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Randomized Controlled Trial
. 2022 Oct 19;62(9):1369-1380.
doi: 10.1093/geront/gnac010.

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

Mary Janevic  1 , Sheria G Robinson-Lane  2 , Rebecca Courser  1 , Elizabeth Brines  1 , Afton L Hassett  3
Affiliations
Randomized Controlled Trial

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

Mary Janevic et al. Gerontologist. .

Abstract

Background and objectives: 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.

Research design and methods: 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.

Results: 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.

Discussion and implications: 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.

Clinical trial number: NCT04321239.

Keywords: African Americans; Community-engaged research; Mobile health.

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Figures

Figure 1.
Figure 1.
Positive STEPS sequence and content. CHW = community health worker.
Figure 2.
Figure 2.
Positive STEPS flowchart.
Figure 3.
Figure 3.
Participant satisfaction with Positive STEPS intervention. CHW = community health worker.
See this image and copyright information in PMC

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