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Stories for Reprint
Arthritis Disability Higher Among Hispanics, Study Finds
By Petya Eckler, MARRTC Staff
A study in the June issue of the journal Arthritis Care & Research showed that the risk of worse health, activity limitations and disability at work or house work was more than two times greater in Hispanics with arthritis than in Caucasians. The authors are from the Columbia University Mailman School of Public Health in New York City. They examined data on 3,000 people with arthritis from the 1994 National Health Interview Survey, an annual nationwide household survey by the Centers for Disease Control and Prevention.
The people in the data were predominantly female in their mid-60s on average, and weren't employed. But Hispanics still had a twice higher risk of having work disability. The number of additional chronic conditions was the same for all respondents, as well as their use of health care, which led researchers to conclude that access to health care wasn't the reason for the poorer health in Hispanics. Lower education and being Hispanic increased the odds for poorer health however. Researchers also concluded that differences in social status between Hispanics and Caucasians may be another reason for the disparities.
Health disparities have been proven to exist in various subgroups in this country and documenting them has been the focus of many researchers. But for Dr. Kate Lorig, professor at the Stanford School of Medicine and director of the Stanford Patient Education Research Center in Palo Alto, Calif., the fact that health disparities exist is already yesterday's news.
Instead, she's looking at tomorrow's opportunities.
"There's definitely health disparities but I think there can be something done about it," Lorig said. "We need to start looking at ways to overcome those disparities and that's what I'm much more interested in."
She has been working on that since the mid-1990s, when the center started an arthritis self-management program in Spanish. The Spanish program wasn't just a translation of the English version they had been developing for years but instead, a course which was culturally adapted to the new audience. Lorig and her colleagues first assessed the needs of their Spanish-speaking participants and discovered that they didn't have a chance to or didn't enjoy exercising on their own. So to answer those needs, the organizers incorporated the needs into their course and also gave participants CDs with the routines to take home. The assessment survey also showed that the U.S. practice of medical referrals frustrated the participants, mainly because they had different health systems back at home. The organizers included in their course a section on the health system in the United States, something which didn't exist in the English version.
The Spanish intervention proved a success as participants experienced better health and improved self-efficacy in managing their arthritis. Lorig says she wasn't surprised by the results.
"We've seen that English speakers and people who speak Spanish with arthritis have basically the same problems and when you do culturally-appropriate education, there's no reason for them not to respond the same," she said.
The key word here is culturally-appropriate, Lorig said.
"The bottom line is knowing the community and not stereotyping the community," she said.
The term "cultural competence" has been a popular buzz word in the health community recently and it incorporates health professionals' awareness that they need to serve the population in a culturally competent way. But for Lorig that term sends the wrong message to professionals in her field.
"I don't love it [the term] because there's no way an individual can be competent in all cultures," she said. "Instead I prefer cultural humility - you know you have a lot to learn and you try to learn it in a respectful way."
Such an approach pays off, she said. "Even if you make mistakes, if you're humble, you get forgiven."
Lorig's own cultural humility has served her well in the past 15 years and has opened doors for her not only in the Hispanic community in California but also in many countries in South America, where she's currently implementing the arthritis self-management program with local health officials. The Patient Education Research Center is now working with agencies in Chile, Ecuador, Brazil, Columbia, Mexico and Spain.
Lorig's work with Hispanics has showed her that health disparities can be overcome when the appropriate combination of methods is applied.
"It's not a matter of what is a solution, but a matter of a whole combination of things," she said.
She says behaviors can be changed when small group intervention is combined with legislation, environmental changes, Internet and phone approaches and the use of Spanish-speaking mentors (promotoras). The end goal is to increase the belief that participants can have some control (self-efficacy) of not only arthritis, but of any type or combination of chronic diseases.
"Self-efficacy is not just a middle class white thing but it's a psychological construct that crosses culture and language," Lorig said. "Being Hispanic does not mean that one can't get some confidence and change behaviors."
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