Examining whether the information-motivation-behavioral skills model predicts medication adherence for patients with a rare disease.

The information-motivation-behavioral skills (IMB) model has been used to explain and promote medication adherence among patients with diabetes and HIV. The objective of this study was to examine whether the IMB model predicted medication adherence among vasculitis patients. Adult vasculitis patients (n=228) completed online questionnaires at baseline and 3-month follow-up. Linear regressions were calculated to determine the direct effects of information and motivation on medication adherence (P<0.05). A mediation analysis using a bootstrapping approach was used to test whether behavioral skills significantly mediated the effect of information and motivation on medication adherence. Participants reported high levels of information (M=4.0; standard deviation [SD]=0.68), moderate levels of motivation (M=2.7; SD=1.00), and high levels of behavioral skills (M=4.1; SD=0.74). In the regression model, only behavioral skills (B=0.38; P<0.001) were significantly associated with medication adherence; however, mediation analysis revealed that behavioral skills significantly mediated the effects of information and motivation on medication adherence. The results support the IMB-hypothesized relationships between information, motivation, behavioral skills, and medication adherence in our sample. Findings suggest that providers should work with vasculitis patients to increase their medication-related skills to improve medication adherence.

Hope Matters: Developing and Validating a Measure of Future Expectations Among Young Women in a High HIV Prevalence Setting in Rural South Africa (HPTN 068).

Hope is a future expectancy characterized by an individual's perception that a desirable future outcome can be achieved. Though scales exist to measure hope, they may have limited relevance in low resource, high HIV prevalence settings. We developed and validated a hope scale among young women living in rural South Africa. We conducted formative interviews to identify the key elements of hope. Using items developed from these interviews, we administered the hope scale to 2533 young women enrolled in an HIV-prevention trial. Women endorsed scale items highly and the scale proved to be unidimensional in the sample. Hope scores were significantly correlated with hypothesized psycholosocial correlates with the exception of life stressors. Overall, our hope measure was found to have excellent reliability and to show encouraging preliminary indications of validity in this population. This study presents a promising measure to assess hope among young women in South Africa.

Medication-related Self-management Behaviors among Arthritis Patients: Does Attentional Coping Style Matter?

OBJECTIVE: The aim of this study was to investigate the relationship between the attentional coping styles (monitoring and blunting) of rheumatoid arthritis (RA) and osteoarthritis (OA) patients and: (a) receipt of medication information; (b) receipt of conflicting medication information; (c) ambiguity aversion; (d) medication-related discussions with doctors and spouse/partners; and (e) medication adherence. METHOD: A sample of 328 adults with a self-reported diagnosis of arthritis (RA n=159; OA n=149) completed an Internet-based survey. Coping style was assessed using the validated short version of the Miller Behavioral Style Scale. Measures related to aspects of medication information receipt and discussion and validated measures of ambiguity aversion and medication adherence (Vasculitis Self-Management Survey) were collected. Pearson correlation coefficients, ANOVA, independent samples t-tests and multiple regression models were used to assess associations between coping style and the other variables of interest. RESULTS: Arthritis patients in our sample were more likely to be high monitors (50%) than high blunters (36%). Among RA patients, increased information-receipt was significantly associated with decreased monitoring (b = -1.06, p = .001). Among OA patients, increased information-receipt was significantly associated with increased blunting (b = .60, p = .02). CONCLUSION: In our sample of patients with arthritis, attentional coping style is not in accordance with the characteristic patterns outlined in the acute and chronic disease coping literature.

Measuring Concurrency Attitudes: Development and Validation of a Vignette-Based Scale.

