INTRODUCTION:

Background:

Osteoarthritis (OA) is a prevalent and debilitating condition, particularly among the elderly, and is the leading cause of disability in adults. Knee OA is the most common form, often accompanied by comorbid conditions such as type II diabetes, hypertension, and heart disease. The symptoms of OA extend beyond localized pain, affecting overall mobility and quality of life.

Arthritis, characterized by joint inflammation, discomfort, swelling, and restricted motion, significantly limits individuals' ability to perform daily activities. OA, the most common form of arthritis, involves the degeneration of joint components, leading to pain and stiffness. It is also known as degenerative arthritis, degenerative joint disease, or "wear and tear" arthritis. OA primarily affects the knees, hips, hands, and spine, and its progression is irreversible^1,2.

Globally, OA is a major cause of disability. According to the World Health Organization (WHO), 9.6% of men and 18.0% of women over 60 years have symptomatic OA. In India, OA is the second most common rheumatologic problem, with a prevalence of 22% to 39%. The National Health Portal (NHP) in India reports that approximately 45% of women over 65 years have symptoms, and 70% show radiological evidence of OA³.A study by Long et al. (2022) highlighted a significant increase in the global prevalence of OA, rising by over 113% from 1990 to 2019. The highest numbers of cases were reported in China, India, and the US⁴. Another review by Zamri et al. (2019) found that the prevalence of OA in Asia ranges from 20.5% to 68.0%, with knee OA being particularly common⁵.

Several factors contribute to the development of OA, including age, sex, increased weight, joint injuries, repetitive stress, heredity, bone abnormalities, and specific metabolic diseases. In Asia, higher BMI, low education levels, family history, smoking, and environmental factors are significant risk factors⁵.

The American College of Rheumatology (ACR) and the Arthritis Foundation recommend various management strategies for OA, including exercise, weight loss, self-management programs, and certain medications. Surgical interventions are generally reserved for severe cases⁶. In India, the high cost of surgery limits its accessibility, emphasizing the need for preventive strategies such as a healthy diet and regular exercise⁷.

In India, the prevalence of OA is notably high, particularly among adults of working age. Studies have shown significant rates of knee OA in both rural and urban areas. The increasing prevalence of OA, coupled with aging and obesity, underscores the need for effective and safe treatments. There is a critical need for exploratory studies to assess the risk factors and burden of OA, which can inform government policies and funding for prevention and treatment programs.

OBJECTIVES:

This study aims to explore the risk factors and preventive measures for OA among adults in Derabassi, Punjab, with the goal of developing an informational booklet. The specific objectives are:

1. To assess the risk factors of OA among adults.

2. To determine the preventive measures adopted by these adults.

3. To find associations between OA risk factors and demographic variables.

4. To develop an informational booklet on OA risk factors, prevention, and management.

METHODOLOGY:

Research Approach:

The study employed a quantitative research approach to assess the risk factors of OA among adults and to determine the preventive measures adopted by adults.

Research Design:

A non-experimental exploratory research design was utilized to systematically investigate the research questions related to OA risk factors and preventive measures among the target population.

Research Setting:

The study was conducted in Adarsh Nagar and Shakti Nagar, Derabassi, Distt. Mohali, Punjab. These areas are situated approximately 1 km from Sri Sukhmani College of Nursing and are located near the Chandigarh-Ambala National Highway. The population of Adarsh Nagar was 3955, and Shakti Nagar was 1884 as per 2020 records.

Target Population, Sample Size and Sampling Technique:

A sample of 100 adults aged 40 years and above was selected using a convenience sampling technique. Subjects were chosen through door-to-door visits, ensuring they met the eligibility criteria and were available during the data collection period.

Inclusion Criteria:

· Adults aged 40 years and above, and willing to participate in the study

· Present during the data collection period and able to read and write

Exclusion Criteria:

· Adults below 40 years of age and not willing to participate in the study.

· Staying as paying guests or on rent in Adarsh Nagar and Shakti Nagar.

