An Efficacy Trial of Community Health Worker-Delivered Chronic Pain Self-Management Support for Vulnerable Older Adults

社区卫生工作者为弱势老年人提供慢性疼痛自我管理支持的有效性试验

• 批准号: 10693973
• 负责人: Mary Rose Janevic
• 金额: $ 60.15万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-15 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10693973
• 关键词: Acceleration; Accelerometer; Address; Adult; Affect; African American; Age; Aging; Behavior; Behavioral; COVID-19; COVID-19 impact; Caring; Cities; Cognitive; Color; Communities; Community Health Aides; Computers; Data; Disadvantaged; Discipline of Nursing; Disparity; Economics; Educational process of instructing; Elderly; Enrollment; Evidence based intervention; Face; Frontline worker; Goals; Health; Health system; Housing; Human; Income; Inequity; Intervention; Knowledge; Learning; Mediating; Mediator; Methods; Michigan; Modeling; Monitor; Musculoskeletal Pain; Needs Assessment; Older Population; Online Systems; Outcome; Pain; Pain Research; Pain intensity; Pain interference; Pain management; Participant; Persons; Pharmaceutical Preparations; Physical Medicine; Physical Rehabilitation; Physical activity; Pilot Projects; Population; Positioning Attribute; Prevalence; Process; Public Health; Racial Segregation; Randomized, Controlled Trials; Reporting; Research; Resources; Risk; Role; Self Efficacy; Services; Social Distance; Social Mobility; Standardization; Structural Racism; Sustainable Development; Technology; Testing; Therapeutic; Training; Transportation; Urban Community; Vulnerable Populations; adult of color; aged; chronic pain; comparison control; cost; economic disparity; efficacy trial; environmental stressor; evidence base; field study; group intervention; health disparity; high risk; impression; improved; innovation; intervention effect; intervention participants; mHealth; marginalization; novel; pain reduction; pain self-management; pain-related disability; pilot test; population health; primary outcome; programs; psychologic; psychosocial stressors; public health priorities; racial disparity; remote delivery; secondary outcome; self-management program; sex; skills; social health determinants; socioeconomic disadvantage; socioeconomic disparity; stem; stressor; telephone based; telephone delivery; telephone session; tool; underserved area; underserved community; urban setting; usual care arm; virtual

Project Summary Chronic pain is an enormous public health problem, and African American older adults bear a disproportionate burden of disabling pain. Evidence-based chronic pain self-management support can improve pain-related functioning, yet standard models for providing this support are not well-suited to reach older people in communities of color such as Detroit, Michigan, which face severe racial segregation and socioeconomic disadvantage. Existing pain self-management interventions are mostly group-based and require in-person contact, making them less accessible to older adults with transportation or mobility barriers. Moreover, existing interventions seldom address the social determinants of health (e.g., economic stressors) that are rooted in the same structural inequities that produce high rates of pain and hinder its management. The long-term goal of this line of research is to build a robust evidence base for chronic pain self-management interventions that meet the needs of vulnerable older adults in underserved communities. The objective of this proposed project is to determine whether community health workers (CHWs)—i.e., lay health workers with close ties to the communities they serve – can effectively teach cognitive-behavioral pain management strategies to older adults in a disadvantaged urban setting. CHWs are uniquely suited for this role, given their ability to provide culturally appropriate care and their deep knowledge of community resources that enables them to address social determinants of health. The central hypothesis is that a CBT-based pain self-management intervention (“STEPS”) delivered over 7 weeks through telephone sessions with a CHW and mobile health tools improves one-year pain-related outcomes. Our highly encouraging preliminary findings indicate that STEPS is feasible, deliverable by CHWs with high fidelity, and well-received by participants (n=31). Its potential efficacy is suggested by significant improvement in pain interference (pre-post Standardized Mean Difference = 0.84, p = 000). The proposed trial will take place in partnership with the Detroit-based Henry Ford Health System. There are three specific aims: 1) Conduct a Stage 3 efficacy trial to assess whether STEPS can reduce one-year pain interference and intensity among 414 primarily African American older adults, 2) Assess psychobehavioral mediators and moderators of intervention effects, and 3) Using qualitative data from participants and other stakeholders, conduct mixed-methods analysis to provide context for quantitative findings and inform a toolkit for dissemination, if the intervention is effective. This project is innovative in that it enlists CHWs, who have delivered evidence-based interventions for other conditions but are not yet part of the pain care workforce. It has strong potential impact given that the model being tested is low-cost, scalable, and suitable for deeply disadvantaged settings, where the burden of chronic pain is greatest. Moreover, it can be delivered remotely, which not only maximizes access but is compatible with social distancing. Ultimately, this research could lead to a transferable model that can be applied to other vulnerable populations in need of improved pain care.

项目概要 慢性疼痛是一个巨大的公共卫生问题，非裔美国老年人承受着不成比例的痛苦 基于证据的慢性疼痛自我管理支持可以改善与疼痛相关的负担。 功能正常，但提供这种支持的标准模式不太适合帮助老年人 有色人种社区，例如密歇根州底特律，面临着严重的种族隔离和社会经济问题 现有的疼痛自我管理干预措施大多是基于团体的，并且需要亲自进行。 接触，使有交通或行动障碍的老年人更难接触到它们。 干预措施很少涉及根植于健康的社会决定因素（例如经济压力因素） 同样的结构性不平等会产生高痛苦率并阻碍其管理的长期目标。 这一系列研究旨在为慢性疼痛自我管理干预措施建立强有力的证据基础， 满足服务欠缺社区中弱势老年人的需求 该拟议项目的目标。 的目的是确定社区卫生工作者 (CHW)——即与社区有密切联系的非专业卫生工作者 他们所服务的社区——可以有效地向老年人传授认知行为疼痛管理策略 处于不利地位的城市环境中的成年人因其提供服务的能力而特别适合这一角色。 文化上适当的护理以及他们对社区资源的深入了解使他们能够解决 健康的社会决定因素是基于 CBT 的疼痛自我管理干预。 （“STEPS”）通过与社区卫生工作者和移动健康工具的电话会议在 7 周内交付，改善了 我们非常令人鼓舞的初步结果表明 STEPS 是可行的， 由社区卫生工作者以高保真度交付，并受到参与者的好评（n = 31）。 疼痛干扰的显着改善表明（前后标准化均值差 = 0.84，p = 000）。拟议的试验将与底特律的亨利·福特医疗系统合作进行。 三个具体目标： 1) 进行第 3 阶段疗效试验，以评估 STEPS 是否可以减轻一年的疼痛 414 名主要是非裔美国老年人的干扰和强度，2) 评估心理行为 干预效果的中介者和调节者，以及 3) 使用参与者和其他人的定性数据 利益相关者进行混合方法分析，为定量结果提供背景并为工具包提供信息 如果干预措施有效，则该项目具有创新性，因为它招募了社区卫生工作者，而社区卫生工作者已经 针对其他病症提供了基于证据的干预措施，但尚未成为疼痛护理队伍的一部分。 鉴于正在测试的模型成本低、可扩展且适合深度学习，因此具有强大的潜在影响 此外，慢性疼痛负担最重的弱势环境可以远程提供。 最终，这项研究不仅可以最大限度地提高接触机会，而且可以与社交距离相兼容。 一种可转移的模式，可应用于需要改善疼痛护理的其他弱势群体。