BACKGROUND: Concurrent sexual partnerships (partnerships that overlap in time) may contribute to higher rates of HIV transmission in African Americans. Attitudes toward a behavior constitute an important component of most models of health-related behavior and behavioral change. We have developed a scale, employing realistic vignettes that appear to reliably measure attitudes about concurrency in young African American adults. METHODS: Vignette-based items to assess attitudes about concurrency were developed following focus groups and cognitive testing of items adapted from existing scales assessing psychosocial constructs surrounding related sexual behaviors. The new items were included in a telephone survey of African American adults (18-34 years old) in Eastern North Carolina immediately before and after a radio campaign designed to discourage concurrency. We performed an exploratory factor analysis on each sample (pre- and post-campaign) to cross-validate results. We retained factors with a primary loading of ≥0.50 and no secondary loading >0.30. Cronbach's coefficient alpha was used to evaluate internal reliability. Associations in the predicted direction between the mean responses to items on the final factor and known correlates of concurrency validated the scale. RESULTS: Factor analysis in a random pre-campaign subsample yielded a one-factor 6-item scale with acceptable internal consistency (Cronbach's α = 0.79). As expected, the attitude factor was positively associated with participation in concurrent partnerships, whether assessed by self-report (r = 0.298, p<0.0001) or deduced from dates of recent sexual partnerships (r = 0.298, p<0.0001). The factor was also positively associated with alcohol (r = 0.216, p<0.0001) and drug use (r = 0.225, p<0.0001) and negatively associated with increasing age (r = -0.088, p- = 0.02) and female gender (r = -0.232, p<0.0001). Factor analyses repeated in the second random pre-campaign subsample and post-campaign sample confirmed these results. CONCLUSION: A vignette-based scale may be an effective measure of key attitudes related to concurrency and potentially a useful tool to evaluate interventions addressing this network pattern.

Associations Between Patient Characteristics and the Amount of Arthritis Medication Information Patients Receive.

Little is known about factors associated with the receipt of medication information among arthritis patients. This study explores information source receipt and associations between demographic and clinical/patient characteristics and the amount of arthritis medication information patients receive. Adult patients with osteoarthritis (OA) or rheumatoid arthritis (RA; n = 328) completed an online cross-sectional survey. Patients reported demographic and clinical/patient characteristics and the amount of arthritis medication information received from 15 information sources. Bivariate and multivariate linear regression analyses were used to investigate whether those characteristics were associated with the amount of medication information patients received. Arthritis patients received the most information from health professionals, followed by printed materials, media sources, and interpersonal sources. Greater receipt of information was associated with greater medication adherence, taking more medications, greater medication-taking concerns, more satisfaction with doctor medication-related support, and Black compared to White race. RA patients reported receiving more information compared to OA patients, and differences were found between RA patients and OA patients in characteristics associated with more information receipt. In conclusion, arthritis patients received the most medication information from professional sources, and both positive (e.g., greater satisfaction with doctor support) and negative (e.g., more medication-taking concerns) characteristics were associated with receiving more medication information.

The Relationship Between Social Support, Social Constraint, and Psychological Adjustment for Patients with Rare Autoimmune Disease.

Our goals were to describe the balance of social support to negative social interactions (i.e. social constraint) for autoimmune disease patients and determine whether support and constraint from spouses and non-spousal family and friends interact to influence patients' psychological adjustment. Using crosssectional survey data from 109 married vasculitis and lupus patients, we found that patients reported that spouses and family/friends provided more social support than social constraint. In regression models, constraint from spouses (ß= -0.45, p<0.01) and family/friends (ß= -0.89, p<0.001) were associated with worse patient psychological adjustment. A significant 3-way interaction revealed that patients with low spousal support had worse psychological adjustment as the levels of family and friend support increased. In contrast, patients with high levels of spousal support reported better psychological adjustment as family and friend support increased. Future longitudinal studies may help to elucidate the complex interplay between constraint and support from spouses, family, and friends.

Gist and verbatim communication concerning medication risks/benefits.

