Background/Purpose:

Arthritis affects > 1 in 5 American adults, and is the most common cause of disability.  Nearly ½ of people with diabetes or heart disease also have arthritis.  Public health interventions such as community-based physical activity (PA) and self-management education (SME) programs have demonstrated health benefits among people with arthritis, yet availability is limited. State legislation addresses other chronic diseases, yet arthritis receives little attention. The purpose of this qualitative research was to explore state legislators’ attitudes towards arthritis, factors influencing their attention to health issues, and potential legislative actions to increase availability of arthritis-appropriate community PA and SME programs.

Methods:

The National Conference of State Legislatures (NCSL) invited a purposive sample of 20 state legislators and 2 legislative staff to participate in focus groups (FGs) that preceded the NCSL 2013 Legislative Summit.  Selection criteria included: leadership of NCSL’s Health Committee, appointment by presiding officers, or attendance at an arthritis education session at the 2012 Legislative Summit.  2 FGs were held; group assignment balanced Democrats and Republicans, men and women, geographic region, and previous education session attendance.

 Each FG was conducted by an experienced moderator using a structured guide.  The two moderators coded each FG transcript independently and met to identify key findings.

Results:

16 Legislators and 2 staff participated (82% response rate). The legislators were: 56% Democrat, 38% Republican, and <1% Independent.  Legislators were both interested in and surprised by the national and state level arthritis statistics, but not compelled to take action (i.e. legislation, health benefit design).  Participants identified perceived seriousness (particularly mortality) and belief that state action would save money as key factors influencing their health action decisions.  Participants reported that advocacy groups could influence their thinking on health issues; yet few participants recalled any contact with arthritis advocates.

Arthritis was not perceived as a serious health issue warranting state legislator attention.  Participants believed the most effective way to address arthritis was to include it with higher priority health conditions (e.g., heart disease, diabetes).

Participants were unaware of evidence-based PA or SME programs offered in the community, and had trouble distinguishing them from clinical interventions.  There was no support for including these interventions in state-covered Medicaid benefits, but some support for including them in state employee benefit packages.

Conclusion:

Arthritis is an invisible problem to state legislators; they are unaware of arthritis statistics and have not been contacted by arthritis advocates.  Arthritis alone is not compelling enough to motivate legislator action.   Attention to arthritis could be increased by educating state legislators on the role arthritis plays in complicating management of other chronic diseases, developing promising policy options, and addressing arthritis within the context of other chronic diseases.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/what-do-state-legislators-think-about-arthritis-results-of-focus-groups-with-state-legislators/