Capturing lay perspectives in a randomized control trial of a health promotion intervention for people with osteoarthritis of the knee

Osteoarthritis (OA) is a common and often disabling condition that predominately affects older adults. It is the commonest cause of locomotor disability and forms a major element of the workload in primary care. Previous studies suggest that there are both deficits in the knowledge patients have about their disease and extensive 'unmet' information needs. This paper explores the patients' perspective on the meaning and significance of living with arthritis, identified through quantitative and qualitative approaches undertaken during a trial that evaluated the effectiveness of a primary care-based patient education programme. This paper draws on qualitative and quantitative data from: the baseline interview (knowledge of arthritis, satisfaction with services and support received in primary care); patient diaries (individual goals and reflections on treatment); and group teaching sessions (themes describing the patient's experience). The different data sources were interrogated for common and divergent themes. One hundred and ninety-four participants were identified and 170 completed baseline interviews. Participants were predominantly female (73%), with a mean age of 63 and arthritis of long-standing; 55% reported that they had had it for 5 years or more. Use of primary care services was high, with 41% consulting their GP in the 2 weeks before interview. Levels of information were low, with less than 25% receiving support/advice about the disease, pain management or its impact upon daily life. Set against negative perceptions of the quality of services, patients' personal priorities were for improved pain management and enhanced mobility/functional ability. The combined quantitative and qualitative data provide insight into the patients' perspective on the causes and impact of knee OA, individual goals desired from treatment and the quality of care. There is consistent evidence of unmet needs for information and support and the priority placed by patients on finding strategies to cope with OA and maintaining independence. Even within a tightly defined study sample participating in the intervention, a diversity of experience and goals were revealed, which highlights the importance of taking account of contextual factors and individual differences when evaluating complex interventions.