Abstract
Objective:
Research indicates that social support may promote physical activity; however, most Latinas with osteoarthritis (OA) are not sufficiently active. This qualitative dyadic study explored how Latinas with OA and a self-selected physical activity “supporter” motivate each other to be more active. Furthermore, perceptions of how OA symptoms impact support and physical activity were examined.
Methods:
Semi-structured dyadic interviews were conducted with Latinas with OA and a member of their social network ≥ 16 years old who supports their physical activity (N=14 dyads). We used framework analysis to reduce qualitative data to themes and subthemes.
Results:
Daughters (n=5), spouses (n=4), sons (n=2), a granddaughter (n=1), nephew (n=1), and friend (n=1) provided support for the target behavior. In many cases, dyads said the motivation to engage in physical activity was reciprocated rather than focused solely on Latinas with OA. Support was often reciprocated by a) engaging in physical activity together, b) using pressure, c) talking about being active, d) modeling physical activity, and e) helping with household responsibilities. Although participants agreed that physical activity was beneficial and Latinas desired additional support when experiencing OA symptoms, there was concern about the safety of activity in the presence of symptoms. Several adult daughters indicated that their mothers’ OA symptoms motivated their physical activity.
Conclusion:
Dyadic strategies for promoting physical activity among Latinas with OA and how support may be reciprocated were identified.
More than one in five adult Latinos in the United States (US) has osteoarthritis (OA) (1). Latinos with arthritis have higher odds of severe joint pain (1.9 times higher), functional limitations (1.3 times higher), and work limitations (1.6 times higher) than non-Latino whites (2, 3). OA symptoms are made worse with physical inactivity (4). Unfortunately, among individuals with OA, Latinos are less likely to report engaging in any exercise (50%) than non-Latino Whites (65%) (5).
Social influences may directly or indirectly affect physical activity (6). Direct influences occur when resources are shared to enable physical activity (7) and by offering physical activity companionship (7, 8). Indirect influences occur when social modeling (9) or social control (e.g., pressure to exercise) (10) promote self-efficacy, when others’ (in) activity creates physical activity norms (11), and when social support motivates self-regulation (12). Finally, the Social Cognitive Theory posits that behaviors, individual factors (e.g., cognitions), and environmental factors (e.g., social influences) determine one another (13). For example, dyadic analyses among couples showed a bi-directional association between self-efficacy and social support provided by one’s partner (14).
Traditional Latino culture emphasizes interdependence and reliance on others to regulate behaviors (15). Interdependence may be especially crucial to the promotion of physical activity among Latinas who often rely on social support and companionship to engage in physical activity (16–18). In a physical activity intervention with 266 Latinas, a greater increase in physical activity was found among women who were active with others versus alone (8). Qualitative research shows that expectations for social support from one’s social network are strong, especially among Latinas with arthritis (19, 20). One of the few studies examining the social support of Latinas/os with arthritis and other rheumatic diseases found that 87% of participants reported receiving social support to cope with their symptoms (21). However, these few studies of social support for Latinas largely focus on general social support to cope with arthritis pain (20–22) and the psychological well-being gained from receiving support (19, 23). What is unknown is how others influence the physical activity of Latinas with OA. Understanding the perceived social influences on Latinas’ physical activity is imperative given the interpersonal nature of Latino culture (15) and the general insufficiency of physical activity among Latinas with OA (24). Thus, the purpose of this study was to explore the social influences of physical activity between Latinas with OA and a supporter of their physical activity.
Methods
We conducted semi-structured, dyadic interviews in the preferred language of participants (English or Spanish), which were digitally recorded, transcribed verbatim, and coded in their original language. Quotes used in the presentation of the results were translated to English when necessary. All procedures were approved by the University of North Carolina’s (UNC) Institutional Review Board in accordance with their ethical standards and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written informed consent was obtained by all participants prior to data collection.
Participants and sampling
Our research team used purposive sampling (25) to recruit participants who met predefined criteria: Latinas with OA of the knee/hip and a supporter of their physical activity. Latinas with OA were recruited in person through the Rheumatology Clinic at UNC, a local senior center, and via mailed letters to individuals identified through the Carolina Data Warehouse for Health (a clinical repository of UNC Health Care data). Interested Latinas were called by the PI or a trained interviewer, given an overview of the study, and if interested in participating, screened for eligibility. Eligibility criteria included a clinical diagnosis of hip and/or knee OA or probable OA (26) and the ability to nominate a person who supports their physical activity (“supporter”). Participants then provided the contact information of supporters, who were contacted via telephone and screened for eligibility (≥ 16 years old and willing and able to attend the interview).
