Group Education for Rheumatoid Arthritis Patients Erik Taal, Johannes J. Rasker, and Oene Wiegman This article reviews the effectiveness of group education programs in improv- ing the knowledge, behavior, and health status of patients with rheumatoid arthritis (RA) and evaluates to what extent various programs fulfill certain criteria for educational self-management programs. Thirty-one studies are reviewed: in 12, patients with various rheumatic diseases including RA were included, and in 19, only RA patients were studied. Group education increased the knowledge of the participants, which was maintained over long intervals. Beneficial behavioral effects were found in mixed populations but less often found in RA patients. Group education often improved physical health status both in mixed and in RA populations, but seldom led to improved psychosocial health status. In general, the beneficial effects of group education were found more often in mixed populations than in strictly RA patients. Further investiga- tions must examine which mechanisms make educational interventions effec- tive and determine the types of interventions or combinations of interventions that are effective. Effects of group education on health status are almost never maintained over long intervals. More research is needed to develop strategies for maintaining and enhancing early gains from group education. Semin Arthritis Rheum 26:805-816. Copyright © 1997 by W.B. Saunders Com- pany INDEX WORDS: Patient education; rheumatoid arthritis; group methods; literature review. G ROUP METHODS are often used in patient education for rheumatoid arthritis (RA) suf- ferers. We review studies involving group educa- tion for RA patients. Our purposes are to evaluate the effectiveness of the programs in improving knowledge, behavior, and health status and to determine to what extent they meet the standards for educational self-management programs that we have recently proposed (1). A MODEL OF PATIENT EDUCATION IN RHEUMATIC DISEASES Patient education can improve the lives of pa- tients with rheumatic disease (2-4). Arthritis patient education has been shown to be effective in improv- ing knowledge and behavior as well as physical and psychosocial health status. An important focus of arthritis patient education is teaching the knowl- edge and skills necessary to self-manage the conse- quences of the disease on a day-to-day basis. Adequate self-mai~agement is important for RA patients. Treatment for RA is usually a combination of rest, exercises, and medication (5). RA patients must learn to adjust rest, exercise, and medication to the daily, varying phases of disease activity. Patient education can help them adjust their treat- ment regimens and attain the self-management skills necessary for dealing with the consequences of the disease. According to the social learning theory of Ban- dura (6), people's behavior is influenced by their self-efficacy expectations. Self-efficacy expecta- tion refers to beliefs in one's capabilities to success- fully execute the behavior required to produce a certain desired outcome. In a previous paper, we described a self-efficacy approach to arthritis pa- From the Department of Psychology, University of" Twente, and the Department of Rheumatology, Medisch Spectrum Twente, Enschede, The Netherlands. Erik Taal, PhD: Social psychologist, Department of Psychol- ogy, University of Twente; Johannes J. Rasker, MD, PhD: ProfessoJ; Department of Psychology, University of Twente and Rheumatologist, Department of Rheumatology, Medisch Spec- trum Twente; Oene Wiegman, PhD: Psychologist, Professol, Department of Psychology, University of Twente. Address reprint requests to Erik Taal, PhD, Department of Psychology, University of Twente, PO BoA 21Z 7500 AE Enschede, The Netherlands. Copyright © 1997 by W.B. Saunders Company 0049-0172/97/2606-000555. 00/0 Seminars in Arthritis and Rheumatism, Vo126, No 6 (June), 1997: pp 805-816 805