A Community Health Worker-Led Positive Psychology Intervention for African American Older Adults With Chronic Pain

• Published in: The Gerontologist 2022-10, Vol.62 (9), p.1369-1380
• Main Authors: Janevic, Mary, Robinson-Lane, Sheria G, Courser, Rebecca, Brines, Elizabeth, Hassett, Afton L
• Format: Article
• Language: English
• Subjects: African Americans; Aged; Black or African American - psychology; Chronic pain; Chronic Pain - therapy; Community Health Workers; Female; Health; Health disparities; Humans; Intervention; Intervention Research; Male; Management; Older people; Pain; Pain Management; Psychology, Positive; Racism; Research design; Resilience; Retention; Skills; Social participation; Systemic racism; Teaching
• ISSN: 0016-9013; 1758-5341; 1758-5341
• DOI: 10.1093/geront/gnac010

Experiencing structural racism over the life course contributes to disproportionate pain-related disability among African American older adults. Positive STEPS, delivered by community health workers, is a culturally congruent chronic pain self-management intervention that incorporates positive psychology principles and gives attention to social determinants of pain and pain management. We conducted a randomized pilot trial among older adults with chronic musculoskeletal pain in an underserved, primarily African American community (Detroit, Michigan). The 7-week intervention included weekly telephone sessions with a community health worker; web-based videos teaching pain self-management skills; positive activities (e.g., Life Review, Gratitude Jar); and use of wearable activity trackers. Outcomes were measured at baseline and 8-week follow-up. We assessed participant retention, engagement, and satisfaction. Study completers (n = 46; 90% retention) were 93% African American, 89% female, mean 72 years, and completed 5.7 of 7 sessions. Intervention participants versus controls showed greater improvement in PROMIS Pain Interference (4.3-point T-score decrease vs. 0.4-point increase; p = .01) and the Pain Self-Efficacy Questionnaire (p = .007). Furthermore, compared with controls, significantly more intervention participants reported "better" or "much better" global functioning (86% vs. 25%; p = .000) and pain (67% vs. 21%; p = .003) since baseline. Improvements in physical functioning, social participation, and resilience were noted, but differences were not significant. Participant feedback on the intervention was overwhelmingly positive. A community health worker-led chronic pain self-management intervention combining positive activities with self-management skills training demonstrated the potential to enhance pain-related functioning among a vulnerable group of older adults. NCT04321239.