1023
THE PUBLIC’S PERCEPTIONS AND
MISPERCEPTIONS OF ARTHRITIS
JAMES H. PRICE, KATHY S. HILLMAN, MICHAEL E. TORAL, and SUSAN N E W E L L
A telephone survey of a random sample of 300
respondents indicated that the respondents relied main-
ly on the mass media €or their information about
arthritis. Almost half of the respondents believed arthri-
tis could be caused by “poor diet” or “cold, wet
climates.” Furthermore, quack or unproven “treat-
ments” for arthritis, such as bee venom (83%),vitamins
(76%), copper bracelets (74%), special diets (57%), and
DMSO (54%) were all supported by more than half of
the respondents. However, a followup to the random
survey, using only diagnosed arthritis patients as re-
spondents, did not reveal as high a level of actual use of
unproven treatments. Numerous factors were found
which imply that the lay public is not as well informed
about arthritis as arthritis patients are, and that sus-
tained, community-wide educational efforts about ar-
thritis are greatly needed.
Few studies on the public’s perceptions of
arthritis have been reported in the literature. This is
despite the fact that nearly 32 million Americans are
victims of arthritis and arthritis related diseases (I).
The Health Interview Survey of 1976 of the National
Center for Health Statistics found that 117 of every
1,000 persons (11.7%) had arthritis (2). Since these
diseases are chronic and their outcomes are directly
From the Department of Health Education, University of
Toledo, Toledo, Ohio.
James H. Price, PhD, MPH: Professor and Chairman;
Kathy S. Hillman, MEd: Doctoral Student; Michael E. Toral:
Student; Susan Newell. MA: Doctoral Student.
Address reprint requests to James H. Price, Chairman.
Department of Health Education, The University of Toledo, Tole-
do, OH 43606.
Submitted for publication February 8, 1983; accepted in
revised form April 5 , 1983.
Arthritis and Rheumatism, Vol. 26, No. 8 (August 1983)
related to patient compliance, it would seem that
further information on the public’s perceptions and
misperceptions of arthritis could help health practitio-
ners reduce the fear, ignorance, stress, and anxiety
present in those confronted with the diagnosis of
arthritis.
Swezey, as quoted by Rudd and Robinson,
found that 35% of the arthritis patients he surveyed did
not understand their doctor’s explanations and 80%
wanted more information about their illnesses (3). The
chronicity of arthritis, combined with the public’s
fears of being crippled and limited understanding of
arthritis, lead millions of Americans to try unproven
and quack arthritis remedies totaling $950 million each
year (1). Thus, this study was undertaken to identify
the incidence of arthritis misperceptions in a sample of
the public, with the intent of providing a basis for
better public education in rheumatic diseases.
METHODS
The respondents in this survey were contacted by
random phone calls to households in a medium-sized com-
munity in the midwestern United States. Random digit
dialing, first outlined by Cooper in 1964, was used to select
the sample (4). Random digit dialing has been shown to be a
valid method of data collection and a way to eliminate
possible bias introduced into telephone surveys which use
phone directories to create the samples (5). No attempt was
made to select a particular member of the households
contacted; the first adult aged 20 or older to answer the
phone was asked to participate.
The respondents were asked to answer a question-
naire consisting of 40 questions and 4 background questions
(Table 1). Two interviewers were used, 1 male and 1 female,
each identifying himherself with the same written statement
of identification. Face validity for the questionnaire was
established by 3 practicing rheumatologists. Reliability of
1024 PRICE ET AL

Table 1. Telephone questionnaire: the public’s knowledge and beliefs about arthritis
Yes No
I . Do you have a diagnosed case of Yes No
arthritis? - -

