1
|
Fritz JM, Gibson B, Wetter DW, Del Fiol G, Solis V, Ford I, Lundberg K, Thackeray A. Use of implementation mapping in the planning of a hybrid type 1 pragmatic clinical trial: the BeatPain Utah study. Implement Sci Commun 2024; 5:3. [PMID: 38183154 PMCID: PMC10768478 DOI: 10.1186/s43058-023-00542-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/21/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Considerable disparities in chronic pain management have been identified. Persons in rural, lower income, and minoritized communities are less likely to receive evidence-based, nonpharmacologic care. Telehealth delivery of nonpharmacologic, evidence-based interventions for persons with chronic pain is a promising strategy to lessen disparities, but implementation comes with many challenges. The BeatPain Utah study is a hybrid type 1 effectiveness-implementation pragmatic clinical trial investigating telehealth strategies to provide nonpharmacologic care from physical therapists to persons with chronic back pain receiving care in ommunity health centers (CHCs). CHCs provide primary care to all persons regardless of ability to pay. This paper outlines the use of implementation mapping to develop a multifaceted implementation plan for the BeatPain study. METHODS During a planning year for the BeatPain trial, we developed a comprehensive logic model including the five-step implementation mapping process informed by additional frameworks and theories. The five iterative implementation mapping steps were addressed in the planning year: (1) conduct needs assessments for involved groups; (2) identify implementation outcomes, performance objectives, and determinants; (3) select implementation strategies; (4) produce implementation protocols and materials; and (5) evaluate implementation outcomes. RESULTS CHC leadership/providers, patients, and physical therapists were identified as involved groups. Barriers and assets were identified across groups which informed identification of performance objectives necessary to implement two key processes: (1) electronic referral of patients with back pain in CHC clinics to the BeatPain team and (2) connecting patients with physical therapists providing telehealth. Determinants of the performance objectives for each group informed our choice of implementation strategies which focused on training, education, clinician support, and tailoring physical therapy interventions for telehealth delivery and cultural competency. We selected implementation outcomes for the BeatPain trial to evaluate the success of our implementation strategies. CONCLUSIONS Implementation mapping provided a comprehensive and systematic approach to develop an implementation plan during the planning phase for our ongoing hybrid effectiveness-implementation trial. We will be able to evaluate the implementation strategies used in the BeatPain Utah study to inform future efforts to implement telehealth delivery of evidence-based pain care in CHCs and other settings. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04923334 . Registered June 11, 2021.
Collapse
Affiliation(s)
- Julie M Fritz
- Department of Physical Therapy & Athletic Training, University of Utah, 383 Colorow Dr., Room 391, Salt Lake City, UT, 84108, USA.
| | - Bryan Gibson
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - David W Wetter
- Department of Population Health Sciences, Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Victor Solis
- Department of Physical Therapy & Athletic Training, University of Utah, 383 Colorow Dr., Room 391, Salt Lake City, UT, 84108, USA
| | - Isaac Ford
- Department of Physical Therapy & Athletic Training, University of Utah, 383 Colorow Dr., Room 391, Salt Lake City, UT, 84108, USA
| | - Kelly Lundberg
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | - Anne Thackeray
- Department of Physical Therapy & Athletic Training, University of Utah, 383 Colorow Dr., Room 391, Salt Lake City, UT, 84108, USA
| |
Collapse
|
2
|
Zvolensky MJ, Shepherd JM, Garey L, Woody M, Otto MW, Clausen B, Smit T, Mayorga NA, Bakhshaie J, Buitron V. Negative emotional reactivity to minority stress: measure development and testing. Cogn Behav Ther 2024; 53:1-28. [PMID: 37766610 PMCID: PMC10840979 DOI: 10.1080/16506073.2023.2260560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023]
Abstract
The purpose of the present investigation was to develop and test a measure of negative emotional reactivity to racial/ethnic minoritized stress. In Study 1, we developed item content for a measure of negative emotional reactivity to racial/ethnic minoritized stress. We then evaluated item performance and produced a refined 15-item scale among a large sample of racial/ethnic minority adults (N = 1,343). Results supported a unidimensional construct and high levels of internal consistency. The factor structure and internal consistency were replicated and extended to a sample of Latinx persons who smoke (N = 338) in Study 2. There was evidence of convergent validity of the Emotional Reactivity to Minoritized Stress (ERMS) total score in terms of theoretically consistent and statistically significant relations with indices of mental health problems, social determinants of health, and substance use processes. There was also evidence that the ERMS demonstrated divergent validity in that it was negatively associated with psychological well-being, health literacy, subjective social status in Study 1, and positive abstinence expectancies in Study 2. Overall, the present study establishes the reliability and validity of measuring individual differences in negative emotional reactivity to racial/ethnic minority stress with the ERMS and that such responsivity is associated with behavioral health problems.
