. National Library of Australia Cataloguing-in-Publication entry Author: Gill, Tiffany. Title: Evaluation of self-management course using the Health education impact questionnaire / Tiffany Gill ; Jing Wu ; Anne Taylor. ISBN: Subjects: 9780987207944 (pbk.) Arthritis--Patients. Patient self-monitoring. Self-care, Health. Other Authors/Contributors: Wu, Jing. Taylor, Anne, 1950- Dewey Number: 616.722 --------------------------------------------------------------------------------------------------------------------------- National Library of Australia Cataloguing-in-Publication entry Author: Title: ISBN: Subjects: Gill, Tiffany. Evaluation of self-management course using the Health education impact questionnaire [electronic resource] / Tiffany Gill ; Jing Wu ; Anne Taylor. 9780987207951 (ebook) Arthritis--Patients. Patient self-monitoring. Self-care, Health. Other Authors/Contributors: Wu, Jing. Taylor, Anne, 1950- Dewey Number: 616.722 Suggested citation: Gill T, Wu J, Taylor A. Evaluation of a Self-management course using the Health education impact questionnaire. School of Medicine, University of Adelaide, 2011. Page 2
TABLE OF CONTENTS CHAPTER 1: INTRODUCTION AND METHODOLOGY... 7 Introduction... 8 Aim... 8 Methodology... 8 Questionnaires... 8 Sample selection... 9 Response rates... 9 CHAPTER 2: DEMOGRAPHIC PROFILE AND TYPE OF ARTHRITIS...11 Introduction... 12 Age and sex of respondents... 12 Health conditions... 12 How long ago participated in the MTW course... 14 Severity of condition... 14 Summary... 16 CHAPTER 3: HEALTH EDUCATION IMPACT QUESTIONNAIRE (HEIQ )...17 Health Education Impact questionnaire (heiq )... 18 Positive engagement with life... 19 Health directed behaviour... 21 Skill and technique acquisition... 24 Constructive attitudes and approaches... 26 Self-monitoring and insight... 28 Health service navigation... 30 Social integration and support... 32 Emotional wellbeing negative effect... 34 Summary... 35 Page 3
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EXECUTIVE SUMMARY
Executive Summary Arthritis SA is a leader in conducting self-management courses in South Australia. Known as the Moving Towards Wellness Course (MTW), sessions are conducted throughout the year with approximately 200 attendees annually. The aim of this study was to examine whether participants in self-management courses still used the skills they had learnt and to determine their perception of their current quality of life. The Health Education Impact Questionnaire (heiq TM ) was then used to evaluate the impact of the MTW course in conjunction with these other factors. The heiq was developed in order to provide a relevant and valid evaluation and data management system for health education and selfmanagement programs. Demographic characteristics Generally females and those aged over 65 years attended MTW courses. While those with arthritis were those who most commonly attended the courses, there were also participants with a wide range of other conditions. Older people (those who were more likely to attend the course) and recent attendees were also more likely to say that their condition was not severe at the time of attending the course. Results Demographic factors impact on the quality of life following a self management course, as measured by the heiq TM, with age and severity of the condition generally the most significant factors. Generally, it can be seen that for the eight evaluation domains, as measured by the heiq TM, those who were able to do things that they could not do before, were able to exercise, deal with problems differently, had improve interactions with health care providers, improved quality of life and life had improved a lot, generally had higher scores. This indicates improvements in functioning as a result of the self-management course. Thus, the MTW course does have some benefits as measured by the heiq TM. Page 6
CHAPTER 1: INTRODUCTION AND METHODOLOGY
Introduction and methodology Introduction Arthritis SA is a leader in conducting self-management courses in South Australia. Known as the Moving Towards Wellness Course (MTW), sessions are conducted throughout the year with approximately 200 attendees annually. However the impact of the course has not been assessed since its implementation. Aim The aim of this study was to examine whether participants in self-management courses still used the skills they had learnt and to determine their perception of their current quality of life. The Health Education Impact Questionnaire (heiq TM ) was then used to evaluate the impact of the MTW course in conjunction with these other factors. Methodology Questionnaires A short questionnaire was designed by the Education and Research Committee of the Board of Arthritis SA. The questionnaire examined disease severity, skills learnt during the course and whether these skills were