Media coverage of chronic diseases in the Netherlands

OBJECTIVE

Little is known about the quantity or quality of information on rheumatic diseases provided by the mass media. The aim of this study was to gain insight into the media coverage of rheumatic diseases compared with other chronic diseases in the Netherlands.

MATERIALS AND METHODS

Newspaper articles, magazine articles, and medical television programs that appeared or were broadcast during a 1-year period, and contained information on rheumatic diseases, heart disease, cancer, chronic lung disease, or diabetes mellitus, were selected for content analysis. For each article and program, it was determined whether coverage concentrated on treatment, influence of lifestyle, scientific progress, or disease consequences. It was also determined whether professional experts and patients were featured.

RESULTS

Nine hundred seventeen newspaper articles, 304 magazine articles, and 163 medical programs were found. Most dealt with cancer (43%) and heart disease (37%). The amount of media attention given to each of the five disease categories was found to correspond with mortality but not with prevalence. The contents of the articles and programs differed significantly according to disease topic. The main focus in rheumatic diseases was on patients' experiences, as well as regular and alternative medications. In heart disease and cancer, the main focus was on professional medical viewpoints, operations, and mortality, whereas in chronic lung disease and diabetes it was on treatments in the context of regular medications, scientific progress, and incurability. The influence of lifestyle on the disease process was mentioned most often in connection with diabetes, rheumatic disease, and chronic lung disease.

CONCLUSIONS

The amount of attention a disease category received from the media depended on its fatality rates and not on its prevalence. Heart disease and cancer were portrayed as being more serious than the more lingering diseases. Surprisingly, the proportion of articles and programs that included the influence of lifestyle in their coverage was lowest for cancer and heart disease. More frequent and more accurate coverage of chronic diseases, especially rheumatic diseases, is needed if their image is to be brought into line with their importance for and impact on the community.

Determinants of compliance with medication in patients with rheumatoid arthritis: the importance of self-efficacy expectations

In this study we examine which factors are related to compliance with medication in patients suffering from rheumatoid arthritis (RA).

PATIENTS

persons suffering recently developed, active RA, who cooperated in a randomized study on the effect of patient education. We analyzed the relation between adherence to Sulphasalazine therapy and personal factors, environmental influences, demographic factors, disease-related factors, and barriers to compliance. Moreover, a logistical regression analysis was performed on these factors, considering > or = 80% a high compliance, both with compliance as dependent factor. Only self-efficacy correlated with compliance (r = 0.58; P < 0.001). The logistical regression analysis identified self-efficacy as the only factor determining > or = 80% adherence (P = 0.01). Self-efficacy regarding the use of prescribed medication is related to compliance with this treatment. Further study is needed to determine the test characteristics of self-efficacy as a predictor for compliance with medication.

Fatigue in rheumatoid arthritis: the role of self-efficacy and problematic social support

OBJECTIVE

To examine the relationship of fatigue in people with rheumatoid arthritis (RA) with self-efficacy, positive and problematic aspects of social support, and demographic and disease-related variables.

METHOD

Out-patients with at least 5 yr RA were studied. Fatigue was measured with a visual analogue scale. Other variables included were: positive social support [Social Support List-Interactions (SSL12-I)] and problematic social support; self-efficacy towards coping with RA and towards mobilizing support; health status (Dutch-AIMS2); and laboratory tests: erythrocyte sedimentation rate (ESR), haemoglobin (Hb) and rheumatoid factor (RF); and disease duration.

RESULTS

A total of 229 out-patients were included. Fatigue correlated with all scales of the Dutch-AIMS2: with pain, physical function and affect (P < 0.001). There was no significant correlation with social support, but there was a highly significant correlation of fatigue with problematic social support (P < 0.001). Both forms of self-efficacy correlated strongly with fatigue: patients with high self-efficacy expectations towards coping with RA, and towards mobilizing the social network (P < 0.001), had less fatigue. In the regression analysis to explain the variation in fatigue, only pain, self-efficacy expectations towards coping with RA, and towards asking for help and problematic social support remained significant.