Collapse
Affiliation(s)
- Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- HEALTH Institute, University of Houston, Houston, TX, USA
| | | | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX, USA
- HEALTH Institute, University of Houston, Houston, TX, USA
| | - Mary Woody
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael W. Otto
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Bryce Clausen
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Tanya Smit
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Nubia A. Mayorga
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Jafar Bakhshaie
- Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, 1 Bowdoin Square, Suite 100, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Victor Buitron
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| |
Collapse
|
3
|
Garey L, Salwa A, Smit T, Mayorga NA, Redmond BY, Fernandez SB, Ditre JW, Obasi E, Zvolensky MJ. Pain Severity in Relation to Smoking Cessation Problems and Self-Efficacy for Quitting among Latinx Individuals Who Smoke Cigarettes: The Moderating Role of Perceived Discrimination. Subst Use Misuse 2023; 59:225-234. [PMID: 37838964 PMCID: PMC10842610 DOI: 10.1080/10826084.2023.2267117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Background: Latinx individuals experience significant tobacco cigarette smoking-related diseases and illnesses. Although most Latinx smokers report a desire to quit smoking, evidenced-based cessation treatments are underutilized in this group, which may partially be due to lower likelihood of receiving advice from a healthcare professional. Further, there are a lack of cessation treatments that account for comorbid symptoms/conditions (e.g., co-occurring pain) and social determinants of health (e.g., perceived discrimination). Extant work has established the reciprocal relation between pain and smoking trajectories. Additionally, although social determinants, such as perceived racial/ethnic discrimination, have demonstrated clinical relevance to a variety of health-related behaviors, limited work has examined the role of perceived discrimination in pain-smoking relations. The current study examined the effects of perceived discrimination and pain severity in relation to smoking cessation problems and self-efficacy for quitting among Latinx cigarette smokers. Method: Participants included 226 (Mage = 34.95 years, SD = 8.62; 38.5% female) adult Latinx daily cigarette smokers. Results: Results indicated that the interaction of pain and perceived discrimination was predictive of greater quit problems (p = 0.041) as well as greater confidence in the ability to refrain from smoking in response to internal (p < 0.001) and external stimuli (p < 0.001). Conclusions: Overall, this work provides a more nuanced understanding of the psychosocial contexts in which Latinx smokers may encounter problems related to quitting, and this data is important for future smoking cessation research and treatment.
Collapse
Affiliation(s)
- Lorra Garey
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Aniqua Salwa
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Tanya Smit
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Nubia A. Mayorga
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Brooke Y. Redmond
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Sofia B. Fernandez
- School of Social Work, Florida International University, Miami, Florida, USA
| | - Joseph W. Ditre
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Ezemenari Obasi
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, Texas, USA
- HEALTH Institute, University of Houston, Houston, Texas, USA
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, Texas, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- HEALTH Institute, University of Houston, Houston, Texas, USA
| |
Collapse
|
4
|
Boehm LM, Bird CM, Warren AM, Danesh V, Hosey MM, McPeake J, Potter KM, Su H, Eaton TL, Powers MB. Understanding and Managing Anxiety Sensitivity During Critical Illness and Long-Term Recovery. Am J Crit Care 2023; 32:449-457. [PMID: 37907373 DOI: 10.4037/ajcc2023975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Anxiety sensitivity is a fear of symptoms associated with anxiety (eg, rapid respiration and heart rate, perspiration), also known as "fear of fear." This fear is a misinterpretation of nonthreatening symptoms as threatening across 3 domains: physical ("When my heart rate increases, I'm afraid I may have a heart attack"), social ("If people see me perspire, I fear they will negatively evaluate me"), and cognitive ("When I feel these symptoms, I fear it means I'm going crazy or will lose control and do something dangerous like disconnect my IV"). These thoughts stimulate the sympathetic nervous system, resulting in stronger sensations and further catastrophic misinterpretations, which may spiral into a panic attack. Strategies to address anxiety sensitivity include pharmacologic and nonpharmacologic interventions. In intensive care unit settings, anxiety sensitivity may be related to common monitoring and interventional procedures (eg, oxygen therapy, repositioning, use of urine collection systems). Anxiety sensitivity can be a barrier to weaning from mechanical ventilation when patients are uncomfortable following instructions to perform awakening or breathing trials. Fortunately, anxiety sensitivity is a malleable trait with evidence-based intervention options. However, few health care providers are aware of this psychological construct and available treatment. This article describes the nature of anxiety sensitivity, its potential impact on intensive care, how to assess and interpret scores from validated instruments such as the Anxiety Sensitivity Index, and treatment approaches across the critical care trajectory, including long-term recovery. Implications for critical care practice and future directions are also addressed.
