Over the past decade results from a series of research studies have contributed to the development and evaluation of the Arthritis Self-Management Program (ASMP), a volunteer-led patient education program for persons with arthritis. To date, these studies have primarily focussed on program effectiveness, process, implementation, and dissemination. In these studies self-efficacy was identified as an important construct contributing to the program's effectiveness, however, the exact relationship between self-efficacy and health outcomes has not been determined. In this dissertation research I investigate the evidence of a causal relationship between self-efficacy and three program outcomes (a decrease in depression, less pain, and a higher self-rating of overall health status), and attempt to determine the nature of that relationship. The research methodology involved the use of structural equation modeling (SEM) with two longitudinal samples, one (n=122) of 1991 ASMP participants in British Columbia, the other (n=189) of 1992 ASMP participants in Ontario. In the analysis self-efficacy was paired separately with depression, pain and perceived health status. The results of the SEM failed to confirm a dominant causal relationship from self-efficacy to depression, or to pain. This may indicate that these variables have a reciprocal or "spiral" relationship or that both sets of variables may be caused by factors not considered in the analysis. The results of the SEM between self-efficacy and perceived health status did, however, show that higher self-rated health status leads to higher self-efficacy at a later time. The data did not show statistical significance for other causal patterns among these variables. The findings suggest that self-efficacy may play a moderator role in the complex relationship involving individuals with arthritis, their behaviors, and health outcomes. As well, the findings have implications for health promotion planning and research in that they reinforce the complex interplay of psychological and behavioral variables (probably influenced by social variables) in programs which attempt to give individuals greater control over their health. The efficacy and effectiveness of the ASMP has been established in previous studies. This study in no way calls these into question. It does, however, suggest that the mechanism by which these effective outcomes are achieved warrants further investigation.

Over the past decade results from a series of research studies have contributed to the development and evaluation of the Arthritis Self-Management Program (ASMP), a volunteer-led patient education program for persons with arthritis. To date, these studies have primarily focussed on program effectiveness, process, implementation, and dissemination. In these studies self-efficacy was identified as an important construct contributing to the program's effectiveness, however, the exact relationship between self-efficacy and health outcomes has not been determined. In this dissertation research I investigate the evidence of a causal relationship between self-efficacy and three program outcomes (a decrease in depression, less pain, and a higher self-rating of overall health status), and attempt to determine the nature of that relationship. The research methodology involved the use of structural equation modeling (SEM) with two longitudinal samples, one (n=122) of 1991 ASMP participants in British Columbia, the other (n=189) of 1992 ASMP participants in Ontario. In the analysis self-efficacy was paired separately with depression, pain and perceived health status. The results of the SEM failed to confirm a dominant causal relationship from self-efficacy to depression, or to pain. This may indicate that these variables have a reciprocal or "spiral" relationship or that both sets of variables may be caused by factors not considered in the analysis. The results of the SEM between self-efficacy and perceived health status did, however, show that higher self-rated health status leads to higher self-efficacy at a later time. The data did not show statistical significance for other causal patterns among these variables. The findings suggest that self-efficacy may play a moderator role in the complex relationship involving individuals with arthritis, their behaviors, and health outcomes. As well, the findings have implications for health promotion planning and research in that they reinforce the complex interplay of psychological and behavioral variables (probably influenced by social variables) in programs which attempt to give individuals greater control over their health. The efficacy and effectiveness of the ASMP has been established in previous studies. This study in no way calls these into question. It does, however, suggest that the mechanism by which these effective outcomes are achieved warrants further investigation. / Graduate and Postdoctoral Studies / Graduate

published_or_final_version / Social Work / Master / Master of Social Work

Two instruments were developed and administered to fifteen female and three male rheumatoid arthritics (mean age 44) previously hospitalized for allergy treatment by ecological methods. The Physical Functioning Ability Scale assessed functional capacity according to common daily activities, and the Rehabilitation Questionnaire surveyed adjustment problems subjects encountered after hospital discharge. ANOVA was performed on the functionality scale comparing dimensions of dependence, pain, and difficulty with categorical activities of mobility, work, and personal care, Significant F values (p(.05) were obtained for interaction and dimensions, but not for categories. Functional independence from human/mechanical assistance was particularly noted. Recommendation for future research concerns replicating this study using a control group of rheumatoid arthritics treated by traditional medical approaches.