Applying the health belief model to understand the usage and experience of self-management techniques in knee osteoarthritis: A mixed-methods observational study.

Self efficacy, the confidence an individual has to perform a task, is an important determinant of physical performance in individuals with knee osteoarthritis (OA). The purpose of this study was to determine what personal, pathophysiologic, and impairment factors relate to self efficacy for physical tasks in community-dwelling adults with knee OA. Fifty-four persons with radiographically confirmed knee OA (mean +/- SD age 68.3 +/- 8.7 years, range 50-87 years) participated. The Functional Self-Efficacy subscale of the Arthritis Self-Efficacy Scale was the dependent measure. Independent measures included age, education, scores from the Center for Epidemiologic Studies Depression and State-Trait Anxiety Inventory questionnaires, medial joint space and varus/valgus tibiofemoral angle from radiographs, body mass index, and isokinetic quadriceps and hamstrings strength. Knee pain and stiffness, assessed using the Western Ontario and McMaster Universities Osteoarthritis Index, were independent measures. Fifty-one percent of the variance of Functional Self Efficacy was explained by knee stiffness, hamstrings strength, age, and depression scores. Pain, education, anxiety, radiographic joint space, and body weight did not significantly contribute to the variance in Functional Self-Efficacy scores. Substituting quadriceps strength for hamstrings strength resulted in a regression model that included only stiffness, age, and depression, which explained nearly as much variance as the original model. Self efficacy for physical tasks is related to the sensation of stiffness, hamstrings strength, age, and level of depressive symptoms in persons with knee OA. Clinicians and researchers could consider these variables when assessing the level of self efficacy for physical tasks in persons with knee OA.

Background: Knee osteoarthritis is the most common articular disease, and non-medical treatment of this disease has attracted the attention of researchers. The purpose of this study was to compare the effects of aromatherapy and massage therapy on knee pain, morning stiffness, daily life function, and quality of life in patients with knee osteoarthritis. Methods: This is a clinical trial. In this study, 93 patients referred to the Imam Ali Hospital (Physical Therapy Clinic) who entered the study were randomly divided into three groups including massage therapy (n = 31), aromatherapy (n = 31), and the control (n = 31). The data gathering tools were a demographic characteristics questionnaire and the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire. The questionnaire was completed before intervention and at the 5th and 10th sessions after intervention in all three groups. Data were analyzed by SPSS software version 20, and Chi-square, Fisher’s exact test, repeated measures test, one-way ANOVA test, and Tukey’s post hoc test were used for analysis. Results: The study shows that mean score subscale Symptoms and dryness in the 5th session and 10th session of intervention in the aromatherapy group is significantly higher than in the control group (p < 0.05). The massage therapy group had the highest pain score at the beginning of the intervention, but at the end of the 10th session of intervention had the least pain score. Mean score subscale Performance of daily life in the 5th session and 10th session of intervention in the aromatherapy group is significantly higher than in the control group (p < 0.05). Mean score in the subscale Performance, exercise, and recreational activities significantly differs between the aroma therapy and massage therapy groups compared with the control group in all times of interventions (p < 0.05), and in the mean score in the subscale Quality of life, there is no significant difference between the groups in all times of interventions (p > 0.05). Conclusion: The use of both massage therapy and aromatherapy is recommended for patients with knee osteoarthritis. Interventions should be prolonged for at least 6 months in patients so their effects appear on the patient.

Objectives Workplace-based competency is increasingly considered fundamental to patient safety and quality healthcare. The aim of the present study was to identify and describe physiotherapists' perceptions of workplace competency. Methods The present study was a mixed-methods cross-sectional observational study. Thematic and descriptive analysis of qualitative and survey data were undertaken. Forty-six physiotherapists employed at a metropolitan acute public hospital participated in interviews or focus groups; a subgroup of 31 participants also completed an online survey. Results Five main themes were identified: (1) despite the availability of workplace learning opportunities and supports, less-experienced staff reported limited confidence; (2) assessment and feedback around workplace competency was limited, predominantly informal and unstructured, with less than half of the cohort (42%) agreeing feedback received was useful for improving their workplace skills; (3) practicing within individual scope is an important aspect of workplace competency as a physiotherapist; (4) most (81%) agreed it was important for them to self-determine their learning and development goals, and they relied primarily on informal discussion to achieve these goals; and, (5) physiotherapists felt motivated regarding workplace learning, with 97% interested in developing their workplace skills however, nearly half (45%) did not feel they had sufficient time to do so. Conclusions The perceptions of physiotherapists working in a metropolitan acute public hospital are reflected in five themes. These themes elucidate how workplace competency is supported, maintained and developed among physiotherapists in this setting. These themes also highlight key challenges of workplace learning faced by this cohort of physiotherapists and allude to methods that may assist with improving feedback mechanisms and knowledge acquisition. What is known about this topic? Studies investigating employee perceptions around workplace competency, knowledge, skills and learning are found across a range of industries. Workplace-based competency is increasingly considered fundamental to patient safety and quality health care. There is little known about physiotherapists' perceptions of workplace competency. What does this paper add? This study has identified and described themes around physiotherapists' perceptions of their workplace knowledge and skills. What are the implications for practitioners? The themes identified provide support for the development, implementation and evaluation of a workplace-based competency framework for physiotherapists.

