Patient perspectives on improving osteoarthritis management in urban and rural communities

Figures & data

Table 1 Participant demographics

Characteristic	Urban participants (N=11)	Rural participants (N=9)
Average age (years)	72 (range 67–83)	72 (range 68–81)
Sex	Female 82% (n=9)	Female 78% (n=7)
Education level	High school completed 55% (n=6)	High school completed 11% (n=1)
	College/university completed 45% (n=5)	College/university completed 89% (n=8)
Occupational status	Employed part-time 9% (n=1)	Employed full-time 22% (n=2)
	Retired 91% (n=10)	Retired 78% (n=7)
Current living arrangements	Alone 9% (n=1)	Alone 22% (n=2)
	With spouse/partner 82% (n=9)	With spouse/partner 67% (n=6)
	With other family member 9% (n=1)	With other family member 11% (n=1)
Self-rated assessment of overall health	Excellent 27% (n=3)
	Good 27% (n=3)	Good 56% (n=5)
	Fair 36% (n=4)	Fair 44% (n=4)
	Poor 9% (n=1)
Self-rated assessment of osteoarthritis	Good 9% (n=1)	Good 22% (n=2)
	Fair 18% (n=2)	Fair 56% (n=5)
	Poor 45% (n=5)	Poor 22% (n=2)
	Extremely bad 18% (n=2)
	No response 9% (n=1)
Age (years) of onset of osteoarthritis symptoms	Before age 45 36% (n=4)	Before age 45 34% (n=3)
	Age 45–55 27% (n=3)	Age 45–55 22% (n=2)
	Age 56–65 36% (n=4)	Age 56–65 44% (n=4)
Frequency of joint pain experienced	Weekly 9% (n=1)	Weekly 22% (n=2)
	Daily 55% (n=6)	Daily 56% (n=5)
	Always 36% (n=4)	Always 22% (n=2)

Table 2 Themes resulting from inductive thematic analysis, with examples from urban (U) and rural (R) participants

Themes	Verbatim example [participant ID]
Common themes among urban and rural participants
Community services	I’ve never had anything to do with The Arthritis Society. I read about it and listened to their speeches, but I don’t think it’s for me […]. It doesn’t seem to have the symptoms I have. Arthritis, it comes and goes and does different things. Osteoarthritis is different because your bones wear away. [U7]
	I think for sure they (The Arthritis Society) are lacking, if I don’t even know they are in the area, unless I’ve drawn a complete blank. I think that is super lacking. [R1]
Social networks	Everybody always feels better after they talked to somebody, we always feel kind of supported. I’m not the only one who’s got this pain! [U9]
	My sister was the first one who told me a better get to a doctor because I was limping but I said it doesn’t hurt. But you’re limping! You better get to a doctor. [R8]
Self-directed information seeking	I look at every bulletin board, I read every newspaper, I read every event that’s happening […] but a lot of people aren’t into that. [U8]
	I do my own investigation […] it is best to get your own information. [R4]
Attitudes toward medication	I have medication that I have, but I’m not taking it if I don’t have to […] I have a phobia with medications. If I don’t have to take it, I don’t. [U5]
	One thing I keep asking her (general practitioner) is what damage am I doing to myself with the medications I’m on and I never really get that explained to me. [R4]
Formal support	The doctor has given me a little information. Actually, very little. Basically, her information has been, uhh, you know what, live with it […] But you see to me, that’s a no-good answer. Yeah, I now know, there is something you could do about it. [U2]
	I don’t go in completely complaining about my hands or my fingers too. So I guess they don’t really address it that much. [R1]
Trial and error	I’ve learned to never say no and never say never […] if somebody came along to me and said, hey you know what? This is the greatest, and you know […] why not try it? [U3]
	I don’t know if there is any evidence, but it (strategy) certainly made a difference for me. [R5]
Facilitators of OA management	[…] workshops that were addressing strictly OA, that would be more of a positive step for people like me. A general arthritis workshop, I don’t think works if you have something specific. [U11]
	If people were more aware of how bad it can be, how painful it can be, you know, just like the people who don’t have it […] helpful for them to understand what you are going through. [R2]
Individual contextualization of OA	If you’ve got it, you’ve got it, I don’t think there’s any cure for it period. I think if you’ve got osteoarthritis your bones are wearing away, it doesn’t matter what you’re plastering them with, it’s not going to stop it! [U7]
	I think people who sit back and let it get to them are just going to get worse. I get up and keep working to make sure I’m on the move all the time. [R4]
Unique theme among rural participants
Access to local care	They don’t offer any afterhours clinic […] We are very neglected in that regard up here (rural setting) […] We are very underserviced in many ways. [R1]
	So my arthritis, because I go to a doctor at (urban setting), now I just go once a year […] my information comes from when I see my doctor in (urban setting). [R7]

Abbreviation: OA, osteoarthritis.

Figure S1 Osteoarthritis Screening test.

Note: Affirmative answers indicate the presence of OA.

Abbreviation: OA, osteoarthritis.