still utilised. A separate report focuses specifically on the responses to these questions. The Health Education Impact Questionnaire (heiq TM ) was chosen to evaluate the self-management program and examines these responses in conjunction with those obtained from the questionnaire designed by the Education and Research Committee. The questions used in conjunction with the heiq TM were: Sex. Age. On a scale of 1 to 10 with 1 being not severe at all and 10 being the most severe imaginable, how would you rate the severity of your condition when you started the Moving Towards Wellness course? On a scale of 1 to 10 with 1 being not severe at all and 10 being the most severe imaginable, how would you rate the severity of your condition now? How long ago did you participate in a Moving Towards Wellness course? Are you still using the skills you learnt? As a result of the course, have you been able to do things that you weren t able to do before? As a result of the course do you do more exercise? As a result of the course do you deal with problems differently? As a result of the course have your interactions with health care providers (including medical practitioners) improved? As a result of the course has your quality of life improved? On a scale of 1 to 10 with 1 being not at all, how has your life improved following the Moving Towards Wellness course As a result of the Moving Towards Wellness Course have you used any of the other services offered by Arthritis SA? Page 8
Introduction and methodology Sample selection All respondents who had attended a MTW course in the last ten years and whose contact details were recorded by Arthritis SA were eligible to participate. All were sent a copy of the two questionnaires with an accompanying letter explaining the purpose of the survey. A reply paid envelope was included. All questionnaires had a number which was linked to the address database at Arthritis SA. Arthritis SA maintained a list of returned questionnaires and then provided all deidentified questionnaires for data entry. Response rates The response rate has been calculated as shown in Table 1.1. Overall, 701 questionnaires were sent with six people reporting that they had not done the course, six were deceased and 26 returned to sender, leaving 663 questionnaires in the eligible sample. There was no follow up for unreturned questionnaires. Overall 244 questionnaires were returned (response rate 36.8%). Table 1.1: Response rate n % Eligible sample 663 Declined 18 2.7 Not returned 401 60.5 Returned questionnaires 244 36.8 Page 9
Introduction and methodology Page 10
CHAPTER 2: DEMOGRAPHIC PROFILE AND TYPE OF ARTHRITIS
Demographics Introduction This section presents the general information collected from all of the respondents (n=244) in regards to their demographic profile (age, sex and time since course), the type of arthritis and/or other health conditions respondents had, and a rating of the severity of their condition. Age and sex of respondents Information about age and sex was collected from all respondents (n=244). Results are shown in Table 2.1. The mean age was 65.33 years (SD 11.274, Range 22-90). Table 2.1: Sex and age group of respondents n % Sex Males 36 14.8 Females 201 82.4 Refused 7 2.9 Age group 22 to 44 years 6 2.5 45 to 64 years 102 41.8 65 years or over 135 55.3 Refused 1 0.4 Total 244 100.0 Health conditions The following table presents the types of arthritis and other health conditions reported by all of the respondents (n=244) (Table 2.2). Table 2.2: Arthritis and other health conditions of respondents* n % 95% CI Arthritis and other health conditions* Osteoarthritis 160 67.2 (60.9-73.2) Fibromyalgia 59 24.8 (19.4-30.8) Rheumatoid arthritis 50 21.0 (16.0-26.7) Osteoporosis 14 5.9 (3.3-9.7) Psoriatic arthritis 11 4.6 (2.3-8.1) Lupus 6 2.5 (0.9-5.4) Sjögren s syndrome 6 2.5 (0.9-5.4) Other 61 25.6 (20.2-31.7) * Multiple response Page 12
Demographics Other arthritis and musculoskeletal conditions that the course participants had are listed below: Paget s disease (3) Scleroderma, Crest (3) Scoliosis (3) Unknown type of arthritis (3) Polymyalgia rheumatica (2) Inflammatory spondyloarthropathy (2) Disc bulges (2) Connective tissue disorder (2) Seronegative synovitis (1) Scheuermann's (1) Sciatica (1) Bursitis (1) Osteopenia (1) Calcification of the spine (1) Back injury (1) Other health conditions that the course participants had are listed below: Cardiovascular disease (stroke, high blood pressure, angina, atrial fibrillation) (8) Depression, chronic fatigue syndrome and bipolar disease (7) Chronic airway or lung disease (COPD, COAD, bronchiectasis) (6) Asthma (4) Neuropathic disorder, multiple sclerosis (3) Diabetes (2) Auto-immune disease (2) Allergies (1) Coeliac (1) Colitis (1) Methicillin-resistant Staphyococcus aureus (MRSA) (1) Insulinemia (1) Poliomyelitis (1) Urticaria (1) Hearing or eye problem (2) Page 13
