Health Literacy and Appropriateness of Self‐Care and Pain Management in Osteoarthritis: An Understanding of the Patient's Perspective

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Abstract
Objective: Management guidelines encourage self‐care in patients with symptomatic osteoarthritis (OA). We undertook this study to investigate the relationship between health literacy (HL) and appropriateness of selection of self‐care strategies in people with self‐reported symptoms of OA.Methods: We conducted an online national observational, demographically representative, cross‐sectional survey of adults (ages 45–74 years). The eligibility criterion of “self‐reported OA symptoms” was screened for using guideline‐endorsed clinical criteria. Participants completed a custom‐built questionnaire that included validated scales for HL, pain intensity, sleep quality, and OA function/disability. Management strategies were grouped into self‐care activities, analgesics, and complementary medicines, and analyses of appropriateness were based on predefined, evidence‐based quality indicators.Results: Of 6,800 participants, 628 met the inclusion criteria and completed the survey. HL was categorized as follows: low (100 of 628, 15.9%), moderate (317 of 628, 50.5%), and excellent (211 of 628, 33.6%). In the past 7 days, mean pain intensity (0–10 scale) was 3.11 (95% confidence interval [95% CI] 3.06–3.16), and 71.7% of participants (450 of 628) had not achieved adequate pain relief. In the past month, 54.1% (340 of 628) reported disrupted sleep. Participants managed their pain with multiple self‐care activities (mean 1.44; 95% CI 1.32–1.57), analgesics (mean 1.74; 95% CI 1.60–1.88), and complementary medicines (mean 1.01; 95% CI 0.90–1.12). There was a statistically significant (P < 0.001) interaction between HL and appropriateness of current management strategies (HL low, guideline‐recommended management strategies less likely). Higher HL did not always translate into making appropriate pain management choices.Conclusion: Appropriate selection and use of evidence‐based management options is critical for patients with OA to obtain the full benefits from their treatment. Knowledge about suitable choices for OA self‐care is suboptimal, and future education should be tailored to different levels of HL.

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