OBJECTIVES: To describe the information about medication risks/benefits that rheumatologists provide during patient office visits, the gist that patients with rheumatoid arthritis (RA) extract from the information provided, and the relationship between communication and medication satisfaction. METHODS: Data from 169 RA patients were analyzed. Each participant had up to three visits audiotaped. Four RA patients coded the audiotapes using a Gist Coding Scheme and research assistants coded the audiotapes using a Verbatim Coding Scheme. RESULTS: When extracting gist from the information discussed during visits, patient coders distinguished between discussion concerning the possibility of medication side effects versus expression of significant safety concerns. Among patients in the best health, nearly 80% reported being totally satisfied with their medications when the physician communicated the gist that the medication was effective, compared to approximately 50% when this gist was not communicated. CONCLUSION: Study findings underscore the multidimensional nature of medication risk communication and the importance of communication concerning medication effectiveness/need. PRACTICE IMPLICATIONS: Health care providers should ensure that patients understand that medication self-management practices can minimize potential risks. Communicating simple gist messages may increase patient satisfaction, especially messages about benefits for well-managed patients. Optimal communication also requires shared understanding of desired therapeutic outcomes.

The impact of co-morbidity on health-related quality of life in rheumatoid arthritis and osteoarthritis patients.

OBJECTIVES: We investigated whether comorbidities differentially impacted health-related quality of life (HRQOL) for rheumatoid arthritis (RA) and osteoarthritis (OA) patients. METHODS: Adult patients with self-reported doctor-diagnosed RA (n=159) or OA (n=149) were recruited from multiple sources and completed an online cross-sectional survey. Patients self-reported sociodemographic variables, arthritis severity and comorbid conditions. HRQOL was assessed using the SF-12v2 and comorbidity counts were assigned using an expanded Functional Comorbidities Index. HRQOL (8 domain and 2 composite (physical and mental health) scores) was compared with norm-based general US population scores and between RA and OA patients to determine if they significantly differed from one another. Linear regression was used to test whether comorbidity count was associated with the physical and mental health of RA and OA patients. RESULTS: OA and RA patients experienced significantly worse HRQOL across all dimensions compared with that of the general US population. There were no significant differences between RA and OA patients on any HRQOL dimension. A higher comorbidity count was associated with worse physical (p=0.0007) and mental (p=0.0295) health scores when controlling for patient gender, age, education, and arthritis severity. CONCLUSIONS: Arthritis negatively impacted patients' HRQOL. OA patients in our sample perceived their condition as similarly disabling in terms of physical and mental health as RA patients. Arthritis patients with more chronic comorbid conditions may be at particular risk for poor physical and mental health. Providers should discuss management of comorbid conditions with arthritis patients.

Automated Internet-based pain coping skills training to manage osteoarthritis pain: a randomized controlled trial.

Osteoarthritis (OA) places a significant burden on worldwide public health because of the large and growing number of people affected by OA and its associated pain and disability. Pain coping skills training (PCST) is an evidence-based intervention targeting OA pain and disability. To reduce barriers that currently limit access to PCST, we developed an 8-week, automated, Internet-based PCST program called PainCOACH and evaluated its potential efficacy and acceptability in a small-scale, 2-arm randomized controlled feasibility trial. Participants were 113 men and women with clinically confirmed hip or knee OA and associated pain. They were randomized to a group completing PainCOACH or an assessment-only control group. Osteoarthritis pain, pain-related interference with functioning, pain-related anxiety, self-efficacy for pain management, and positive and negative affect were measured before intervention, midway through the intervention, and after intervention. Findings indicated high acceptability and adherence: 91% of participants randomized to complete PainCOACH finished all 8 modules over 8 to 10 weeks. Linear mixed models showed that, after treatment, women who received the PainCOACH intervention reported significantly lower pain than that in women in the control group (Cohen d = 0.33). Intervention effects could not be tested in men because of their low pain and small sample size. Additionally, both men and women demonstrated increases in self-efficacy from baseline to after intervention compared with the control group (d = 0.43). Smaller effects were observed for pain-related anxiety (d = 0.20), pain-related interference with functioning (d = 0.13), negative affect (d = 0.10), and positive affect (d = 0.24). Findings underscore the value of continuing to develop an automated Internet-based approach to disseminate this empirically supported intervention.