Demographics How long ago participated in the MTW course All respondents (n=244) were asked how long ago they participated in the MTW course. The results are in Table 2.3. The majority of respondents had participated in the course within the last three years. Table 2.3: Time since participating the MTW course n % 95% CI Less than one month to three years 131 53.7 (47.2-60.1) More than three years 94 38.5 (32.4-44.9) Don t know 19 7.8 (4.7-11.9) Total 244 100.0 Severity of condition All respondents (n=244) were asked to rate, on a scale of 1 to 10, the severity of their condition when they started the MTW course and the severity of their condition at the time of the survey. All participants who gave a score for both before the course and now were compared (n=239). The severity score now was statistically significantly lower compared to at the time of the course (p<0.01) (Table 2.5). Table 2.4: Comparison of severity score before MTW course and now Mean (SD) When started MTW course 6.2 (2.1) Now 4.9 (2.5) p <0.01 The severity, on a 1-10 scale, was classified into not severe (score of 1 to 5) and severe (score of 6 to10). A higher proportion of respondents rated their condition more severe before the MTW course compared to the now, at the time of the survey (Table 2.5). Table 2.5: Severity of condition n % 95% CI When started MTW course Not severe 88 36.5 (30.4-42.9) Severe 153 63.5 (57.1-69.6) Total 241 100.0 Now Not severe 142 59.4 (52.9-65.7) Severe 97 40.6 (34.3-47.1) Total 239 100.0 Page 14
Demographics When examining severity at the time of the MTW course, respondents aged 65 years and over, were less likely to report that their condition was severe and those who had attended the course more than three years ago were more likely to report that their condition was severe at the time of the course (Table 2.6). Table 2.6: Severity of condition when started MTW course by age, sex and when participated in the MTW course Sex Not severe Severe n % (95% CI) n % (95% CI) Males 14 16.3 (9.2-25.8) 22 14.8 (9.5-21.5) Females 72 83.7 (74.2-90.8) 127 85.2 (78.5-90.5) Total 86 100.0 149 100.0 Age 18 to 44 years - - 6 3.9 (1.5-8.3) 45 to 64 years 31 35.2 (25.3-46.1) 70 45.8 (37.7-54.0) 65 years or over 57 64.8 (53.9-74.7) 77 50.3 (42.1-58.5) Time since participation Less than one month to three years ago 58 65.9 (55.0-75.7) 72 47.1 (38.9-55.3) More than three years ago 21 23.9 (15.4-34.1) 72 47.1 (38.9-55.3) Don t know 9 10.2 (4.8-18.5) 9 5.9 (2.7-10.9) Total 88 100.0 153 100.0 Statistically significantly higher or lower (p<0.05) compared between categories of severity Page 15
Demographics There were no significant differences between sex, age group and the time since participating in the MTW course in terms of the rating of severity at the time of the survey (Table 2.7). Table 2.7: Severity of condition now by age, sex and when participated in the MTW course Sex Not severe Severe n % (95% CI) n % (95% CI) Males 25 18.1 (12.1-25.6) 11 11.6 (5.9-19.8) Females 113 81.9 (74.4-87.9) 84 88.4 (80.2-94.1) Total 138 100.0 95 100.0 Age 18 to 44 years 3 2.1-3 3.1-45 to 64 years 54 38.0 (30.0-46.5) 45 46.4 (36.2-56.8) 65 years or over 85 59.9 (51.3-68.0) 49 50.5 (40.2-60.8) Time since participation Less than one month to three years ago 76 53.5 (45.0-61.9) 53 54.6 (44.2-64.8) More than three years ago 56 39.4 (31.3-48.0) 37 38.1 (28.5-48.6) Don t know 10 7.0 (3.4-12.6) 7 7.2 (3.0-14.3) Total 142 100.0 97 100.0 Summary Generally females and those 65 years and over attended MTW courses, thus the course is not targeting males or the younger population. While those with arthritis were those who most commonly attended the courses, there were also participants with a wide range of other conditions, which raises questions of who the course is being targeted at. Older people (those who were more likely to attend the course) and recent attendees were also more likely to say that their condition was not severe at the time of attending the course. Page 16
CHAPTER 3: HEALTH EDUCATION IMPACT QUESTIONNAIRE (HEIQ )
Health Education Impact questionnaire (heiq ) The Health Education Impact Questionnaire (heiq ) was developed in order to provide a relevant and valid evaluation and data management system for health education and self-management programs. The questionnaire is composed of eight domains and 40 questions 1. All respondents (n=244) were asked to complete the heiq Version 3 follow up questionnaire. The mean scores for each of the eight domains are presented in Table 3.1. Table 3.1: Eight domains of heiq heiq Domain Mean (SD, range) Positive and active engagement in life 2.99 (0.38, 1.00 4.00) Health directed behaviour 3.19 (0.51, 1.00 4.00) Skill and technique acquisition 2.87 (0.33, 2.00 3.80) Constructive attitudes and approaches 2.86 (0.40, 1.75 3.80) Self-monitoring and insight 2.74 (0.37, 1.83 3.83) Health service navigation 2.92 (0.35, 1.50 4.00) Social integration and support 2.98 (0.46, 1.40 4.00) Emotional wellbeing 3.97 (0.51, 3.00 6.00) 1 http://www.crd.unimelb.edu.au/heiq/ Page 18
