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
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
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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
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What Is Arthritis?
• Not an old person’s 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
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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
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The Solution: Tennessee Arthritis
Education Partnership Since 2003
• Tennessee Department of Health’s
Arthritis Control Program
• Tennessee Chapter of the Arthritis
Foundation
• UT Extension statewide educational
network of Family and Consumer
Sciences educators
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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
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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
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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
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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
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County Demographics
• Rural counties in
Tennessee
geographically
isolated, especially
in the Appalachian
Mountain chain
• Services and
educational
resources are limited
in this area
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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
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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 selfmanagers of their disease by changing their
behaviors that lead to better control of
symptoms.
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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
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Role of Partners
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
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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
►
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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
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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
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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 (n=1,987):
– 100% improved ability in coping with
arthritis
– 57% improved overall health
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Demonstrating Results
Arthritis Self-Help
Exercise Program
End-of-Course
Evaluation
3-Month
Follow-Up
Tai Chi
Self-Reporting through Pen and Paper Surveys
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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 (n=350):
– 75% increased range-of-motion
– 63% decreased pain and stiffness
– 88% continued the exercise routines
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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 (n=1,200)
– 100% continued practicing Tai Chi
– 77% improved in overall health
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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
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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
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• Work with media and community
events to promote AF programs
and educate public about
arthritis
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User Fees
• All fee-based programs
• ASHP - $35.00
• AFEP - $32.00
• Tai Chi - $48.00
• Fees Enhance:
– Course Materials
– Agent Training
– Travel
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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.
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Tennessee Arthritis Education
Partnership
THANK YOU!