CONCLUSIONS

Fatigue can to a large extent (37%) be explained by pain, self-efficacy towards coping with RA, and towards asking for help and problematic social support. It is known that self-efficacy can be enhanced by self-management courses and it may thus be possible to improve fatigue.

Video game playing and its relations with aggressive and prosocial behaviour

In this study of 278 children from the seventh and eighth grade of five elementary schools in Enschede, The Netherlands, the relationship between the amount of time children spent on playing video games and aggressive as well as prosocial behaviour was investigated. In addition, the relationship between the preference for aggressive video games and aggressive and prosocial behaviour was studied. No significant relationship was found between video game use in general and aggressive behaviour, but a significant negative relationship with prosocial behaviour was supported. However, separate analyses for boys and girls did not reveal this relationship. More consistent results were found for the preference for aggressive video games: children, especially boys, who preferred aggressive video games were more aggressive and showed less prosocial behaviour than those with a low preference for these games. Further analyses showed that children who preferred playing aggressive video games tended to be less intelligent.

A self-report Thompson articular index: what does it measure?

The aim of this study was to investigate the reliability and validity of the self-report Thompson articular index (ThAI) in Dutch patients with rheumatoid arthritis (RA). A rheumatologist assessed the ThAI in 43 patients with RA. Patients completed the self-report ThAI and the AIMS-2 questionnaire to assess physical function, pain, mood and level of tension. Blood samples were taken to measure the erythrocyte sedimentation rate (ESR). After 4 weeks, patients were sent a questionnaire for a repeat assessment of the self-report AI. The test-retest reliability of the self-report ThAI was adequate (ICC=0.83). There was low agreement between ThAI scores from patients and AI scores assessed by the rheumatologist (ICC=0.44). Self-report ThAI scores (mean=230.5) were significantly higher than the rheumatologist's scores (mean=110.8). Levels of agreement between patients and rheumatologist for individual joints were disappointing, ranging from 49% to 74% (Cohen's kappa from -0.02 to 0.48). The rheumatologist's ThAI scores correlated significantly with ESR (r=0.55) and physical function (r=0.44), but not with pain, mood or level of tension. Patients' scores correlated significantly with physical function (r=0.51), pain (r=0.43), and mood (r=0.36) but not with ESR or level of tension. In regression analyses the only significant predictor of the rheumatologist's ThAI scores was ESR, and for patients' scores physical function, thus showing that patients' responses are not confounded by mood or level of tension. In conclusion, the self-report ThAI is a reliable measure, but the validity is questionable because of the non-significant correlation with ESR and the low level of agreement between patients and rheumatologist. The results indicate that self-reported joint involvement is more closely related to physical function than to arthritic activity.

The supply of and demand for informal and professional care for patients with rheumatoid arthritis

The objective of this study is to determine supply of, and demand for, informal care for rheumatoid arthritis (RA) patients and to evaluate the factors that contribute to the amounts of help needed and received from professional and informal care providers at home. Data were collected by questionnaire from 229 RA patients and 174 informal caregivers. Most of the help required is also received, though 24% of the patients did not receive help for one or more tasks. Most help given at home is by informal caregivers. The amount of help needed is related primarily to the patient's physical condition, sex, and self-efficacy expectations towards coping with RA. The amount of help received from informal caregivers is largely explained by the physical condition and the marital status of the patient, the sex of the caregiver, the patient's self-efficacy expectations towards coping with RA, and the age of the patient. The amount of help received from health professionals is related primarily to the marital status and the physical condition of the patient.

Effects of patient education on compliance with basic treatment regimens and health in recent onset active rheumatoid arthritis

OBJECTIVES

To determine the effects of patient education on compliance and on health in patients with active, recent onset rheumatoid arthritis (RA).

