# A community health worker-delivered intervention (STEPS) to support chronic pain self-management among older adults in an underserved urban community: protocol for a randomized trial

## TL;DR

This study tests a program called STEPS to help older adults in underserved urban areas manage chronic pain using community health workers and technology.

## Contribution

The study introduces a culturally tailored, CHW-led chronic pain self-management program for disadvantaged older adults.

## Key findings

- The STEPS program includes weekly CHW calls, videos, and wearable activity tracking to support pain self-management.
- Participants will be randomly assigned to STEPS or a control group to evaluate improvements in pain outcomes.
- The study aims to reduce pain-related disability and promote non-pharmacological pain management strategies.

## Abstract

Older adults in disadvantaged urban communities contend with chronic psychosocial and environmental stressors that contribute to high levels of chronic pain-related disability. African American older adults are especially at risk due to the health-damaging effects of structural racism. The purpose of this study is to test the efficacy of a chronic pain self-management intervention tailored for this context. STEPS (Seniors using Technology to Engage in Pain Self-management) is a community health worker (CHW)-led chronic pain self-management program designed for older adults living in underserved communities. It is a 7-week intervention that includes (a) brief videos presenting pain self-management skills; (b) weekly telephone calls with a CHW to support the practice of new skills and goal setting; and (c) tracking daily step counts using a wearable activity tracker. CHWs also screen for social needs and make appropriate community referrals.

We will randomly assign 414 participants to the STEPS intervention or a control condition in a 1:1 ratio, stratifying by gender and age group. We hypothesize that participants in the STEPS intervention will have greater improvements in pain interference and pain intensity, and a more positive Global Impression of Change immediately following the intervention and at 12 months from baseline. Control group members are invited to attend a workshop covering key intervention content after the final data collection point.

Growing evidence supports the effectiveness of CHWs as culturally sensitive liaisons between healthcare systems and underserved communities. If the STEPS program is shown to significantly improve pain-related outcomes, STEPS could be integrated into healthcare systems to more comprehensively treat chronic pain while reducing barriers to care and promoting non-pharmacological pain management strategies.

ClinicalTrials.gov, NCT05278234. Registered on March 3, 2022.