Effectiveness of a patient educational program on rheumatoid arthritis disease activity

Abstract

Objectives To validate Arabic version of rheumatoid arthritis disease-specific patient's knowledge and attitude questionnaire (PKAQ-RA) and to assess the effect of health education on RA disease activity. Background RA is a disease requiring a change in patient's behavior, and hence preventing disability. Patients and methods A quasi-experimental pretest and posttest interventional study was conducted on 403 patients with RA. An equal number of matched controls were recruited. Patient's knowledge questionnaire on RA and authors' designed attitude questionnaire (PKAQ-RA) were delivered. All patients were assessed regarding disease duration and disease activity score 28. Laboratory investigations including fibrinogen, albumin, rheumatoid factor titer, and anti-cyclic citrullinated peptide antibodies in addition to gray-scale ultrasonography were conducted. Results Patients with RA (n = 403) had significantly higher laboratory investigation values than healthy controls (n = 403). Cronbach's alpha of the Arabic version of PKAQ-RA was 0.75 and 0.82, respectively. The total knowledge and attitude scores were significantly higher in posthealth than prehealth education implementation period (13.11 ± 1.93, R: 9–19 and 5.79 ± 1.44 vs. 15.18 ± 1.91 and 7.78 ± 1.50, respectively) (P < 0.001). Unsatisfactory knowledge was associated with male patients [odds ratio (OR)=2.02, 95% confidence interval (CI): 1.19–3.43], being of low education (OR = 2.03, 95% CI: 1.29–3.19), and having increased medications (OR = 2.03, 95% CI: 1.29–3.19). Negative attitude was associated with low education (OR = 3.15, 95% CI: 1.97–5.02) and increased number of medications (OR = 0.18, 95% CI: 0.10–0.34). Patients showed some improvement but still significantly different from controls. Biomarkers like albumin/fibrinogen ratio were significantly increased, whereas grayscale ultrasonography was significantly decreased after health education in active and inactive groups (P < 0.001). Conclusion The Arabic version of the PKAQ-RA was created and proved to be a reliable and valid tool. Patients' knowledge of RA was poor. RA disease activity got improved when upgrading patients' knowledge and modifying their attitude. Integration of patient-directed education programs in the treatment of RA to raise the patients' awareness, increase compliance, and improve the disease condition is required.