R01AG071511

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

Regents Of The University Of Michigan

TO ENCOURAGE BIOMEDICAL, SOCIAL, AND BEHAVIORAL RESEARCH AND RESEARCH TRAINING DIRECTED TOWARD GREATER UNDERSTANDING OF THE AGING PROCESS AND THE DISEASES, SPECIAL PROBLEMS, AND NEEDS OF PEOPLE AS THEY AGE. THE NATIONAL INSTITUTE ON AGING HAS ESTABLISHED PROGRAMS TO PURSUE THESE GOALS. THE DIVISION OF AGING BIOLOGY EMPHASIZES UNDERSTANDING THE BASIC BIOLOGICAL PROCESSES OF AGING. THE DIVISION OF GERIATRICS AND CLINICAL GERONTOLOGY SUPPORTS RESEARCH TO IMPROVE THE ABILITIES OF HEALTH CARE PRACTITIONERS TO RESPOND TO THE DISEASES AND OTHER CLINICAL PROBLEMS OF OLDER PEOPLE. THE DIVISION OF BEHAVIORAL AND SOCIAL RESEARCH SUPPORTS RESEARCH THAT WILL LEAD TO GREATER UNDERSTANDING OF THE SOCIAL, CULTURAL, ECONOMIC AND PSYCHOLOGICAL FACTORS THAT AFFECT BOTH THE PROCESS OF GROWING OLD AND THE PLACE OF OLDER PEOPLE IN SOCIETY. THE DIVISION OF NEUROSCIENCE FOSTERS RESEARCH CONCERNED WITH THE AGE-RELATED CHANGES IN THE NERVOUS SYSTEM AS WELL AS THE RELATED SENSORY, PERCEPTUAL, AND COGNITIVE PROCESSES ASSOCIATED WITH AGING AND HAS A SPECIAL EMPHASIS ON ALZHEIMER'S DISEASE. SMALL BUSINESS INNOVATION RESEARCH (SBIR) PROGRAM: TO EXPAND AND IMPROVE THE SBIR PROGRAM, TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT, TO INCREASE SMALL BUSINESS PARTICIPATION IN FEDERAL RESEARCH AND DEVELOPMENT, AND TO FOSTER AND ENCOURAGE PARTICIPATION OF SOCIALLY AND ECONOMICALLY DISADVANTAGED SMALL BUSINESS CONCERNS AND WOMEN-OWNED SMALL BUSINESS CONCERNS IN TECHNOLOGICAL INNOVATION. SMALL BUSINESS TECHNOLOGY TRANSFER (STTR) PROGRAM: TO STIMULATE AND FOSTER SCIENTIFIC AND TECHNOLOGICAL INNOVATION THROUGH COOPERATIVE RESEARCH DEVELOPMENT CARRIED OUT BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, TO FOSTER TECHNOLOGY TRANSFER BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT, AND TO FOSTER AND ENCOURAGE PARTICIPATION OF SOCIALLY AND ECONOMICALLY DISADVANTAGED SMALL BUSINESS CONCERNS AND WOMEN-OWNED SMALL BUSINESS CONCERNS IN TECHNOLOGICAL INNOVATION.

93.866 - Aging Research

National Institute on Aging (NIA) [HHS - NIH]

Ann Arbor, Michigan 481091276 United States

Single Zip Code

Mechanisms, Models, Measurement, and Management in Pain Research (R01 Clinical Trial Optional) (PA-18-141)

Amendment Since initial award the total obligations have increased 432% from $617,996 to $3,289,340.