METHODS

A randomised, controlled, assessor blinded, one year trial. The experimental group followed an education programme. All patients started on sulphasalazine therapy. Compliance with sulphasalazine was measured by pill counting. Compliance rates with regimens of physical exercise, endurance activities, and energy conservation were measured by questionnaires. Compliance with prescriptions of joint protection was scored using a test for joint protection performance. Health was measured by a Disease Activity Score (function of erythrocyte sedimentation rate, Ritchie score, and number of swollen joints), C reactive protein, Dutch-AIMS scores, and M-HAQ scores, range of motion of shoulder, elbow, and knee joints. Parameters were scored at baseline and after three, six, and 12 months.

RESULTS

Sixty of 65 patients gave informed consent, five of them withdrew from follow up. Compliance with sulphasalazine exceeded 80% with no differences between groups. Compliance with physical exercise (at three months), energy conservation (at three and at 12 months), and joint protection (at three months) improved significantly more in the experimental group. The improvements of health were not different in the groups.

CONCLUSION

Compliance with sulphasalazine among patients with active, recent onset RA is high, whether formal patient education is followed or not. Compliance with physical exercise, energy conservation, and joint protection was increased by patient education. Formal patient education did not improve health status.

Patient education and disease activity: a study among rheumatoid arthritis patients

OBJECTIVE

To determine whether patients experiencing high disease activity derive more benefit from patient education than those experiencing low disease activity.

METHODS

Data from a randomized study on the effects of a program of patient education were analyzed retrospectively. Four subgroups were studied: the high disease activity subgroup of patients who had participated in the educational program, the complementary low disease activity subgroup, the high disease activity subgroup of controls, and its low disease activity complement. Patients with erythrocyte sedimentation rate > 28 mm/first hour were classified as having high disease activity. Effects on frequency of physical exercises, endurance exercises, and relaxation exercises and effects on health status (Modified Health Assessment Questionnaire, Dutch Arthritis Impact Measurement Scales [AIMS]) were measured.

RESULTS

There were no significant differences between the adherence parameters of the various pairs of groups. Four months after the educational program began, anxiety and depression scores on the Dutch-AIMS had increased among participating patients who were experiencing high disease activity and decreased among those who were experiencing low disease activity.

CONCLUSIONS

Patients experiencing high disease activity did not derive more benefit from patient education than those experiencing low disease activity. On the contrary, an increase of anxiety and depression is found in these patients. Further study is needed to confirm our findings.

Coordinated individual education with an arthritis passport for patients with rheumatoid arthritis

OBJECTIVE

To evaluate the effects of a program for individual education in combination with the use of an arthritis passport.

METHODS

We studied 3 groups of patients with rheumatoid arthritis. The first experimental group received educational materials and followed the program under the guidance of their regular providers of health care whose activities were coordinated through arthritis passports. The second experimental group only received education materials; the control group received only usual care.

RESULTS

There were no effects on self-efficacy expectations, knowledge, health status, or behavior in either experimental group. Opinions of general practitioners, physiotherapists, and visiting nurses concerning the arthritis passport were very positive, but rheumatologists' opinions were not. Opinions on coordination of care were more positive among the physiotherapists of the experimental group.

CONCLUSIONS

Individual education for patients with rheumatoid arthritis by health care providers during routine consultations, as implemented in this program, had no effect on self-efficacy expectations, knowledge, health status, or health behavior. Likewise, the distribution of educational materials by itself without the involvement of health care providers had no effect. The use of the arthritis passport improved coordination of care, especially for physiotherapists.

Group education for rheumatoid arthritis patients

This article reviews the effectiveness of group education programs in improving the knowledge, behavior, and health status of patients with rheumatoid arthritis (RA) and evaluates to what extent various programs fulfill certain criteria for educational self-management programs. Thirty-one studies are reviewed: in 12, patients with various rheumatic diseases including RA were included, and in 19, only RA patients were studied. Group education increased the knowledge of the participants, which was maintained over long intervals. Beneficial behavioral effects were found in mixed populations but less often found in RA patients. Group education often improved physical health status both in mixed and in RA populations, but seldom led to improved psychosocial health status. In general, the beneficial effects of group education were found more often in mixed populations than in strictly RA patients. Further investigations must examine which mechanisms make educational interventions effective and determine the types of interventions or combinations of interventions that are effective. Effects of group education on health status are almost never maintained over long intervals. More research is needed to develop strategies for maintaining and enhancing early gains from group education.

