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、密歇根和其他地方的非裔美国老年人对新冠肺炎的易感性增加 边缘化社区与一生中经历的系统性种族主义有关。结构性不平等 也放大了大流行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孤立，关闭社区中心几乎没有留下安全的东西 体力活动的选择。因此，底特律的许多老年人在健康状况不佳之前就背负着沉重的负担 大流行，面临着痛苦增加、体力和社会活动减少以及体力活动减少的螺旋式下降 解除条件。及时干预对于防止或减缓这一下降至关重要。“积极的步伐”是一种自我 底特律社区卫生工作者(CHW)领导的管理和复原力建设干预 卫生部(DHD)。社区卫生组织有一种独特的能力，能够接触到服务不足的群体，在文化上提供 一致的护理，并形成通往正式服务的桥梁；然而，在 大流行。这项干预的目标是个人(自我管理、韧性)、人际关系(社会支持)和 社区(增强的DHD容量)级别。这项研究的长期目标是建立一个证据基础 让CHW工作人员参与，以减轻大流行对弱势群体的影响。该项目的 目的是评估积极步骤对功能结果的影响。中心假设是 积极的步骤，通过同步集团电话平台、异步播客系列和 活动跟踪器，将在2个月和8个月时改善心理社会和身体功能。在一个正在进行的 随机试点试验，积极步骤的一个版本受到了CHWS的好评，并得到了高度重视 富达。到目前为止，在对计划后结果的分析中，干预组(n=16)临床上表现出 在生理功能、焦虑、抑郁、 疲劳和疼痛干预，而对照组(n=18)没有变化或更差。DHD将与其他城市合作 底特律部队招募身体或心理症状升高的参与者。具体目标有：1) 根据社区咨询委员会的意见，修改团体分娩的积极步骤并增加流行病 内容；进行一项小型试验(n=10)。2)开展RCT以评估其影响(与COVID教育/电话对比 健康检查)PROMIS-29心理社会评分(痛苦、疲劳、疼痛、社交的加权组合 在456名主要是非裔美国人的老年人中)。3)使用以下定性数据 参与者和其他利益攸关方进行混合方法分析，为目标2的调查结果提供背景， 评估社区影响，并告知传播工具包。这个项目意义重大，因为它将严格地 测试一种可扩展的模型，用于在处于严重不利地位的老年人中解决流行病的后遗症 布景。它的创新之处在于它测试了CHW支持与广泛访问的移动医疗的独特组合 工具。最后，考虑到该模式对其他弱势群体的可转移性，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.