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

项目摘要 底特律、密歇根和其他城市的非裔美国老年人对COVID-19的脆弱性增加 边缘化社区与其一生中经历的系统性种族主义有关。结构性不平等 这也扩大了这一流行病对老年人身体和心理社会功能的影响。例如社交 广泛的数字排斥加剧了隔离，社区中心的关闭使很少有人安全 体育活动的选择。因此，底特律的许多老年人，甚至在失业之前就受到健康状况不佳的困扰， 大流行病，面临日益加剧的痛苦，减少身体和社会活动， 去适应及时干预对于防止或减缓这种下降至关重要。“积极的步骤”是一个自我- 由底特律社区卫生工作者（CHW）领导的管理和依从性建设干预 卫生部。社区卫生工作者有一种独特的能力，可以接触到服务不足的群体， 一致的照顾，并形成一个桥梁，以正式的服务，但他们一直大大利用不足，在 流行病这种干预针对个人（自我管理、复原力）、人际（社会支持）和 社区一级（提高人力资源开发能力）。这项研究的长期目标是建立一个证据基础 让社区卫生工作者参与进来，减轻疫情对弱势群体的影响。该项目的 目的是评估积极步骤对功能结果的影响。核心假设是， 积极的步骤，通过同步组电话平台，异步播客系列， 活动追踪器将在2个月和8个月时改善心理社会和身体功能。以不间断 在一项随机试点试验中，积极步骤的一个版本受到了CHW的好评， 忠诚在迄今为止的程序后结果分析中，干预组（n=16）显示临床 在PROMIS的身体功能、焦虑、抑郁、 疲劳和疼痛干扰，而对照组（n=18）不变或更糟。DHD将与其他城市合作 招募身体或心理症状加重的参与者。具体目标是：1） 根据社区咨询委员会的意见，修改团体交付的积极步骤，并添加流行病 内容;进行小型试点（n=10）。2)进行随机对照试验以评估其影响（对比COVID教育/电话 PROMIS-29心理社会评分（苦恼、疲劳、疼痛、社会和心理健康检查的加权组合） 参与和睡眠）456主要是非洲裔美国老年人。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，为目标2的结果提供背景， 评估社区影响，并为传播工具包提供信息。该项目的重要性在于，它将严格 测试一个可扩展的模式，以解决处于严重不利地位的老年人中的大流行病后遗症， 设置.它的创新之处在于它测试了CHW支持与广泛访问的移动的健康的独特融合 工具.最后，鉴于该模式可推广到其他弱势群体，它具有广泛影响的潜力。

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.