Procedure for data collection
Data were collected in the location of participants’ choice (home (n=11) or private community space (n=3)). Conducting the interviews and collecting demographic information from participants lasted 60–90 minutes. Participants were given $20 each for their time. A trained bilingual interviewer conducted the interviews.
We developed a semi-structured interview guide (Table 1) based on a literature review and prior experience of important social influences on physical activity. The guide was pilot tested with one dyad consisting of sisters-in-law (not included in the study sample), which demonstrated redundancy in some of the items. Most interviews were conducted in Spanish, three in English, and one in both languages. Using open-ended questions, the semi-structured interview guide allowed for participants to stray from the questions to discuss related topics (27). Interviews were conducted until saturation of the data had been reached with respect to themes related to social influences on physical activity among dyads (28).
Table 1.
Interview guide
| Topics | Prompts |
|---|---|
| Physical activity | How do you feel about physical activity in general? |
| Physical activity and social support | Are there certain types of support that help you be physically active? |
| Osteoarthritis and physical activity | How does your arthritis or joint pain affect your physical activity? (directed at Latinas with OA) |
| Osteoarthritis and social support | Does your arthritis or joint pain affect how you prefer to receive motivation or help to be physically active? (directed at Latinas with OA) |
Note: Unless otherwise stated, prompts were directed at both participants
Data analysis
An initial codebook was created based on the interview guide and then adjusted after two bilingual coders separately coded four interviews that varied by language and dyad type. To analyze the coded data, framework analysis (29), which uses a systematic approach to identify themes within and between dyads, was implemented using ATLAS.ti (Mac v.1.6.0 (1999), Berlin, Scientific Software Development). The transcripts were coded and hierarchically grouped to reduce the data to themes and subthemes for interpretation. Themes/subthemes were initially examined using all the data. Then the data were categorized by participant type (Latinas with OA versus supporters), and dyad type (e.g., mother-child), and themes/subthemes were examined across the various groups.
We used the concepts of trustworthiness and authenticity outlined by Gupta & Lincoln (30) to ensure the rigor of our methods (see (31) for a recent description among clinical populations). Trustworthiness was established through a) credibility, by interviewing dyads to obtain data from multiple sources and develop a more comprehensive understanding of the themes (i.e., triangulation); furthermore, investigator triangulation was used to provide alternative explanations from investigators of Latino and non-Latino backgrounds, b) transferability, by providing illustrative “thick” quotes connected to the themes/subthemes, c) dependability, by carefully documenting the evolution of the codebook and crosschecking with previously coded interviews to safeguard the use of stable codes across interviews, and d) confirmability, by using a second coder and discussing discrepancies to reach an agreement on codes and code definitions. Authenticity (30) was established through fairness (eliciting different perspectives) by interviewing a range of supporters and relationship types.
Results
Participant characteristics
There were a variety of dyads represented in the sample: Latinas with OA and their daughters (n=5), spouses/partners (n=4), sons (n=2), and others, including a granddaughter, nephew, and friend. Except for the friend and one spouse, all supporters identified as Latina/o (Table 2).
Table 2.
Participant characteristics (N = 14 dyads)
| Latinas with OA | Supporters | |
|---|---|---|
| 66 (18) | 48 (23) | |
| Married or cohabitating (n and %) | 7 (50%) | 10 (71%) |
| ≥ High school education (n and %) | 7 (50%) | 13 (93%) |
| Retired or homemakers (n and %) | 9 (65%) | 5 (36%) |
| Monthly household income <$1,500 (n and %) | 5 (36%) | 3 (23%) |
| Born outside the US (n and %) | 13 (93%) | 5 (36%) |
| Female (n and %) | 14 (100%) | 7 (50%) |
| Supporter relation (n and %) | ||
| Daughter | 5 (36%) | |
| Spouse/partner | 4 (29%) | |
| Son | 2 (14%) | |
| Granddaughter | 1 (7%) | |
| Nephew | 1 (7%) | |
| Friend | 1 (7%) |
Themes and subthemes
Interviews with dyads revealed four overarching themes and corresponding subthemes (Figure 1). The following sections describe the themes/subthemes with some illustrative quotes. An outline of the themes/subthemes, along with more extensive quotes, is provided in Table 3.