Positive engagement with life This construct covers the motivation to be active and assesses whether participants in selfmanagement/health education programs have engaged or re-engaged in life-fulfilling activities as a result of the program. The items measure the individuals activities to convert intentions into positive outcomes, and imply a change of lifestyle and life activities 2. The questions used to measure this construct are: I am doing interesting things in my life. Most days I am doing some of the things I really enjoy. I try to make the most of my life. I have plans to do enjoyable thing for myself during the next few days. I feel like I am actively involved in life 2. There was a significant difference between age groups in the mean score for positive and active engagement in life, with older age groups reporting a lower score compared to the youngest age group (p=0.02) (Table 3.2). Table 3.2: Positive and active engagement in life by sex, age group, when participated in the MTW course, severity of condition, still use skills learnt Sex Positive and active engagement in life n Mean (SD) p-value Male 36 2.89 (0.33) Female 195 3.02 (0.36) Age group 18 to 44 years 6 3.24 (0.20) 45 to 64 years 100 3.05 (0.31) 65 years or over 131 2.93 (0.42) Time since participation Less than one month to three years ago 128 2.99 (0.43) More than three years ago 92 3.00 (0.32) Don t know 18 2.92 (0.25) 0.73 Severity of condition when started the MTW course Not severe 88 2.98 (0.35) Severe 149 2.99 (0.40) Severity of condition now Not severe 141 2.96 (0.36) Severe 94 3.02 (0.41) Still use the skills learnt Yes 206 2.98 (0.38) No 16 2.95 (0.31) Differences between means tested by one-way ANOVA or independent samples t-test. Significance p<0.05 0.06 0.02 0.75 0.25 0.78 2 http://www.crd.unimelb.edu.au/heiq/ heiq items Version 3 Page 19
There were no significant differences between mean scores for positive and active engagement in life for: able to do things that weren t able to before; able to do more exercise; dealing with problems differently; having improved interaction with health care providers; having improved quality of life; life had improved somewhat or a lot; and having used other services offered by Arthritis SA (Table 3.3). Table 3.3: Positive and active engagement in life as a result of the MTW course Able to do things that weren t able to Positive and active engagement in life n Mean (SD) p-value Yes 112 2.99 (0.43) No 118 2.99 (0.34) Do more exercise Yes 149 2.98 (0.41) No 84 3.00 (0.32) Deal with problems differently Yes 168 3.00 (0.39) No 66 2.95 (0.36) Improved interaction with health care providers Yes 152 3.01 (0.41) No 77 2.93 (0.31) Improved quality of life Yes 152 3.01 (0.39) No 75 2.98 (0.34) How has life improved Improved somewhat 137 2.96 (0.33) Improved a lot 97 3.03 (0.43) Have used other services offered by Arthritis SA Yes 100 3.00 (0.39) No 132 3.00 (0.33) Differences between means tested by one-way ANOVA or independent samples t-test. Significance p<0.05 0.95 0.69 0.32 0.14 0.66 0.17 0.94 Page 20
Health directed behaviour This scale is similar to the first in that it relates to a change in lifestyle, however in this case the change is tangible and specifically related to healthy behaviours. The activities may include changes in exercise, relaxation routines and diet which are aimed at either disease prevention and/ or health promotion 3. The questions used to measure this construct are: I walk for exercise, for at least 15 minutes per day, most days of the week. I do at least one type of physical activity every day for at least 30 minutes (e.g. walking, gardening, housework, golf, bowls, dancing, Tai Chi, swimming). On most days of the week, I do at least one activity to improve my health (e.g. walking, relaxation, exercise). On most days of the week, I set aside time for healthy activities (e.g. walking, relaxation, exercise) 3. Respondents who rated their condition as not severe now had a significantly higher score than those with a severe condition and those who still used the skills learnt from the course also had a significantly higher score for this domain than those who did not still use the skills (Table 3.4). 3 http://www.crd.unimelb.edu.au/heiq/ heiq items Version 3 Page 21