Medication risk communication during rheumatology office visits.

OBJECTIVE: We used a multidimensional framework to describe the types of information about medication risks that rheumatologists provide to rheumatoid arthritis (RA) patients during routine office visits. METHODS: We analyzed 1,094 audiotaped rheumatology office visits involving 450 RA patients. Each patient had up to 3 visits audiotaped. In conjunction with each office visit, patients also completed a self-administered questionnaire and interview and the rheumatologists provided ratings of patient health status. RESULTS: The number of medication risks discussed per visit ranged from 0-18, with a mean ± SD of 3.23 ± 2.93. The rheumatologist initiated ∼80% of the medication risk discussions. Approximately one-fourth of the discussions (25.6%) were limited to an assessment of whether or not the patient was experiencing a medication side effect. More risks were discussed during visits when changes to the patient's regimen were discussed than when no changes were discussed (X= 3.93, SD = 3.10 and X = 2.20, SD = 2.34, respectively; P < 0.0001). When medications were being proposed for addition to the patient's regimen, the most frequently discussed risk dimensions were the importance of monitoring (30%), probability (29.8%), things the patient should do to minimize risk (25.5%), and risk severity (21.8%). CONCLUSION: Most discussions of medication risks that we observed were quite limited and often restricted to an assessment of whether the patient was experiencing side effects from their current medications. The amount of information that is optimal and how to tailor information to the preferences and abilities of individual patients remain important areas for future research.

Opt-out HIV testing in prison: informed and voluntary?

HIV testing in prison settings has been identified as an important mechanism to detect cases among high-risk, underserved populations. Several public health organizations recommend that testing across health-care settings, including prisons, be delivered in an opt-out manner. However, implementation of opt-out testing within prisons may pose challenges in delivering testing that is informed and understood to be voluntary. In a large state prison system with a policy of voluntary opt-out HIV testing, we randomly sampled adult prisoners in each of seven intake prisons within two weeks after their opportunity to be HIV tested. We surveyed prisoners' perception of HIV testing as voluntary or mandatory and used multivariable statistical models to identify factors associated with their perception. We also linked survey responses to lab records to determine if prisoners' test status (tested or not) matched their desired and perceived test status. Thirty-eight percent (359/936) perceived testing as voluntary. The perception that testing was mandatory was positively associated with age less than 25 years (adjusted relative risk [aRR]: 1.45, 95% confidence interval [CI]: 1.24, 1.71) and preference that testing be mandatory (aRR: 1.81, 95% CI: 1.41, 2.31) but negatively associated with entry into one of the intake prisons (aRR: 0.41 95% CI: 0.27, 0.63). Eighty-nine percent of prisoners wanted to be tested, 85% were tested according to their wishes, and 82% correctly understood whether or not they were tested. Most prisoners wanted to be HIV tested and were aware that they had been tested, but less than 40% understood testing to be voluntary. Prisoners' understanding of the voluntary nature of testing varied by intake prison and by a few individual-level factors. Testing procedures should ensure that opt-out testing is informed and understood to be voluntary by prisoners and other vulnerable populations.

The relationship between partner information-seeking, information-sharing, and patient medication adherence.

OBJECTIVES: We describe the medication information-seeking behaviors of arthritis patients' partners and explore whether partner medication information-seeking and information-sharing are associated with patient medication adherence. METHODS: Arthritis patients and their partners (n = 87 dyads) completed an on-line questionnaire. Partners indicated how often they obtained medication information from 14 sources, how much they trusted these sources, and whether they shared medication information with the patient. Patients reported their medication adherence. Bivariate associations were calculated to explore the relationships between partner information-seeking, information-sharing, and patient medication adherence. RESULTS: Partners sought little information about the patient's medications. Partners sought more information if the patient's medication regimen was more complex (r = 0.33, p = 0.002). Most partners (∼ 98%) shared medication information with the patient; older partners shared more information with the patient (r = 0.25, p = 0.03). Neither partner information-seeking (r = 0.21, p = 0.06) nor partner information-sharing (r = 0.12, p = 0.31) were significantly associated with patient medication adherence. CONCLUSIONS: Although partners of arthritis patients do not seek large amounts of medication information, the vast majority share this information with the patient. PRACTICE IMPLICATIONS: Involving partners in medical consultations can help them better understand the patient's medications, have questions answered by providers, and engage in more informed discussions with patients about their medications.