Figure 1.
Themes and subthemes
Table 3.
Themes, subthemes, and sample quotes
| Theme | Subtheme | Sample quote(s) |
|---|---|---|
| How participants support one-another’s physical activity | Reciprocated and bidirectional motivation |
Daughter: For example, if I know that my mom is going dancing, then I will probably want to go with her too. Mother: Me too. In fact, we motivate each other, her and I. She motivates me with some things like, ‘Mom, you should try this,’ ‘Mom, you should try that.’ And I with her, like, ‘Look, I saw this thing, why don’t we go do it?’, ‘I’m going to this thing, want to come?’ Dyad #6 |
| ‘Let’s go for a walk’ | What motivated me personally is that he helps me. He tells me let’s go do this. I feel supported. We’re going to do this together, that way we work as a team, him and I. That motivates me. – Spouse/partner of supporter (Dyad #9) | |
| Usually my mom is the one who tells me, “Let’s go for a walk”… We try to go once a week. Sometimes we do it, sometimes because of our schedules or because the kids need help with their homework, but our goal is to go out together for a walk. – Daughter (Dyad #2) | ||
| Pressure | [Son] tells me, ‘Go to the gym. Go do that. Did you go to the gym? Have you done the exercises prescribed by your doctor?’ ‘Yes’ I tell him, ‘I’ve done them.’ He motivates me a lot. – Mother of son supporter (Dyad #5) | |
| [I started going to the gym class] about two months ago because she was going to it before. I used to hear it every day, ‘You have to go. You have to do this.’ I have to give her credit for that. Persistence and perseverance paid off. – Spouse/Partner supporter (Dyad #4) | ||
| Talk about physical activity | Yes, sometimes when I see her after [she exercises], I ask her, ‘How was your day?’ or ‘How’s the exercise? What did you do? What did you like? What didn’t you like?’ And we’ll discuss it. Other times, she’ll tell me, ‘I want to go to a new class’ and I’ll say, ‘You should do it. If you don’t have a ride, I can take you.’ – Mother of daughter supporter (Dyad #10) | |
| Help with chores | The support is: I have to go walk and he has to take care of [his sister] or vice versa. Or if it’s a little more cold and our grandson is here, ‘you stay with him but I’m going to go [for a walk]. Then you can go.’ – Spouse/partner of supporter (Dyad #9) | |
| Sometimes I’ll tell her, ‘Can you watch my dog a little while longer, I’m going to my gym class.’ It’s the only way that I sometimes ask for help because the class has a specific schedule. Leaving work at 6:30pm leaves me time to go to the last class at 7:15pm. From 7:15pm to 8:15pm is the time of the class and I say, ‘Please, I just want to quickly go to the gym. One hour. I’ll be there at 8:30pm.’ She tells me, ‘Ok, it’s fine’ or ‘I have to go out so hurry,’ that kind of thing. – Daughter (Dyad #6) | ||
| Modeling physical activity | Watching her [dance] motivates me. – Grandmother of a granddaughter supporter (Dyad #1) | |
| How OA symptoms impact support for physical activity | Desire for support when experiencing OA symptoms | There are moments when you’re in a lot of pain and you don’t want to even move. In that moment, I do need someone to tell me, ‘Do it so that the pain will ease.’ – Spouse/partner of supporter (Dyad #11) |
| ‘I keep it to myself’ |
Daughter: I see in her face that she’s not feeling well because her face changes. What I do is I ask her, “Mom, what’s wrong?” and she tells me, “Nothing.” But I notice her face and I keep asking her and she gets angry. I prefer to not ask her anything and not say anything. Mother: Yes, because what I have in my head about these problems, based on what I’ve read, is that there is no cure. I don’t know if it’s true or if it’s a lie. What I understand is that I have to live with this problem. But if I have to live with it, I’m not going to internalize it. I try to think of it as something that will pass. – Dyad #13 |
|
| No, no, I don’t talk about my pain (laughs), never. – Mother of daughter supporter (Dyad #12) | ||
| ‘They don’t understand’ | She looks at me and says, ‘Are you angry?’ She often asks me, ‘Why are you mad?’ or ‘Are you mad?’, and sometimes I tell her, ‘No, daughter, I’m just tired, in pain,’ but it’s like those words don’t work, like she’s thinking that I’m mad at her or at something that happened in the moment but that’s not it. The pain sometimes puts me in a bad mood, and I’ll go, I’ll agree and go [to the gym] but sometimes, I tell her ‘No, you go’ because I don’t feel up to it. She also knows that there’s a point at which she’ll say, ‘Ok mom, go rest.’ – Mother of daughter supporter (Dyad #10) | |