Development and Description of Tool:

The tool for data collection was developed after an extensive literature review and consultation with experts in Community Health Nursing. It was prepared in English and divided into three sections:

· Socio-demographic Profile: Included items related to age, gender, education status, marital status, area of residence, employment status, religion, dietary pattern, co-morbidities, and BMI.

· Self-reported Checklist to Assess Risk Factors of OA: Consisted of 18 statements with "YES" or "NO" responses. Scoring was based on positive and negative statements, with a maximum score of 18 and a minimum score of 0.

· Semi-structured Questionnaire to Explore Preventive Measures of OA: Included questions on physical, occupational/work, and dietary measures adopted to prevent OA.

Validity and Reliability of Tool:

Content validity was established through expert opinions from 10 professionals in Community Health Nursing. Reliability was tested using the test-retest method with Karl Pearson’s correlation coefficient, resulting in a reliability score of r = 0.8 for the self-reported checklist and r = 0.9 for the semi-structured questionnaire.

Pilot Study:

A pilot study was conducted in May 2023 with 10 adults from Saraswati Vihar, Derabassi, to test the feasibility and reliability of the tool. Written permission was obtained from relevant authorities, and informed consent was secured from participants.

Data Collection Procedure:

Data collection took place in May 2023 in Adarsh Nagar and Shakti Nagar. A total of 100 subjects were selected using convenience sampling. Written permissions were obtained from the Principal of Sri Sukhmani College of Nursing and the Executive Officer, Municipal Corporation, Derabassi. Home visits were conducted to collect data, with each subject taking approximately 15-20 minutes to respond to the tool.

Ethical Considerations:

· Approval was obtained from the ethical and research committee of Sri Sukhmani College of Nursing.

· Written permissions were secured from relevant authorities.

· Informed consent was obtained from all participants, ensuring voluntary participation and the right to withdraw at any time.

· Confidentiality and anonymity of the subjects were maintained.

Data Analysis:

Data analysis was performed using descriptive and inferential statistics. Descriptive statistics included frequency and percentages for demographic data, while mean and standard deviation were calculated for risk scores. Chi-square tests were used to find associations between OA risk factors and demographic variables. Preventive measures were described using frequency and percentages. The level of significance was selected at p<0.05.

RESULTS:

Description of the Sample Characteristics:

Out of 100 respondents, 35% were aged 70 and above, 23% were aged 60-69, and the remaining 42% were equally split between the 40-49 and 50-59 age groups. Females made up 58% of the sample, while males were 42%. Education levels varied, with 31% having senior secondary education, 23% primary, 24% secondary, 14% diploma, and 8% graduation or higher. Most respondents (96%) were married, and 4% were unmarried. Urban and semi-urban residents were 48% and 52%, respectively. Among the women, 32% were homemakers, 28% retired, 27% in government jobs, 9% in private jobs, and 4% self-employed. Religiously, 41% were Hindu, 46% Sikh, and 13% from other religions. Dietary habits included 42% vegetarians, 56% non-vegetarians, and 2% eggetarians. Co-morbidities were present in 59% of respondents, with hypertension (18%), diabetes (13%), kidney diseases (11%), obesity (11%), and asthma (6%). Weight-wise, 37% were overweight, 21% obese, 38% normal weight, and 4% underweight.

As per the self-reported checklist and risk factor analysis, 72% of the subjects were at moderate risk for OA, while 6% were at high risk, and 22% were at low risk (Table 1). The average risk factor score was 8.53 with a standard deviation of 2.58.