Table 3.4: Health directed behaviour by sex, age group, when participated in the MTW course, severity of condition, still use skills learnt Sex Health directed behaviour n Mean (SD) p-value Male 36 3.18 (0.39) Female 194 3.21 (0.51) Age group 18 to 44 years 6 3.33 (0.68) 45 to 64 years 100 3.11 (0.53) 65 years or over 130 3.26 (0.48) Time since participation Less than one month to three years ago 128 3.19 (0.55) More than three years ago 91 3.22 (0.47) Don t know 18 3.10 (0.46) 0.64 Severity of condition when started the MTW course Not severe 88 3.21 (0.44) Severe 148 3.19 (0.55) Severity of condition now Not severe 141 3.33 (0.44) Severe 93 2.99 (0.54) Still use the skills learnt Yes 205 3.23 (0.49) No 16 2.93 (0.61) Differences between means tested by one-way ANOVA or independent samples t-test. Significance p<0.05 0.72 0.05 0.71 0.02 Page 22
Respondents who were able to do things that they weren t able to previously; were able to do more exercise; could deal with problems differently; had improved interaction with health care providers; had improved quality of life; and whose life had improved a lot as a result of MTW course scored statistically significantly higher for health directed behaviour (Table 3.5). Table 3.5: Health directed behaviour as a result of the MTW course Able to do things that weren t able to Health directed behaviour n Mean (SD) p-value Yes 112 3.30 (0.51) No 117 3.10 (0.50) Do more exercise Yes 148 3.27 (0.51) No 84 3.07 (0.49) Deal with problems differently Yes 167 3.24 (0.51) No 66 3.06 (0.48) Improved interaction with health care providers Yes 152 3.27 (0.50) No 76 3.01 (0.50) Improved quality of life Yes 152 3.30 (0.50) No 74 2.98 (0.50) How has life improved Improved somewhat 136 3.07 (0.47) Improved a lot 97 3.36 (0.53) Have used other services offered by Arthritis SA Yes 99 3.22 (0.53) No 132 3.19 (0.47) Differences between means tested by one-way ANOVA or independent samples t-test. Significance p<0.05 0.002 0.005 0.02 0.66 Page 23
Skill and technique acquisition This scale captures the knowledge-based skills and techniques that assist participants to manage disease related symptoms and health problems more effectively 4. The questions used to measure this construct are: When I have symptoms, I have skills that help me cope. I have a good understanding of equipment that could make my life easier. I have a very good idea of how to manage my health problems. I have effective ways to prevent my symptoms (e.g. discomfort, pain and stress) from limiting what I can do in my life 4. Females scored statistically significantly higher for skill acquisition compared to males. Those who did not know when they had participated in the MTW course and those who rated their condition as severe at the time of the survey scored statistically significantly lower for skill acquisition than the other respondents (Table 3.6). Table 3.6: Skill and technique acquisition by sex, age group, when participated in the MTW course, severity of condition, still use skills learnt Sex Skill and technique acquisition n Mean (SD) p-value Male 36 2.74 (0.29) Female 196 2.89 (0.34) Age group 18 to 44 years 6 2.87 (0.43) 45 to 64 years 100 2.85 (0.33) 65 years or over 131 2.88 (0.33) Time since participation Less than one month to three years ago 128 2.89 (0.34) More than three years ago 91 2.88 (0.32) Don t know 19 2.66 (0.30)* 0.02 Severity of condition when started the MTW course Not severe 88 2.87 (0.34) Severe 149 2.87 (0.33) Severity of condition now Not severe 142 2.91 (0.33) Severe 93 2.81 (0.33) Still use the skills learnt Yes 205 2.88 (0.33) No 16 2.80 (0.38) Differences between means tested by one-way ANOVA or independent samples t-test. Significance p<0.05 0.01 0.82 0.94 0.02 0.34 4 http://www.crd.unimelb.edu.au/heiq/ heiq items Version 3 Page 24
Respondents who reported they did more exercise; had improved interaction with health care providers; had improved quality of life; and that life had improved a lot as a result of the MTW course had significantly higher scores for skill and technique acquisition (Table 3.7). Table 3.7: Skill and technique acquisition as a result of the MTW course Able to do things that weren t able to Skill and technique acquisition n Mean (SD) p-value Yes 111 2.90 (0.35) No 119 2.84 (0.32) Do more exercise Yes 148 2.93 (0.34) No 84 2.77 (0.30) Deal with problems differently Yes 166 2.89 (0.34) No 67 2.81 (0.32) Improved interaction with health care providers Yes 152 2.90 (0.36) No 76 2.79 (0.27) Improved quality of life Yes 152 2.92 (0.34) No 75 2.78 (0.29) How has life improved Improved somewhat 137 2.79 (0.32) Improved a lot 96 2.98 (0.32) Have used other services offered by Arthritis SA Yes 99 2.89 (0.35) No 134 2.85 (0.32) Differences between means tested by one-way ANOVA or independent samples t-test. Significance p<0.05 0.17 0.09 0.01 0.001 0.42 Page 25
