Escoge Salud (Choose Health): a Chronic Pain Self-Management Program in Middle to Older Age Hispanic Americans
Condition: Chronic Pain
MeSH terms: Chronic Pain
Study type: Interventional

Summary: 
      The purpose of this study is to evaluate patient satisfaction and health status before and
      after a 6-week established self-management training program for middle to older age Hispanic
      Americans living with chronic musculoskeletal pain in a large, hospital based urban health
      maintenance organization. The secondary aim is to evaluate the effects of remote, nonfrequent
      healthcare provider feedback for 6 months on health care utilization, health status and
      patient satisfaction.
    

Detailed description: 
      Managing chronic pain in the US costs approximately $635 billion and half of this expenditure
      is for joint and arthritis related pain syndromes. Interestingly, compared with non-Hispanic
      whites (NHWs), Hispanic Americans (HAs) report significantly lower rates of chronic pain with
      consistently higher levels of pain intensity in both population and clinically based studies.
      Chronic musculoskeletal pain (CMP) incidence increases with age and the HA aging population
      is among the fastest growing segments of the US population. Despite reporting more intense
      pain, HA are less likely to seek medical care versus NHWs for acute and chronic pain. Lack of
      access, cultural stoicism and an external locust of control are thought to explain why HAs
      seek care at a reduced rate. Psychological factors play a significant role in pain
      experience, HAs may employ catastrophic thinking and experience more pain related anxiety
      which are predictors of exacerbated pain experience. Pain comorbidities may be amenable to
      treatment with appropriate, culturally sensitive treatment focusing on enhancing
      self-efficacy to manage the complex array of psychological pain comorbidities. There is a
      societal impact of undertreating chronic pain in the HA population. While HAs have the lowest
      rate of short-term sick usage (<1-2 days), they have the highest rate of long-term sick usage
      (>31 days). This increased long-term time off puts HAs at risk of losing their job if the
      time off exceeds Family Leave and Medical Act minimums. Lastly, it is well documented, HAs
      are hesitant to take strong pain medication and there is conflicting evidence surrounding
      taking over-the-counter medications for pain management. There is a need to provide
      culturally sensitive, effective chronic pain management treatments for HAs.

      There have been 5 well designed studies (n=931) demonstrating efficacy of a trans-created
      Spanish version of the Chronic Disease Self-Management Program (CDSMP) for HAs with chronic
      musculoskeletal pain. CDSMP has demonstrated effectiveness in improving pain intensity,
      self-efficacy (SE) and health behaviors in a community setting . The intervention is a
      healthcare provider and/or peer led 2.5 hour self-management training session, 1 time per
      week for 6 weeks taught in a group setting in Spanish. The program is grounded in Bandura's
      Social Cognitive Theory and uses goal setting and problem solving as corner stones to create
      a personalized self-management program. Improvements post-intervention in SE predict
      sustainability of health behaviors and maintenance of improved health status in the long
      term. Additionally, remote non-frequent health care provider feedback has been associated
      with maintenance of health behaviors, however this his not been tested in the HA population.

      The purpose of this study is to test the feasibility (patient satisfaction and change in
      health status) after bringing the CDSMP programming to a large urban hospital based medical
      center that does not currently offer a culturally sensitive, self-management training program
      in Spanish middle to older age HAs with chronic pain. The secondary aim is to pilot the
      effectiveness of an every 6th week phone/video visit feedback visit for 24 months on both
      health status and healthcare utilization.
    

Intervention name(s): Chronic Disease Self-Management Program (CDSMP) for chronic pain in Spanish; Remote feedback active group; Remote feedback control group
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): The CDSMP meets for 2.5 hours for 6 weeks. Topics covered are: understanding pain, finding resources, mindfulness, pain science, pacing, exercise, relaxation, communication, sex/intimacy, healthy eating, weight and medication management, making treatment decisions and confronting fears.
Participants are encouraged to create their own personal health goals and make weekly action plans to meet their personal goals. Each week participants learn new tools and problem-solving techniques to meet their health goals and themes are repeated throughout 6-week period to ensure understanding and integration. Participants are encouraged to problem-solve and ask questions to the group about creating and carrying out their self-management plan.
The intervention follows the content of the book Programa de Manejo Personal del Dolor Crónico (Living a Healthy Life with Chronic pain); After the 6-week self management program, half the participants will be randomized to an every 6 weeks for 6 months phone or video visit from a health care provider, in Spanish. The phone or video sessions will include: review previous action-plans (goals) and provide support in forming new action-plans (goals); After the 6-week self-management program, half the participants will be randomized to a control group for 6 months.
Other intervention name(s): CDSMP for chronic pain in Spanish
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: This is a prospective study with a secondary randomization to a remote, nonfrequent provider feedback sustainability intervention. All participants will receive the 6-week self-management intervention and do pre/post evaluations. After the 6-week intervention, half the group will be randomized to a every 6th week for 6 months healthcare provider phone/video visit session and half will be received to no treatment control for 6 months.
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Hispanic American; Latino; self-management training; sustainability; health care utilization