2. Have you ever personally known anyone 9. In your opinion, can arthritis be helped
who has had arthritis? - - by treatment?
If yes, which of the following would
3. How serious an illness would you say help treat arthritis?
arthritis is? Aspirin
-Very serious Copper bracelets
-Serious Heat applied to the area
-Slightly serious Antibiotics
-Not very serious Exercise of the joint affected
-Not serious at all Bee venom
4. How likely do you think you are that you
Massage the joint affected
Vitamins
will develop arthritis? (Read-skip
Special diet
if they have arthritis)
Surgery on the affected joints
-Very likely
Dimethylsulfoxide (DMSO)
-Likely
Other
S o m e w h a t likely
-Not very likely
-Not likely at all 10. Can you name the two major types of
arthritis?
5 . From what people or media have you Osteoarthritis
received information about arthritis? Rheumatoid

Friends 11. Can you identify some signs or

Relatives symptoms w h c h indicate you
TV may be developing arthritis’?
Radio A. Persistent pain and stiffness on
Newspaper arising.
Magazines B. Pain, tenderness or swelling in one
Books or more joints.
Physician C. Recurrence of these symptoms,
Arthritis Foundation especially when they involve
Other? (identify) more than one joint.
6. I will read you a list of items. Tell me D. Recurrent or persistent pain and
whether you agree, disagree, or don’t stiffness in the neck, lower back,
know about each of them. knees and other joints.
Don’t E. Others?
Agree Disagree know
A. Arthritis is a natural part of 12. If you wanted more information about
growing old. arthritis where would you obtain the
9. You can inherit arthritis. information?
C. Arthritis can be caused by
Demographics
stress.
D. Arthritis can be caused by
injuries.
13. Sex -Male -Female
E. Arthritis can be caused by
infections.
F. Arthritis can be caused by 14. Age range
-20-29
cold or wet climates.
-30-39
G . Arthritis can be caused by
-40-49
poor diet.
-50-59
H. Arthritis can be caused by
-60+
drugs.
I. Most people who get arthritis
IS. Race -Black -White -Other
eventually become crippled - - -
from it. Don’t 16. Which of the following describes your
Yes No know level of education?
7. In your opinion, can arthritis be -Attended high school
prevented?
- G r a d u a t e d from high school
How do you think it can be prevented?
-Attended college
-Graduated from college
8. In your opinion, can arthritis be cured -Attended graduate school
after a person once gets it? - - -
How can it be cured?
PERCEPTIONS OF ARTHRITIS
the questionnaire was established by a call/recall of 10% of
the respondents, yielding a reliability of 0.73 for the instru-
ment.
The survey was conducted during the winter of 1982.
The phone calls were made during both the days and
evenings on weekdays and weekends. Telephone numbers
generated totaled 929. Of these, 357 (38%) were business,
disconnected, or nonworking numbers and 103 (1 1%) were
numbers at which there was no answer. The “no answer”
represents numbers that were called 3 times, at different
times of the day and week, with no answer. Of the remaining
469 calls, 169 (36%) individuals refused to participate. Inter-
views were completed with 300 respondents, 64% of the net
sample of 469 respondents. Chi-square analyses were con-
ducted for each of the questions asked, on the basis of sex,
race, age, and educational level of the respondent.
RESULTS
Respondents. Of the 300 respondents, 99 (33%)
were male and 201 (67%) were female. The high level
of female respondents is probably due to the fact that
women are more likely to be at home and not at an
outside workplace, especially during the day when
some of the calls were made. Eighty percent of the
respondents were white and 18% were black. The
population of Toledo is 77% white and 17% black
based on 1980 census data. When divided into groups
on the basis of age, 84 (28%) were in their twenties, 57
