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.

项目摘要 底特律，密歇根州和其他人的非裔美国人老年人的脆弱性加剧了19岁 边缘化社区与在生活过程中经历的系统种族主义有关。结构不平等 还放大了大流行对老年人身体和社会心理功能的影响。例如，社交 隔离因宽度数字排除而加剧，社区中心的关闭几乎没有安全 体育锻炼的选项。因此，许多老年人在底特律，甚至在 大流行，面临着痛苦增加，身体和社交活动减少以及身体的下降螺旋 调节。及时干预对于预防或减缓这种下降至关重要。 “积极步骤”是一个自我 由底特律社区卫生工作者（CHW）领导的管理和弹性建设干预措施 卫生部（DHD）。 CHW具有到达服务不足的群体，在文化上提供独特的能力 一致的护理，并形成了正式服务的桥梁；然而，在 大流行。该干预措施针对个人（自我管理，韧性），人际关系（社会支持）和 社区（增强的DHD容量）水平。这项研究的长期目标是建立证据基础 为了让CHW劳动力减轻大流行对弱势群体的影响。项目 目的是评估积极步骤对功能结果的影响。中心假设是 积极的步骤，通过同步组电话平台，异步播客系列和 活动跟踪器将在2和8个月时改善心理和身体功能。正在进行中 随机试验试验，一个正面步骤的版本已被CHW备受关注和交付 忠诚。在截至程序后结果的分析中，干预组（n = 16）在临床上显示 在身体机能，焦虑，抑郁， 疲劳和疼痛干扰，而对照（n = 18）不变或更糟。 DHD将与其他城市合作 底特律单位以招募身体或心理症状升高的参与者。具体目的是：1） 通过社区顾问委员会的意见，修改了小组交付的积极步骤并添加大流行 内容;进行迷你轮子（n = 10）。 2）进行RCT评估其影响（与COVID教育/电话 健康检查）PROMIS-29社会心理评分（痛苦，疲劳，痛苦，社会的加权组合 参与和睡眠）在456名非裔美国人老年人中。 3）使用定性数据 参与者和其他利益相关者进行混合方法分析，为AIM 2调查结果提供背景， 评估社区影响，并告知传播工具包。这个项目很重要，因为它将严格 测试一个可伸缩模型，以解决老年人中大流行的后遗症，深深地受到干扰 环境。它具有创新性，因为它测试了CHW支持的独特混合物与广泛可访问的移动健康 工具。最后，鉴于该模型转移到其他弱势群体的情况下，它具有广泛影响。