Compliance in rheumatoid arthritis and the role of formal patient education

OBJECTIVE

This study was performed to determine the compliance with the basic treatments for rheumatoid arthritis (RA; medication, physical therapy, and ergonomic measures), to study psychological factors that influence compliance in light of the social learning theory, to learn whether patient education positively influences compliance and health, and to find an approach to patient education that improves compliance.

METHODS

A MEDLINE search of the English language literature was performed.

RESULTS

Few studies have dealt with compliance in RA patients; levels of adherence are generally low. According to the social learning theory, human function involves a continuous interaction between behavior, personal factors, and external environment. Self-efficacy is a personal factor that refers to the belief in one's capabilities and opportunities for being compliant with treatment advice. Patient education may improve ergonomic performance and compliance with physical exercise programs.

CONCLUSIONS

Compliance with medication was infrequently studied. Whether improved compliance leads to better health status could not be determined. Compliance with RA treatments are generally low. Systematic study of the effect of patient education on treatment and health is warranted. Self-efficacy enhancing techniques in patient education may improve compliance.

Evaluation of a Dutch version of the AIMS2 for patients with rheumatoid arthritis

DUTCH-AIMS2, a Dutch version of AIMS2 and successor to DUTCH-AIMS, is an instrument to assess health status among patients with rheumatic diseases. It provides measurements of 12 areas of health status on scales for health status proper, satisfaction, attribution and arthritis impact. We assessed the reliability of its scales in terms of internal consistency and their validity according to both internal standards and external standards. Correctly completed questionnaires were returned by 231 RA patients and 131 controls. Internal consistency coefficients for the health status scales ranged from 0.66 and 0.89, but most exceeded 0.80. Within-scale factor analyses produced single factors in all composite health status scales for both patients and controls, with only two exceptions. Factor analysis also identified a physical, social and psychological dimension among 11 areas of health. External validity was established by strong correlations between DUTCH-AIMS2 health status scales and functional class, laboratory parameters, and self-assessments of fatigue, loneliness, pain, functional disability and social support. DUTCH-AIMS2 is acceptably reliable and valid for use in a variety of settings.

Perception of nuclear energy and coal in France and The Netherlands

This study focuses on the perception of large scale application of nuclear energy and coal in the Netherlands and France. The application of these energy-sources and the risks and benefits are judged differently by various group in society. In Europe, France has the highest density of nuclear power plants and the Netherlands has one of the lowest. In both countries scientists and social scientists completed a questionnaire assessing the perception of the large scale application of both energy sources. Furthermore, a number of variables relating to the socio cultural and political circumstances were measured. The results indicate that the French had a higher risk perception and a more negative attitude toward nuclear power than the Dutch. But they also assess the benefits of the use of nuclear power to be higher. Explanations for these differences are discussed.

Group education for patients with rheumatoid arthritis

Patients with rheumatoid arthritis must learn to adjust their exercise, rest and medication to the varying activity of the disease. Patient education can help patients in making the right decisions about adjustments in their treatment regimen and in attaining "self-management" behaviors. We developed a group education program based on social learning theory and the 'Arthritis Self-Management Course' developed in the USA by Lorig. Goal of the program is the strengthening of self-efficacy, outcome expectations and self-management behaviors of RA patients which may lead to better health status. The program has been evaluated in an experimental design. We established significant positive effects of the group training on functional disability, joint tenderness, practice of relaxation and physical exercises, self-management behavior, outcome expectations, self-efficacy function and knowledge. After 14 months we still found effects on practice of physical exercises, self-efficacy function and knowledge.

