National Meeting 2007

3043 — Prayer is More Important to Blacks than Whites in Coping with Chronic Osteoarthritis Pain

Jones AC (Center for Health Equity Research and Promotion; Pittsburgh VAHCS) , Kwoh CK (Center for Health Equity Research and Promotion; Pittsburgh VAHCS), Groeneveld PW (Center for Health Equity Research and Promotion; Philadelphia VAMC), Mor MK (Center for Health Equity Research and Promotion; Pittsburgh VAHCS), Geng M (Center for Health Equity Research and Promotion; Pittsburgh VAHCS), Ibrahim SA (Center for Health Equity Research and Promotion; Pittsburgh VAHCS)

Objectives:
Previous studies have shown blacks and whites may differ in their use of conventional, alternative/complementary, and spiritual approaches to the management of chronic pain in hip/knee osteoarthritis (OA). These cultural differences may underlie the observed racial differences in utilization of hip/knee replacement. To better understand these differences, we examined the relationship between race and different coping strategies for the management of pain in hip/knee OA.

Methods:
We performed a cross-sectional survey of 939 veterans (459 blacks, 480 whites) ages 50 to 79 years old with chronic moderate-to-severe knee/hip pain, that is, potential candidates for joint replacement, from VA Primary Care Clinics in Philadelphia and Pittsburgh. Standardized, validated questionnaires were used to obtain information on religiosity, spirituality, pain coping strategies, arthritis self-efficacy (pain and function), use/helpfulness of prayer for OA, OA severity (Western Ontario McMaster Osteoarthritis Index, WOMAC), and patient demographics. Separate multivariable ordinary least squares or logistic regression models were fitted, adjusting for age, income, education, disease severity, mental health subscale of the SF-12, and study site.

Results:
Compared to whites, blacks had higher religiosity scores (ß = 1.24, 95% CI 0.72 to 1.77), higher spirituality scores (ß = 2.42, 95% CI 1.64 to 3.20), and greater use of “praying or hoping” as a coping strategy (ß = 0.74, 95% CI 0.50 to 0.99). Blacks were more likely than whites to perceive prayer as helpful (adjusted OR = 3.38, 95% CI 2.33 to 4.89) and use prayer (adjusted OR = 2.19, 95% 1.50 to 3.03) in the management of OA. In contrast, race was not associated with arthritis pain self efficacy, arthritis function self efficacy, or other coping strategies including use of “diverting attention,” “reinterpreting pain sensations,” “catastrophizing,” “ignoring sensations,” “coping self-statements,” or “increased behavioral activities.”

Implications:
In veterans with hip/knee OA, blacks were more likely than whites to consider prayer as an important coping strategy for chronic pain, whereas there were no racial differences in pain self efficacy, function self efficacy, and other pain coping strategies.

Impacts:
Understanding racial differences in culturally-based disease-coping strategies may help to improve quality of care and reduce health disparities.