Development of the Health Literacy Assessment Scale for Adolescents (HAS-A).

BACKGROUND: Health literacy has been found to be a crucial component of successful communication and navigation in health care. Various tools have been developed to measure health literacy skills, but few have been developed specifically for adolescents, and most require in-person administration. This study sought to develop a self-report health literacy scale for adolescents to assess four key health literacy domains: the ability to obtain, communicate, understand, and process health information. METHODS: We collected data from 272 youth aged 12-19 recruited from a pediatrics clinic (37%) and the community (63%). We administered the Rapid Estimate of Adolescent Literacy in Medicine-Teen, Newest Vital Sign, and three surveys, and used factor analysis to identify scale items. RESULTS: Using multiple health literacy assessments, it was clear that many teens struggle with low health literacy skills. When identifying items that can be used as self-report items in future research, factor analysis identified three subscales; a 5-item communication scale (alpha = 0.77), a 4-item confusion scale (alpha = 0.73), and a 6-item functional health literacy scale (alpha = 0.76). The scales performed reasonably well when compared with validation items. CONCLUSIONS: Self-report items can be used to assess health literacy skills for adolescents when in-person administration is not possible or feasible. Such items will allow for greater study of how health literacy impacts communication in not only health care settings, but for all levels of health communication. The tool will also allow researchers to better understand how adolescent health literacy is related to a variety of health outcomes. Further testing of these scales with different populations is warranted.

New English and Spanish social health measures will facilitate evaluating health determinants.

OBJECTIVE: To develop psychometrically sound, culturally relevant, and linguistically equivalent English and Spanish self-report measures of social health guided by a comprehensive conceptual model and applicable across chronic illnesses. METHODS: The Patient-Reported Outcomes Measurement Information System (PROMIS) Social Health Workgroup implemented a mixed methods approach to evaluate earlier results (v1.0); expand and refine domain definitions and items; translate items into Spanish; and obtain qualitative feedback. Computer-based and paper/pencil questionnaire administration was conducted with a variety of U.S. respondent samples during 2009-2012. Analyses included exploratory factor analysis (EFA), confirmatory factor analysis (CFA), two-parameter logistic item response theory (IRT) modeling, evaluation of differential item functioning (DIF), and evaluation of criterion and construct validity. RESULTS: Qualitative feedback supported the conceptualization of the Social Health domain framework (Social Function and Social Relationships subcomponents). Validation testing participants (n = 2,208 English; n = 644 Spanish) were diverse in terms of gender, age, education, and ethnicity/race. EFA, CFA, and IRT identified 7 unidimensional factors with good model fit. There was no DIF by language, and good evidence of criterion and construct validity. CONCLUSIONS: PROMIS English and Spanish language instruments (v2.0), including computer-adaptive tests and fixed-length short forms, are publicly available for assessment of Social Function (Ability to Participate in Social Roles and Activities, and Satisfaction with Social Roles and Activities) and Social Relationships (Companionship; Emotional, Informational and Instrumental Support; and Social Isolation). Measures of social health will play a key role in applications that use ecologic (or determinants of health) models that emphasize how patients' social environments influence their health.

The role of companionship, esteem, and informational support in explaining physical activity among young women in an online social network intervention.