Research is needed to develop evidence-based behavioral interventions for preventing and treating obesity that are specific to the schizophrenia population. This study is the precursor to such intervention research where we examined the utility of the social cognitions outlined within the Health Action Process Approach (HAPA) model for predicting moderate to vigorous physical activity (MVPA) intentions and behavior among individuals with schizophrenia or schizoaffective disorder. A prospective cohort design [baseline (T1), week 2 (T2), and week 4 (T3)] was used to examine the HAPA constructs and MVPA across a sample of 101 adults (Mage = 41.5 ± 11.7 years; MBMI = 31.2 ± 7.8 kg/m2; 59% male). Two hierarchical regression analyses were conducted controlling for age, gender, BMI, and previous self-reported MVPA. In the first regression, intentions at T1 were regressed onto the T1 motivational HAPA constructs (risk perception, affective attitudes, task self-efficacy) and social support; MVPA status (meeting vs. not meeting the MVPA guidelines) assessed via accelerometry at T3 was regressed onto T1 social support and intentions followed by T2 action and coping planning, and maintenance self-efficacy in the second analysis. Overall, the motivational and social support variables accounted for 28% of the variance in intentions, with affective attitudes (β = 0.33, p < 0.01) and task self-efficacy (β = 0.25, p < 0.05) exhibiting significant, positive relationships. For MVPA status, the model as a whole explained 39% of the variance, with the volitional HAPA constructs explaining a non-significant 3% of this total variance. These findings suggest a need for interventions targeting self-efficacy and affective attitudes within this clinical population.

Life-space mobility describes the spatial areas through which an individual moves, and the frequency and need for assistance. Although patients with knee osteoarthritis (OA) have shown restricted life-space mobility, total knee arthroplasty (TKA) does not improve it beyond preoperative levels. Life-space mobility after TKA was influenced by self-efficacy for walking tasks; thus, an intervention to improve self-efficacy for walking tasks may contribute to better life-space mobility. We provided a walking event including several walking tasks as the intervention. We assessed the effect of the walking event on life-space mobility and self-efficacy for walking tasks in patients following TKA. In this nonrandomized controlled trial, patients who underwent primary TKA were recruited. After recruitment, patients who could not participate in the walking event due to scheduling conflicts were included in the control group. The walking event consisted of 3.5 km of walking course and included walking tasks as follows: crossing at the crosswalk, walking up- and downstairs without a railing, walking along dirt roads, and walking up and down a slope. The primary outcome was life-space mobility measured using Life-Space Assessment (LSA) and self-efficacy for walking tasks measured using the modified Gait Efficacy Scale (mGES). We enrolled 104 patients, of whom 36 were assigned to the intervention group and participated in the walking event. Participants in the intervention group had significantly better LSA score (adjusted mean difference between groups: 13.9; 95% confidence interval: 12.4-15.5; p < 0.001) and mGES score (adjusted mean difference between groups: 13.8; 95% confidence interval: 12.4-15.1; p < 0.001) than the control group even after adjusting for age, gender, body mass index, elapsed time from surgery, the severity of knee OA of nonoperated limb, and patient-reported functional outcome. The walking event including various walking tasks improved life-space mobility and self-efficacy in patients following TKA. It is important to design a program that can improve self-efficacy for walking tasks through mastery experiences to improve life-space mobility after TKA.