| We have gotten in the habit of walking [by the river] on Saturday mornings. All of us except my mom because she doesn’t like to go because of the pain. What we do is, I try to insist, but she tells me that I don’t know the pain that she feels, so she prefers to not come with us when we go for a walk. I go with my daughters and my husband. – Daughter (Dyad #6) | ||
| ‘We understand each other’ | [Arthritis] is a part of me. When something happens to her related to the arthritis, I also feel it. Why? Because I have also felt the same pain and so we motivate each other to do exercise. – Spouse/partner supporter (Dyad #11) | |
| How OA symptoms impact the physical activity of Latinas with OA | ‘Exercise is indispensable when arthritis is present’ | Yes. I was telling her, maybe if you get to go to exercise and do lots of activities of all of your muscles, your leg muscles maybe need to reinforce it. Myself I’m less for surgery, I’m more proactive with the exercise. – Friend supporter (Dyad #3) |
| When I’m in pain I tell him, “My knee hurts and he tells me, “That’s because you haven’t been to the gym. You haven’t been walking. You have to walk.” He tells me, “Don’t lay down to sleep or rest. No, it’s because you haven’t done anything. Let’s go.” – Aunt of nephew supporter (Dyad #8) | ||
| ‘I just don’t know’ | I think, maybe I’m not informed, but when I see her suffering, I’m like, ‘Don’t do anything,’ more as a precaution, to prevent her from wearing herself out more, that’s how I think of it. Surely, I’m wrong, I don’t know. – Granddaughter (Dyad #1) | |
| ‘I’m not saying go to the gym but do some stretching at home’ | I think, [exercise when in pain] depends on the pain, because a lot of times if you’re stiff and in pain, throughout the day you warm up and feel better. Maybe an activity that’s very light, but not to stop moving. For example, any extreme activity, for example, doing squats or something with pain, you’re going to do it wrong and you can hurt yourself. I think there has to be a middle ground, everything depends on the activity. My mom has never tried swimming, but I feel like that would be very gentle with her joints and it’s good exercise. – Daughter (Dyad #6) | |
| How OA symptoms impact the physical activity of supporters | ‘If she’s hurting, I just don’t exercise’ | The times that she’s like not feeling it and she doesn’t like it, she doesn’t want to do anything, it’s a barrier because like I said earlier, I don’t like doing exercise by myself because I guess if I’m not seeing someone else to do with it, it’s like why should I do it? – Spouse/Partner supporter (Dyad #7) |
| If the pain is strong, it’s best to keep still. – Mother of son supporter (Dyad #14) | ||
| ‘She tells me to stay active so that I don’t develop OA like she has’ | Seeing her like that in that moment is motivation for me to not end up like that. It’s exactly the reason why it’s important to keep moving. Laws of physics, an object in motion stays in motion. – Daughter (Dyad #5) |
How participants support one another’s physical activity
Reciprocated motivation.
Motivation and support were not always unidirectional, from supporters to Latinas. Eight dyads reported that support for physical activity was reciprocated, flowing back and forth between them. A mother (Dyad #6) explained, “In fact, we motivate each other, her and I.” These dyads described relying on each other for support and providing additional support when the motivation was lacking in one person to ensure their continued efforts to be physically active.
‘Let’s go for a walk.’
The most common way that dyads said they provided and preferred to receive support was by engaging in physical activity together (e.g., walking; 10 dyads). The use of this method was equally discussed by Latinas with OA and their supporters. For example, one daughter (Dyad #2) said, “Usually my mom is the one who tells me, ‘Let’s go for a walk’… We try to go once a week.” Across dyads, the commitment to exercise together varied with some having a recurring appointment and others creating opportunities to exercise together on occasion.
Pressure.