The primary objective of the current study was to examine the relationship between social support and physical activity within the theory of planned behavior (TPB) theoretical framework. This study used data from the Internet Support for Healthy Associations Promoting Exercise randomized controlled trial. A total of 134 female undergraduate students participated in the study, which included baseline and post measures of perceived social support for physical activity (esteem, informational, and companionship), TPB variables related to physical activity (perceived behavioral control, intention, and attitude), and physical activity behavior. Path analysis revealed a significant indirect relationship between change in companionship support and physical activity mediated by change in intention (.13, p < .01) and a significant direct relationship between change in esteem support and change in physical activity (.26, p = .03). The model explained 27% of the variance in physical activity and 59% of the variance in intention. Overall, change in social support exerted a small to medium amount of influence on change in physical activity in this modified TPB model when controlling for traditional model constructs. Encouraging companionship and esteem support should be considered as a strategy for increasing physical activity in this population.

Composite measures of multi-joint symptoms, but not of radiographic osteoarthritis, are associated with functional outcomes: the Johnston County Osteoarthritis Project.

PURPOSE: To determine associations between multiple joint symptoms and radiographic osteoarthritis (rOA) and functional outcomes. METHOD: Complete cross-sectional data for multi-joint symptoms and radiographs, Health Assessment Questionnaire (HAQ) scores, and gait speed were available for 1307 Johnston County Osteoarthritis Project participants (34% men, 32% African American, mean age 66 years). Factor analysis of symptom scores and radiographic grades for the lumbosacral spine, bilateral hands, knees, and hips provided composite scores. Regression models were used to determine associations between composite scores, HAQ, and gait speed, adjusting for age, body mass index, gender, and race. RESULTS: Five rOA factors were identified: (1) IP/CMC factor (carpometacarpal [CMC] and all interphalangeal [IP] joints); (2) MCP factor (metacarpophalangeal joints 2-5); (3) Knee factor (tibiofemoral and patellofemoral joints); (4) Spine factor (L1/2 to L5/S1); and (5) Symptom factor. After adjustment, only the Symptom composite was significantly associated with HAQ and gait speed; a 1-standard deviation increase in Symptom score was associated with 9 times higher odds of having poorer function on the HAQ (odds ratio 9.32, 95% confidence interval [CI] 6.80, 12.77), and a clinically significant decline in gait speed (0.06 m/s, 95% CI -0.07, -0.05). CONCLUSIONS: A novel Symptom composite score was associated with poorer functional outcomes. IMPLICATIONS FOR REHABILITATION: Osteoarthritis (OA) commonly affects multiple joints and is the most common form of arthritis. Symptomatic assessments, which can be easily executed by rehabilitation practitioners, are more closely related to self-reported and performance-based functional status than are less accessible and more costly radiographs. Symptomatic assessments are likely to be more informative for understanding, treating, and potentially preventing functional limitations than radiographic assessments.

Conflicting medication information: prevalence, sources, and relationship to medication adherence.

Conflicting medication information has been defined as contradictory information about a medication topic from two or more sources. The objective of this study was to determine whether arthritis patients are exposed to conflicting medication information, to document sources of conflicting information, and to explore whether conflicting information is associated with sociodemographic factors, clinical characteristics, and medication adherence. Using an online survey, arthritis patients (N = 328) reported how often they received conflicting information about 12 medication topics as well as sources of conflicting information, demographic/clinical characteristics, and medication adherence. A linear regression model, which controlled for various demographic/clinical factors, determined whether conflicting information was associated with medication adherence. The majority of patients (80.1%) received conflicting information and were most likely to receive conflicting information about medication risks. Physicians, media sources, and the Internet were the most common sources of conflicting information. Less conflicting information (B =-0.13, p < .05), more information source use (B = 0.22, p < .01), and lower perceived regimen complexity (B =-0.17, p < .05) were associated with better medication adherence. In conclusion, conflicting medication information is pervasive, comes from a variety of sources, and may negatively affect patient health outcomes. To potentially decrease exposure to conflicting information, providers should direct patients to high-quality medication information sources.