(19%) were in their thirties, 54 (18%) in their forties, 47
(16%) in their fifties, and 58 (19%) in their sixties or
older. When divided into groups by level of education,
48 (16%) had attended high school or had less educa-
tion, 129 (43%) had graduated from high school, 76
(25%) had attended college, 21 (7%) had graduated
from college, and 26 (9%) had attended or graduated
from graduate school. Twenty-one percent of the
respondents claimed they had a diagnosed case of
arthritis. Because this diagnosis could not be con-
firmed, this high level of self-reporting must be viewed
with skepticism.
Major sources of information about arthritis.
The respondents were asked, “From what people or
media have you received information about arthritis?”
The question was scored as a list of 9 sources were
read, and after the respondent was asked if there were
any other sources of arthritis information. The source
cited most often was TV (75%), magazines (62%),
relatives (60%), newspapers (52%), friends (5 l%),
physicians (38%), radio (36%), books (34%), and the
Arthritis Foundation (33%) (Table 2). Only 13 subjects
mentioned “other” sources of information on arthri-
tis. The 8 “other” sources included 3 mentions of
hospitals and 3 mentions of school. Chi-square analy-
1025
sis based on sex and race did not reveal any significant
differences. Furthermore, chi-square analysis based
on education level indicated that books were signifi-
cantly more likely to be used by better educated
subjects. Older subjects were significantly more likely
to use newspapers and physicians but were less likely
to use relatives, friends, and the Arthritis Foundation
as sources of information (Table 3).
When the respondents were asked, “If you
wanted more information about arthritis, where would
you obtain the information?”, the responses given by
at least 10% of the respondents were: physician (62%),
Arthritis Foundation (48%), and library (13%). Thus,
the respondents identified more reliable sources of
correct information about arthritis when asked where
they would seek out such information. Apparently
when the respondents did not seek out information,
they simply relied on the mass media (i.e., TV, maga-
zines, and newspapers).
General beliefs about arthritis. The majority of
the respondents believed that arthritis was “very
serious” (60%) or “serious” (33%). There were no
significant differences for perceived seriousness by
sex, race, age, or education. Furthermore, over 40%
believed it was “very likely” (15%) or “likely” (29%)
that they would eventually develop arthritis. There
were no significant differences in perceived suscepti-
bility based on sex, race. age, or education. Forty-
three percent of the respondents believed that “people
who get arthritis eventually become crippled from it. ”
There were no significant differences in belief of
crippling by arthritis by sex, race, age, or education.
The levels of “perceived severity” and “perceived
susceptibility,” combined with the finding that more
than 1 in 3 respondents believe arthritis can be cured
(18%) or “don’t know” whether it can be cured (I%),
set the stage for susceptibility to quackery.
When respondents were asked, “Can you name
the two major types of arthritis?” only 22% of the
respondents could name osteoarthritis and 13% could
name rheumatoid arthritis. There were no significant
differences in ability to identify the 2 forms of arthritis
by sex, race, age, or education. The respondents were
asked if they could “identify some signs or symptoms
which indicate you may be developing arthritis.”
Symptoms identified by the respondents were: 1)
recurrent or persistent pain and stiffness in the neck,
lower back, knees, and other joints (8%);2) persistent
pain and stiffness on arising (37%); 3) pain, tenderness,
or swelling in 1 or more joints (54%); 4) recurrence of
these symptoms, especially when they involve more
1026 PRICE ET AL