Constructive attitudes and approaches This scale uses the statement I am not going to let this disease control my life and measures if there is a shift in how the individual views the impact of their condition(s) on their life 5. The questions used to measure this construct are: If others can cope with problems like mine, I can too. I try not to let my health problems stop me from enjoying life. I do not let my health problems control my life. My health problems do not ruin my life. I feel I have a very good life even when I have health problems 5. Respondents who stated that their condition was not severe at the time of survey had a statistically significantly higher score for constructive attitudes and approaches than those who stated that their condition was severe at the time of survey (Table 3.8). Table 3.8: Constructive attitudes and approaches by sex, age group, when participated in the MTW course, severity of condition, still use skills learnt Sex Constructive attitudes and approaches n Mean (SD) p Male 36 2.80 (0.40) Female 193 2.87 (0.40) Age group 18 to 44 years 6 2.93 (0.50) 45 to 64 years 98 2.78 (0.39) 65 years or over 130 2.92 (0.39)* Time since participation Less than one month to three years ago 126 2.88 (0.40) More than three years ago 91 2.85 (0.41) Don t know 18 2.80 (0.36) 0.67 Severity of condition when started the MTW course Not severe 87 2.88 (0.37) Severe 147 2.86 (0.41) Severity of condition now Not severe 141 2.92 (0.36) Severe 91 2.78 (0.44) Still use the skills learnt Yes 202 2.88 (0.39) No 16 2.69 (0.45) Differences between means tested by one-way ANOVA or independent samples t-test. Significance p<0.05 0.30 0.03 0.69 0.006 0.06 5 http://www.crd.unimelb.edu.au/heiq/ heiq items Version 3 Page 26
Respondents who stated that they did more exercise; had improved interactions with health care providers; had improved quality of life; and life had improved a lot as a result of the MTW course had significantly higher scores for constructive attitudes and approaches (Table 3.9). Table 3.9: Constructive attitudes and approaches as a result of the MTW course Able to do things that weren t able to Constructive attitudes and approaches n Mean (SD) p Yes 111 2.90 (0.42) No 115 2.82 (0.39) Do more exercise Yes 146 2.92 (0.38) No 83 2.76 (0.42) Deal with problems differently Yes 164 2.89 (0.39) No 66 2.78 (0.42) Improved interaction with health care providers Yes 150 2.92 (0.38) No 75 2.74 (0.42) Improved quality of life Yes 151 2.91 (0.40) No 73 2.77 (0.40) How has life improved Improved somewhat 135 2.80 (0.40) Improved a lot 96 2.96 (0.39) Have used other services offered by Arthritis SA Yes 97 2.84 (0.41) No 133 2.88 (0.40) Differences between means tested by one-way ANOVA or independent samples t-test. Significance p<0.05 0.13 0.004 0.05 0.002 0.02 0.003 0.46 Page 27
Self-monitoring and insight This scale examines the ability to monitor one s condition, and the physical and/or emotional responses that lead to insight and the appropriate action or actions to self manage. There needs to be an acknowledgement of realistic disease-related limitations, and an ability and confidence to remain within these limits 6. The questions used to measure this construct are: With my health in mind, I have realistic expectations of what I can and cannot do. As well as seeing my doctor, I regularly monitor changes in my health. I know what things can trigger my health problems and make them worse. When I have health problems, I have a clear understanding of what I need to do to control them. I have a very good understanding of when and why I am supposed to take my medication. I carefully watch my health and do what is necessary to keep as healthy as possible 6. There were no significant differences in the mean score between groups for self-monitoring and insight (Table 3.10). Table 3.10: Self-monitoring and insight by sex, age group, when participated in the MTW course, severity of condition, still use skills learnt Sex Self-monitoring and insight n Mean (SD) p Male 36 2.65 (0.41) Female 195 2.76 (0.36) Age group 18 to 44 years 6 2.92 (0.49) 45 to 64 years 100 2.69 (0.35) 65 years or over 130 2.76 (0.37) Time since participation Less than one month to three years ago 127 2.77 (0.35) More than three years ago 91 2.71 (0.39) Don t know 19 2.64 (0.29) 0.26 Severity of condition when started the MTW course Not severe 88 2.71 (0.37) Severe 148 2.75 (0.36) Severity of condition now Not severe 141 2.75 (0.37) Severe 93 2.73 (0.37) Still use the skills learnt Yes 204 2.74 (0.36) No 16 2.67 (0.38) Differences between means tested by one-way ANOVA or independent samples t-test. Significance p<0.05 0.10 0.19 0.34 0.67 0.45 6 http://www.crd.unimelb.edu.au/heiq/ heiq items Version 3 Page 28