The use of pressure was rare among couples and typically given by Latinas rather than by their spouses. Five Latinas and eight supporters remarked that their counterpart did not use pressure and would be discouraged if they did. Three Latinas with OA said their reaction depended on the type of pressure and from whom. Four Latinas and three supporters said that receiving pressure was effective in motivating their physical activity. One mother (Dyad #5) said, “[Son] tells me, ‘Go to the gym. Go do that. Did you go to the gym? Have you done the exercises prescribed by your doctor?’ ‘Yes,’ I tell him, ‘I’ve done them.’ He motivates me a lot.” In other words, although pressure was not universally embraced, it was welcomed and deemed useful among those who received this type of social influence.
Talk about physical activity.
Three Latinas with OA and four supporters said that they liked to talk about and receive verbal encouragement for physical activity. Topics of discussion often focused on using physical activity to prevent or manage long-term diseases, overcome barriers to physical activity, or in general conversation around exercise. For example, this mother (Dyad #10) explained, “Yes, sometimes when I see her after [she exercises], I ask her, ‘How was your day?’ or ‘How’s the exercise? What did you do? What did you like? What didn’t you like?’”
Help with chores.
Three Latinas with OA and two daughters said that help with household responsibilities made it possible for them to be active. This daughter (Dyad #6) said, “Sometimes I’ll tell [my mom], ‘Can you watch my dog a little while longer, I’m going to my gym class.’”
Modeling.
Modeling physical activity was a motivator for only two Latinas with OA: an aunt of a nephew supporter who works in a gym and a grandmother of a granddaughter supporter who is a dance teacher. For example, the grandmother (Dyad #1) said, “Watching her [dance] motivates me.”
How OA symptoms impact support for physical activity
Desire for support when experiencing OA symptoms.
Six Latinas expressed a desire to receive support for physical activity when they experienced OA-related pain and stiffness. A Latina interviewed with her spouse (Dyad #11) said, “There are moments when you’re in a lot of pain and you don’t want to even move. In that moment, I do need someone to tell me, ‘Do it so that the pain will ease.’” They believed physical activity could ease their symptoms, but their pain and stiffness impeded their motivation to be active, hence their desire for additional support.
‘I keep it to myself.’
Three Latinas with OA said they did not discuss their OA symptoms with their supporters because they did not want to complain and burden their loved ones, especially if they believed that there is nothing that can be done for OA symptoms. For instance, this mother (Dyad #12) said, “No, no, I don’t talk about pain (laughs), never.” By not disclosing their symptoms, however, supporters did not know that they should modify or increase their support to accommodate their loved one’s physical and emotional state.
‘They don’t understand.’
The inability to recognize OA-related symptoms in their mothers resulted in misunderstandings in two mother-daughter dyads. This was illustrated by this mother (Dyad #10): “She looks at me and says, ‘Are you angry?’ She often asks me, ‘Why are you mad?’ or ‘Are you mad?’, and sometimes I tell her, ‘No, daughter, I’m just tired, in pain.’” This lack of understanding led to mothers’ expressed frustration that their daughters did not grasp the extent of their pain experience. In these cases, mothers tended to decline invitations to be active when experiencing OA symptoms.
‘We understand each other.’
Conversely, negative situations were avoided when both participants had OA and could empathize with each other’s symptoms (two dyads). For example, this spouse (Dyad #6) explained, “When something happens to her related to the arthritis, I also feel it. Why? Because I have also felt the same pain and so we motivate each other to do exercise.”
How OA symptoms impacts the physical activity of Latinas with OA
‘Exercise is indispensable when arthritis is present.’
Overall, dyads believed it was a good idea to be physically active when Latinas were experiencing OA symptoms (8 Latinas with OA and 9 supporters). Reasons for this centered around the belief that movement could alleviate pain and stiffness and is a preferable alternative to surgery as a treatment of arthritis. This was explained by a friend (Dyad #3), “Yes. I was telling her, maybe if you get to go to exercise and do lots of activities of all of your muscles, your leg muscles maybe need to reinforce it. Myself I’m less for surgery, I’m more proactive with the exercise.”
‘I just don’t know.’
