State Public Health Approaches to Addressing Arthritis

More than 58 million adults in the United States have arthritis, a leading cause of work-related disability. Many adults with arthritis have moderate or severe joint pain and approximately 44% of adults with arthritis report limitations, which can include trouble doing daily activities, attributable to arthritis. Arthritis can affect anyone, but some groups are more affected than others. Recent research found that arthritis prevalence increased with increasing age, body mass index, and physical inactivity. Further, arthritis and arthritis-attributable activity limitations are most prevalent among adults with worse physical and mental health profiles and greater social disadvantage.
One in 3 adults with arthritis is inactive and only 11% have taken part in an educational program or course to manage their arthritis. Though research shows that primary care providers are recommending physical activity to patients with arthritis 58% percent of the time, there is room for increasing counseling among providers further, improving the quality of the counseling itself, and increasing referrals to proven interventions. Currently, 65.5% of primary care providers do not recommend arthritis appropriate evidence based interventions (AAEBIs) for patients with arthritis; the most common reported barrier is that the provider was not aware of these specific interventions.

People with arthritis face barriers to physical activity such as fear of worsening arthritis pain and progression. These barriers can be effectively addressed through education and training to support physical activity counseling by providers, including physical activity assessments. Arthritis can be better managed, and symptoms improved through routine appropriate physical activity and participation in self-management education programs. Low-cost AAEBIs proven to decrease arthritis pain and disability and/or improve quality of life are available in geographic pockets across the US but are still underused by people who can benefit from them. Lack of awareness about AAEBIs, their benefits, and how to access them remain a challenge and a barrier to participation in these programs. Lack of widespread availability in local communities is a barrier against providers recommending these programs and participation in them. Increasing AAEBI offerings, with greater geographic dispersion and greater promotion, may increase participation. Providing health care providers and other health professionals with education and training to increase their awareness about the effectiveness of physical activity assessment and counseling, the benefits of AAEBIs and ways patients can access them, and how to partner with AAEBI providers to establish a patient referral pathway can increase physical activity and improve arthritis management, ultimately improving health outcomes among adults with arthritis.

The purpose of this notice of funding opportunity (NOFO) is to support dissemination of arthritis appropriate evidence based interventions (AAEBIs) and implementation of referral pathways to increase AAEBI access and participation, increase the proportion of adults with arthritis who get counseling for physical activity, reduce health disparities, and improve health outcomes for adults with arthritis. NOFO activities will be accomplished through collaboration with key stakeholders, national and state initiatives, and CDC funded programs in ways that support cross-referrals between interventions and help sustain activities beyond grant funding. AAEBIs and physical activity counseling, including physical activity assessments, will be available and accessible to people with arthritis who are disproportionately affected by arthritis, including, but not limited to high burden and underserved populations and communities. Lack of AAEBI availability and/or accessibility for disproportionately affected populations can exacerbate health disparities. The NOFO will address health disparities by making AAEBIs available to people disproportionately affected by arthritis, including, but not limited to, high burden and underserved populations and communities such as veterans, uninsured/underinsured adults or Medicaid beneficiaries; adults living in rural or frontier areas or other areas lacking health services or AAEBIs; adults with arthritis-attributable work or activity limitations, severe joint pain, disabilities or moderate to serious psychological distress; and adults from racial and ethnic groups with high arthritis prevalence or burden, e.g. American Indian, Alaska Native, African-American or Hispanic/ Latino populations.

The NOFO will fund two Components. Component A will focus on capacity and infrastructure building to support AAEBI dissemination and raising awareness about physical activity counseling and AAEBIs among healthcare providers. Component B will support expansion and scaling up efforts, including expanding referral pathways and systems changes for AAEBI dissemination and implementation and physical activity assessment, counseling and referral to AAEBIs for arthritis management by health care providers and other health professionals. Component A eligibility is open only to applicants who are not currently funded by CDC’s Arthritis Program's CDC-RFA-DP21-2106 and CDC-RFA-DP18-1803 cooperative agreements in order to increase national capacity and geographic diversity of arthritis activities and impacts. Component B eligibility is unrestricted. CDC anticipates awarding 6-10 awards of $200-300K under Component A, and 5-7 awards of $375-550K under Component B. Average anticipated award for Component A is $250,000 and Component B is $450,000.

Specific outcomes expected by the end of the project period are:

Increased AAEBI enrollment resulting from sustainable strategies;
Increased adults with arthritis who get provider counseling for physical activity;
Reduced disparities in arthritis management and outcomes among adults with arthritis.