This study examined the extent to which baseline measures of quadriceps strength, quadriceps power, knee pain and self-efficacy for functional tasks, and their interactions, predicted 2-year changes in mobility performance (walking, stair ascent, stair descent) in women with knee osteoarthritis. We hypothesized that lesser strength, power and self-efficacy, and higher pain at baseline would each be independently associated with reduced mobility over 2years, and each of pain and self-efficacy would interact with strength and power in predicting 2-year change in stair-climbing performance. This was a longitudinal, observational study of women with clinical knee osteoarthritis. At baseline and follow-up, mobility was assessed with the Six-Minute Walk Test, and stair ascent and descent tasks. Quadriceps strength and power, knee pain, and self-efficacy for functional tasks were also collected at baseline. Multiple linear regression examined the extent to which 2-year changes in mobility performances were predicted by baseline strength, power, pain, and self-efficacy, after adjusting for covariates. Data were analyzed for 37 women with knee osteoarthritis over 2years. Lower baseline self-efficacy predicted decreased walking (β=1.783; p=0.030) and stair ascent (β=-0.054; p<0.001) performances over 2years. Higher baseline pain intensity/frequency predicted decreased walking performance (β=1.526; p=0.002). Lower quadriceps strength (β=0.051; p=0.015) and power (β=0.022; p=0.022) interacted with lesser self-efficacy to predict worsening stair ascent performance. Strategies to sustain or improve mobility in women with knee osteoarthritis must focus on controlling pain and boosting self-efficacy. In those with worse self-efficacy, developing knee muscle capacity is an important target.

Objectives:Cancers and various terminal illnesses need integrated palliative care with curative management, but, unfortunately, our health care system mainly focuses on the treatment of disease. Lack of awareness, difficulty in pain management and untrained staff are some of the challenges in palliative care services.The study was done to explore the perception of healthcare workers regarding availability, utilisation and challenges in the delivery of palliative care services.Material and Methods:A mixed method study was conducted at tertiary care teaching hospital in North India. Qualitative approach using interviews and focus group discussions (FGDs) among healthcare workers was done to understand their knowledge, perception, barriers and challenges in implementing palliative care services. One hundred and thirteen healthcare workers were interviewed using a semi-structured questionnaire and FGD was conducted to gain more insight into the issues of palliative care. The data obtained was analysed with the help of computer software Microsoft Excel and SPSS version 23 for windows. The data was presented as proportion and mean (S.D.) as deemed appropriate for qualitative and quantitative variables respectively. Thematic analysis was done with the data of FGD.Results:The knowledge, attitude and practices regarding palliative care were poor across the HCW. During FGD with faculty and residents, the participants showed great concern about the absence of palliative care across many specialties while expressing an acute need for the establishment of a separate interdisciplinary unit on palliative care to improve the quality of life in patients.Conclusion:The study shows that there are gaps that need to be addressed to make palliative services available in our hospital.

Purpose Despite the growing number of cashierless stores, few studies have examined the factors that influence the success of such stores. This paper aims to identify the influence of store attributes in customers’ affective attitudes regarding cashierless stores and to understand how customers’ need for interaction and risk reduction affect the relationship between customer experiences and evaluation. Design/methodology/approach Quantitative research is conducted using a partial least squares structural equation model. Data was collected from 174 customers with cashierless store experience. Findings The results identify the influence of hedonic and utilitarian characteristics on affective attitudes and the impact of attitudes on behavioral intentions. Also, multigroup analysis reveals that hedonic features are stronger indicators of customer attitudes among those with a low need for interaction, whereas utilitarian attributes are more important among customers with a low need for risk reduction. Customers’ affective attitudes are stronger influences on behavioral intentions among members of customer groups with a low need for both interaction and risk reduction. Originality/value To add to the limited research in customers’ experience with unstaffed stores, this study provides useful insights to achieve sustainable growth in the retailing context. Managerial considerations suggest that operators of cashierless stores should design store environments to guarantee customers’ purchasing and recommendation intentions.

