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: 10668485
• 负责人: Mary Rose Janevic
• 金额: $ 51.88万
• 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/10668485
• 关键词: Acceleration; Accelerometer; Address; Adult; Affect; African American; Age; Anxiety; Behavioral; Biometry; COVID-19; COVID-19 impact; COVID-19 morbidity; COVID-19 mortality; COVID-19 pandemic; COVID-19 pandemic effects; COVID-19 risk; Caring; Chronic; Chronic Disease; Cities; Cognitive; Collaborations; Communities; Community Health Aides; Crowding; Data; Disadvantaged; Discipline of Nursing; Disparity; Distress; Education; Educational Curriculum; Educational process of instructing; Elderly; Exclusion; Face; Fatigue; Goals; Health; Health Services Needs; High Prevalence; Individual; Inequity; Institutional Racism; Intervention; Life Cycle Stages; Link; Mental Depression; Mental Health; Methods; Michigan; Modeling; Moods; Outcome; Pain; Pain interference; Participant; Patient Recruitments; Personal Satisfaction; Persons; Physical Function; Physical Medicine; Physical Rehabilitation; Physical activity; Physical environment; Pilot Projects; Pollution; Population; Psychology; Public Health; Randomized; Research; Resources; Safety; Self Management; Series; Services; Sleep; Social Work; Social isolation; Social support; Symptoms; Telephone; Testing; Underserved Population; Urban Community; Vulnerable Populations; Work; chronic pain; clinically significant; community center; community engagement; 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 community; marginalized population; pandemic disease; pandemic impact; pandemic response; physical conditioning; physical symptom; pilot trial; podcast; population health; prevent; programs; promote resilience; psychologic; psychological symptom; psychosocial; racial health disparity; resilience; secondary outcome; skills; social; social engagement; socioeconomic disadvantage; successful intervention; symptom management; telephone session; 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.

项目概要 底特律、密歇根州和其他地区的非裔美国老年人对 COVID-19 的脆弱性更高 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 还放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孤立，社区中心的关闭几乎没有留下安全的地方 身体活动的选择。因此，底特律的许多老年人甚至在 大流行期间，面临着痛苦增加、体力和社交活动减少以及体力下降的螺旋式下降。 去调理。及时干预对于防止或减缓这种下降至关重要。 “积极的步骤”是一种自我 由底特律社区卫生工作者 (CHW) 领导的管理和复原力建设干预措施 卫生部门（DHD）。社区卫生工作者拥有独特的能力，能够接触到服务不足的群体，提供文化服务 一致的护理，并形成通往正式服务的桥梁；然而，它们在 大流行。该干预措施针对个人（自我管理、复原力）、人际交往（社会支持）和 社区（增强 DHD 能力）水平。这项研究的长期目标是建立证据基础 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 目标是评估积极步骤对功能结果的影响。中心假设是 Positive STEPS，通过同步群组电话平台、异步播客系列以及 活动追踪器将改善 2 个月和 8 个月大时的心理和身体功能。在正在进行的 在一项随机试点试验中，Positive STEPS 的一个版本受到了社区卫生工作者的热烈欢迎，并得到了社区卫生工作者的高度认可。 保真度。在迄今为止的项目后结果分析中，干预组 (n=16) 的临床表现表明 在身体机能、焦虑、抑郁、 疲劳和疼痛干扰，而对照组 (n=18) 没有变化或更糟。 DHD 将与其他城市合作 底特律单位招募身体或心理症状严重的参与者。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（与新冠病毒教育/电话相比） PROMIS-29 心理社会评分（痛苦、疲劳、疼痛、社会心理评分的加权组合） 参与和睡眠）在 456 名主要是非裔美国老年人中进行。 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 的发现提供背景， 评估社区影响，并为传播工具包提供信息。该项目意义重大，因为它将严格 测试一个可扩展的模型，以解决处境极为不利的老年人中大流行的后遗症 环境。它的创新之处在于它测试了 CHW 支持与广泛可访问的移动医疗的独特结合 工具。最后，考虑到该模型可以转移到其他弱势群体，它具有产生广泛影响的潜力。