Two Latinas with OA and five supporters either did not believe it was a good idea to be active while experiencing OA symptoms or were unsure. This granddaughter from Dyad #1 said, “I think, maybe I’m not informed, but when I see her suffering, I’m like, ‘Don’t do anything,’ more as a precaution, to prevent her from wearing herself out more, that’s how I think of it. Surely, I’m wrong, I don’t know.” Although they believed physical activity was beneficial to OA, these participants expressed concern that it could cause harm to the joints when symptoms were present.
‘I’m not saying go to the gym but do some stretching at home.’
Two Latinas with OA and one supporter reconciled their ambivalence about the safety of physical activity by deciding that it was a good idea unless those symptoms were severe, in which case, taking it slow by doing gentle stretching/yoga, walking, swimming, or resting was the best approach. One daughter (Dyad # 6) shared: “I think, [exercise when in pain] depends on the pain, because a lot of times if you’re stiff and in pain, throughout the day you warm up and feel better. Maybe an activity that’s very light, but not to stop moving.”
How OA symptoms impact the physical activity of supporters
‘If she’s hurting, I just don’t exercise.’
The physical activity of supporters was sometimes altered by Latinas’ OA symptoms. Three supporters, typically spouses, explained that they were less likely to engage in physical activity when their partner experienced OA symptoms because they no longer received the same level of physical activity support from their partner. For example, this spouse (Dyad #7) said, “… it’s a barrier because like I said earlier, I don’t like doing exercise by myself.” Supporters also explained that they were less likely to engage in physical activity when Latinas were experiencing OA symptoms because they would opt to stay home to provide care rather than leaving them to be active.
‘She tells me to stay active so that I don’t develop OA like she has.’
Four supporters explained that they became more active when Latinas experienced OA symptoms. A few said that this was because they took on more household chores, thus engaged in more activity. Others, typically daughters, said that seeing their mothers in pain motivated them to become more active to prevent the onset of OA. This daughter (Dyad #5) explained that “Seeing her like that in that moment is motivation for me to not end up like that. It’s exactly the reason why it’s important to keep moving.” Similarly, mothers used their pain experience as an example to encourage their daughters to become more physically active.
Discussion
This dyadic interview study explored support for physical activity between Latinas with OA and a family member/friend. While others have observed Latinos seeking social support to cope with arthritis pain (20–22), our study explored how Latinas are seeking support for physical activity, a pain-coping behavior.
Supporters were primarily adult children, mostly daughters, and to a lesser degree, spouses and others, consistent with prior research showing that Latinas typically rely on daughters as a source of social support (7, 22). However, interventions on the management of chronic illnesses have generally focused on couples (32), underscoring a gap in intervention research that is responsive to the needs of Latino communities. Thus, an essential next step for research is designing dyadic interventions that include non-spouse supporters, especially because the efficacy of these interventions does not appear to depend on the composition of the dyad (33).
The dyadic design of our study enabled us to identify examples of reciprocity between participants and to respond to limitations of prior social support literature that describe support recipients as passive receivers (34). We found that social support for physical activity is received and given by Latinas with OA, especially when both participants are inactive. When physical activity is not yet a habit, providing support may promote physical activity above and beyond receiving support (34), thus reciprocated support may explain why including dyads in physical activity interventions may be more effective than enrolling target participants alone (33). Furthermore, equal intervention participation by both participants likely has a greater effect on physical activity than does unequal participation (35, 36).
Participants supported one another’s physical activity in a variety of ways, primarily by engaging in physical activity together. This echoes prior research showing that engaging in physical activity with others (i.e., activity partners) is highly influential among women (7, 16) because of the accountability and enjoyment created by their partners (37). Our finding supports social support theory (6), which posits the direct influence of activity partners on physical activity, and adds to prior literature demonstrating these effects among Latinas (7, 8). Walking was a common method of engaging in physical activity together in the current study. In addition to being accessible and easily modifiable, walking is deemed safe and recommended as an effective self-management method of reducing OA symptoms (38). Evidence-based walking interventions for OA that target individuals (39) may be more effective among Latinas if they are adapted to dyads.