Health status, adherence with health recommendations, self-efficacy and social support in patients with rheumatoid arthritis

A study was performed in 86 patients with rheumatoid arthritis (RA) to assess their health problems, the problems they experience in adhering to health recommendations and the relationships of these problems with self-efficacy and social support. Feeling dependent, disability and pain were the most important health related problems. The results showed self-efficacy to be related to the subjective experience of health status as measured by DUTCH-AIMS. Social emotional support was not related to health status, and contrary to what we expected social instrumental support was positively related to health status. The majority of the patients (55%) experienced adherence problems with health recommendations. These problems were not related to functional incapacity, pain or other aspects of health status but to the patient's self-efficacy expectations about coping with arthritis. Our conclusion is that to improve the self-management of disability and pain and adherence to health recommendations, patient education should be aimed at strengthening self-efficacy expectations in which social emotional support might be a motivating factor.

A longitudinal study of the effects of television viewing on aggressive and prosocial behaviours

A longitudinal study investigated the extent to which children's exposure to aggressive and prosocial television models in drama programmes influences their aggressive and prosocial behaviour. In The Netherlands we did not find significant positive correlations between prosocial behaviour and the viewing of prosocial behaviour on television. Positive correlations were found, however, between aggression and television violence viewing. This relationship disappeared almost completely when corrections for the starting level of aggression and intelligence were applied. The hypothesis, formulated on the basis of social learning theory, that television violence viewing leads to aggressive behaviour could not be supported. Our findings are further discussed and compared with the results found in the other countries participating in the international study.

The development of reactions of the public to warning and emergency situations in France, Greece, and the Netherlands

This article describes the different reactions to emergency warning messages among residents living within a 3-km radius of a hazardous chemical complex and by people living at least 10 km from an industrial site in France, Greece, and the Netherlands. Belief in warning, primary and secondary appraisal, emotional response, and adherence to normal routine were assessed by conducting face-to-face interviews in which a four-phase scenario simulating a credible industrial accident was presented. The results showed that respondents who did not reside in the neighborhood of the hazardous site were, in general, more inclined to trust the warning messages than respondents who resided in the neighborhood were. With the exception of primary appraisal, the warning phases evoked very distinct reactions in the respondents from all three countries with regard to warning belief, secondary appraisal, emotional response, and adherence to normal routine.

Evaluation of the Dutch Arthritis Impact Measurement Scales (DUTCH-AIMS) in patients with rheumatoid arthritis

The Arthritis Impact Measurement Scales (AIMS) have been used to measure health status in patients with rheumatic diseases in North America. In this study, a Dutch version of this self-assessment questionnaire named the DUTCH-AIMS was evaluated in 73 Dutch patients with rheumatoid arthritis. Significant correlations between scores from the DUTCH-AIMS on the one hand and ARA functional class, haemoglobin, erythrocyte sedimentation rate, self-assessments of functional impairment and perceived overall health on the other hand indicate that the scales are valid and provide good estimations of various components of the health status of the Dutch arthritic patient.

Previous experiences with epilepsy and effectiveness of information to change public perception of epilepsy

Differences with regard to the effectiveness of health information and attitude change are suggested between people with direct, behavioral experiences with a health topic and people with indirect, nonbehavioral experiences. The effects of three different methods of health education about epilepsy, frequently used in health education practice, are assessed in a pretest posttest design with control groups, controlling for experiences with epilepsy. Subjects were 132 students from teacher-training colleges. After all treatments, attitudes, and knowledge about epilepsy were changed in a positive way. Treatments were found to be equally effective. Before treatment, direct behavioral experiences were related to knowledge and a more positive attitude towards epilepsy. After treatment, subjects with direct behavioral experiences with epilepsy showed less change of attitude and knowledge as compared with subjects with indirect experiences. Direct experiences appear to restrain the processing of new information and attitude change.