Arthritis Education Partnership Reaching Rural Tennessee Audiences

1
Arthritis Education Partnership Reaching Rural
Tennessee Audiences

• Barbara (Bobbi) P. Clarke, PhD, RD
• Professor, Extension Health Specialist and
• Co-Director, UT Center for Community-Based Health
  Initiatives
• SERA 19 Rural Health Conference
• September 11, 2007

2
Purpose of Presentation

• Share with you
• A unique state partnership addressing arthritis
  self-management education
• Strategies for success
• Program impact at the state and county levels

3
Did You Know

• One out of every three adult Tennesseans has
  arthritis
• Tennessee ranks above the national average for
  arthritis prevalence
• Arthritis is the major cause of chronic pain and
  disability, impacting medical expenses, lost
  wages and the ability to maintain independence

4
What Is Arthritis?

• Not an old persons disease
• Half of seniors do not experience arthritis
• Three out of five Tennesseans are younger than
  age 65
• Other causes besides aging
• Injury
• Joint abuse
• Overweight/obese
• Chronic condition without a cure
• Term covers over 100 diseases and conditions
  affecting the joints and connective tissue

5
Arthritis Control Challenges

• Self-management disease
• No treatment is right for everyone
• Lack knowledge to self-manage disease to control
  the pain, depression and minimize further joint
  damage
• Lacking access to arthritis intervention and
  treatment
• Healthcare providers lack the time to teach
  self-management skills

6
The Solution Tennessee Arthritis Education
Partnership Since 2003

• Tennessee Department of Healths Arthritis
  Control Program
• Tennessee Chapter of the Arthritis Foundation
• UT Extension statewide educational network of
  Family and Consumer Sciences educators

7
Three Evidence-based Educational Programs

• Focus on self-care skills to reduce pain and
  discomfort of arthritis, decrease medications
  decrease doctor visits
• Arthritis Self-Help Program
• Arthritis Foundation Exercise Program
• Tai Chi

8
Arthritis Self-Help Program (6 2-hour Session)

• Teaches how to
• Self-manage arthritis daily
• Exercise, medications, pain control, expressing
  feelings, weight control, relaxation techniques,
  pacing daily activities
• Communicate with healthcare provider
• Benefits decreased pain, medication use,
  depression, improved daily activities of living
  and doctor visits

9
Arthritis Foundation Exercise Program(8 Session)

• Low impact, joint safe exercises
• Standing or sitting exercises
• Benefits decreased pain, joint stiffness,
  medication use, and increased energy, muscle
  strength, flexibility

10
Tai Chi(8 Session)

• High stance Sun Style Tai Chi gentle on joints
• Range of motion exercises and agile steps
• Pain control through breathing and relaxation
  techniques
• Benefits reduced pain, depression and stiffness,
  improved flexibility and balance, improved
  cardiovascular function

11
County Demographics

• Rural counties in Tennessee geographically
  isolated, especially in the Appalachian Mountain
  chain
• Services and educational resources are limited in
  this area

12
County Demographics (cont.)

• Arthritis cases increased 53 from 1990 to 2000
• 17 Rheumatologist locations in the state, mostly
  urban areas
• While there are senior centers located within
  each county, there is a lack of educational
  providers for Arthritis education

13
TN Arthritis Education Partnership Goals

• Establish and maintain a network of UT Extension
  educators who are certified to teach AF programs.
• Improve the understanding about arthritis as a
  chronic disease among rural Tennesseans.
• Teach rural Tennesseans to be better
  self-managers of their disease by changing their
  behaviors that lead to better control of symptoms.

14
Building the UT Extension AF Certified
Instructor Network

• Conducted series of AF certification programs
  across the state from 2004 2007
• Training 54 UT Extension educators in various
  programs
• Conducted an Arthritis Update professional
  development conference in 2005 at three regional
  sites
• Rheumatologist, pharmacist, physical therapist
  and AF staff
• Requested by UT Extension educators
• 2008 Arthritis Update

15
Role of Partners
16
TN Chapter of the Arthritis Foundation

• Tennessee Chapter of the AF
• Certification training
• Evidence-based programs
• Quality control of instructors and programs
• Record keeping for national reporting

17
Tennessee Department of Health

• Provide funding for
• instructor training registrations (100 ASHP
  AFEP, 200 Tai Chi
• travel to and from the certification trainings,
  meals and hotel if necessary
• AF educational resources
• partner meetings and national meeting
• development of low literacy educational and
  promotional materials

18
University of Tennessee Extension

• Coordinate training sites
• Promoted training opportunities
• Develop low literacy educational and promotional
  materials
• Funded the Tai Chi instructor trainings
• Institutionalize the AF programs as part of the
  UT Extension Public Health Education Program.
  Must include in annual plans of work.
• Provide web-based impact reporting system (SUPER)
• Develop indicators and collecting program impact
  data
• Develop and maintain individual Web sites for
  each program and the partnership

19
Partnership Impact

• CDC Grant revenue (60,000)
• Improving the quality of life for 5,737
  Tennesseans in 2006
• Recipient of two national awards in 2006
• CDC Partnership Award
• National Arthritis Foundation Public Health
  Innovation Award
• 2005 CDC Exemplary Program model for other states

20
Arthritis Self-Help Program

• 2,383 ASHP Graduates
• 86 women, 12 men,
• 2 youth
• End-of-Program Survey
• 86 increased confidence in arthritis management
• 3-Month Follow-Up (n1,987)
• 100 improved ability in coping with arthritis
• 57 improved overall health

21
Demonstrating Results
Arthritis Self-Help Exercise Program Tai Chi
End-of-Course Evaluation
3-MonthFollow-Up
Self-Reporting through Pen and Paper Surveys
22
Arthritis Foundation Exercise Program

• 747 participant
• 54 women,46 men,
  15 youth
• End-of-Program Survey
• 81 reported exercises safe and enjoyable
• 74 improved performance of daily activities
• 74 decreased pain and stiffness
• 3-Month Follow-Up (n350)
• 75 increased range-of-motion
• 63 decreased pain and stiffness
• 88 continued the exercise routines

23
Tai Chi

• 3,607 Tai Chi Graduates
• 77 women, 15 men,
• 8 youth
• End-of-Program Survey
• 86 decreased stiffness
• 82 improved balance
• 71 improved in overall health
• 3-Month Follow-Up (n1,200)
• 100 continued practicing Tai Chi
• 77 improved in overall health

24
Outreach Strategies

• Extension educators collaborate, plan, promote,
  implement, evaluate/report
• Partner with newspapers, health care providers,
  senior centers, county health councils, health
  departments
• Offer program to community colleges and
  university

25
Outreach Strategies

• Partner with newspapers, health care providers
  (physicians, pharmacists, physical therapist,
  worksites, senior centers, county health
  councils, health departments
• Offer program community colleges and
  universities, senior centers, fitness centers,
  rec centers, churches, worksites
• Work with media and community events to promote
  AF programs and educate public about arthritis

26
User Fees

• All fee-based programs
• ASHP - 35.00
• AFEP - 32.00
• Tai Chi - 48.00
• Fees Enhance
• Course Materials
• Agent Training
• Travel

27
Conclusions

• Partnerships are vital
• Must have strong coordination, trust, respect,
  follow-through and cooperation among partners
• Outreach through Extension can expand the rural
  capacity of AF in creative and diverse ways
• Funding from CDC is vital
• Win-win partners at state and county levels
• Real winners are the Tennesseans who participated
  in the programs and now reduced their suffering
  from arthritis.

28
Tennessee Arthritis Education PartnershipTHANK
YOU!