Table 1: Percentage Distribution of Subjects as per Risk Category

N=100

Category of Risk	Scoring	n	Percentage (%)
High risk	13 - 18	6	6%
Moderate risk	7 - 12	72	72%
Low risk	0 - 6	22	22%

Maximum =18, Minimum=0

Item-wise Analysis of Risk Factors for OA among Adults:

Out of the 100 subjects, 49% had a family history of joint problems. Past joint injury or bone deformity was reported by 53%, and 49% experienced joint stiffness or decreased range of motion. Altered joint shape or malalignment was noted in 54%. Overuse of joints during physical activities was reported by 55%, and 46% had occupations involving weightlifting or excessive joint load. Strain around joints was experienced by 41%. Tobacco use was reported by 28%, and alcohol consumption by 32%. Junk food consumption was high at 57%, while 46% avoided highly processed foods. About 48% preferred low-fat dairy products rich in calcium and vitamin D, and the same proportion ate colourful fruits and vegetables. Non-vegetarian diets were avoided by 46%, and 51% avoided high-heel shoes. Healthy oils like olive oil were used by 44%, and 49% engaged in regular walking or swimming. Overweight and obesity were prevalent in 57% of the subjects. (Figure 1).

Preventive Measures Adopted by Adults for OA:

· Physical Measures: 57% did not follow any physical measures. Among those who did, 14% focused on weight control, 11% on muscle strengthening exercises, 10% stayed physically active, and 8% avoided joint injury.

· Occupational/Work Measures: 51% did not practice preventive measures at work. Among those who did, 18% reduced stress on joints, 16% wore comfortable shoes, and 15% did appropriate weightlifting.

· Dietary Measures: 48% were not aware of dietary measures. Among those who were, 7% ate colorful fruits and vegetables, 6% took antioxidant-rich diets, 6% consumed low-fat dairy products, 6% used healthy oils, 6% avoided processed food, 6% ate nuts regularly, and 5% avoided red meat.

Association between Risk Factors of OA and Selected Demographic Variables:

Gender (χ² = 18.769, p = 0.000) and education status (χ² = 15.639, p = 0.048) were significantly associated with risk factor scores (p ≤ 0.05) (Table 2). There was no significant association between risk factor scores and age (χ² = 7.643, p = 0.469), marital status (χ² = 0.272, p = 0.873), area of residence (χ² = 0.563, p = 0.755), employment status (χ² = 13.025, p = 0.111), religion (χ² = 4.171, p = 0.383), dietary pattern (χ² = 2.775, p = 0.596), co-morbidity (χ² = 1.266, p = 0.531), or BMI (χ² = 4.315, p = 0.634) as their p-values were greater than 0.05 (Table 2).

Table 2: Association between Risk Factor Scores and Selected Demographic Variables N=100

Demographic Variables	High risk score	Moderate risk score		Low risk score		c²Test	p value	df
Age (yrs)
40-50 years	3	14		5		7.643 ^NS	0.469	8
51-60 years	2	18		4
61-70 years	0	13		7
71-80 years	1	18		3
81-90 years	0	9		3
Gender
Male	5	36		1		18.769*	0.000	2
Female	1	36		21
Education status
Primary	1	14		8		15.639*	0.048	8
Secondary	2	15		7
Senior secondary	0	25		6
Diploma	3	10		1
Graduate and above	0	8		0
Marital Status
Married	6	69		21		0.272^NS	0.873	2
Unmarried	0	3		1
Area of residence
Urban	2	35		11		0.563^NS	0.755	2
Semi-urban	4	37		11
Employment status
Self-employed	0		4		0	13.025^NS	0.111	8
Homemaker	1		18		13
Private job	1		6		2
Government job	3		20		4
Retired	1		24		3
Religion
Hindu	1		32		8	4.171^NS	0.383	4
Sikh	3		33		10
Other religion	2		7		4
Dietary pattern
Vegetarian	1		32		9	2.775^NS	0.596	4
Eggetarian	0		2		0
Non-vegetarian	5		38		13
Do you have any co-morbidity
Yes	4		40		15	1.266^NS	0.531	2
No	2		32		7
If yes for co-morbidity, please specify
Asthma	0		5		1	5.076^NS	0.749	8
Diabetes	1		7		5
Hypertension	2		11		5
Kidney disease	1		9		1
Obesity	0		8		3
BMI calculations
Underweight	0		3		1	4.315^NS	0.634	6
Normal Weight	1		27		11
Overweight	4		25		7
Obese	1		17		3

Abbreviations: c²Chi-square test; *=Significant at p≤0.05 level; ^NS=Not significant at p≤0.05 level

