Low levels of formal education are associated with increased prevalence, morbidity and mortality of most common chronic diseases. Several studies suggest that formal education level may be a surrogate for behavioral/psychosocial variables, which are also independently correlated with health status and outcomes. While circumstances associated with lower levels of formal education and poor SES cannot be altered through medical intervention, certain behavioral variables may be amenable to improvement, at least in part. The set of behaviors an individual uses to cope with a chronic condition is known as self-management. Individuals with a chronic disease negotiate the specific practices in their self-management strategies based on their needs and resources. Formal education level may be a marker for the capacity of individuals with a chronic disease to develop optimal self-management strategies. The objective of this study to examine self-management strategies of individuals with rheumatoid arthritis (RA) in the context of measures of disease activity, perceived control, and formal education level vis a vis health outcomes. The objective will be approached through the following specific aims: 1) to characterize self-management in individuals with RA; 2) to examine associations between self-management and formal education level in individuals with RA; 2) to examine associations between self management and formal education level in individuals with RA; 3) to determine whether the domains and frequency of use of self-management strategies reported by individuals with RA vary over time with changes in measures of disease activity; and 4) to define the relative contribution of self-management strategies and formal education level to health care utilization and health-related quality of life over a three year period in individuals with RA. If associations between level of formal education and health status can be accounted for, at least in part, by psychological status and self- management strategies, health care providers might more effectively target patient education interventions to effect an improvement in health status. In addition, there is emerging evidence that helping patients manage not just their disease, but also common underlying needs, is cost effective. Therefore, clinicians, health care policy-makers, public health planners and voluntary health agencies could all benefit from a better understanding of possible mechanisms.
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