Knee osteoarthritis prevalently causes significant pain, activity limitations, psychological distress, and reduced quality of life. Despite lower limb strength training being a core treatment for knee osteoarthritis, adherence remains a challenge, prompting the exploration of virtual reality (VR) to improve exercise compliance. Recent research suggests the potential of VR in providing enhanced pain management and functional outcomes for knee osteoarthritis, necessitating further exploration of immersive VR technology. We aimed to study the feasibility, acceptability, and preliminary efficacy of an immersive VR-assisted lower limb strength training for knee osteoarthritis (VRiKnee). A convergent, parallel, mixed methods study was conducted in 30 participants with knee osteoarthritis. After 1:1 randomization, the VRiKnee group (n=15) was assigned to perform repetitive concentric quadriceps and isometric vastus medialis oblique exercise in an immersive environment using a head-mounted display for 12 weeks. The control group (n=15) completed the same exercises without VRiKnee. VRiKnee participants were interviewed at week 12 to study VRiKnee acceptability and user experience. Quantitative data included feasibility outcomes such as recruitment, dropout, and exercise adherence rates, and effectiveness outcomes such as the numeric rating scale, the Western Ontario and McMaster Universities Osteoarthritis Index (100 points) pain and function subscales, and objective physical activity measured by metabolic equivalents of task using an ActivPAL accelerometer. Qualitative data were analyzed by thematic analysis, followed by integration with quantitative data using joint displays. The recruitment rate was 100% (N=30), with enrollment of 30 participants in 7.57 weeks. The median age was 63.5 (IQR 61.8-66.3) years, with 76% (n=23) being female. The response rates were 80% and 93% for the VRiKnee and control groups. Dropout rates were 13% for VRiKnee and 7% for the control group. Median exercise adherence was 77% (IQR 37-104%) for VRiKnee and 62% (IQR 40-166%) for the control group, respectively, with adherence reduction over this study's period and no significant intergroup differences (P=.82). No statistically significant differences were observed in primary and secondary outcomes, though positive trends were observed in pain and stiffness. Cybersickness was reported by 5 (33%) participants in the VRiKnee group. In the qualitative analysis, 4 themes, 11 subthemes, and 16 quotes were generated, identifying facilitators and barriers with practical suggestions to enhance the usability of VRiKnee. VRiKnee demonstrated feasibility, acceptability, and potential efficacy in managing knee osteoarthritis. Future trials of larger sample sizes and better VR designs will confirm its role in clinical practice.

Osteoarthritis is a serious health problem in Thailand. The therapeutic massage is an alternative medicine to increase range of motion of knee joints. This study aimed to examine the effects of therapeutic massage on the range of motion of knee joints among patients with osteoarthritis. The samples were 32 osteoarthritis patients seeking treatment at Khlung Hospital. The samples were purposively selected and given therapeutic massage for three weeks. The study tools used are: 1) questionnaire which consists of two parts: demographic characteristics and a form for range movement of knee joint record; and 2) goniometer where range movements of knee joint before and after receiving therapeutic massage were compared by Paired t-test. The results revealed that after receiving therapeutic massage, average scores of range movement of knee flexion and extension were significantly higher than that before receiving therapeutic massage(t = 7.759 p <.05, t = 7.744 pp <.05 respectively). The findings showed that the therapeutic massage could increase the range movement of knee joints. Therefore, therapeutic massage should be promoted as a complementary medicine among osteoarthritis patients. Keywords - Health Education, therapeutic massage, range movement, osteoarthritis, quasi-experimental design, Thailand

A study was conducted to explore (a) the dimensional structure of perceived behavioural control (PBC), (b) the conceptual basis of perceived difficulty items, and (c) how PBC components and instrumental and affective attitudes, respectively, relate to intention and behaviour. The material stemmed from a two-wave study of Norwegian graduate students (N = 227 for the prediction of intention and N = 110 for the prediction of behaviour). Data were analysed using confirmatory factor analysis (CFA) and multiple regression by the application of structural equation modelling (SEM). CFA suggested that PBC could be conceived of as consisting of three separate but interrelated factors (perceived control, perceived confidence and perceived difficulty), or as two separate but interrelated factors representing self-efficacy (measured by perceived difficulty and perceived confidence or by just perceived confidence) and perceived control. However, the perceived difficulty items also overlapped substantially with affective attitude. Perceived confidence was a strong predictor of exercise intention but not of recycling intention. Perceived control, however, was a strong predictor of recycling intention but not exercise intention. Affective attitudes but not instrumental attitudes were identified as substantial predictors of intentions. The findings suggest that at least under some circumstances it may be inadequate to measure PBC by means of perceived difficulty. One possible consequence may be that the role of PBC as a predictor of intention is somewhat overestimated, whereas the role of (affective) attitude may be similarly underestimated.