DISCUSSION:

The study revealed that 72% of adults aged 40 years and above in the selected areas of Derabassi, Distt. Mohali, Punjab, are at moderate risk for OA, with 22% at low risk and 6% at high risk. These findings align with Sharma et al. (2007), who reported a prevalence of OA ranging from 41.6% to 70.1% in males and females, respectively, in Chandigarh. The higher prevalence in urban areas (60.3%) compared to rural areas (32.6%) further supports the current study's findings⁸.The study found that approximately half of the adults are not aware of or practicing preventive measures for OA, with 57% ignoring physical measures, 51% not adopting occupational/work measures, and 48% unaware of dietary measures. These results are consistent with Zamri et al. (2019), who reported under-utilization of preventive measures by general physicians, with only 27% advising on exercise and 33% on weight reduction⁵.The study identified gender (p=0.000) and education status (p=0.048) as significant predictors of OA. This is supported by Blanco et al. (2021), who found that gender and low educational levels were statistically significant predictors of OA in a cross-sectional population-based study. The current study's findings highlight the need for targeted interventions considering these demographic factors⁹.An informational booklet on the risk factors, prevention, and management of OA was developed and disseminated to the study participants. This initiative is supported by Salve et al. (2010), who emphasized the need for community awareness programs on OA prevention and rehabilitation in South Delhi. The booklet aims to bridge the knowledge gap and promote preventive practices among adults at risk for OA¹⁰.

LIMITATIONS:

The study was limited to adults aged 40 years and above residing in Adarsh Nagar and Shakti Nagar, Derabassi. The generalizability of the findings may be limited because a small sample size of 100 participants was considered. Additionally, the dependency on self-reported risk factors could introduce bias into the results.

IMPLICATIONS:

The study findings have important implications for nursing research, education, community health, practice, and administration. It contributes to the knowledge of OA and its risk factors, suggesting the need for further research and replication in different settings. Nursing education should be updated to include comprehensive training on OA management, emphasizing the importance of preventive measures. Community health nursing should focus on OA prevention at all levels, raising awareness and promoting coping strategies like regular physical activity and healthy eating. In nursing practice, professionals should provide holistic care and early interventions to prevent OA, guided by the study's insights. Nursing administrators should support ongoing education and training for nurses, organizing workshops and seminars on OA and its prevention. These efforts will enhance nurses' ability to identify and manage OA risk factors, ultimately improving patient care and outcomes.

RECOMMENDATIONS:

Based on the study's findings, several recommendations have been made. Conducting a similar study with a larger sample size would improve the generalizability of the results. Replicating the study in different settings could provide broader applicability. Additionally, a descriptive study could be conducted to assess the knowledge and attitudes of subjects regarding osteoarthritis (OA). A comparative study between urban and rural settings would help in assessing the prevalence of OA. Including additional demographic variables in future studies could offer a more comprehensive analysis.

CONCLUSION:

The study concluded that a significant proportion of adults are at moderate to high risk for OA and are not adequately practicing preventive measures. There is a need for increased awareness and education on OA prevention and management.

CONFLICT OF INTEREST:

The authors have no conflicts of interest regarding this investigation.

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9. Blanco FJ, Silva-Díaz M, Quevedo Vila V, et al. Prevalence of symptomatic osteoarthritis in Spain: EPISER2016 study. Reumatol Clínica Engl Ed. 2021; 17(8): 461-470. doi:10.1016/j.reumae.2020.01.005

10. Salve H, Gupta V, Palanivel C, et al. Prevalence of knee osteoarthritis amongst perimenopausal women in an urban resettlement colony in South Delhi. Indian J Public Health. 2010; 54(3): 155-157. doi:10.4103/0019-557X.75739.

Received on 21.01.2025 Revised on 10.02.2025

Accepted on 27.02.2025 Published on 27.10.2025

Available online from November 08, 2025

Int. J. Nursing Education and Research. 2025;13(4):221-226.

DOI: 10.52711/2454-2660.2025.00045

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.