A biopsychosocial approach towards understanding disparities in exercise participation between Hispanic and non-Hispanic White patients living with knee osteoarthritis

Navin Kaushal; Donya Nemati; Eric Kholodovsky; Jacob Jahn; Thomas M Best

doi:10.1016/j.socscimed.2024.117610

A biopsychosocial approach towards understanding disparities in exercise participation between Hispanic and non-Hispanic White patients living with knee osteoarthritis

Soc Sci Med. 2024 Dec 6:366:117610. doi: 10.1016/j.socscimed.2024.117610. Online ahead of print.

Authors

Navin Kaushal¹, Donya Nemati², Eric Kholodovsky³, Jacob Jahn³, Thomas M Best³

Affiliations

¹ Department of Health Sciences, School of Health & Human Sciences, Indiana University, Indianapolis, IN, USA. Electronic address: nkaushal@iu.edu.
² College of Nursing, The Ohio State University, Columbus, Ohio, USA; Kirwan Institute for the Study of Race and Ethnicity, Columbus, Ohio, USA.
³ Miller School of Medicine, University of Miami, Miami, USA.

PMID: 39708444
DOI: 10.1016/j.socscimed.2024.117610

Abstract

Engaging in regular exercise is essential for managing knee osteoarthritis (KOA) symptoms. Despite the established findings, sustained exercise adoption remains a challenge for KOA patients, with notable disparities among Hispanic patients, warranting a need to identify determinants that explain the racial discrepancy in exercise participation. The purpose of this study was to employ a biopsychosocial model to identify determinants of exercise participation and highlight racial disparities. Patients (n = 163) from a university hospital clinic were medically examined to be considered eligible for the study based on radiographs. Eligible participants completed validated survey measures that assessed exercise participation over the past two weeks, along with measures from biological, psychological and social domains to predict future intention exercise. Structural equation modelling tested hypothesized the paths. Past exercise behavior predicted attitudes, self-efficacy, and future exercise intentions. Pain catastrophizing correlated with exercise participation, but the competing effects of physician and (personal) social support on exercise nullified the significance of pain catastrophizing to exercise participation. Significant ethnicity comparisons found non-Hispanic white patients to have higher education, income, lower BMI, stronger scores on attitudes and self-efficacy, and greater exercise participation time. Non-significant effects between the two ethnicities include intention, physician support, and social support. Designing an intervention that helps foster support from the patient's physician and proximal friends/family members can play a vital role in exercise participation for both ethnicities. Additional focus on developing attitudes and self-efficacy among Hispanics can address some disparities. Further notes on promoting exercise equity using a biopsychosocial approach are provided.

Keywords: Equity; Knee osteoarthritis; Physical activity; Theory.