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Principal Investigator: Mary Rose Janevic
Organization: UNIVERSITY OF MICHIGAN AT ANN ARBOR
Fiscal Year: 2024
Award: $524,065
Funding agency: National Institute on Aging
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.
Terms: <21+ years old><Accelerometer><Address><Adult><Adult Human><Affect><African American><Afro American><Afroamerican><Age><Aging><Behavior><Behavioral><COVID-19><COVID-19 affected><COVID-19 consequence><COVID-19 effect><COVID-19 impact><COVID-19 impacted><CV-19><Caring><Cities><Cognitive><Color><Communities><Community Health Aides><Computers><Coronavirus Infectious Disease 2019><Data><Disadvantaged><Discipline of Nursing><Disparities><Disparity><Drugs><Economic Income><Economical Income><Economically Deprived><Economics><Educational process of instructing><Enrollment><Evidence based intervention><Face><Front line employee><Front line person><Front line personnel><Front line staff><Front line worker><Frontline employee><Frontline person><Frontline personnel><Frontline staff><Frontline worker><Goals><Health><Health system><Housing><Human><Income><Inequity><Intervention><Intervention Strategies><Knowledge><Learning><Mediating><Mediator><Medication><Methods><Michigan><Modeling><Modern Man><Monitor><Musculoskeletal Pain><Needs Assessment><Nursing><Nursing Field><Nursing Profession><Older Population><On-Line Systems><Online Systems><Pain><Pain Control><Pain Research><Pain Therapy><Pain intensity><Pain interference><Pain management><Painful><Participant><Persons><Pharmaceutical Preparations><Physiatrics><Physiatry><Physical Medicine><Physical Rehabilitation><Physical activity><Physical distancing><Pilot Projects><Population><Position><Positioning Attribute><Prevalence><Process><Public Health><Racial Segregation><Randomized, Controlled Trials><Rehabilitation Medicine><Reporting><Research><Research Resources><Resources><Risk><Role><SES disparity><Self Efficacy><Services><Social Distance><Social Mobility><Socioeconomically disadvantaged><Standardization><Structural Racism><Sustainable Development><Teaching><Technology><Testing><Therapeutic><Training><Transportation><Urban Community><Vulnerable Populations><accelerated aging><accelerated biological age><accelerated biological aging><accelerometry><activity monitor><activity tracker><adult of color><adulthood><age acceleration><aged><ages><chronic pain><community health worker><compare to control><comparison control><coronavirus disease 2019><coronavirus disease 2019 consequence><coronavirus disease 2019 effect><coronavirus disease 2019 impact><coronavirus disease-19><coronavirus disease-19 impact><coronavirus infectious disease-19><cost><delivered remotely><delivered via telephone><disabling pain><disparities in race><disparity due to race><disparity in health><drug/agent><economic><economic disparity><economically disadvantaged><efficacy trial><enroll><environmental stresses><environmental stressor><evidence base><faces><facial><group intervention><health disparity><high risk><impression><improved><incomes><inequality due to race><inequity due to race><innovate><innovation><innovative><intervention effect><intervention participants><interventional strategy><m-Health><mHealth><marginalization><mobile health><novel><older adult><older adulthood><older groups><older individuals><older person><online computer><pain outcome><pain reduction><pain self-management><pain treatment><pain-related disability><pain-related outcome><phone session><physical rehab><pilot study><pilot test><population health><primary outcome><programs><psychologic><psychological><psychosocial stresses><psychosocial stressors><public health priorities><race based disparity><race based inequality><race based inequity><race disparity><race related disparity><race related inequality><race related inequity><racial disparity><racial inequality><racial inequity><racially unequal><randomized control trial><reduce pain><remote delivery><secondary outcome><self-management program><sex><skills><social health determinants><social role><socio-economic disadvantage><socio-economic disparity><socio-economic inequality><socio-economic inequity><socio-economically disadvantaged><socio-economically underprivileged><socioeconomic disadvantage><socioeconomic disparity><socioeconomic inequality><socioeconomic inequity><socioeconomically underprivileged><stem><stressor><telephone based><telephone based delivery><telephone based session><telephone delivered><telephone delivery><telephone session><tool><under served area><under served community><under served geographic area><under served location><under served region><underserved area><underserved community><underserved geographic area><underserved location><underserved region><urban environment><urban setting><usual care arm><usual care control group><virtual><vulnerable group><vulnerable individual><vulnerable people><wearable><wearable device><wearable electronics><wearable system><wearable technology><wearable tool><wearables><web based>