Scores for self-monitoring and insight were significantly higher for those respondents who were able to: do things that weren t able to before; do more exercise; and deal with problems differently. The scores were also higher for those who have improved interactions with health care providers; have improved quality of life; and for those who had improved a lot as a result of the MTW course (Table 3.11). Table 3.11: Self-monitoring and insight as a result of the MTW course Able to do things that weren t able to Self-monitoring and insight n Mean (SD) p Yes 111 2.79 (0.38) No 118 2.68 (0.34) Do more exercise Yes 147 2.79 (0.33) No 84 2.63 (0.39) Deal with problems differently Yes 166 2.76 (0.36) No 66 2.66 (0.36) Improved interaction with health care providers Yes 151 2.80 (0.36) No 76 2.61 (0.34) Improved quality of life Yes 151 2.79 (0.36) No 75 2.66 (0.34) How has life improved Improved somewhat 136 2.66 (0.34) Improved a lot 96 2.85 (0.37) Have used other services offered by Arthritis SA Yes 99 2.74 (0.36) No 133 2.74 (0.37) Differences between means tested by one-way ANOVA or independent samples t-test. Significance p<0.05 0.02 0.002 0.04 0.008 0.91 Page 29
Health service navigation This scale examines the understanding of and ability to interact with a range of health organisations and health professionals. It also measures the ability and confidence to communicate and negotiate with healthcare providers to get needs met 7. The questions used to measure this construct are: I communicate very confidently with my doctor about my healthcare needs. I have very positive relationships with my healthcare professionals. I confidently give healthcare professionals the information they need to help me. I get my needs met from available healthcare resources (e.g., doctors, hospitals and community services). I work in a team with my doctors and other healthcare professionals 7. Scores for health service navigation were statistically significantly higher for respondents whose condition was not severe condition at the time of survey (Table 3.12). Table 3.12: Health service navigation by sex, age group, when participated in the MTW course, severity of condition, still use skills learnt Sex Health service navigation n Mean (SD) p Male 36 2.86 (0.26) Female 197 2.94 (0.35) Age group 18 to 44 years 6 3.13 (0.16) 45 to 64 years 100 2.90 (0.35) 65 years or over 133 2.92 (0.35) Time since participation Less than one month to three years ago 129 2.92 (0.35) More than three years ago 92 2.95 (0.36) Don t know 19 2.79 (0.19) 0.23 Severity of condition when started the MTW course Not severe 88 2.92 (0.33) Severe 151 2.92 (0.36) Severity of condition now Not severe 142 2.97 (0.32) Severe 95 2.84 (0.38) Still use the skills learnt Yes 207 2.92 (0.35) No 16 2.92 (0.33) Differences between means tested by one-way ANOVA or independent samples t-test. Significance p<0.05 0.20 0.28 0.90 0.006 1.00 7 http://www.crd.unimelb.edu.au/heiq/ heiq items Version 3 Page 30
Scores for health service navigation were significantly higher for respondents who reported that they: were able to do things that weren t able to before; could do more exercise; could deal with problems differently; have improved interaction with health care providers; have improved quality of life; and had improved a lot as a result of the MTW course (Table 3.13). Table 3.13: Health service navigation as a result of the MTW course Able to do things that weren t able to Health service navigation n Mean (SD) p Yes 112 2.97 (0.36) No 120 2.87 (0.34) Do more exercise Yes 150 2.98 (0.34) No 84 2.81 (0.33) Deal with problems differently Yes 168 2.96 (0.34) No 67 2.81 (0.32) Improved interaction with health care providers Yes 153 2.94 (0.36) No 77 2.85 (0.29) Improved quality of life Yes 153 2.96 (0.35) No 76 2.81 (0.32) How has life improved Improved somewhat 138 2.86 (0.30) Improved a lot 97 3.00 (0.38) Have used other services offered by Arthritis SA Yes 100 2.90 (0.37) No 134 2.94 (0.31) Differences between means tested by one-way ANOVA or independent samples t-test. Significance p<0.05 0.03 0.002 0.04 0.001 0.002 0.36 Page 31
Social integration and support This scale attempts to capture the positive impact of social engagement and support that occurs through interaction with others and the impact that may arise from associating with others who share similar health-related life experiences. This also involves the confidence to seek support from interpersonal relationships as well as community-based organisations on a continuing basis 8. The questions used to measure this construct are: I have enough friends who help me cope with my health problems. I get enough chances to talk about my health problems with people who understand. If I need help, I have plenty of people I can rely on. Overall, I feel well looked after by friends or family. When I feel ill, my family and carers really understand what I am going through 8. Respondents who stated that their condition was not severe at the time of survey had statistically significantly higher scores for social integration and support (Table 3.14). Table 3.14: Social integration and support by age, sex, when participated in the MTW course, severity of condition, still use skills learnt Sex Social integration and support n Mean (SD) p Males 36 2.98 (0.41) Females 194 2.98 (0.46) Age 18 to 44 years 6 3.17 (0.45) 45 to 64 years 100 2.93 (0.45) 65 years or over 129 3.01 (0.45) Time since participation Less than one month to three years ago 126 3.00 (0.48) More than three years ago 92 2.97 (0.44) Don t know 18 2.83 (0.34) 0.31 Severity of condition when started the MTW course Not severe 88 3.02 (0.43) Severe 147 2.96 (0.46) Severity of condition now Not severe 140 3.07 (0.44) Severe 93 2.84 (0.42) Still use the skills learnt Yes 204 2.99 (0.45) No 16 2.83 (0.46) Differences between means tested by one-way ANOVA or independent samples t-test. Significance p<0.05 0.94 0.22 0.27 0.16 8 http://www.crd.unimelb.edu.au/heiq/ heiq items Version 3 Page 32