Table 2. Percent of respondents who obtain arthritis information from selected sources, by sex and
race
Source Male Female White Black Total
Friends 42 56* 53 45 51
Relatives 59 61 61 61 60
TV 76 74 76 69 75
Radio 38 35 35 37 36
Newspaper 48 54 56 35* 52
Magazines 57 64 65 47 62
Books 32 34 34 33 34
Physicians 32 42 40 28 38
Arthritis Foundation 27 35 35 22 33
* Significant by chi-square analysis (P< 0.05).

than 1 joint (74%). Of the aforementioned symptoms, believe in both the myth of copper bracelets (79%) and
only persistent pain and stiffness on arising had re- the accepted treatment of surgery for affected joints
sponse levels that were significantly different based on (61%) as methods of treating arthritis. Whites were
sex, race, age, and education. Females (45%) more significantly more likely to believe in copper bracelets
than males (21%), whites (44%) more than blacks (80%) for arthritis treatment. No significant differ-
(12%), those who were older, and those with more ences were found based on the age of the respondents.
education were all significantly more likely to identify However, based on education level, those with more
persistent pain and stiffness on arising. education were less likely to believe that “heat applied
Belief in selected causes of arthritis. Respon- to affected joints” would help arthritis.
dents were asked to “tell me whether you agree, Diagnosed arthritis patients’ use of selected treat-
disagree, or don’t know about each of the following” ment methods. In the above study 21% of the respon-
(Table 4). Almost half of the respondents expressed a dents claimed that they had arthritis. However, this
belief in the myths that arthritis can be “caused by subsample was not analyzed separately, since the
poor diet” (48%) and “caused by cold and wet cli- diagnosis of arthritis in these subjects could not be
mates (53%). Furthermore, blacks were significantly
” confirmed. Instead, a second sample was selected
more likely to believe that “arthritis can be caused by using the first 150 patients with confirmed arthritis
cold and wet climates” (69%). seeking teatment at a Toledo rheumatology clinic.
Chi-square analysis based on sex showed that Sixteen of the patients either refused to participate or
females were significantly more likely to believe the only partially completed the questionnaire. The sam-
potentially correct responses that “you can inherit ple consisted of 98 females and 36 males, 130 whites
arthritis” (45%) and “arthritis can be caused by infec- and 4 nonwhites.
tions” (37%). Respondents with more education and This sample was selected to determine the
older individuals were both significantly more likely to actual incidence of utilization of unproven arthritis
believe that “arthritis can be caused by infections.”
Unfortunately, the correctness of the responses is Table 3. Percent of respondents who obtain arthritis information
confounded by the lack of separation of the various from selected sources, by age
forms of arthritis in the survey questions.
Belief in selected methods of treating arthritis.
The respondents were asked, “Which of the following Source 20-29 30-39 4049 50-59 60+
would help treat arthritis?” and a list of 11 potential Friends 42 40 65 70 48*
treatment methods was read (Table 5 ) . The overall Relatives 68 64 65 62 40*
TV 81 70 76 75 69
positive responses to selected items were somewhat Radio 32 29 35 53 36
disturbing. Quack “treaments” or unproven “treat- Newspaper 37 48 65 66 55*
Magazines 63 61 63 75 48
ments” such as bee venom (83%), vitamins (76%), Books 31 38 37 45 21
copper bracelets (74%), special diets (57%), and Physicians 29 32 33 51 53*
DMSO (54%) were all supported by at least 50% of the Arthritis
respondents. Chi-square analysis based on sex re- Foundation 21 42 33 49 26*
~

vealed that females were significantly more likely to * Significant by chi-square analysis (P< 0.01).
PERCEPTIONS OF ARTHRITIS 1027

Table 4. Percent of respondents who believe id selected causes of arthritis. by sex and race
Belief Male Female White Black Total
Arthritis is a natural part of
growing old. 31 26 28 28 28
You can inherit arthritis. 29 45 * 42 35 40
Arthritis can be caused by
stress. 30 40 31 31 31
Arthritis can be caused by
injuries. 19 80 81 13 19
Arthritis can be caused by
cold and wet climates. 60 50 49 69* 53
Arthritis can be caused by
poor diet. 40 52 49 43 48
Arthritis can be caused by
drugs. 25 20 20 33 22
Arthritis can be caused by
infections. 21 31* 34 29 34
* Significant by chi-square ~ a l y s i (s P < 0.05).

remedies. Table 6 indicates that the reported use of
unproven arthritis remedies is much less than would
be expected from the general population sample. A
total of 66 patients (49%) have used 1 or more unprov-
en remedies. Furthermore, this table indicates that
56% of the recommendations for various unproven
remedies came from friends. However, it should be
noted that the highest recommendation for an unprov-
en remedy (vitamins) was from physicians. Most likely
this is a communication problem between the physi-
cian and patient on the purpose of the recommended
vitamins.
DISCUSSION
The only other American study on the public’s
understanding of arthritis was conducted almost a
decade ago by Elder (6). This study found that two-
thirds of the respondents thought arthritis was a natu-
ral part of growing older, while our stud), found only
28% of the respondents believing in this concept. One-
third of the Elder respondents believed that arthritis
was caused by cold and damp climateb, whereas over
50% of the current respoddents believed in cold and
damp climates in the etiology of arthritis. One-fourth
of Elder’s respondents believed that arthriiis was
caused by injuries, whereas almost 80% of the current
respondents supported this idea. Approximately 25%
of Elder’s respondents believed that heredity was
responsible for arthritis, whereas the current study
found 40% of the sample supporting this idea. Finally,
one-quarter of the Elder respondents implied that
stress was responsible for developing arthritis, while
the current study found that over one-third supported
this belief. The differences between the two studies
can be attributed to Elder’s use of a study population
that was older (ages 45-64 years) and was limited to
those who had specific symptoms of arthritis.
In a more recent study of British citizens by