As in previous studies, some of our participants said receiving pressure-like tactics would backfire and cause them to resist being physically active (40). However, other women – with and without OA – welcomed the use of pressure and deemed it an effective motivator. In a study among couples, receiving pressure-like tactics resulted in greater self-efficacy (10), possibly due to a defiant response in one’s confidence to be more active. In our study, however, participants were pleased with the pressure they received. Although the examples of pressure provided by participants sound negative: “Have you done the exercises prescribed by your doctor?”, “You’re not going to fit in your bikini sitting on the couch,” the tone of the messages may be more persuasive (e.g., a concerned tone in the former quote and a jovial tone in the latter) (41). The tone, context, and the perceptions of the receiver may be more important than the content of the message (40). To date, most studies have investigated the use of pressure among non-Latino white couples (10, 40, 42, 43); but, the couples in our study rarely used this tactic, suggesting possible differences in methods used by spouses across ethnicities. Further research can address this gap and clarify associations among pressure, mediating theoretical constructs, and physical activity in non-couple dyads.
Our findings showed that most Latinas wanted additional support for physical activity when they experienced more severe OA symptoms and needed help overcoming physical activity barriers. This was also seen in a study of 588 Latinos with arthritis (44). Those with severe pain had stronger motivation to exercise compared to those with less severe pain. However, individuals with more pain also experienced more barriers to physical activity. Unfortunately, many supporters in our study were unaware of how to provide physical activity support when their counterpart experienced OA symptoms.
Some Latinas said their supporters did not sympathize with their pain experience and described interpersonal conflict, misunderstanding, and frustration, making it difficult to receive support. For dyads who face conflict during increased OA symptom severity, interventions can build skills in support provision and develop interpersonal communication (45, 46). Interventions have demonstrated effectiveness in increasing support for coping with pain among couples (47), however, the dyads in our study who discussed interpersonal difficulty typically consisted of mothers and children. Again, research that focuses on non-couple dyads is especially needed among Latinas who frequently rely on their adult children for social support (7, 22).
Although most participants agreed that physical activity was beneficial to the management of OA, some were uncertain about its safety during episodes of severe OA symptoms. This uncertainty has also been documented among individuals with rheumatoid arthritis living in the United Kingdom where 44% said they worry that physical activity could cause harm to their joints, and 34% were not sure (48). Furthermore, 39% said they did not know what type of exercise they should be doing.
Supporters’ physical activity was influenced by the presence of OA symptoms in Latinas. In some cases, supporters engaged in less activity either because they depended on their counterpart to motivate them or because caregiving superseded time to exercise. Conversely, some supporters, especially daughters, noticed an increase in their physical activity when their mothers experienced OA symptoms, primarily because they were reminded of their own risk for OA. A population-based study in the US among adults between 25–44 years of age showed a higher perceived risk of developing OA in those with a family history versus no family history of OA (49). Thus, adult children and their mothers may have an awareness of children’s elevated risk for OA and may become prompted to engage in healthy behaviors in the presence of OA symptoms. Given the potentially reciprocal nature of support and physical activity between dyads, the physical activity of supporters warrants further investigation.
It is essential to consider our study’s limitations when interpreting its findings. First, due to the qualitative design, our results may not generalize to other populations. Specifically, our sample consisted of Latinas with OA and a supporter of their physical activity recruited from an urban area of North Carolina. Findings cannot speak to Latino men with OA or support provided by individuals not represented here (e.g., healthcare providers). Furthermore, supporters were eligible if they were willing and able to attend the interview. Thus, we did not include supporters who did not live locally but provide support remotely. It is also important to note that data collection and interpretation were primarily conducted by the first author, S.S., a bicultural/bilingual Latina. S.S.’s perspectives helped to attach cultural meaning to the data. The second coder and co-authors are non-Latino white and helped to offer alternative explanations for the data.
Conclusion
This study provides the foundation for future investigation and potential dyadic strategies to promote physical activity among Latinas with OA. Further research will help to generalize findings to other Latinos with OA and provide valuable insight into the development of interventions for this population.
Significance and Innovations.
Social support for physical activity was often reciprocated between Latinas with OA and their supporters
Engaging in physical activity together was a common and often preferred way of receiving support for physical activity among dyads
Some participants were unsure if it was safe to engage in physical activity when experiencing severe OA symptoms
OA symptoms prompted adult children of Latinas with OA to become more active
Acknowledgments
The research reported in this manuscript was supported by National Center for Advancing Translational Sciences (NCATS), North Carolina Translational and Clinical Sciences Institute (TraCS) (UL1TR002489), and a matching grant from the Thurston Arthritis Research Center with funding from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS; P30 AR072520-01).
Footnotes
The authors declare that they have no conflict of interest
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