Scores for social integration and support were statistically significantly higher for respondents who reported that they: were able to do things that weren t able to before, do more exercise, deal with problems differently. These respondents also had improved interaction with health care providers, improved quality of life and had improved a lot as a result of the MTW course (Table 3.15). Table 3.15: Social integration and support as a result of the MTW course Able to do things that weren t able to Social integration and support n Mean (SD) p Yes 111 3.05 (0.51) No 117 2.91 (0.38) Do more exercise Yes 147 3.05 (0.45) No 84 2.85 (0.42) Deal with problems differently Yes 167 3.04 (0.44) No 66 2.81 (0.43) Improved interaction with health care providers Yes 151 3.07 (0.44) No 77 2.78 (0.40) Improved quality of life Yes 151 3.06 (0.48) No 75 2.81 (0.38) How has life improved Improved somewhat 137 2.89 (0.42) Improved a lot 96 3.11 (0.47) Have used other services offered by Arthritis SA Yes 100 2.97 (0.51) No 131 2.99 (0.41) Differences between means tested by one-way ANOVA or independent samples t-test. Significance p<0.05 0.02 0.67 Page 33
Emotional wellbeing negative effect This scale measures the overall negative affective responses to illness, including anger, depression and anxiety, which are attributed to the illness 9. The questions used to measure this construct are: If I think about my health, I get depressed. I get upset when I think about my health. I often feel angry when I think about my health. My health problems make me very dissatisfied with my life. I often worry about my health I feel hopeless because of my health 9. Scores for emotional wellbeing were statistically significantly lower for those respondents who did not have a severe condition at the time of survey (Table 3.16). Table 3.16: Emotional wellbeing by age, sex, when participated in the MTW course, severity of condition, still use skills learnt Sex Emotional wellbeing n Mean (SD) p Males 36 4.01 (0.42) Females 193 3.94 (0.52) Age 18 to 44 years 6 3.97 (0.53) 45 to 64 years 98 4.01 (0.52) 65 years or over 131 3.92 (0.50) Time since participation Less than one month to three years ago 127 3.93 (0.52) More than three years ago 91 3.98 (0.51) Don t know 18 4.16 (0.42) 0.17 Severity of condition when started the MTW course Not severe 87 3.94 (0.46) Severe 148 3.98 (0.54) Severity of condition now Not severe 141 3.83 (0.48) Severe 92 4.16 (0.49) Still use the skills learnt Yes 204 3.94 (0.51) No 16 4.18 (0.57) Differences between means tested by one-way ANOVA or independent samples t-test. Significance p<0.05 0.46 0.40 0.56 0.07 9 http://www.crd.unimelb.edu.au/heiq/ heiq items Version 3 Page 34
The scores for emotional wellbeing were statistically significantly lower for respondents who reported that they: were able to do things that weren t able to before, do more exercise, or deal with problems differently. These respondents also had improved interaction with health care providers, improved quality of life and had improved a lot as a result of the MTW course (Table 3.17). Table 3.17: Emotional wellbeing as a result of the MTW course Able to do things that weren t able to Emotional wellbeing n Mean (SD) p Yes 112 3.85 (0.53) No 116 4.08 (0.48) Do more exercise Yes 148 3.85 (0.51) No 83 4.16 (0.47) Deal with problems differently Yes 166 3.91 (0.51) No 66 4.12 (0.48) Improved interaction with health care providers Yes 151 3.87 (0.49) No 76 4.16 (0.51) Improved quality of life Yes 151 3.85 (0.52) No 74 4.19 (0.43) How has life improved Improved somewhat 136 4.07 (0.46) Improved a lot 96 3.81 (0.54) Have used other services offered by Arthritis SA Yes 98 3.93 (0.52) No 132 3.98 (0.50) Differences between means tested by one-way ANOVA or independent samples t-test. Significance p<0.05 0.001 0.006 0.52 Summary Demographic factors impact on the quality of life following a self management course, as measured by the heiq TM, with age and severity of the condition generally the most significant factors. Other variables also demonstrated significant differences in scores for each domain except for positive and active engagement with life. Page 35