Table 5. Percent of respondents who believe in selected methods of treating arthritis, by sex and
race
Treatment Male Female White Black Total
Aspirin 97 91 98 94 91
Bee venom 80 d5 85 16 83
Antibiotics 18 81 81 16 80
Vitamins 12 77 74 78 16
Copper bracelets 64 19’ 8Q* 41 14
Special diet 62 55 51 61 57
Surgery of a!€ected joints 45 61* 55 57 56
dimethylsulfoxide (DMSO) 59 51 56 41 54
Exercise of affected joints 38 32 31 41 34
Heat applied to affected joints 10 9 7 20 9
Massage the affected joints 6 4 6 2 5
* Significant by chi-square analysis (P< 0.05).
1028 PRICE ET AL

Table 6. Arthritis treatments and their sources of recommendation, for diagnosed arthritis uatients*

No.
Recommended hy
patients -
who have News- Maga- Rela- Phys-
Remedy used TV Dauer zines Books Radio Friends tives icians
Traditional remedies
Aspirin I14 6 10s
Antibiotics 21 - 21
Exercise joints 107 - 98
Gold salts 36 - 36
Heat 80 I 65
Lotions (Heel. Ben Gay. etc.) 48 10 7
Steroids (1.e.. cortisone) 72 - 72
Unproven remedies
Acupuncture
Alfalfa tablets -
Bee or ant venom
Chiropractor 3
Cod liver oil 1
Copper bracelets 2
DMSO 3
Gerovital (GH-3) -
Herbs -
Honeykinegar mixture I
Radiation mittens -
Snake venom
Vibrators 1
Vitamins 29
*n = 134.

Badley and Wood, it was found that 35% of the
respondents believed arthritis was a natural part of
growing old (7). Some respondents also believed that
arthritis could be caused by cold weather (21%) or
damp climates (30%). Finally, 75% believed there was
no known cure for arthritis.
The present study found numerous disturbing
factors which imply that the lay public is not well
informed about arthritis. First, their sources of infor-
mation on arthritis, the mass media. would not be
considered reliable. The results of this study indicated
that almost half the respondents believed that arthritis
could be caused by “poor diet” and “cold and wet
climqtes.” Finally, the widely accepted quack and/or
unproven remedies for arthritis. such as copper brace-
lets, antibiotics. bee venom, vitam’ins, special diets,
and DMSO, are evidence of a public highly susceptible
to arthritis quacks. Fortunately, the followup study of
confirmed arthritis paticnts did not reveal as high a
rate of use of quack remedies as might be suspected
from the general population survey. Furthermore. the
findings indicate the need for more and better quality
public education on the problems of arthritis.
REFERENCES
1. The mistreatment of arthritis: part I . Consumer Reports
44:340-343. 1979
2. Bonham GS: National Health Survey, Vital and Health
Statistics Series 10. DHEW Publication No. (PHS)79-
1552. 1978, p 1
3. Kudd E. Robinson HS: Public education in rheumatic
diseases. J Rheumatol 1:343-347, 1974
4. Cooper SL: Random sampling by telephone: an improved
method. J Market Research 1:45-58, 1964
5 . Glasser GJ. Metzger GA: Bandom-digit dialing as a
method of telephone sampling. J Market Research 9:59-
64. 1972
6 . Elder KG: Social class and lay explanations of the etiolo-
gy of arthritis. J Health SOCRehav 428-38, 1973
7. Badley EM, Wood PHN: Attitudes of the public to
arthritis. Ann Kheum Dis 38:97-100. 1979