This article offers insights into the influence of the tax administrator’s power on individual taxpayers’ cognitive and affective (emotion) attitudes in Malaysia. This article applies a quantitative approach using surveyed questionnaires on professional taxpayers in Malaysia. A structural equation model (SEM) using AMOS is employed in the data analysis. Two relationships are reported as insignificant concerning legitimate foundation power with cognitive capitulation and affective capitulation. The remaining hypothesised relationships are found significant. First, both cognitive resistance and affective resistance attitude are influenced positively by coercive power. Second, both cognitive capitulation and affective capitulation attitudes are influenced positively by persuasive power and reward power. Third, cognitive and affective commitment are influenced negatively by coercive power and positively by the legitimate foundation and reward power. This article argues that the tax administrator’s power influences both cognitive attitude and emotion, which means a comparable effect was found on cognitive and affective attitudes. However, harsh power through enforcement has a greater influence on cognitive defiance attitude than negative emotion. Similarly, the influence of coercive power (negatively), legitimate foundation and reward power is seen more on cognitive deference attitude than their influence on taxpayers’ deference emotion. In contrast, using the soft power of persuasive and reward power has more effect on taxpayers’ deference emotions than cognitive deference. The results suggest that tax administrators implement a targeted approach in their compliance strategies depending on taxpayers’ attitudes. This targeted approach could yield the highest compliance level using the minimum resources possible. Keywords: Power; tax attitude; cognitive attitude; affective attitude; emotion

Extended abstract Abstract The aim of this research was to investigate the effect of security awareness on compliance with security regulations by teleworkers during the epidemic of COVID-19 using the Health Belief Model (HBM). Users who experienced teleworking in organizations in Tehran after the outbreak of the disease were selected as the statistical population of this study and 288 people completed the research questionnaire and participated in it. The samples were selected using the available sampling method and then the information and research hypotheses were analyzed using structural equation modeling. The research findings showed that security awareness does not directly affect the compliance with security regulations in organizations by teleworking personnel, but it affects their privacy concerns and security expectations, and these two elements can lead them to more adhering to security regulations and policies of organizations. Introduction Covid-19 pandemic is considered to be the most important global health disaster of the century and is the greatest challenge facing humanity since World War II. In fact, the corona outbreak is an example of a widespread crisis; A crisis in which events or their sequences occur on a large scale and are of astonishing speed, leading to a high degree of uncertainty that exacerbates irregularities. It creates a feeling of lack of control and causes emotional disturbance in people. This study attempts to examine the issue of security awareness and compliance with security regulations by employees, using the health belief model. Hochbaum (1958) developed the health belief model to study the behavior of individuals in health research. Based on what has been stated, the purpose of this study is to investigate whether users involved in telecworking have security awareness and whether there is a relationship between this security awareness and users' compliance with security regulations. Theoretical framework The health belief model was developed in the 1950s to explain and predict preventive health behaviors. This model identifies the feasibility, benefits, and costs associated with behavior intervention or change based on the four constructs (sensitivity, severity, benefits, and perceived barriers). In the field of information systems, this model can be used to explain the security behavior of users. This study uses the health belief model as the basis of its research model. The model includes constructs of perceived severity, perceived sensitivity, perceived threat, expectations (perceived benefits and barriers), and cues of action. In addition, the proposed model of the present study includes three other structures that do not exist in the health belief model: security awareness, privacy concern, and compliance with security regulations. Methodology The approach of this study to achieve the results is to use a quantitative method with the data collected through a questionnaire and a survey. The questionnaire assesses security awareness, information privacy concerns, self-efficacy, expectations of security measures, security threats, and participants' security behavior. The statistical population of this study consists of people involved in teleworking in Iranian organizations. The questionnaire consists of two parts: general questions (gender, job title, passing security courses in the organization and the level of proficiency in using common IT tools) and specialized questions that are categorized based on the components of the research. Specialized questions consist of four parts; health belief model, privacy concern, security compliance, and security awareness. To test the hypotheses of this study, structural equation modeling and multiple regression analysis were used. Discussion and results According to the results obtained from the test of research hypotheses, it was found that all research hypotheses were confirmed and only hypothesis 9 (the effect of perceived threat on compliance with security regulations) was not approved. These results mean that security awareness has a positive effect on expectations (perceived benefits - perceived barriers), privacy concerns, and perceived threats. These results are consistent with the results of previous studies. In addition, the results showed that the severity and sensitivity perceived by users has a positive effect on the perceived threat by them. These results are consistent with the results of previous studies. Expectations and privacy concerns also have a positive and significant effect on compliance with security regulations. These results are completely consistent with the results obtained in the past. In another part of the research results, it was found that privacy concerns and cues of action have a positive and significant effect on perceived threat. These results are fully consistent with studies conducted other researchers. However, the results of the study indicate that perceived threats to security issues do not have a significant effect on compliance with security regulations. Conclusion In summary, the findings of this study show that the majority of teleworking users are somewhat aware of security issues (especially in the field of social engineering). Although this issue does not directly affect compliance with organizations' security regulations and policies, it does affect expectations, privacy concerns, and perceived threats. Also, expectations and privacy concerns have a positive and significant effect on compliance with security regulations in organizations, but the perceived threat has no significant effect on compliance with these regulations. Based on the above results, the managers of organizations (especially information technology and security managers) can be advised to improve their staff awareness of security issues related to teleworking by holding awareness and training courses in the field of information security. Consequently, in the case of incidents and events (such as the outbreak of Covid-19 pandemic) that inevitably lead to teleworking, they can comply with the organization's security regulations in their organizational activities so as not to compromise the organization's data and information.