Collapse
Affiliation(s)
- Leanne M Boehm
- Leanne M. Boehm is an assistant professor, Vanderbilt University School of Nursing, Nashville, Tennessee; and an investigator, Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Claire M Bird
- Claire M. Bird is a postdoctoral fellow, Baylor University Medical Center, Dallas, Texas
| | - Ann Marie Warren
- Ann Marie Warren is a research center director, Trauma Research Center, Baylor Scott & White Research Institute, Dallas, Texas; and an adjunct professor, Texas A&M University College of Medicine, Bryan
| | - Valerie Danesh
- Valerie Danesh is a research investigator, Center for Applied Health Research, Baylor Scott & White Research Institute; and an assistant professor, Baylor College of Medicine, Temple, Texas
| | - Megan M Hosey
- Megan M. Hosey is an assistant professor, Division of Pulmonary and Critical Care Medicine, and the Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joanne McPeake
- Joanne McPeake is a research fellow, The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, United Kingdom
| | - Kelly M Potter
- Kelly M. Potter is a research assistant professor, Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center in the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Han Su
- Han Su is an assistant professor, Vanderbilt University School of Nursing; and an investigator, CIBS Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tammy L Eaton
- Tammy L. Eaton is an associate investigator, VA Health Services Research & Development, Center for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, Michigan
| | - Mark B Powers
- Mark B. Powers is a research center director, Trauma Research Center, Baylor Scott & White Research Institute, Dallas, Texas; and an adjunct professor, Texas A&M University College of Medicine, Bryan
| |
Collapse
|
5
|
Fritz JM, Gibson B, Wetter DW, Fiol GD, Solis VH, Ford I, Lundberg K, Thackeray A. Use of implementation mapping in the planning of a hybrid type 1 pragmatic clinical trial: the BeatPain Utah study. RESEARCH SQUARE 2023:rs.3.rs-3267087. [PMID: 37790359 PMCID: PMC10543377 DOI: 10.21203/rs.3.rs-3267087/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Background Considerable disparities in chronic pain management have been identified. Persons in rural, lower income and minoritized communities are less likely to receive evidence-based, nonpharmacologic care. Telehealth delivery of nonpharmacologic, evidence-based interventions for persons with chronic pain is a promising strategy to lessen disparities, but implementation comes with many challenges. The BeatPain Utah study is a hybrid type I effectiveness-implementation pragmatic clinical trial investigating telehealth strategies to provide nonpharmacologic care from physical therapists to persons with chronic back pain receiving care in Community Health Centers (CHCs). CHCs provide primary care to all persons regardless of ability to pay. This paper outlines the use of implementation mapping to develop a multifaceted implementation plan for the BeatPain study. Methods During a planning year for the BeatPain trial we developed a comprehensive logic model including the 5-step implementation mapping process informed by additional frameworks and theories. The five iterative implementation mapping steps were addressed in the planning year; 1) conduct needs assessments for involved groups; 2) identify implementation outcomes, performance objectives and determinants; 3) select implementation strategies; 4) produce implementation protocols and materials; and 5) evaluate implementation outcomes. Results CHC leadership/providers, patients and physical therapists were identified as involved groups. Barriers and assets were identified across groups which informed identification of performance objectives necessary to implement two key processes; 1) electronic referral of patients with back pain in CHC clinics to the BeatPain team; and 2) connecting patients with physical therapists providing telehealth. Determinants of the performance objectives for each group informed our choice of implementation strategies which focused on training, education, clinician support and tailoring physical therapy interventions for telehealth delivery and cultural competency. We selected implementation outcomes for the BeatPain trial to evaluate the success of our implementation strategies. Conclusions Implementation mapping provided a comprehensive and systematic approach to develop an implementation plan during the planning phase for our ongoing hybrid effectiveness-implementation trial. We will be able to evaluate the implementation strategies used in the BeatPain Utah study to inform future efforts to implement telehealth delivery of evidence-based pain care in CHCs and other settings. Trial registration Clinicaltrials.gov Identifier: NCT04923334. Registered June 11, 2021 (https://clinicaltrials.gov/study/NCT04923334.
