Reducing disparities in chronic pain with a tailored psychosocial education intervention for an underrepresented population

PROJECT SUMMARY/ABSTRACT Health inequalities in chronic pain exists in the US, with a greater burden of chronic pain and higher rate of misdiagnosis and undertreatment reported in minoritized groups compared to non-Hispanic Whites. Asian Americans (AA) are the fastest-growing racial/ethnic group in the US, yet despite the rapid growth in their

numbers, AA remain under-represented in pain disparity research. People from culturally and linguistically diverse communities are known to have higher levels of pain, disability, and psychological distress when they live in a Western environment. AA are linguistically diverse and among the racial groups most likely to be

limited in English proficiency, which may contribute to their linguistic and social isolation. Underdiagnosis and underreporting of pain among AA have been reported. Cultural norms of Asians may discourage reporting their pain to avoid burdening others or being seen as weak. Rather than seeking medical assistance, Asians have

been reported to tend to accept the pain as natural or to suffer to maintain their independence. Our preliminary studies found that Korean Americans (KA) exhibited higher levels of pain severity and pain catastrophizing compared to their counterparts living in Korea. However, very few evidence-based programs are available that

can be implemented for this linguistically/socially isolated population in the US. This proposed study aims to fill critical knowledge gaps in pain disparity research by providing evidence of feasibility and acceptability of a culturally-tailored psychosocial pain education intervention for an underrepresented population using the KA

community as an exemplar. Using a sequential exploratory mixed-method design incorporating a Community- Based Participatory Research approach, we will: (1) iteratively adapt and culturally-integrate a previously established psychosocial education intervention for KA to develop an effective program to improve pain

outcomes for underserved KAs with chronic pain in the community; conduct KA Community Advisory Board meetings and participant focus group interviews to improve the intervention design, content, and cultural relevance, and (2) evaluate the feasibility and acceptability of the culturally adapted psychosocial education

intervention using a single group, pre-posttest design with 30 foreign-born Korean immigrants with chronic pain dwelling in the community. We will conduct a survey to assess improvements in the outcomes (i.e., pain catastrophizing, pain intensity/interference) at 3 time points (pre-test, post-test, 12 weeks after the

intervention). Post-intervention in-depth interviews will be conducted with subset of the participants (n = 10) on their reflections about the program. Feasibility and acceptability will be evaluated by integrating quantitative (i.e., recruitment/retention rate, participants engagement) and qualitative (i.e., perceived appropriateness)

findings. Achievement of study goals will demonstrate for the first time that a nurse-led, community-based psychosocial education intervention to reduce chronic pain for the underrepresented KA population may be feasible and acceptable, forming the basis for a larger efficacy trial to test the tailored intervention.