Apni Jung (our fight) against rheumatoid arthritis; fEasibility of an online Learning patient Education programme for improVing outcomes in pAtients from a minority eThnic background in England (ELEVATE)

Background: Our research shows that people from South Asian backgrounds are diagnosed with immune-mediated diseases, including RA, significantly earlier than White individuals (by 2–30 years) [1]. Indeed, RA is diagnosed at a median age of 45–48 years in South Asian populations, compared to 56 years in White individuals [1]. The group also is known to be at a greater risk of most co-morbidities such as cardiovascular conditions [2]. The earlier onset highlights the need for accessible, proactive self-management, particularly when people are facing peak career and family responsibilities [1]. Outcomes have been shown to be poorest among non-English speakers from South Asian backgrounds. An analysis of national data (n=35,807) from the British Society for Rheumatology s National Early Arthritis Audit [3] shows that people from ethnic minority backgrounds had lower odds of RA remission at three months (adjusted odds ratio 0.79, 95% CI 0.65–0.96), compared to adjusted odds ratio 0.79 (95% CI: 0.65, 0.96) relative to White individuals [3]. Delays in achieving RA control, necessitate targeted interventions to mitigate for these disparities. Empowering people with RA through supported self-management leads to improved health outcomes, lower healthcare use, and greater well-being. Yet, educational resources in rheumatology have predominantly been in English, limiting access for people with non-English-speaking skills. Addressing cultural and linguistic barriers is crucial, particularly as the NHS adopts remote appointments and Patient-Initiated Follow-up Pathways [4]. In summary, South Asian people develop RA earlier, with more severe symptoms, and face barriers to self-management resources. Without culturally-tailored approaches, these challenges will continue, worsening health inequalities. Aims: (1) To test the recruitment methods, outcomes and retention rates appropriate for a future trial of Apni Jung; (2) to record the uptake and utility of Apni Jung for people with RA, in terms of how well it was received and the extent to which components of Apni Jung met the needs of the target population; and (3) to ensure the study design minimises the potential for contamination. Brief plan of study methods: This feasibility study will take place across six early arthritis clinics, recruiting newly-diagnosed South Asian people with RA. Using a 2-arm, service-level randomised design, people will receive either 1) usual care or 2) usual care plus the Apni Jung online programme—a 2-3 hour culturally-tailored intervention to improve RA understanding and self-management. The Research Associate will assess engagement with Apni Jung through structured questions. Data collection will occur at baseline and three months post-intervention, using validated, language-appropriate questionnaires to evaluate RA knowledge, self-management, and healthcare usage. Qualitative interviews with people will explore their experiences, impact on symptoms and management, and suggestions for future improvements to the Apni Jung programme. Potential impact: If the results demonstrate feasibility, we will advance to a larger 12-month trial to assess the clinical and cost-effectiveness of the Apni Jung programme in enhancing RA self-management among South Asians. We hypothesise that empowering self-management will reduce symptom severity, improve quality of life, and lower work loss, presenteeism, and healthcare use.