Improving Physical and Psychosocial Functioning in Underserved Older Adults During the COVID-19 Pandemic: A Community Health Worker-Led Intervention

在 COVID-19 大流行期间改善服务不足的老年人的身体和心理社会功能：社区卫生工作者主导的干预措施

• 批准号: 10306867
• 负责人: Mary Rose Janevic
• 金额: $ 71.25万
• 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: 2021-09-24 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10306867
• 关键词: Accelerometer; Address; Adult; Affect; African American; Age; Anxiety; Behavioral; Biometry; COVID-19; COVID-19 morbidity; COVID-19 mortality; COVID-19 pandemic; Caring; Chronic; Chronic Disease; Cities; Cognitive; Communities; Community Health Aides; Data; Disadvantaged; Distress; Education; Educational Curriculum; Educational process of instructing; Elderly; Exclusion; Face; Fatigue; Goals; Health; Health Services Needs; High Prevalence; Individual; Institutional Racism; Intervention; Life Cycle Stages; Link; Mental Depression; Mental Health; Methods; Michigan; Modeling; Moods; Outcome; Pain; Pain interference; Participant; Patient Recruitments; Personal Satisfaction; Physical Function; Physical Medicine; Physical activity; Physical environment; Pilot Projects; Pollution; Population; Psychology; Public Health Nursing; Randomized; Research; Resources; Risk; Safety; Self Management; Series; Services; Sleep; Social Work; Social isolation; Social support; Structure; Symptoms; Telephone; Testing; Time; Underserved Population; Urban Community; Vulnerable Populations; Work; chronic pain; clinically significant; community center; computer human interaction; coronavirus disease; daily functioning; deconditioning; design; digital; evidence base; experience; functional outcomes; group intervention; hearing impairment; high risk; impression; improved; innovation; intervention participants; mHealth; marginalized population; pandemic disease; physical conditioning; physical symptom; pilot trial; podcast; population health; prevent; programs; psychologic; psychological symptom; psychosocial; racial health disparity; resilience; secondary outcome; skills; social; social engagement; socioeconomic disadvantage; successful intervention; symptom management; tool; uptake

Project Summary The heightened vulnerability to COVID-19 of African American older adults in Detroit, Michigan and other marginalized communities is linked to systemic racism experienced over the life course. Structural inequities also magnify the pandemic's impact on older adults' physical and psychosocial functioning. For example, social isolation is exacerbated by widespread digital exclusion, and closures of community centers leave few safe options for physical activity. Hence, many older adults in Detroit, burdened by poor health even before the pandemic, face a downward spiral of increased distress, reduced physical and social activity, and physical deconditioning. Timely intervention is critical to prevent or slow this decline. “Positive STEPS” is a self- management and resilience-building intervention led by community health workers (CHWs) at the Detroit Health Department (DHD). CHWs have a unique ability to reach underserved groups, provide culturally congruent care, and form a bridge to formal services; yet they have been vastly underutilized during the pandemic. This intervention targets individual (self-management, resilience), interpersonal (social support) and community (enhanced DHD capacity) levels. The long-term goal of this research is to build an evidence base for engaging the CHW workforce to mitigate the pandemic's impact on vulnerable groups. The project's objective is to assess the impact of Positive STEPS on functional outcomes. The central hypothesis is that Positive STEPS, delivered via a synchronous group telephone platform, asynchronous podcast series, and activity trackers, will improve psychosocial and physical functioning at 2 and 8 months. In an ongoing randomized pilot trial, a version of Positive STEPS has been well-received and delivered by CHWs with high fidelity. In analysis to date of post-program outcomes, the intervention group (n=16) has shown clinically significant improvements of 2 to 5 points across PROMIS domains of physical functioning, anxiety, depression, fatigue and pain interference, while controls (n=18) are unchanged or worse. The DHD will work with other City of Detroit units to recruit participants with elevated physical or psychological symptoms. Specific aims are: 1) With input from a Community Advisory Board, modify Positive STEPS for group delivery and add pandemic content; conduct a mini-pilot (n=10). 2) Conduct an RCT to assess its impact (vs. COVID education/telephone wellness check) on PROMIS-29 Psychosocial Score (a weighted combination of distress, fatigue, pain, social participation and sleep) among 456 primarily African American older adults. 3) Using qualitative data from participants and other stakeholders, conduct mixed-methods analyses to provide context for Aim 2 findings, assess community impact, and inform a dissemination toolkit. This project is significant in that it will rigorously test a scalable model for addressing sequelae of the pandemic among older adults in a deeply disadvantaged setting. It is innovative in that it tests a unique blend of CHW support with broadly-accessible mobile health tools. Last, it has potential for broad impact, given the model's transferability to other vulnerable populations.

项目总结