The role of sex hormones and inflammation in the causal pathway of high bmi to knee oa the role of sex hormones and inflammation in the causal pathway of high bmi to knee OA

A patient's experience with knee osteoarthritis (OA) is influenced by many psychosocial contributors that can influence the impact of pain. Such factors are known to explain some of the discordance between objective clinical parameters and patient-reported levels of disability and treatment effectiveness. However, few data are available to help clinicians understand the psychosocial factors that apply to the world's many Asian populations. Insights gained from a qualitative study in such a population may support targeted interventions. In this qualitative study involving a group of Asian patients with knee OA in Singapore, we asked: (1) What psychologic factors contribute to patients' experiences, rehabilitation, and recovery? (2) What social factors contribute to patients' experiences, rehabilitation, and recovery? Semistructured interviews eliciting broad patient experiences of managing knee OA were conducted in an urban, referral-based tertiary hospital in central Singapore. Patients were recruited if they met either of the following criteria: Kellgren-Lawrence grade ≥ 3 (minimum of one knee); Knee Injury and Osteoarthritis Outcome Score ≤ 60; or the Pain average (P), interference with Enjoyment of life (E), and interference with General activity (G) (PEG) ≥ 5. All patients had a clinical diagnosis of knee OA, were ambulatory in the community with or without a walking aid, had not undergone partial arthroplasty or TKA, were prescribed nonsurgical treatment, and were conversant in either English or Mandarin. Forty-six patients (30 women and 16 men, mean age 64 years old) were recruited for this study. A thematic analysis with elements of grounded theory and framework analysis was performed using a deductive approach. Psychologic influences specific to patients' behavioral and emotional responses to pain, as well as social factors known to have an impact on the experience of managing knee OA, were identified in the interview transcripts and coded according to established factors from earlier research. An inductive thematic analysis was then applied to the remaining transcripts to identify new themes that emerged from the data. Thematic saturation was attained when study team members agreed data and thematic sufficiency were met in the 46 transcripts. The study team discussed and deemed the 46 transcripts to contain sufficient insights for a reasonably clear understanding of the codes and development of themes to answer the study's research questions. Six main themes related to psychosocial influences on pain emerged. Psychologic factors were "loss of face" because of knee OA, anticipation and avoidance of pain and suffering, and a vicious cycle of negative emotional experiences. The social factors we identified were social and family support, workplace environment and employment uncertainty, and built environment (patients' ability to navigate manmade structures and facilities). Psychosocial factors have an important impact on patients' physical, psychologic, and social functioning. Although several of our findings have been addressed previously, the phenomenon of loss of face and the wide spectrum of social and family support dynamics found in our Asian patients with knee OA were new findings. With loss of face, patients were concerned about how others would view the change in them, including movement changes because of knee OA. They appeared to associate the use of walking canes with major disability, loss of respect, and being discriminated against by others, motivating patients to "save face" by dissociating themselves from those stigmas, even at the cost of mobility and independence. An interplay of complex cultural processes (perceived social roles and contributions to family, desire to avoid burdening family, help-seeking behavior, and the preference for unsolicited social support) underpinned by the value of collectivism impacted the behaviors and choices patients exhibited. With knowledge about the impact of culturally relevant psychosocial factors on the experience and outcomes of patients with knee OA, clinicians will be able to screen and actively explore these factors more effectively. Especially important themes include pain perception (paying close attention to signs of pain catastrophizing and negative affect), presence of chronic illness shame associated with a diagnosis of knee OA (including the stigma associated with using a walking aid), and level of social support received and contributions of a patient's built environment to kinesiophobia. For patients who are still working, the presence of workplace stressors and management of these stressors should also be explored. Where possible, screening tools that measure psychosocial factors such as pain catastrophizing and emotional distress can also be used as an added layer of screening in busy clinical settings.