Collapse
|
6
|
Overstreet DS, Pester BD, Wilson JM, Flowers KM, Kline NK, Meints SM. The Experience of BIPOC Living with Chronic Pain in the USA: Biopsychosocial Factors that Underlie Racial Disparities in Pain Outcomes, Comorbidities, Inequities, and Barriers to Treatment. Curr Pain Headache Rep 2023; 27:1-10. [PMID: 36527589 PMCID: PMC10683048 DOI: 10.1007/s11916-022-01098-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW This review synthesizes recent findings related to the biopsychosocial processes that underlie racial disparities in chronic pain, while highlighting opportunities for interventions to reduce disparities in pain treatment among BIPOC. RECENT FINDINGS Chronic pain is a prevalent and costly public health concern that disproportionately burdens Black, Indigenous, and people of color (BIPOC). This unequal burden arises from an interplay among biological, psychological, and social factors. Social determinants of health (e.g., income, education level, and lack of access or inability to utilize healthcare services) are known to affect overall health, including chronic pain, and disproportionately affect BIPOC communities. This burden is exacerbated by exposure to psychosocial stressors (i.e., perceived injustice, discrimination, and race-based traumatic stress) and can affect biological systems that modulate pain (i.e., inflammation and pain epigenetics). Further, there are racial/ethnic disparities in pain treatment, perpetuating the cycle of undermanaged chronic pain among BIPOC.
Collapse
Affiliation(s)
- Demario S Overstreet
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Woman's Hospital, 75 Francis Street, Boston, MA, 02411, USA
- Harvard Medical School, Boston, MA, USA
| | - Bethany D Pester
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Woman's Hospital, 75 Francis Street, Boston, MA, 02411, USA
- Harvard Medical School, Boston, MA, USA
| | - Jenna M Wilson
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Woman's Hospital, 75 Francis Street, Boston, MA, 02411, USA
- Harvard Medical School, Boston, MA, USA
| | - K Mikayla Flowers
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Woman's Hospital, 75 Francis Street, Boston, MA, 02411, USA
- Harvard Medical School, Boston, MA, USA
| | - Nora K Kline
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Woman's Hospital, 75 Francis Street, Boston, MA, 02411, USA
- Department of Psychology, Clark University, Worcester, MA, USA
| | - Samantha M Meints
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Woman's Hospital, 75 Francis Street, Boston, MA, 02411, USA.
- Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
7
|
Fang S, Ding D. Which outcome variables are associated with psychological inflexibility/flexibility for chronic pain patients? A three level meta-analysis. Front Psychol 2022; 13:1069748. [PMID: 36562078 PMCID: PMC9767366 DOI: 10.3389/fpsyg.2022.1069748] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
The psychological flexibility model can be seen as a basis for an integrated and progressive psychological approach to chronic pain management. Some researchers suggest that psychological flexibility and inflexibility represent distinct processes and constructs. This meta-analysis is the first to provide a summary estimate of the overall effect size for the relationship between psychological (in)flexibility and common outcomes among chronic pain patients. The research protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO, https://www.crd.york.ac.uk/PROSPERO/), registration number CRD42021285705. Four databases were searched (PsycINFO; PubMed; Web of Science, CINAHL) along with reference lists. Thirty-six cross-sectional studies were included (7,779 participants). Meta-analyses (random effects model) indicated a significant medium negative association between psychological flexibility and pain intensity or functional impairment. The present study also indicated a significant small to medium association between psychological inflexibility and pain intensity, a nearly large association between psychological inflexibility and functional impairment as well as the quality of life, and a large association between psychological inflexibility and anxiety/depression. Due to the limited number of included studies, the relationship between risk behavior and psychological inflexibility may not be significant. Types of countries and instruments measuring psychological inflexibility may explain part of the heterogeneity. These findings may carry significant implications for chronic pain patients regarding the potential relationship between psychological inflexibility or flexibility and these outcomes. It may consequently form the basis for more robust testing of causal and manipulable relationships. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021285705.
Collapse
|