Pain Characteristics, Activity Limitation and their Influence on Health-seeking Behaviours of Community-dwelling Older Adults with Osteoarthritis in Nigeria
Joel Olayiwola Faronbi (1) , Dorcas Ayobami Akinlose (1), Bolaji Agboola (2) Chidozie Emmanuel Mbada (3)
1Department of Nursing Science, College of Health Science, Obafemi Awolowo University, Ile-Ife, Nigeria,
2Centre for Distance Learning, Obafemi Awolowo University, Ile-Ife, Nigeria,
3Department of Medical Rehabilitation, College of Health Science, Obafemi Awolowo University, Ile-Ife, Nigeria
Received: 14 Oct 2021; Revised: 18 Nov 2021; Accepted: 26 Nov 2021; Available online: 21 Dec 2021
Background: It is postulated that osteoarthritis (OA) patients' health-seeking behavior depends largely on the disease severity and loss of function. Objective: This study aimed to assess the pain characteristics, activity limitations, and health-seeking behaviors of older adults with OA in Nigeria. Methods: A cross-sectional survey was conducted among 230 purposively selected community-dwelling older adults in a semi-urban setting in Nigeria. Pain characteristics, activity limitations, and health-seeking behavior were assessed by an interviewer using the Chronic Pain Grade Scale, Western Ontario and McMaster Universities Arthritis Index, and Health-Care Seeking Behaviour Questionnaire, respectively. Data were analyzed using descriptive statistics and inferential statistics (chi-square and multiple regression) to predict factors influencing health-seeking behavior, and we set the alpha level at p<0.05. Results: Pain at the knee (73.0%) was the most defining feature of OA, and it was typically severe (59.1%), frequent (51.3%), felt deep in the bone (47.0%), and associated with morning stiffness (27.4%). OA led to severe activity limitation (54.3%), and 51.7% of the respondents had an overall negative health-seeking behavior. Furthermore, activity limitation was significantly associated with religion (p=0.008) and pain severity (p=0.001). Similarly, the age (p=022), sex (p=0.006), marital status (p=0.005), and ethnicity (p=0.018) were significantly associated with health-seeking behavior. In addition, health-seeking behavior was predicted by cost, preference, ethnicity, employment, marital status, and limitation inactivity. Conclusion: OA pain is prevalent among community-dwelling older adults, it imposes a severe limitation on activities of daily living, and sociodemographic factors influenced the health-seeking behaviors of patients with OA.
Keywords: Pain, Health-seeking behaviours, Limitations in Activities, Osteoarthritis, Nigeria
Ann Afr Surg. 2022; 19(1): 41-49
Conflict of interest: None
© 2022 Author. This work is licensed under the Creative Commons Attribution 4.0 International License.
Osteoarthritis (OA) is the most common form of arthritis and the most prevalent musculoskeletal disorder (1) as well as one of the leading causes of pain and disability worldwide (2, 3). Typically, OA is characterized by pain, physical function limitations, impairment, and disability (4-6). The most commonly joint affected by OA is the knee, with a prevalence of 5.39%, followed by the hand (1.95%), and hip (1.61%) (6). The prevalence of OA increases with advancing age (7, 8). Thus, OA is the most common cause of chronic disability in older adults (9), with a consequent reduction in quality of life, constant pain experience, and limitations in the performance of daily tasks (5, 10). Approximately 20% of affected older patients have chronic pain with impairment in activities of daily living and mobility (11), and approximately 58.5% of them experience pain and disability (5). Higher pain perception among older patients with OA (12) seems to be linked with nociception changes, which increase with advancing age (13). Many complex factors influence health-seeking practices (14). Ahmed and Omer (15) reported that adults seek independence, and their health-seeking behavior depends largely on the disease severity and loss of function. Some patients perceive OA as a natural part of aging that is not curable should be tolerated (16). However, some authors opined that many people might ascribe a mystical or biophysical etiology of OA and thus engage in pluralistic health-seeking behavior that involves vacillation among conventional, complementary, and alternative medicine (17-19). Although the literature is substantial on the prevalence, pain, and functional limitations of older persons with OA, the pattern and undercurrents of their health-seeking behaviors are less explored. Thus, the study’s objectives were to assess pain characteristics, activity limitation, and their influence on the health-seeking behavior of older adults with OA.
Materials and Methods
This is a cross-sectional study conducted in Ile-Ife, Nigeria, between March 17, 2020, and May 16, 2020. The sample size comprised 230 purposively selected older adults 60 years and older living with OA. The inclusion criterion was being symptomatic for OA for at least 3 months.Data were collected on a one-on-one basis by one of the authors, using an interviewer-administered questionnaire comprising four sections. The first section explores the demographic information of the respondents. Similarly, the second section assesses pain characteristics using the Chronic Pain Grade Scale (CPGQ) (20). CPGQ is a seven-item instrument designed to evaluate the severity of chronic pain categorized as grades 0 (no pain) to IV (high disability– severely limiting) by summing up the pain intensity and disability subscales. The third section of the questionnaire was adopted from the Western Ontario and McMaster Universities Arthritis Index (WOMAC) to assess activity limitation (21). The WOMAC contains 17 items that measure physical functions, with responses ranging from none to mild, to moderate, and to severe. The score for the section ranges from 0 (minimum) to 51 (maximum). Higher scores on the WOMAC indicate worse functional limitations, whereas lower scores indicate better performance of activities. The fourth section was adopted from the Health-Care Seeking Behaviour Questionnaire (HCSBQ) and assessed the respondents’ health-seeking behavior (22, 23). It contains 11 items on a Likert scale of strongly agree, agrees, disagrees, and strongly disagree (1–4), wherein higher scores indicate positive health-seeking behaviors. In addition, respondents were asked whether they prefer a separate clinic or hospital to be devoted to the older adults, with response options of yes and no. We also asked if respondents consider the cost of purchasing health-care services as an impediment to their HSB, with response options of yes and no.
The study obtained ethical approval from the Human Research Ethics Committee of the Institute of Public Health, Obafemi Awolowo University (IPH/OAU/12/1476). In addition, the researcher also gave a detailed explanation to the respondents with assurance of anonymity and confidentiality, and written informed consent was obtained from the respondents.
Data were analyzed using descriptive statistics of frequency, percentages, and graphs. A test of association between variables was conducted with chi-square, whereas multiple regression was conducted to assess factors that predict health-seeking behavior. Stata version 14 (Stata Corp., College Station, TX, USA) was used for analysis, and alpha level was set at p<0.05.