Patient-rheumatologist communication concerning prescription medications: getting to the gist.

OBJECTIVE: Fuzzy trace theory was used to develop a coding scheme that captures the gist that patients extract from information about medication risks and benefits and to explore the extent to which different patients extract different gist representations from the same information. METHODS: Data were collected from 2003-2007 in a study that included audiotape recording office visits that rheumatoid arthritis (RA) patients had with their rheumatologists. Each patient (n = 365) had up to 3 visits audiotape recorded. The audiotapes were transcribed to facilitate content analysis. Four patients with RA who did not participate in the original study guided development of the coding scheme and used it to code the transcripts. RESULTS: The coding scheme contains 14 gist themes centering on medication effectiveness, need, and safety. There was considerable variation among the gist coders in the specific themes they extracted from individual transcripts. We observed the greatest intercoder agreement for the 4 gist theme variables related to whether the rheumatologist wanted to make changes to the medication regimen. Furthermore, the coders rarely used the "not clear" category to code these 4 variables. In contrast, intercoder agreement for the remaining gist themes, which were designed to capture issues central to the communication of information about medication risks and benefits, was low and the "not clear" category was used more frequently. CONCLUSION: Our study findings suggest that different people exposed to the same information may form different gist representations. Patient-provider communication concerning medication risks and benefits might be enhanced by better understanding the factors that influence the gist extraction process.

Psychometric properties of the foot and ankle outcome score in a community-based study of adults with and without osteoarthritis.

OBJECTIVE: Foot and ankle problems are common in adults, and large observational studies are needed to advance our understanding of the etiology and impact of these conditions. Valid and reliable measures of foot and ankle symptoms and physical function are necessary for this research. This study examined psychometric properties of the Foot and Ankle Outcome Score (FAOS) subscales (pain, other symptoms, activities of daily living [ADL], sport and recreational function [sport/recreation], and foot- and ankle-related quality of life [QOL]) in a large, community-based sample of African American and white men and women ages ≥50 years. METHODS: Johnston County Osteoarthritis Project participants (n = 1,670) completed the 42-item FAOS (mean age 69 years, 68% women, 31% African American, mean body mass index [BMI] 31.5 kg/m(2) ). Internal consistency, test-retest reliability, convergent validity, and structural validity of each subscale were examined for the sample and for subgroups according to race, sex, age, BMI, presence of knee or hip osteoarthritis, and presence of knee, hip, or low back symptoms. RESULTS: For the sample and each subgroup, Cronbach's alpha coefficients ranged from 0.95-0.97 (pain), 0.97-0.98 (ADL), 0.94-0.96 (sport/recreation), 0.89-0.92 (QOL), and 0.72-0.82 (symptoms). Correlation coefficients ranged from 0.24-0.52 for pain and symptoms subscales with foot and ankle symptoms and from 0.30-0.55 for ADL and sport/recreation subscales with the Western Ontario and McMaster Universities Osteoarthritis Index function subscale. Intraclass correlation coefficients for test-retest reliability ranged from 0.63-0.81. Items loaded on a single factor for each subscale except symptoms (2 factors). CONCLUSION: The FAOS exhibited sufficient reliability and validity in this large cohort study.

Social support for physical activity-role of Facebook with and without structured intervention.

Despite their widespread use and extensive technical features, little is known about how to use online social networking sites to increase physical activity. This study aims to examine Facebook engagement among participants in the online social networking arm of a randomized controlled physical activity promotion trial (n = 67). Facebook communications were double coded and analyzed using ATLAS.ti. Regression procedures were used to determine predictors of Facebook use and associations between types of use and changes in perceived social support and physical activity. Changes in perceived social support and physical activity were more strongly associated with participants' individual Facebook use than use of the Facebook intervention group. The way social media sites are used in intervention design could have an impact on their effects. Including existing friends in interventions and using applications that incorporate intervention activities into a more naturalistic use of Facebook may improve the efficacy of future interventions.