A new model to reach vulnerable older adults with pain self-management support
African American adults and people of low socioeconomic status suffer disproportionately from chronic pain-related disability. Chronic pain self-management (CPSM) support can help patients improve daily functioning and quality of life, while avoiding risks associated with opioids and other pharmacological treatments. However, the vast majority of people living in resource-challenged communities lack structured opportunities to learn CPSM skills. There is thus a critical need to test innovative ways to expand CPSM support among vulnerable groups, and I am centering my long-term research program around this goal. Community health workers (CHWs) are one promising strategy to make CPSM interventions more accessible. CHWs are uniquely positioned to address health disparities, by providing cost-efficient, culturally-appropriate care to underserved populations. CHW-led interventions have demonstrated positive outcomes across a range of chronic physical and mental health conditions. To date, however, CHWs have not been involved in delivering chronic pain care. My objective in this application is to adapt the manualized, web-assisted Engage CPSM program to be delivered by community health workers (CHWs) to older, low-income African American adults with chronic musculoskeletal pain. This will be accomplished via the following aims: 1) Through an iterative, user-centered design process, I will identify needed modifications to the Engage facilitator protocol so that it can be successfully delivered by CHWs, and to participant-facing program content so that it is more culturally-responsive and engaging. 2) I will conduct a pilot test of the adapted program in a sample of 10 participants from the priority population, using mixed quantitative and qualitative methods to assess CHW fidelity to intervention protocols, participant engagement, and change in pain-related interference. After completing these aims, I will have a complete set of protocols and materials for a CHW-led CPSM intervention adapted for a population facing disproportionate pain and disability, along with evidence of its feasibility. I will then seek NIH or PCORI funding to test its effectiveness via a large pragmatic trial. Over the long term, by demonstrating the potential of CHWs in the pain care workforce, this line of research could promote improved chronic pain treatment among hard-to-reach populations in both urban and rural settings.
American Pain Society
Funding Period: 1/1/2019 to 5/31/2020