Measuring the Value of Program Adaptation: A Comparative Effectiveness Study of the Standard and a Culturally Adapted Version of the Arthritis Self-Help Program



Arthritis remains an important public health problem.


This study aims to determine the effects of an adapted (vs. the original) Arthritis Self-Help Program (ASHP) among older adults. Specifically, this study sought to determine (1) whether the adapted ASHP improved attendance, retention, and adherence with the use of self-management exercises, and (2) if the original ASHP’s beneficial outcomes were maintained following program adaptation.

Patient and Methods

Individuals age ≥60 with self-reported arthritis were recruited from eight New York City senior centers. Participants were assessed at baseline to assess their demographic and clinical status and at 6 and 24 weeks to ascertain study outcomes using validated measures.


Two-hundred-one participants (64 non-Hispanic African Americans, 86 Hispanics, and 51 non-Hispanic Whites) enrolled. Participants in the adapted (vs. original) ASHP had better average attendance in the six session program (4.7 vs. 3.2 classes attended, p < 0.01) and program retention (93% vs. 74%, p < 0.01). Adherence with use of the self-management exercises (number of days using endurance, stretching, and relaxation exercises) was similar in both groups. Significant positive physical/psychosocial outcomes were documented in both the adapted and original program.


The adapted ASHP improved program attendance and retention while maintaining improvements in physical and psychosocial functions. These results support future efforts to employ controlled designs to quantify the benefits of adapted evidence-based programs to ensure that adaptation maintains program effectiveness.

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This work was supported by the National Institute of Nursing Research [R21NR010200]; and the National Institute on Aging: An Edward R. Roybal Center Grant [P30AG022845].


Conflict of Interest:

M. Carrington Reid, MD received personal fees from Endo Pharmaceuticals during the study. Emily K. Chen, Samantha J. Parker, Charles R. Henderson Jr., Karl Pillemer, Ph.D., have declared that they have no conflict of interest.

Human/Animal Rights:

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

Informed Consent:

Informed consent was obtained from all patients for being included in the study.

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Corresponding author

Correspondence to M. Carrington Reid MD, PhD.

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Level of Evidence: Therapeutic Study Level II.

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Reid, M.C., Chen, E.K., Parker, S.J. et al. Measuring the Value of Program Adaptation: A Comparative Effectiveness Study of the Standard and a Culturally Adapted Version of the Arthritis Self-Help Program. HSS Jrnl 10, 59–67 (2014).

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  • arthritis
  • self-management
  • health promotion