An Efficacy Trial of Community Health Worker-Delivered Chronic Pain Self-Management Support for Vulnerable Older Adults

项目摘要 慢性疼痛是一个巨大的公共卫生问题，非裔美国老年人承受的痛苦不成比例 伤残疼痛的负担。循证慢性疼痛自我管理支持可改善疼痛相关 然而，提供这种支持的标准模式不太适合于 底特律、密歇根等面临严重种族隔离和社会经济问题的有色人种社区 劣势。现有的疼痛自我管理干预大多是以小组为基础的，需要面对面 联系，使有交通或行动障碍的老年人更难接触到他们。此外，现有的 干预措施很少涉及根植于健康的社会决定因素(例如经济压力) 同样的结构性不平等会产生高痛苦率并阻碍其管理。的长期目标是 这项研究旨在为慢性疼痛自我管理干预建立强有力的证据基础 满足服务不足社区中弱势老年人的需求。这个拟议项目的目标是 是确定社区卫生工作者(CHW)--即业馀卫生工作者是否与 他们服务的社区-可以有效地向老年人传授认知-行为疼痛管理策略 处于不利城市环境中的成年人。社区卫生工作者特别适合这一角色，因为他们有能力提供 文化上适当的关怀和对社区资源的深入了解，使他们能够解决 健康的社会决定因素。中心假设是基于CBT的疼痛自我管理干预 (“STEPS”)通过CHW和移动健康工具的电话会议在7周内提供改进 一年的疼痛相关结果。我们非常鼓舞人心的初步发现表明，这些步骤是可行的， 可由高保真的社区卫生工作者提供，并得到参与者的好评(n=31)。它的潜在功效是 疼痛干预显著改善(标准化前平均差=0.84，p= 000)。拟议的试验将与底特律的亨利·福特健康系统合作进行。那里 有三个具体目标：1)进行阶段3疗效试验，以评估步骤是否可以减少一年的疼痛 对414名主要是非裔美国人的老年人的干预和强度，2)评估心理行为 干预效果的调解人和调解人，以及3)使用来自参与者和其他人的定性数据 利益相关者，进行混合方法分析，为量化结果提供背景并为工具包提供信息 在干预有效的情况下进行传播。这个项目是创新的，因为它招募了CHW，他们有 为其他疾病提供循证干预，但尚未成为疼痛护理人员的一部分。它 具有强大的潜在影响，因为正在测试的模型成本低、可伸缩，并且适合深度 处境不利，慢性疼痛负担最重的地方。此外，它还可以远程交付， 这不仅最大限度地提高了访问权限，而且与社交距离兼容。最终，这项研究可能会导致 一种可移植的模式，可适用于其他需要改善疼痛护理的弱势群体。

Project Summary Chronic pain is an enormous public health problem, and African American older adults bear a disproportionate burden of disabling pain. Evidence-based chronic pain self-management support can improve pain-related functioning, yet standard models for providing this support are not well-suited to reach older people in communities of color such as Detroit, Michigan, which face severe racial segregation and socioeconomic disadvantage. Existing pain self-management interventions are mostly group-based and require in-person contact, making them less accessible to older adults with transportation or mobility barriers. Moreover, existing interventions seldom address the social determinants of health (e.g., economic stressors) that are rooted in the same structural inequities that produce high rates of pain and hinder its management. The long-term goal of this line of research is to build a robust evidence base for chronic pain self-management interventions that meet the needs of vulnerable older adults in underserved communities. The objective of this proposed project is to determine whether community health workers (CHWs)—i.e., lay health workers with close ties to the communities they serve – can effectively teach cognitive-behavioral pain management strategies to older adults in a disadvantaged urban setting. CHWs are uniquely suited for this role, given their ability to provide culturally appropriate care and their deep knowledge of community resources that enables them to address social determinants of health. The central hypothesis is that a CBT-based pain self-management intervention (“STEPS”) delivered over 7 weeks through telephone sessions with a CHW and mobile health tools improves one-year pain-related outcomes. Our highly encouraging preliminary findings indicate that STEPS is feasible, deliverable by CHWs with high fidelity, and well-received by participants (n=31). Its potential efficacy is suggested by significant improvement in pain interference (pre-post Standardized Mean Difference = 0.84, p = 000). The proposed trial will take place in partnership with the Detroit-based Henry Ford Health System. There are three specific aims: 1) Conduct a Stage 3 efficacy trial to assess whether STEPS can reduce one-year pain interference and intensity among 414 primarily African American older adults, 2) Assess psychobehavioral mediators and moderators of intervention effects, and 3) Using qualitative data from participants and other stakeholders, conduct mixed-methods analysis to provide context for quantitative findings and inform a toolkit for dissemination, if the intervention is effective. This project is innovative in that it enlists CHWs, who have delivered evidence-based interventions for other conditions but are not yet part of the pain care workforce. It has strong potential impact given that the model being tested is low-cost, scalable, and suitable for deeply disadvantaged settings, where the burden of chronic pain is greatest. Moreover, it can be delivered remotely, which not only maximizes access but is compatible with social distancing. Ultimately, this research could lead to a transferable model that can be applied to other vulnerable populations in need of improved pain care.